B-cell lymphoma refers to a group of cancers that attack the immune system. It is the most common type of non-Hodgkin lymphoma.
The cancer grows in the B cells, also called B lymphocytes, which make antibodies to attack invading pathogens.
B-cell lymphoma is a type of non-Hodgkin lymphoma. Non-Hodgkin lymphoma is the name for a group of cancers that attack the white blood cells of the immune system. Doctors distinguish non-Hodgkin lymphoma from Hodgkin lymphoma by checking for Reed-Sternberg cancer cells, which are a hallmark of the latter.
B-cell lymphoma usually begins in the lymph nodes, but it can also appear in other parts of the immune system, such as the spleen or bone marrow.
Doctors usually detect lymphoma in the lymph system, which includes the lymph nodes and lymph fluid. However, the cancer can also travel outside of this system.
B-cell lymphoma attacks the B cells, which are part of the immune system. There are many different subtypes that vary in terms of where the cancer begins.
Cutaneous B-cell lymphoma is lymphoma in the skin. When cutaneous B-cell lymphoma is primary — meaning that it originated in the skin rather than developing elsewhere before spreading to the skin — it usually grows very slowly.
There are numerous other types of B-cell lymphoma. Some of the most common include:
- Diffuse large B-cell lymphoma: More common in people over the age of 60 years, this form usually begins as a rapidly growing lymph node — often in the neck, armpit, or chest. It grows quickly and can be aggressive, but about 75% of people have no signs of cancer after treatment.
- Follicular lymphoma: Also more common among older people, this type of lymphoma grows more slowly and is less aggressive. Although treatment can slow its growth, curing it is challenging. It can sometimes develop into a fast-growing form of diffuse large B-cell lymphoma.
- Chronic lymphocytic leukemia and small lymphocytic lymphoma: These cancers are so similar that doctors may treat them as the same disease. They are slow-growing and usually originate in the bone marrow or blood. Treatment cannot cure these cancers, but it is possible to live a very long time with them.
- Mantle cell lymphoma: This cancer is much more common in males than in females and primarily affects people over the age of 60 years. By the time a doctor discovers it, it may be in several places in the body, including the lymph nodes and spleen. It is more challenging to treat than many other B-cell lymphomas.
- Burkitt lymphoma: This rare lymphoma is more common in children than in adults. In the United States, this lymphoma usually begins in the stomach, from where it may spread to the central nervous system. It grows quickly, but more than half of those who develop it respond well to treatment.
Doctors stage B-cell lymphoma according to how many areas of the body it affects. More advanced lymphomas can cause more symptoms and are harder to cure than earlier stage lymphomas.
For non-Hodgkin lymphoma, doctors tend to use the following staging system:
- Stage 1: Lymphoma is only present in one lymph node or lymphoid organ, or it is in one area of a single organ outside of the lymph system.
- Stage 2: The lymphoma exists on two or more lymph nodes or lymphoid organs on the same side (below or above) of the diaphragm, or it covers a group of lymphoid organs and a nearby organ.
- Stage 3: Cancer is present on multiple lymphoid organs on both sides of the diaphragm, or it is above the diaphragm but has also traveled to the spleen.
- Stage 4: The lymphoma has spread widely into at least one organ outside of the lymph system.
Other staging criteria include:
Bulky vs. nonbulky
Bulky cancer means that a person has large cancer tumors in their chest. This type of lymphoma demands more aggressive treatment.
Addition of E
Cancers in stage 1 or 2 that also affect an organ outside of the lymphatic system may require more aggressive treatment. Doctors add an E for “extranodal organ” to indicate this stage, e.g., stage 2E.
Binet staging system
Doctors use slightly different staging systems for small lymphocytic lymphoma and chronic lymphocytic leukemia. One system is the Binet staging system:
- Stage A: There are fewer than three affected areas of lymphoid tissue, and the person does not have thrombocytopenia or anemia.
- Stage B: The person has three or more enlarged areas of lymphoid tissue but has neither thrombocytopenia nor anemia.
- Stage C: The person has either anemia or thrombocytopenia with any number of affected lymphoid tissue areas.
Overall, 64% of people with non-Hodgkin lymphoma survive 5 years or longer compared with those without the condition. People with localized or regional cancer have the highest 5-year relative survival rate, at 73%.
However, the odds of survival depend on the type of cancer and the person’s overall health, as well as the treatment plan they follow and how well the cancer responds to it. For example, follicular lymphoma has higher survival rates, with a 5-year relative survival rate of 89% that increases to 96% among those with early stage disease.
No single cause accounts for all cases of B-cell lymphoma, and some people who get the disease have none of the known risk factors.
In general, doctors think that the interaction of several different factors may steadily change the immune system, which can lead to lymphoma. These factors include:
- Immunosuppression: Conditions that weaken the immune system, such as HIV, may lead to lymphoma and increase the risk of more aggressive forms of the disease.
- Autoimmune conditions: Conditions that cause the immune system to attack healthy tissue, such as rheumatoid arthritis, may elevate the risk.
- Infections: Research has linked certain viruses, including the Epstein-Barr virus that causes mononucleosis, to higher rates of lymphoma.
- Medication: Some medications, including a group of immune-suppressing drugs called TNF antagonists, may elevate the risk.
- Chemicals: Exposure to certain toxins and pesticides could raise the risk of lymphoma.
- Age: Being over the age of 60 years puts a person at higher risk.
The symptoms of B-cell lymphoma vary a lot depending on the type. Many people with lymphoma have no symptoms at all. Those who do
- Pain: Some people have pain at the site of the lymphoma. For example, a person with lymphoma beginning in the chest may have chest pain.
- Swollen lymph nodes: Lymphoma often begins as a swollen or painful lymph node. It is important to ask a doctor about any lymph node that does not return to its normal size after an infection.
- Infection symptoms: Some people have symptoms similar to those of an infection, such as a fever, chills, weakness, or fatigue.
- Unintentional weight loss: Some people lose weight without changing their lifestyle.
Treatment varies depending on the type and stage of the lymphoma and the person’s overall health. For some people, the risks of certain types of treatment may outweigh the potential benefits. For others, immediate aggressive treatment may cure the cancer and help a person live a long and healthy life.
Some treatment options include:
- Chemotherapy: Chemotherapy can shrink cancer cells, but it may also damage healthy cells. Methotrexate is an effective chemotherapy drug for many types of B-cell lymphoma.
- Immunotherapy: Immunotherapy uses medications to teach the immune system how to fight the cancer.
- Radiation: As with chemotherapy, radiation therapy can kill cancer cells as well as healthy cells.
- Stem cell transplant: In certain types of cancer, including those that recur or resist treatment, a stem cell transplant may reduce symptoms or even cure the cancer.
- Supportive therapy: Doctors may recommend additional therapy to reduce disease symptoms, as well as the side effects of treatment. For example, a doctor may prescribe antinausea medication to help with chemotherapy-related nausea.
A cancer diagnosis can be very concerning, but most forms of B-cell lymphoma respond well to treatment.
A prompt diagnosis and early treatment improve outcomes, even in those with more aggressive forms of cancer. Therefore, it is essential not to delay seeing a doctor about a swollen lymph node or any other possible cancer symptoms.