Lymphoma is a cancer of the lymphatic system. It develops in lymphocytes, which are a type of white blood cell. These cells help fight disease in the body and play an essential role in the body’s immune defenses.
As this type of cancer is present in the lymph system, it can quickly metastasize, or spread, to different tissues and organs throughout the body. Lymphoma most often spreads to the liver, bone marrow, or lungs.
People of any age can develop lymphoma, but it is among the most common causes of cancer in children and young adults aged 15–24 years. It is often treatable.
In this article, we look at the symptoms of lymphoma, how to treat it, and the risk factors for the different types.
There are two main types of lymphoma: Hodgkin and non-Hodgkin lymphoma. Within these, there are many subtypes.
Non-Hodgkin lymphoma, which is the most common type, typically develops from B and T lymphocytes (cells) in the lymph nodes or tissues throughout the body. Tumor growth in non-Hodgkin lymphoma may not affect every lymph node, often skipping some and growing on others.
It accounts for 95% of lymphoma cases.
According to the National Cancer Institute (NCI), non-Hodgkin lymphoma accounts for 4.2% of all cancers in the United States, and a person’s lifetime risk of developing it is about 2.2%.
Hodgkin lymphoma is a cancer of the immune system, and doctors can identify it by the presence of Reed-Sternberg cells, which are abnormally large B lymphocytes. In people with Hodgkin lymphoma, the cancer usually moves from one lymph node to an adjacent one.
The NCI estimate that Hodgkin lymphoma accounts for 0.5% of all cancers and approximately 0.2% of people in the U.S. will receive a diagnosis in their lifetime.
The symptoms of lymphoma are similar to those of some viral diseases, such as the common cold. However, they typically continue for a more extended period.
Some people will not experience any symptoms. Others may notice a swelling of the lymph nodes. There are lymph nodes all around the body. Swelling often occurs in the neck, groin, abdomen, or armpits.
The swellings are often painless. They may become painful if the enlarged glands press on organs, bones, and other structures. Some people confuse lymphoma with back pain.
Lymph nodes can also swell during common infections, such as a cold. In lymphoma, the swelling does not resolve. Pain is also more likely to accompany the swelling if it has occurred due to an infection.
The overlap of symptoms can lead to misdiagnosis. Anyone who has persistently swollen glands should see their doctor for a consultation.
Other symptoms of both types of lymphoma may include:
- ongoing fever without infection
- night sweats, fever, and chills
- weight loss and reduced appetite
- unusual itching
- persistent fatigue or a lack of energy
- pain in lymph nodes after drinking alcohol
Some additional symptoms of non-Hodgkin lymphoma include:
- persistent coughing
- shortness of breath
- pain or swelling in the abdomen
Pain, weakness, paralysis, or altered sensation may occur if an enlarged lymph node presses against spinal nerves or the spinal cord.
Lymphoma can spread rapidly from the lymph nodes to other parts of the body through the lymphatic system. As cancerous lymphocytes spread into other tissues, the immune system cannot defend against infections as effectively.
The course of treatment depends on the type of lymphoma a person has and the stage it has reached.
Indolent, or slow growing lymphoma may not need treatment.
Watchful waiting may be enough to make sure the cancer does not spread.
If treatment is necessary, it may involve the following:
- Biologic therapy: This is a drug treatment that stimulates the immune system to attack the cancer. The drug achieves this by introducing living microorganisms into the body.
- Antibody therapy: A medical professional inserts synthetic antibodies into the bloodstream. These respond to the cancer’s toxins.
- Chemotherapy: A healthcare team administers aggressive drug treatment to target and kill cancer cells.
- Radioimmunotherapy: This delivers high powered radioactive doses directly into cancerous B cells and T-cells to destroy them.
- Radiation therapy: A doctor may recommend this type of therapy to target and destroy small areas of cancer. Radiation therapy uses concentrated doses of radiation to kill cancerous cells.
- Stem cell transplantation: This can help restore damaged bone marrow following high dose chemotherapy or radiation therapy.
