What is Lymphoma?
Lymphoma meaning can be quite confusing because it is broad. Basically, lymphoma is a type of cancer affecting any part of the lymphatic system.
The lymphatic system is a part of our body’s immune system. It consists of the lymph nodes (glands), tonsils, thymus gland, bone marrow, and spleen. However, please note that other organs, such as the heart, lungs, intestines, and skin, also have lymphatic tissues.
Considering that lymph tissues are found almost anywhere in the body, it follows that lymphoma cancer can start anywhere, too.
To get a clear picture of why the lymphatic system is crucial for our protection, let’s review the following concepts:
- Lymph glands, which we commonly call lymph nodes, are little bean-like structures that store antibodies-supplying cells. Moreover, the nodes also “trap” cells that contain waste materials or poisons.
- The lymph nodes are connected to each other via tiny tubes that carry lymph, a milk-colored fluid that allows white blood cells (lymphocytes) to circulate throughout the body.
- In the presence of an infection, white blood cells typically multiply to help fight off the pathogen or the organism causing the infection. As a result, the lymph nodes swell. This is the reason why we can “feel” them when we have bacterial or viral disease, like the common cold or influenza.
Leukemia vs Lymphoma
People often confuse lymphoma with leukemia because they are grouped together as “blood-related” cancers – different from the “solid” cancers like breast, lung, and prostate.
But while the two have similarities, they are still different.
Where lymphoma can start in any part of the lymphatic tissue (but usually in the lymph nodes), leukemia specifically targets the bone marrow or blood cells.
Still, the two are connected. According to experts, having one type of blood-related cancer predisposes you to developing another cancer.
For instance, one type of lymphoma can lead to leukemia. Likewise, being diagnosed with leukemia increases your risk of developing lymphoma.
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Types of Lymphoma
Considering the fact that lymphoma cancer is a broad condition, it’s not surprising for it to have several types. Generally, there are two types of lymphoma cancer: Hodgkin and Non-Hodgkin.
Hodgkin Lymphoma (HL)
Hodgkin lymphoma, sometimes called Hodgkin’s disease, happens when lymphocytes (one type of white blood cell) multiply out of control. In this type of lymphoma, abnormal cells called Reed-Sternberg cells can be seen under the microscope. According to reports, 75% of people with Hodgkin’s disease recover fully.
Hodgkin’s disease is common among people aged 15 to 30 years old and adults over the age of 50.
Please note that Hodgkin’s disease can be further subdivided into two types: Classic Hodgkin and Nodular Lymphocyte-Predominant Hodgkin.
Classic Hodgkin Lymphoma
Classic Hodgkin is more common, accounting for approximately 9 in 10 cases of Hodgkin’s lymphoma in developed countries. It involves the “original” form of the Reed-Sternberg cells.
Please note that classic Hodgkin has several subtypes, including:
- Nodular Sclerosis Hodgkin Lymphoma
- Mixed Cellularity Hodgkin Lymphoma
- Lymphocyte-Rich Hodgkin Lymphoma
- Lymphocyte-Depleted Hodgkin Lymphoma
Nodular Lymphocyte-Predominant Hodgkin
Unlike Classic Lymphoma with the “original” Reed-Sternberg cells, Nodular Lymphocyte-Predominant Hodgkin involves a variant of the Reed-Sternberg cells, which experts call the “popcorn” cells because they look like popcorn under the microscope.
Nodular Lymphocyte-Predominant Hodgkin is not as common as the Classic Hodgkin; it only accounts for 5% of Hodgkin lymphoma cases.
Non-Hodgkin’s Lymphoma (NHL)
Non-Hodgkin’s lymphoma also affects the white blood cells. But, unlike Hodgkin’s lymphoma, non-Hodgkin lymphoma does not present with Reed-Sternberg cells.
It also has several subtypes, including:
B Cell Lymphoma
B cell lymphoma makes up most of the Non-Hodgkin Lymphoma cases. It affects the B cells, one type of lymphocyte or white blood cells.
Please note that B Cell Lymphoma has many subtypes. Some of the most common are:
- Diffuse Large B Cell Lymphoma: This commonly occurs in older people and is the most common type of NHL. Reports say Diffuse B Cell Lymphoma tends to be aggressive (fast-growing), but it responds well to treatment.
- Mantle Cell Lymphoma: This type also tends to affect seniors. Mantle Cell Lymphoma is usually indolent (slow-growing); however, it doesn’t respond well to treatment.
- Follicular Lymphoma: Most Follicular Cell Lymphomas are indolent, but some can be aggressive, too. It can respond well to treatment, but may be hard to cure.
