Lymphoma

The lymphatic system plays an important role in keeping us healthy. (Read about "The Lymph System") Small lymph nodes are found all over the body with clusters in the underarms, neck, chest, groin and abdomen. They are all connected by a system of vessels. They carry infection fighting cells, but sometimes something goes wrong and cells grow out of control, and that is the cancer called lymphoma.

Types of lymphoma

Lymphoma is broken down into two major types: Hodgkin's disease and non-Hodgkin's lymphoma.

• Non-Hodgkin's lymphoma - The vast majority of cases of lymphoma are non-Hodgkin's, over 90 percent, according to the Leukemia and Lymphoma Society (LLS). The number of people with non-Hodgkin's lymphoma is climbing, with the rate doubling since the 1970's. The number of people dying from it had been going up almost 2 percent a year over 30 years, but that trend has reversed over the past decade. There are actually at least 30 different types of non-Hodgkin's lymphoma, according to the Lymphoma Research Foundation of America (LRFA). They are classified according to the type and characteristics of the cancerous cells. Some affect children most, some adults.
  • Childhood non-Hodgkin's lymphoma - There are three major types of childhood non-Hodgkin's lymphomas, according to the National Cancer Institute (NCI). They are lymphoblastic lymphoma, small noncleaved cell lymphoma (either Burkitt's lymphoma or non-Burkitt's lymphoma) and large cell lymphoma. The type is determined mainly by what the cancer cells look like under a microscope (histology).
  • Adult non-Hodgkin's lymphoma - Adult non-Hodgkin's lymphomas are divided into two groups: indolent lymphomas, which are slower growing and have fewer symptoms, and aggressive lymphomas, which grow more quickly. They may also be grouped by cell type, such as T-cell, B-cell, large cell or follicular cell.
• Hodgkin's disease - Hodgkin's disease is a much less common lymphoma, according to NCI, accounting for less than 1 percent of all cases of cancer in the U.S. Hodgkin's disease has a very specific cell called the Reed-Sternberg cell as part of its manifestation. It is more common in men than in women, and occurs most often in people between 15 and 34 and in people over the age of 55, according to NCI. In recent decades, the death rates of Hodgkin's disease have fallen. Hodgkin's now has a survival rate of 80 percent.

Symptoms

The symptoms of Hodgkin's and non-Hodgkin's lymphoma are different.

• Non-Hodgkin's - NCI says the main symptom of the different types of non-Hodgkin's lymphoma is a painless swelling of the lymph nodes, which can occur in the neck, underarm and/or groin. Other symptoms according to NCI and LLS can include:
  • unexplained fever
  • upset stomach and abdominal discomfort
  • unremitting fatigue
  • loss of appetite
  • unexplained weight loss
  • itchy skin
  • reddened patches of skin
  • pain in your bones
• Hodgkin's - The American Cancer Society says that Hodgkin's disease rarely causes swelling of the lymph nodes. Most lymph node swelling is the result of an infection. NCI lists the following as possible symptoms of Hodgkin's:
  • unexplained recurrent fevers
  • night sweats
  • unexplained weight loss
  • itchy skin

  ACS says sometimes the only symptom of Hodgkin's is being tired all the time.

Any symptoms are not sure signs of lymphoma. They can also indicate the flu or other infections (Read about "Influenza"), but it is important to see your doctor if you have symptoms, to deal with any health problem that might be present. NCI warns that early lymphoma does NOT cause pain. The earlier the treatment, the more likely it will be successful. (Read about "Cancer Check-ups")

Treatments

Before treatment can begin on lymphoma, an important question has to be answered. That's, at what stage is the lymphoma? Staging is a way of finding out if the cancer has spread and if it has, where to. According to NCI, a doctor will consider the following in deciding what stage the lymphoma is in:

• How many affected lymph nodes are there?
• Where are the affected lymph nodes? Are they all above or below the diaphragm or on both sides?
• Has the cancer spread to other organs in the lymphatic system such as the bone marrow or the spleen (Read about "The Spleen") or even to organs outside the lymphatic system such as the liver? Oftentimes a biopsy (Read about "Biopsy") is needed to confirm how the disease has progressed.

The actual term used is staging. The following is the way staging is defined, according to NCI for adult non-Hodgkin's lymphoma, childhood non-Hodgkin's lymphoma and Hodgkin's disease.

Adult non-Hodgkin's lymphoma

• Stage I

  Stage I adult non-Hodgkin's lymphoma is divided into stage I and stage IE ("E" stands for extranodal and means that the cancer is found in an organ or tissue other than the lymph nodes). (Read about "The Lymph System")

  • Stage I: Cancer is found in a single lymph node area.
  • Stage IE: Cancer is found in an organ or tissue other than the lymph nodes.

• Stage II

  Stage II adult non-Hodgkin's lymphoma is divided into stage II and stage IIE ("E" stands for extranodal and means that the cancer is found in an organ or tissue other than the lymph nodes).

  • Stage II: Cancer is found in two or more lymph node areas on the same side of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
  • Stage IIE: Cancer is found in an organ or tissue other than the lymph nodes and may have spread to one or more lymph nodes on the same side of the diaphragm.

• Stage III

  Stage III adult non-Hodgkin's lymphoma is divided into stage III, stage IIIE ("E" stands for extranodal and means that the cancer is found in an organ or tissue other than the lymph nodes), stage IIIS ("S" stands for spleen and means that the cancer is found in the spleen), and stage IIIS+E.