- Steroids: A doctor may inject steroids to treat lymphoma.
- Surgery: A surgeon may remove the spleen or other organs after the lymphoma has spread. However, a cancer specialist, or oncologist, will more commonly request surgery to obtain a biopsy.
Different risk factors can increase the risk of both types of lymphoma.
Risk factors for non-Hodgkin lymphoma include:
- Age: Most lymphomas occur in people aged 60 years and older. However, some types are more likely to develop in children and young adults.
- Sex: Some types are more likely in women. Men have a higher risk of other types.
- Ethnicity and location: In the U.S., African American and Asian American people have a lower risk for non-Hodgkin lymphoma than white people. Non-Hodgkin Lymphoma is more common in developed nations.
- Chemicals and radiation: Nuclear radiation and certain agricultural chemicals have links to non-Hodgkin lymphoma.
- Immunodeficiency: A person with a less active immune system has a higher risk. This may be due to anti-rejection medications following an organ transplant or HIV.
- Autoimmune diseases: This type of disease occurs when the immune system attacks the body’s own cells. Examples include rheumatoid arthritis and celiac disease.
- Infection: Certain viral and bacterial infections that transform lymphocytes, such as the Epstein-Barr virus (EBV), increase the risk. This virus causes glandular fever.
- Breast implants: These can lead to anaplastic large cell lymphoma in the breast tissue.
- Body weight and diet: The American Cancer Society (ACS) has suggested that overweight and obesity may have some involvement in the development of lymphoma. However, more research is necessary to confirm the link.
Risk factors for Hodgkin lymphoma include:
- Infectious mononucleosis: The Epstein-Barr virus (EBV) can cause mononucleosis. This disease increases the risk of lymphoma.
- Age: People aged 20–30 years and those 55 years of age have a higher risk of lymphoma.
- Sex: Hodgkin lymphoma is slightly more common in males than females.
- Family history: If a sibling has Hodgkin lymphoma, the risk is slightly higher. If the sibling is an identical twin, this risk increases significantly.
- HIV infection: This can weaken the immune system and increase the risk of lymphoma.
There are no routine screenings for lymphoma. If a person has persistent viral symptoms, they should seek medical consultation.
The doctor will ask about the person’s individual and family medical history and try to rule out other conditions.
They will also carry out a physical examination, including an inspection of the abdomen and chin, neck, groin, and armpits, where swellings may occur.
The doctor will look for signs of infection near lymph nodes since this can account for most cases of swelling.
Tests for lymphoma
Tests will confirm whether lymphoma is present.
Blood tests and biopsies: These can detect the presence of lymphoma and help a doctor distinguish between different types.
A biopsy involves a surgeon taking a sample of lymph tissue. The doctor will then send it for examination in a laboratory. The surgeon may remove a small section or all of a lymph node. In some cases, they might use a needle to take a tissue sample.
It might be necessary to carry out a bone marrow biopsy. This may require a local anesthetic, a sedative, or a general anesthetic.
Biopsies and other tests can confirm the stage of the cancer to see whether it has spread to other parts of the body.
Imaging tests: A doctor may request imaging scans, such as:
A spinal tap: In this procedure, a surgeon uses a long, thin needle to remove and test spinal fluid under local anesthetic.
Staging of the cancer depends on the type, growth rate, and cellular characteristics. In stage 0 or 1, the cancer stays in a confined area. By stage 4, it has spread to more distant organs, and doctors find it more challenging to treat.
A doctor may also describe lymphoma as indolent, meaning that it remains in one place. Some lymphomas are aggressive, which means they spread to other parts of the body.
With treatment, more than 72% of people with a diagnosis of non-Hodgkin lymphoma will survive for at least 5 years.
With Hodgkin lymphoma, 86.6% of people who receive treatment will survive for at least 5 years.
The chances of a good outcome decrease as lymphoma progresses. It is essential to seek medical attention for any symptoms of cold or infection that continue for an extended period. Early diagnosis can improve a person’s chances of successful treatment.
Where does lymphoma spread to?