Frequently Asked Questions About Lymphoma Cancer

What is lymphoma?

Lymphoma is a type of cancer that begins in the lymphatic system and is one of the most common blood cancers that can affect people of all ages. Many people diagnosed with lymphoma cancer and their loved ones often have many questions surrounding lymphoma cancer, and this article aims to address some of the most frequently asked questions, covering everything from its causes and symptoms to treatment options and prognosis.

What are the common symptoms of lymphoma cancer?

• Painless, swollen bumps in areas of the body such as the neck, armpits, and groin due to swollen lymph nodes
• Persistent fever (above 38 degrees)
• Drenching night sweats
• Unexplained weight loss without trying to lose weight (more than 10% of body weight)
• Frequent and long-lasting infections
• Unusual bleeding/bruising without an apparent cause

Other symptoms include: fatigue, itching without a clear cause, shortness of breath, and chest pain. It’s important to note that these symptoms are quite general and could be indicative of other conditions. Moreover, lymphoma symptoms vary depending on the type of lymphoma, and not everyone gets the same symptoms.¹

What are B symptoms?

B symptoms are a specific group of symptoms that are important for doctors to determine the staging of lymphoma cancer. These symptoms are persistent fever above 38 degrees, severe sweating episodes at night, and unintentional weight loss. If a patient has the three B symptoms, the disease is considered more advanced. In the classification of the stages of Hodgkin lymphoma, the letter “B” is added if the patient has the three B symptoms.²

Lymphoma cancer is a cancer that starts in the lymphatic system, but what is the lymphatic system? 

The lymphatic system is a network of vessels and lymph nodes throughout the human body. It helps protect against bacteria and other infections. These lymph nodes, which resemble small beans, are part of a transport system. A clear fluid known as lymph flows through these vessels, carrying lymphocytes, which are specialised white blood cells.

There are several organs that contribute to the lymphatic system, including the bone marrow, spleen, and thymus. This system plays a key role in the body's immune defence. When the body fights an infection like a cold, the lymph nodes may become swollen, but they return to their normal size after the disease has been cured.³

What are the factors that have been linked to the cause of lymphoma?

• Having a family history of lymphoma
• Persistent viral infections, e.g., Epstein-Barr Virus and Hepatitis C
• Constant infection and stimulation of lymphoid tissue, for example, autoimmune infections⁷
• Having a weakened immune system for reasons such as HIV infection or those with genetic immunodeficiency disorders⁴
• Chronic infections that cause recurrent lymphocyte production
• Genetic changes that occur due to exposure to radiation, carcinogenic chemicals (chemicals that cause cancer), or certain infections
• Geographical location: some types of cancers have a high incidence rate in Southern Asia and some parts of Latin America⁵

What are the main categories of lymphoma cancer?

Hodgkin's lymphoma

This type of lymphoma cancer is characterised by the presence of Reed-Sternberg cells, an abnormal type of cell that is not typically found in other lymphoma cancers. Hodgkin's Lymphoma accounts for 10% of all lymphomas. ¹⁵

Non-hodgkin's lymphoma 

NHL represents a broad spectrum of diseases and can involve B cells, T cells, and natural killer cells, which are all cells involved in the immune response. Non-Hodgkin's Lymphoma makes up about 90% of all lymphomas.⁶

What are some common types of non-hodgkin's lymphoma?

• B-cell lymphomas such as Diffuse Large B-cell lymphoma (DLBCL), Follicular Lymphoma, Mantle Cell Lymphoma, and Burkitt Lymphoma
• T-cell lymphomas such as Peripheral T-cell lymphoma (PTCL), Anaplastic Large Cell Lymphoma (ALCL), and Adult T-Cell Leukaemia/Lymphoma (ATLL)⁶

What is the progression of lymphoma cancer like?

• Hodgkin lymphoma spreads in a very predictable manner from one lymph node to another in an orderly fashion. Although it initially spreads through lymph nodes, it can spread to organs such as the liver, bone marrow, spleen, or lungs in advanced stages
• Non-Hodgkin lymphoma can be slow-growing or fast-growing depending on the type of disease. This slow-growing disease takes years to cause symptoms but is often incurable. However, the symptoms of a slow-growing disease are usually manageable in the long term. The aggressive forms of the disease progress much quickly but are often curable if treatment is started promptly⁸

What are the factors that tend to lead to a better prognosis for patients with lymphoma cancer?