- Marginal Zone Lymphoma: This type tends to be indolent, and has subtypes of its own, including the MALT lymphoma, which stands for mucosa-related lymphoid tissue lymphoma.
- Burkitt Lymphoma: Named after the doctor who first described it, Burkitt lymphoma tends to affect children more than adults.
T Cell Lymphoma
T Cell Lymphoma affects another type of white blood cells called T Cells. Like the B Cell Lymphoma, T Cell Lymphoma has many types, like:
- Cutaneous T Cell Lymphoma: This mainly affects the skin, but can also affect lymph nodes and other organs.
- Angioimmunoblastic Lymphoma: This tends to be fast-growing.
- Precursor T-lymphoblastic Lymphoma: This usually starts in the thymus gland, but can spread in other areas, such as the area between the lungs.
Lymphoma Cancer Symptoms
Given that lymphoma cancer has so many types and subtypes, symptoms usually vary from person to person. However, in most cases, patients seek medical help because they notice or feel swelling in the neck, underarms, and groin – areas where the lymph nodes are. They might also feel tumors in their stomach or skin.
The other lymphoma symptoms that a person may feel are:
- Loss of appetite
- Digestive symptoms, such as abdominal pain, indigestion, nausea, and vomiting.
- Weight loss
- Constant coughing
- Fatigue, which may result in anemia.
- Recurring high-grade fever or constant low-grade fever.
- Night sweats
- Bone pain
- Abnormal pressure or congestion in the face, neck, and upper chest.
Experts still do not know the exact lymphoma causes, but they believe it starts when the lymphocytes or white blood cells mutate in ways that make them multiply uncontrollably or survive longer than necessary.
Risk Factors of Lymphoma
Several types of lymphoma cancers are more common in children and young adults; others more commonly affect people over the age of 55.
Reports say men are slightly more likely to develop lymphoma than women.
The risk of developing lymphoma increases with immune system diseases. The same is true for people who take medications that lower their immunity.
Experiencing Particular Infections
Certain infections, such as the Helicobacter pylori infection and Epstein-Barr virus, may predispose a person to lymphoma cancer.
Now that you have a better understanding of the lymphoma signs and symptoms and risk factors, let’s talk about lymphoma staging.
Non-Hodgkin Lymphoma Staging
The Leukemia & Lymphoma Society uses the Ann Arbor Staging System for NHL. Within this system, there are categories and a modified version. Basically, it includes the following stages:
It usually involves one nodal region, but may also include an organ outside a lymph node (extranodal).
It mainly involves one or two nodal regions, and either or both are above or below the diaphragm. Stage II with extranodal involvement usually indicates an organ or area on the same side of the diaphragm as the involved lymph node. Stage II can also include “bulky disease” where multiple lymph nodes are involved and the same side of the diaphragm with the disease.
It may involve several lymph node regions above or below the diaphragm. There could also be extranodal involvements and the spleen may be affected.
Stage 4 lymphoma usually means areas not part of the lymphatic system are already affected. It may also mean the involvement of lungs, bone marrow, cerebrospinal fluid, and liver.
Hodgkin Lymphoma Staging
Hodgkin Lymphoma staging uses what experts call the Lugano Classification, but it’s still derived from the Ann Arbor Staging System.
This means there are HL cells in one lymph node region (or a group of adjacent nodes) or in one organ or area outside the lymphatic system.
This means there are HL cells in two or more lymph node regions above or below the diaphragm. It may also mean HL cells are in a lymph node area and a nearby organ or area outside the lymphatic system but on the same side of the diaphragm.
This means HL cells are in lymph node regions on both sides (above and below) the diaphragm. Stage 3 may also involve an organ outside the lymphatic system or the spleen.
Stage 4 Hodgkin Lymphoma means the HL cells have spread to one or more organs outside the lymphatic system.
Besides the numbered stages, the doctors may also use the letters A, B, E, and S to further classify Hodgkin’s Disease:
- A: The patient doesn’t experience “B symptoms,” which include night sweats, fever, or weight loss.
- B: The patient experiences B symptoms.
- E: The patient has HL cells in tissues or organs outside the lymphatic system.
- S: The patient has HL cells in the spleen.
Lymphoma diagnosis may take a while as doctors would like to rule out other possible conditions that could be causing your symptoms.
Once you arrive at the clinic or hospital, the doctor will ask you about your medical history and perform a physical assessment to check the lymphoma signs and symptoms, particularly swollen lymph nodes, spleen, or liver.
The other tests the doctors might order are:
Lymphoma diagnosis includes a complete blood count mainly to check for increased levels of white blood cells. They might also look for high amounts of lactate dehydrogenase because sometimes, lymphoma causes increased levels of it.