  • Stage III: Cancer is found in lymph node areas on both sides of the diaphragm.
  • Stage IIIE: Cancer is found in lymph node areas on both sides of the diaphragm and in a nearby organ or tissue other than the lymph nodes.
  • Stage IIIS: Cancer is found in lymph node areas on both sides of the diaphragm and in the spleen.
  • Stage IIIS+E: Cancer is found in lymph node areas on both sides of the diaphragm, in a nearby organ or tissue, and in the spleen.

• Stage IV

  In stage IV adult non-Hodgkin's lymphoma, the cancer either:

  • found in at least one organ or tissue other than the lymph nodes and may be in nearby lymph nodes

  • spread to one organ other than the lymph nodes and has spread to lymph nodes far away from that organ.

  Adult non-Hodgkin's lymphomas are also described in terms of how fast they grow and the location of affected lymph nodes.

• Indolent or aggressive:
  • Indolent lymphomas: Low-grade lymphomas. These are slower growing and have fewer symptoms.
  • Aggressive lymphomas: Intermediate-grade and high-grade lymphomas. These grow and spread more quickly and have more severe symptoms. Lymphoblastic lymphoma, diffuse small noncleaved cell lymphoma and Burkitt's lymphoma are 3 types of aggressive adult non-Hodgkin's lymphoma. Aggressive lymphomas are seen more frequently in patients who are HIV-positive (AIDS-related lymphoma).
• Contiguous or noncontiguous:
  • Contiguous lymphomas: Lymphomas in which the lymph nodes containing cancer are next to each other.

  • Noncontiguous lymphomas: Lymphomas in which the lymph nodes containing cancer are not next to each other, but are on the same side of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).

Childhood non-Hodgkin's lymphoma

• Stage I

  Cancer is found in only one area outside of the abdomen or chest.

• Stage II

  Any of the following mean the disease is stage II:

  • Cancer is found in only one area and in the lymph nodes around it.
  • Cancer is found in two or more lymph nodes or other areas on the same side of the diaphragm (the thin muscle under the lungs that helps you breathe).
  • Cancer is found to have started in the digestive tract. The lymph nodes in the area may or may not have cancer.

• Stage III

  Any of the following mean the disease is stage III:

  • Cancer is found in tumors or lymph nodes on both sides of the diaphragm.
  • Cancer is found to have started in the chest.
  • Cancer is found in many places in the abdomen.
  • Cancer is found in the area around the spine, around the outermost covering of the brain (Read about "The Brain"), or on the outermost covering of the brain (these tumors are called epidural tumors).

• Stage IV

  Cancer has spread to the bone marrow or to the brain and/or the spinal cord. (Read about "Nervous System")

Hodgkin's disease

• Stage I

  Cancer is found in only one lymph node area or in only one area or organ outside of the lymph nodes.

• Stage II

  Either of the following means the disease is stage II:

  • Cancer is found in two or more lymph node areas on the same side of the diaphragm (the thin muscle under the lungs that helps us breathe).
  • Cancer is found in only one area or organ outside of the lymph nodes and in the lymph nodes around it. Other lymph node areas on the same side of the diaphragm may also have cancer.

• Stage III

  Cancer is found in lymph node areas on both sides of the diaphragm. The cancer may also have spread to an area or organ near the lymph node areas and/or to the spleen.

• Stage IV

  Either of the following means the disease is stage IV:

  • Cancer has spread in more than one spot to an organ or organs outside the lymph system. Cancer cells may or may not be found in the lymph nodes near these organs.
  • Cancer has spread to only one organ outside the lymph system, but lymph nodes far away from that organ are involved.

Treatment depends on the stage as well as the specific type of lymphoma that is present. Chemotherapy, radiation or a combination of these are the most common treatments for both Hodgkin's and non-Hodgkin's lymphomas. (Read about chemotherapy, radiation and other cancer therapies in "Cancer Treatments") Sometimes the treatment for indolent lymphomas (lymphomas that tend to grow and spread slowly) is what is called "watchful waiting," meaning no treatment, according to LRFA and NCI.

A bone marrow transplant may also be an option, especially for a patient with non-Hodgkin's that has returned. The transplant provides the patient with healthy cells to replace other cells destroyed by cancer treatment. (Read about "Transplants") The bone marrow can come from a donor or can come from the patient. The bone marrow is removed, treated to kill the cancer cells and then returned to the patient after he or she has had heavy radiation or chemotherapy.

Other treatments, including biological therapy or immunotherapy, may be used in addition to chemotherapy or radiation. For example, monoclonal antibodies can use the body's own immune system (Read about "The Immune System"), either directly or indirectly, to help fight the cancer. The Lymphoma Research Foundation of America says an advantage of many of these therapies is that they can spare more healthy cells and be less toxic than standard chemotherapy and radiation therapy. For example, antibodies can target and attach to cancer cells or even to specific parts of cancer cells throughout the body, leading to the destruction of the cancer cell, without affecting as wide an array of normal cells.

Someone with lymphoma may also develop a condition called hypercalcemia - too much calcium in the blood - which in turn can cause loss of appetite, nausea, thirst, fatigue, muscle weakness, restlessness and confusion. This can often require medication and rehydration. (Read about "Hypercalcemia")

Not all therapies are appropriate for all patients, of course. In considering treatment options, there are a number of things to take into account. You'll need to discuss potential outcomes, side effects and benefits carefully with your doctor.

More Cancer Information:

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is

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    Blood Disorders Glossary