So What is Lymphoma?
Lymphoma is a cancer that begins in the lymphatic system. There are two main types of lymphoma – non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (sometimes called Hodgkin disease).
The cells of Hodgkin lymphoma look a particular way under a microscope. Lymphoma cells that do not look like this are a non-Hodgkin lymphoma. It is important for doctors to be able to tell the difference between the cells of Hodgkin and non-Hodgkin cells because they are two different diseases. They are quite similar in many ways, but the treatment for each is different.
Non-Hodgkin lymphoma is one of the most common cancers in Victoria, affecting about 1,155 people a year. It can occur in children, but is more common in adults. Hodgkin lymphoma is much less common. About 165 Victorians are affected each year.
The lymphatic system and lymphoma:
The lymphatic system is part of the immune system, which helps protect our body against infection. It consists of lymph nodes connected by lymph vessels, which branch out into all parts of the body, except the brain and spinal cord.
The lymphatic system also includes the bone marrow, spleen, thymus gland and tonsils. Its main jobs are to:
The lymphatic system carries a clear fluid called ‘lymph’, which contains many white blood cells called lymphocytes. The lymphocytes mature within the blood and bone marrow, and are stored in the lymph nodes. Lymph nodes are found in various areas of the body, including the neck, armpits, chest, abdomen and groin. Lymph fluid is filtered through the lymph nodes, and any foreign organisms (such as bacteria) are trapped and attacked by the lymphocytes.
In a person with lymphoma, large numbers of abnormal lymphocytes are made, which replace some of the normal lymphocytes. This can affect the immune system and the way the body fights infections. The lymph nodes also become swollen, forming painless lumps.
The lymphatic system runs through most of the body. This means you can get lymphoma almost anywhere. It is most commonly first seen in the lymph nodes in the neck, but it is also fairly common to find it in the liver or spleen. Lymphoma can also be found in the bowel, stomach, brain, skin, testicles and eyes.
Symptoms of lymphoma:
The most common symptom of lymphoma is a swelling of the lymph nodes in the neck, armpit or groin. These swellings are usually painless.
Other general symptoms include:
unexplained weight loss (more than one-tenth of your total weight)
fever that comes and goes without any obvious cause
heavy sweating, especially at night
some people have unexplained itching.
Doctors call this group of symptoms ‘B symptoms’. Some people with lymphoma may have them, but many don’t. Sometimes, lymphoma gets into the bone marrow, causing problems with low blood counts.
Most people who have any of these symptoms will not have lymphoma. They will be suffering from a much less serious problem such as a throat infection. However, it is always important to consult a doctor just to be on the safe side.
What causes lymphoma?
Know one really knows why people get lymphoma. There are many different types of lymphoma and it is unlikely that there is one single cause of all lymphoma.
There are some known risk factors, which include:
exposure to radiation
exposure to certain chemicals
infections and viruses, including the human immunodeficiency virus (HIV) and the Epstein-Barr virus in people whose immune system is suppressed.
Other risk factors are still being researched.
Diagnosis of lymphoma:
Most people begin by going to see their doctor with symptoms. If the doctor suspects that someone may have lymphoma, they will refer them to a hospital to have a biopsy. This means having one of the swollen lymph nodes taken out and examined under a microscope to see if it contains cancer cells.
If it does, then they will need to have further tests to see where and how far the lymphoma has spread. These tests may include:
physical examination and blood tests
bone marrow biopsy – some fluid is removed from the bone marrow and examined for cancer cells
computed tomography (CT) scan – a specialised x-ray for building up three-dimensional pictures of the body
gallium scan – a short-lived, radioactive form of gallium is injected into the body, and outlines organs in the body when viewed with a special ‘gamma’ camera
positron emission tomography (PET) scan – a small amount of radioactive material is injected, which highlights cancerous areas when viewed with a special scanner.
Stages of lymphoma:
The disease is ‘staged’ according to its location and spread. This is important to determine the type of treatment you will need. The stages are:
Stage I – cancer is found in one lymph node area or one area or organ outside the lymph nodes.
Stage II – cancer is found in two or more lymph node areas on the same side of the diaphragm. Cancer is found in 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 be involved (the diaphragm is a sheet of muscle slung beneath the lungs that enables breathing).
Stage III – cancer is found in lymph node areas on both sides of the diaphragm. It may have spread to an area or organ near the lymph node area, or to the spleen, or both.
Stage IV – cancer has spread to more than one spot within or outside the lymphatic system.
Treatment for lymphoma:
Treatment for lymphoma depends on the location and severity of the cancer. Treatment for Hodgkin lymphoma is often very successful, with many people being cured. Non-Hodgkin lymphoma is also curable, but it can be harder to treat.
Treatment regimes are slightly different for Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Some people only need one treatment. Others will need a combination. Options include:
Watchful waiting – some forms of slow-growing non-Hodgkin’s lymphoma may not need active treatment when first diagnosed. Regular check-ups will be necessary
Chemotherapy – either tablets or injections of anti-cancer drugs are used
Radiotherapy – x-rays are used to target and kill cancer cells. This is used in adults, but rarely used to treat children with lymphoma
Steroids – tablets or injections improve how well your chemotherapy works
Immunotherapy (biological therapy, monoclonal antibodies) with antibodies – this involves treatment that uses natural body substances or medications made from natural body substances. One treatment available in Australia to treat NHL is called rituximab (Mabthera). It is usually combined with chemotherapy. Several more antibody treatments are in clinical trials and more are being developed
Stem cell (or bone marrow) transplantation – stem cells are the cells that blood cells evolve from. High doses of chemotherapy can damage stem cells so, during this treatment, stem cells are removed from the bone marrow before higher doses of chemotherapy are given. They are then transplanted back after the chemotherapy has finished. This treatment may be suggested if the disease comes back or does not respond to the first treatment
Complementary and alternative therapies – when used alongside your conventional cancer treatment, some of these therapies can make you feel better and improve your quality of life. Others may not be so helpful and in some cases may be harmful. The Cancer Council Victoria booklet called Understanding complementary therapies can be a useful resource
All treatments have side effects. These will vary depending on the type of treatment one needs to have. Many side effects are temporary, but some may be permanent. All side effects are discussed by the doctor who will explain all and the possible side effects before any treatment begins.
Research into lymphoma:
Early detection and better treatment have improved survival for people with lymphoma. Research for lymphoma is ongoing. The Cancer Research UK website has information about research into Hodgkin lymphoma and non-Hodgkin lymphoma.
When a cure isn't possible:
If lymphoma has been diagnosed in its later stages, the cancer may have spread to the point where a cure is no longer possible. Treatment then focuses on improving quality of life by relieving the symptoms (this is called ‘palliative’ treatment). Medications can be used to relieve pain, nausea and vomiting. It’s a sad fact of life that some people may not be cured even after extensive treatment.
Things to remember:
Lymphoma is a group of cancers that affect the lymphatic system.
Symptoms of lymphoma may include swelling of the lymph nodes, weight loss and night sweats.
Lymphomas are one of the more common types of cancer in Victoria.