Lymphoma

More than 70 types of lymphoma have been identified, ranging from slow-growing (indolent) to highly aggressive. Lymphoma is categorized into two broad groups:

Hodgkin Lymphoma

Hodgkin lymphoma (also called Hodgkin disease) is named after Dr. Thomas Hodgkin, who first identified the condition in 1832. It’s marked by the presence of Reed-Sternberg cells (named for the scientists who identified them) ― very large, abnormal cells that often have more than one nucleus. It’s one of the most curable forms of cancer.

Non-Hodgkin Lymphoma

Any lymphoma that doesn’t have Reed-Sternberg cells is called non-Hodgkin lymphoma. The disease has several subtypes, including:

• Diffuse large B-cell lymphoma – This fast-growing lymphoma starts in B-cells, which are white blood cells that help you fight infection. It forms cancer cells that grow larger than normal B-cells and spread in a wide pattern throughout tissue.
• Follicular lymphoma – This slow-growing lymphoma forms cancer cells in round clusters, which look like the follicles found in healthy lymph nodes.
• Mantle cell lymphoma – This less-common lymphoma forms in the mantle zone, or thin outer layer, of the lymph node. It grows moderately but faster than follicular lymphoma.
• Burkitt lymphoma – This type of lymphoma is more common in young adults and children. It grows very rapidly and can cause lymph nodes to double in size within days. Burkitt lymphoma responds well to quick, intense cancer treatment.
• Small lymphocytic lymphoma – This slow-growing lymphoma starts in germ-fighting white blood cells and is mainly found in lymph nodes. It differs from chronic lymphocytic leukemia, which involves the same type of white blood cells but usually occurs in the blood and bone marrow.

The exact cause of lymphoma isn’t known. But certain factors can increase the risk of developing the two main types of lymphoma.

Hodgkin Lymphoma Risk Factors

• Age – The condition can occur at any age, but it’s most common in early adulthood (your 20s) and over age 60.
• Gender – Men have a slightly higher risk of Hodgkin lymphoma than women.
• Family history – Siblings of young people with Hodgkin lymphoma are at increased risk, especially identical twins. But often, there’s no family history of the disease.
• Weakened immune system – HIV/AIDS infection, organ transplants, congenital (present at birth) immune diseases, and autoimmune diseases like rheumatoid arthritis and lupus can increase risk for Hodgkin lymphoma.
• Epstein-Barr virus infection/mononucleosis – People who’ve had the virus have a slightly increased risk (1 in 1,000) of developing Hodgkin lymphoma. In spite of the link, most people who get mononucleosis don’t develop lymphoma.

Non-Hodgkin Lymphoma Risk Factors

• Age – Non-Hodgkin lymphoma can occur at any age, but getting older is a strong risk factor. Most cases occur in people over age 60.
• Gender – The condition occurs more often in men than women, but certain subtypes, such as primary mediastinal (central chest cavity) lymphoma and primary breast lymphoma, are more common in women. 
• Race, ethnicity and geography – In the U.S., white people are the most likely to develop non-Hodgkin lymphoma. And it’s more common in developed countries, with the U.S. and Europe having the highest rates.
• Family history – Having a first-degree relative with the disease, such as a parent, child or sibling, increases your risk.
• Chemical and drug exposure – Benzene, herbicides, pesticides, chemotherapy and some rheumatoid arthritis drugs can increase your risk of non-Hodgkin lymphoma.
• Radiation exposure – Exposure to nuclear accidents, nuclear testing, underground radiation leaks or radiation therapy increases your risk.
• Weakened immune system – HIV/AIDS infection, organ transplants, congenital (present at birth) immune diseases, and autoimmune diseases like rheumatoid arthritis and lupus can increase risk for non-Hodgkin lymphoma.
• Infection – Epstein-Barr virus, hepatitis C and human T-cell leukemia/lymphoma (HTLV-1) can raise risk.
• Obesity – Some studies suggest being obese or overweight increases risk, but more research is needed.
• Breast implants – Although rare, women with breast implants can develop anaplastic large cell lymphoma (ALCL), a type of non-Hodgkin lymphoma.

Lymphoma may not cause symptoms until it becomes advanced. When symptoms occur, they may include:
 

• Enlarged lymph nodes, often in the neck, armpit or groin
• Persistent fever or chills
• Unexplained weight loss
• Nausea or abdominal pain
• Excessive fatigue
• Heavy night sweats
• Shortness of breath
• Skin issues, including a red rash

Certain symptoms feel like other illnesses, such as the flu. Talk with your Mercy doctor if you experience persistent illness or have swollen lymph nodes.

Mercy cancer specialists use several tools to diagnose lymphoma, including:

Physical Exam

During a physical exam, your Mercy doctor reviews your medical history and discusses any symptoms you’re having. You’ll be checked for swollen lymph nodes in your neck, underarm and groin. You’ll also be examined for swelling in the liver or spleen.

Lymph Node Biopsy

A biopsy can confirm whether lymphoma cells are present in the lymph nodes. A sample of lymph tissue or an entire lymph node may be removed and tested in a lab. Types of biopsies include incisional (surgery to collect a tissue sample) and fine-needle aspiration (using a narrow-gauge needle to collect tissue).

Blood Tests

A complete blood count (CBC) test is a test that measures levels of different cells in your blood. People with lymphoma often have abnormal blood counts. An erythrocyte sedimentation rate (ESR) test measures inflammation in the body. ESR can be elevated in people with lymphoma.

Bone Marrow Sampling

A bone marrow sample is removed from your hip bone using a needle. The sample is analyzed to check for lymphoma cells.

Imaging Tests

Imaging tests like x-rays, PET/CT scans and MRIs are used to detect signs of lymphoma throughout the body.

Mercy’s cancer specialists offer more than medical expertise. We bring compassion, support and encouragement to people fighting lymphoma. Your personalized treatment plan is based on the type of lymphoma you have and whether it’s slow-growing or aggressive. Treatments may include:

Chemotherapy

Chemotherapy is a medication that destroys lymphoma cells to keep them from growing or multiplying. It may be given alone or with other treatments like radiation therapy.

Radiation therapy

Radiation therapy uses high doses of radiation to kill lymphoma cells or keep them from growing. External beam radiation therapy uses machines outside the body that aim high-energy x-rays (or beams) at lymphoma cells.

Targeted Therapy

Targeted therapy identifies and attacks specific molecules (molecular targets) on cancer cells that help them grow and spread.

Immunotherapy

Immunotherapy helps the immune system attack lymphoma cells by boosting immunity or changing how it functions.

Active Surveillance

Active surveillance means monitoring cancer closely. Periodic visits with Mercy cancer specialists and testing help detect changes that may require treatment. If your Mercy cancer specialist feels a stem cell transplant (also called a bone marrow transplant) is needed, you’ll be referred to an appropriate transplant center.