• Disease diagnosed at an early stage (Stage I or II)
• Younger patient age
• No presence of B symptoms (such as fever, night sweats, or weight loss)
• Lactate dehydrogenase (LDH) levels within the normal range
• The ability to carry out everyday tasks well⁹

What are factors that tend to lead to a worse prognosis for patients with lymphoma cancer?

• Cancer that has spread widely in the body (advanced stage: Stage III or IV)
• High levels of LDH, a substance in the blood that indicates rapid cell growth
• Cancer affects several areas outside the lymph nodes, such as organs.
• Poor overall health or the presence of other medical conditions ⁹

How is lymphoma cancer diagnosed?

Biopsy

When doctors suspect that a patient has lymphoma, they need to take a sample of the affected tissue. The best way to do this is by using a core or excision biopsy, where a small piece of the tissue is removed for testing.

Positron emission tomography-CT (PET-CT) 

This is extremely sensitive and can detect disease not visible on CT (Computerized Tomography)  alone. ​

Blood tests 

One important test measures the level of a substance called lactate dehydrogenase (LDH), which can be higher in lymphoma. Doctors might also test for infections like HIV, Hepatitis B, and C, because some types of lymphoma cancer are linked to these viruses.¹⁰

What is the treatment for lymphoma cancer? 

• The standard regimen for Hodgkin's Lymphoma often involves chemotherapy combined with radiation therapy. The most common chemotherapy treatment is ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) 
• In more advanced cases, doctors may use stronger chemotherapy regimens, like BEACOPP (which includes additional drugs). The exact treatment depends on how advanced the cancer is
• Immunotherapy is a modern treatment that makes the most of the body's immune system to combat cancer. Medications like rituximab are used in certain lymphoma types to target specific cancer cells so that the immune system is able to identify and destroy them¹⁰

What are the stages of lymphoma? 

Lymphoma is classified into stages I to IV, depending on how much it has spread:

• Stage I: The cancer is found in one lymph node or in a specific area of tissue.
• Stage II: The cancer is in two or more lymph node groups, but all are on the same side of the diaphragm.
• Stage III: The cancer affects lymph nodes on both sides of the diaphragm.
• Stage IV: The cancer has spread to other organs, such as the liver, bone marrow, or lungs⁶

Can lymphoma be prevented?

There is no guaranteed way to prevent lymphoma, but you can reduce your risk by:

• Avoiding exposure to known carcinogens like certain chemicals and radiation
• Practising safe sex to reduce the risk of infections like HIV and hepatitis
• Maintaining a healthy lifestyle to support your immune system and prevent recurrent infections¹¹

Can lymphoma return after treatment?

• Yes, lymphoma can recur after treatment. Regular follow-ups with healthcare providers are essential to monitor for any signs of recurrence.¹¹

Does lymphoma cause pain? 

• Swollen lymph nodes can occasionally press on surrounding areas, leading to discomfort, for example, pain in the stomach area
• In some rare situations, particularly in Hodgkin lymphoma, swollen lymph nodes may become painful immediately after drinking alcohol¹¹

How can having lymphoma affect someone's life?

• Typical treatments for lymphoma, which include chemotherapy and radiation, can result in unintended consequences, including fatigue, nausea, vomiting and hair loss¹²
• Being diagnosed with lymphoma, in addition to treatment, can lead to feelings of anxiety, depression and a feeling of a lack of control¹³
• Living with lymphoma can impact social life, with some people feeling isolated because of treatment schedules and concerns related to health¹⁴
• Living a healthy lifestyle, including appropriate nutrition and increasing physical activity, can help to mitigate treatment side effects and result in an improved quality of life

Summary 

Lymphoma cancer is a multifaceted disease that has many types and stages that can affect a person's health and way of life. Questions commonly asked by lymphoma cancer patients and their family members often focus on the symptoms of lymphoma cancer and the potential causes, as well as the role, if any, of lifestyle factors in the presentation and management of lymphoma cancer. Although there is no way of preventing the development of lymphoma cancer, a healthy lifestyle and reducing exposure to known risks can reduce the likelihood of developing lymphoma cancer. Treatment options, such as immunotherapy, have made great strides in treatments for lymphoma cancer, and offer some hope in targeting cancer cells with fewer side effects.