Doctors use chest x-ray to look for swollen lymph nodes as well as other signs of the cancer in the chest.
Bone Marrow Aspiration or Biopsy
Since lymphoma cancer may affect the bone marrow, the doctor may recommend a bone marrow aspiration or biopsy.
An aspiration means the doctor would take some fluid samples; a biopsy means they will take some tissue samples. Once sent to the laboratory, they would check for lymphoma cells.
Lymph Node Biopsy
Alternatively, the doctor may also recommend a lymph node biopsy, where they would take lymph node tissues.
Please keep in mind that there are two types of lymph node biopsy: one is incisional, where they would take only a portion of the lymph nodes, and the other one is excisional, where they would remove the entire lymph node.
In the laboratory, they will look for the Reed-Sternberg cells; the presence of which points to Hodgkin’s Disease.
Spinal tap, also called lumbar puncture, draws the cerebrospinal fluid from the lower part of the spinal column. The CSF is the fluid around the brain and spinal cord. Finding lymphoma cells there might mean the lymphoma has affected the nervous system.
Other Imaging Tests
Finally, to look for lymphoma in other parts of the body, the doctor may order other imaging tests such as the Computerized Tomography (CT) and Positron Emission Tomography (PET) scans.
After positively diagnosing lymphoma and its stage, the doctor will discuss the possible treatment options.
Please note that treatment depends not only on the stage, but also on the general health of the patient. In Singapore, treatment may involve:
Chemotherapy uses drugs to destroy lymphoma cancer cells. It is a systemic therapy because the drugs travel through the bloodstream. The drugs may be given orally or through the vein and space around the spinal cord.
Chemotherapy drugs are not given continuously. Instead, patients get them in cycles which mean there is a pause between each session.
Radiation therapy uses high-powered radiation to kill lymphoma cancer cells or at least stop them from growing. In most cases, doctors use radiation to target a particular body part where the lymphoma is.
This treatment strategy uses substances that boost the patient’s immune system. However, it is mostly used in patients with non-Hodgkin Lymphoma.
Stem Cell Transplant
In cases where lymphoma comes back after treatment, the doctor may recommend stem cell transplant, where the patient would receive lymphoma-free stem cells or marrow.
Please note that before a stem cell transplant, the patient usually undergoes high doses of chemotherapy, radiation therapy, or both to kill the lymphoma cells and the normal cells in the bone marrow. After that, they can receive the healthy stem cells through a large vein.
Where Can You Get Healthy Stem Cells?
Interestingly, doctors can get healthy stem cells from you before you undergo chemotherapy or radiation therapy. The doctor will collect the healthy stem cells and freeze them while you undergo the necessary treatment. Afterward, they will thaw it and give it back to you.
From Your Identical Twin
If you have an identical twin, the doctor may get the healthy stem cells from them. After the transplant, the stem cells will develop into healthy blood cells, replacing those you lost during treatment. Please note that you might need to stay in the hospital for a few weeks to months to recover.
From a Family Member or Other Donor
It’s also possible for the stem cells to come from your siblings, parents, or other relatives. In fact, as long as doctors find a match, the stem cells could come from another donor you are not related with.
Lymphoma Survival Rate
It’s quite difficult to identify the survival rate for each type of lymphoma. However, experts have identified that 73% of patients with Non-Hodgkin Lymphoma survive for at least 5 years.
On the other hand, 88% of people with Hodgkin Lymphoma who receive treatment survive for at least 5 years.
Despite these figures, please understand that each patient’s survival rate is different.
Unfortunately, there are no clear ways to prevent lymphoma. The best way to reduce our risk is to attend to the modifiable risk factors such as developing an infection, such as HIV. Refrain from unprotected sexual activities and don’t share needles.
Lymphoma Support Group and Resources in Singapore
Do you need to find support for you or your loved one regarding lymphoma?
The National University Cancer Institute Singapore offers a platform to connect with other people who have firsthand experience with lymphoma (e.g.,patients, relatives, caregivers, and other healthcare professionals).
There, they can provide and receive emotional support and other tips in handling lymphoma. The NUCIS also offers lymphoma symposiums, quarterly meet-ups, and year-end parties.
Lymphoma is a cancer affecting any part of the lymphatic system. Primarily, there are two types of Lymphoma: Hodgkin, which involves the Reed-Sterberg cells, and Non-Hodgkin, which doesn’t involve the said cells.
The treatment for lymphoma depends on the type, stage, and general health of the patient at the time of the diagnosis. Usually, it involves radiation therapy, chemotherapy, biological therapy, and stem cell transplant.
Do you or your loved one have lymphoma? Are you worried about your risk or do you need help with your treatment? If that’s the case, don’t hesitate to get in touch with a doctor.
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