Lymphoma

Overview

Lymphoma is a cancer of the lymphatic system. The lymphatic system is part of the body's germ-fighting and disease-fighting immune system. Lymphoma begins when healthy cells in the lymphatic system change and grow out of control.

The lymphatic system includes lymph nodes. They are found throughout the body. Most lymph nodes are in the abdomen, groin, pelvis, chest, underarms and neck.

The lymphatic system also includes the spleen, thymus, tonsils and bone marrow. Lymphoma can affect all these areas and other organs in the body.

There are many types of lymphoma. The main subtypes are:

• Hodgkin lymphoma (formerly called Hodgkin disease).
• Non-Hodgkin lymphoma.

Many treatments for lymphoma exist. The treatment that's best for you will depend on the type of lymphoma you have. Treatments can control the disease and give many people with lymphoma the chance of a full recovery.

Symptoms

Signs and symptoms of lymphoma may include:

• Fever.
• Night sweats.
• Fatigue.
• Itchy skin.
• Painless swelling of lymph nodes in the belly, neck, armpits or groin.
• Pain in chest, abdomen or bones.
• Losing weight without trying.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any ongoing symptoms that worry you. Lymphoma symptoms are like those of many more common conditions, such as infections. The healthcare professional may check for those causes first.

Causes

Healthcare professionals aren't sure what causes lymphoma. Lymphoma begins with changes in the DNA of a disease-fighting blood cell called a lymphocyte.

A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. Healthy cells die at a set time.

In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to make more cells quickly. The cancer cells can go on living when healthy cells would die.

In lymphoma, the DNA changes happen in the lymphocytes. The changes can:

• Lead diseased lymphocytes to grow out of control.
• Cause too many diseased lymphocytes in the lymph nodes.
• Cause the lymph nodes, spleen and liver to swell.

Risk factors

Some factors can increase the risk of lymphoma. They include:

• A weakened immune system. If the immune system is weakened by medicines or illness, there might be a higher risk of lymphoma. People with a weakened immune system include those taking medicines to control the immune system, such as after an organ transplant. Certain health conditions, such as infection with HIV, also can weaken the immune system.
• Family history. People who have a parent, sibling or child with lymphoma are at higher risk of the disease.
• Specific infections. Some infections increase the risk of developing lymphoma. Examples include Epstein-Barr virus, Helicobacter pylori and HIV.
• Your age. Some types of lymphoma are more common in teens and young adults. Others happen more often in people over 55.

There is no way to prevent lymphoma.

Diagnosis

Lymphoma diagnosis often begins with an exam that checks for swollen lymph nodes in the neck, underarm and groin. Other tests include imaging tests and removing some cells for testing. The type of tests used for diagnosis may depend on the lymphoma's location and your symptoms.

Physical Exam

A healthcare professional may start by asking about your symptoms. The health professional also may ask about your health history.

Next, the healthcare professional may feel and press on parts of your body to check for swelling or pain. To find swollen lymph nodes, the health professional may feel your neck, underarm and groin. Be sure to say if you have felt any lumps or pain.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. For lymphoma, the biopsy typically involves removing one or more lymph nodes. The lymph nodes go to a lab for testing to look for cancer cells. Other special tests give more details about the cancer cells. Your healthcare team will use this information to make a treatment plan.

Imaging tests

Your healthcare team may recommend imaging tests to look for signs of lymphoma in other areas of your body. Tests may include CT, MRI and positron emission tomography scans, also called PET scans.

Treatment

Many types of treatments exist for lymphoma. Treatments include radiation, chemotherapy, immunotherapy, targeted therapy and bone marrow transplant, also called stem cell transplant. Sometimes, a combination of treatments is used. The treatment that's best for you will depend on the kind of lymphoma that you have.

Treatment might not need to start right away

Treatment for lymphoma doesn't always need to start right away. Some types of lymphoma grow very slowly. You and your healthcare professional may decide to wait and have treatment if the cancer starts to cause symptoms.

If you don't have treatment, you'll have regular appointments with your healthcare professional to monitor symptoms.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Most chemotherapy medicines are given through a vein. Some come in pill form. Two or more of these medicines together are often used to treat lymphoma.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system to kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. It can be given for different types of lymphoma.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Your lymphoma cells might be tested to see if targeted therapy will help you.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy comes from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points in your body.

CAR-T cell therapy

Chimeric antigen receptor (CAR)-T cell therapy, also called CAR-T cell therapy, trains your immune system cells to fight lymphoma. This treatment begins with removing some white blood cells, including T cells, from your blood. The cells are sent to a lab. In the lab, the cells are treated to recognize the lymphoma cells. The cells are then put back into your body. They then can find and destroy the lymphoma cells.

Alternative medicine

No alternative medicines have been found to treat lymphoma. But integrative medicine may help you cope with the stress of a cancer diagnosis and the side effects of cancer treatment.

Talk to your healthcare professional about your options, such as:

• Acupuncture.
• Art therapy.
• Massage.
• Meditation.
• Music therapy.
• Physical activity.
• Relaxation exercises.
• Yoga.

Coping and support

A lymphoma diagnosis can be overwhelming. With time you'll find ways to cope with the stress and uncertainty that often comes with a lymphoma diagnosis. Until then, you may find that it helps to:

Learn about lymphoma

If you'd like to know more about your lymphoma, ask your healthcare professional for the details of your cancer. Ask about the type and your prognosis. Ask for good sources of up-to-date information on your treatment options. Knowing more about your cancer and your options may help you feel more confident when making treatment decisions.

Keep your friends and family close

Your friends and family can be emotional support and provide the practical support you'll need, too, such as helping take care of your house if you're in the hospital.

Find someone to talk with

Find a good listener with whom you can talk about your hopes and fears. This may be a friend or a family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful. Ask your healthcare professional about support groups in your area. You also might contact a cancer organization such as the National Cancer Institute or the Leukemia & Lymphoma Society.

Preparing for an appointment

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you. If your healthcare professional suspects that you have lymphoma, that person may refer you to a doctor who specializes in diseases that affect the blood cells. This kind of doctor is called a hematologist.

Appointments can be brief, and there's a lot to discuss. It's a good idea to be prepared. Here's how to help get ready and what to expect:

What you can do

• Be aware of any pre-appointment restrictions. When you make the appointment, ask if you need to do anything in advance, like restrict your diet.
• Write down any symptoms you're experiencing, even any that may seem unrelated to why you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements you're taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Your time with your healthcare professional is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For lymphoma, some basic questions to ask include:

• Do I have lymphoma?
• What type of lymphoma do I have?
• What stage is my lymphoma?
• Is my lymphoma aggressive or slow growing?
• Will I need more tests?
• Will I need treatment?
• What are my treatment options?
• What are the potential side effects of each treatment?
• How will treatment affect my daily life? Can I continue working?
• How long will treatment last?
• Is there one treatment that you feel is best for me?
• If you had a friend or loved one in my situation, what advice would you give that person?
• Should I see a lymphoma specialist? What will that cost, and will my insurance cover it?
• Do you have brochures or other printed material that I can take with me? What websites do you recommend?

Ask any other questions that come to mind during your appointment.

What to expect from your doctor

Your healthcare professional is likely to ask you several questions. Being ready to answer them may allow more time to cover other points you want to address. Your healthcare professional may ask:

• When did you first experience symptoms?
• Are your symptoms continuous or occasional?
• How severe are your symptoms?
• What, if anything, helps improve your symptoms?
• What, if anything, worsens your symptoms?
• Has anyone in your family had cancer, including lymphoma?
• Have you or has anyone in your family had immune system conditions?
• Have you or your family been exposed to toxins?