Lymphomas

Lymphoma cancer can develop when your infection-fighting white blood cells, called lymphocytes, grow out of control. It starts in your lymph system, a network of vessels and glands spread throughout your body that produce, store, and carry white blood cells. The affected lymphocytes lose their infection-fighting properties and make you more vulnerable to infection.

There are two main types of lymphoma and within these are many subtypes. It is important to know the type of lymphoma to determine the best course of treatment.

• Hodgkin lymphoma (HL) - uncommon cancer where B-lymphocytes multiply abnormally and collect in parts of your lymphatic system, such as your lymph node glands. HL contains Reed-Sternberg cells that are identifiable under a microscope. Hodgkin lymphoma typically begins in your upper body, such as the neck, chest or armpits.
• Non-Hodgkin lymphoma (NHL) - the fifth most common cancer in the UK. NHL typically develops from B and T-lymphocytes in the lymph nodes or tissues throughout your body. NHL does not contain Reed-Steinberg cells.

The exact cause of lymphoma is unknown. We do know that your risk of developing lymphoma cancer is increased if you have a medical condition that weakens your immune system, you take immunosuppressant medication, you've had exposure to the common Epstein-Barr virus that causes glandular fever, or you have a first-degree relative such as a parent or sibling who has had the condition.

The signs of Hodgkin lymphoma and non-Hodgkin lymphoma include a painless swelling usually in your neck, armpit or groin. Other lymphomas symptoms include fever, night sweats, feeling tired, itching without a rash, and weight loss.

You should see a doctor if you are concerned that you may have lymphoma cancer symptoms. Initially, they will do a physical examination and ask about your symptoms. If your GP suspects lymphoma they will refer you to a hospital specialist for further examination and a biopsy.

A biopsy removes some or all of an affected lymph node and examines it under a microscope. If your biopsy confirms a lymphoma diagnosis further testing is needed to check how far the lymphoma has spread. Further tests may include blood tests, chest X-ray, bone marrow sample, CT scan, MRI scan, PET scan, and lumbar puncture.

Following diagnostic testing, your doctor should be able to stage of your lymphoma. "Staging" means scoring your cancer by how far it has spread.

• stage 1 – cancer is limited to one group of lymph nodes, such as your neck, armpit or groin nodes, either above or below your diaphragm.
• stage 2 – two or more lymph node groups are affected. For non-Hodgkin lymphoma, both groups are either above or below, but just on one side of your diaphragm, and for Hodgkin lymphoma they are either above or below your diaphragm.
• stage 3 – cancer has spread to lymph node groups above and below your diaphragm.
• stage 4 – lymphoma has spread beyond the lymphatic system and is now present in both lymph nodes and organs such as the bone marrow, liver or lungs.

Stages 1 and 2 are also called early-stage or limited lymphoma. Stages 3 and 4 are also referred to as advanced lymphoma. As lymphoma cancer is present in the lymph system, it can quickly metastasize, or spread, to different tissues and organs throughout your body.

The letters "A" or "B" may be added to your stage to indicate whether or not you have certain symptoms. "A" indicates you have no additional symptoms other than swollen lymph nodes and "B" indicates you have additional symptoms of weight loss, fever or night sweats.

Sometimes, health professionals also use additional letters to indicate where cancer first developed, for example, "E" (extranodal) means cancer developed outside the lymphatic system.

Non-Hodgkin lymphoma grading

There are also two main grades of non-Hodgkin lymphoma:

• low-grade/indolent non-Hodgkin lymphoma – slow-growing cancer that may not have any symptoms for many years. These don’t necessarily need treating immediately but they may be difficult to cure.
• high-grade/aggressive non-Hodgkin lymphoma – fast-growing and aggressive cancer. These need immediate treatment and can often be cured.

Sometimes, over time low-grade lymphomas can develop into high-grade lymphomas.

The many types of lymphoma are treated in different ways based on your lymphoma type, severity, and your general health.

Lymphoma treatments

• Chemotherapy- medicine given through a drip or tablet to kill the cancer cells over a few months on an outpatient basis. Chemotherapy can have side effects including potential damage to your bone marrow.
• Radiotherapy– radiation painlessly destroys cancer cells, with the treatment given in short daily sessions over a few weeks but no more than three weeks for non-Hodgkin lymphoma. It can have significant side effects.
• Other targeted drug therapies/immunotherapy medications - work on lymphoma cells more specifically than chemotherapy and reduce the effect of treatment on healthy cells. They stop cancer cells growing or dividing, kill cancer cells or take advantage of your own immune system to help your body get rid of cancer cells. They may include:
  • Monoclonal antibody therapy – medication for some types of non-Hodgkin lymphoma that attaches to healthy and cancerous cells and signals to the immune system to attack and kill the cell.
  • Rituximab - biological therapy to treat a rare type of Hodgkin lymphoma called lymphocyte-predominant Hodgkin lymphoma. It is given through a drip directly into a vein over a few hours and is used in combination with chemotherapy.
  • Brentuximab vedotin – given as a drip directly into your vein to treat a particular type of Hodgkin lymphoma.
• Steroid medication - often used in combination with chemotherapy to treat lymphomas as the steroids make chemotherapy more effective. It is normally given as tablets or injections, usually at the same time as your chemotherapy.

The main treatments for Hodgkin lymphoma are chemotherapy alone, or chemotherapy followed by radiotherapy. Occasionally, chemotherapy may be combined with steroid medication.

For patients with non-Hodgkin lymphoma treatment is normally chemotherapy or radiotherapy. If your disease is low grade and you're well you might adopt and a wait and see approach.