Lymphoma

“Lymphoma” is a general term for many blood cancers that originate in the lymphatic system. Lymphoma results when a lymphocyte (a type of white cell) undergoes a malignant change and multiplies out of control. Eventually, healthy cells are crowded out and malignant lymphocytes amass in the lymph nodes, liver, spleen and/or other sites in the body.

There was an overall increase in the incidence of lymphoma for people between the ages of 15 years and 39 years during the span of years from 2001 to 2010.

Living With Lymphoma

An estimated total of 731,277 individuals in the US population are living with, or in remission from, lymphoma.  There are 172,937 people living with Hodgkin Lymphoma (active disease or in remission).  There are 558,340 people living with non-Hodgkin lymphoma (active disease or in remission).

Hodgkin Lymphoma

Hodgkin lymphoma (HL) represents 11.8 percent of all types of lymphoma diagnosed in 2013. This disease has characteristics that distinguish it from other diseases classified as lymphoma, including the presence of the Reed-Sternberg cell, a large, malignant cell found in HL lymphoma tissues.

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma (NHL) represents a diverse group of diseases that are distinguished by the characteristics of the cancer cells associated with each disease type. The designations “indolent” and “aggressive” are often applied to types of NHL. Each type is associated with factors that categorize the prognosis as either more or less favorable. NHL is the sixth most common cause of cancer deaths in males and seventh in females.

Signs and Symptoms

A common early sign of HL or NHL is a painless enlargement of one or more lymph nodes. However, enlarged lymph nodes may be the result of inflammation in the body and are not necessarily a sign of cancer.

Other HL signs and symptoms may include recurrent high fever, persistent cough and shortness of breath, drenching night sweats of the whole body, itching and weight loss.

Other signs and symptoms of NHL may include bone pain, cough, chest pain, abdominal pain, rash, fever, night sweats, enlarged spleen, unexplained fatigue or weight loss. Some individuals may have no symptoms, and a diagnosis of NHL is made as a result of routine examination.

Diagnosis

Your doctor may order imaging tests if your medical history and physical exam suggest a possible diagnosis of Hodgkin lymphoma. Your doctor looks for:

  • enlarged lymph nodes in the chest or abdomen or both
  • tumor masses outside the lymph nodes in lung, bone or other body tissue

Imaging tests can include:

  • a chest X-ray
  • a computed tomography (CT) scan of the chest, pelvis and abdomen (stomach area)
  • a magnetic resonance imaging (MRI) scan
  • a positron emission tomography (PET) scan
  • a fluorodeoxyglucose PET (FDG-PET) scan of the entire body with a radioactive tracer

Lymph Node Biopsy

Diagnosing Hodgkin lymphoma usually involves performing a lymph node biopsy. If the biopsy confirms that you have the disease, your doctor performs additional tests to stage the lymphoma.

The lymph node biopsy’s purpose is to confirm a diagnosis and:

  • identify your Hodgkin lymphoma subtype
  • develop a treatment plan

Hodgkin lymphoma can be a difficult disease to diagnose. You may want to get a second medical opinion by an experienced hematopathologist before you begin treatment. Hodgkin lymphoma can be confused with some types of non-Hodgkin lymphoma. The appropriate treatment depends on having the correct diagnosis.

Staging Tests

Once your hematologist oncologist confirms a Hodgkin lymphoma diagnosis, he or she orders more tests to stage your disease. Staging identifies the extent of your disease and where it’s located in your body.

Staging tests include:

  • blood tests
  • bone marrow tests
  • imaging tests

Blood Tests

After your blood is taken, it’s sent to a lab for a complete blood count (CBC) and more blood work. Your blood is measured for:

  • levels of red cells, white cells and platelets
  • blood protein levels
  • uric acid levels
  • erythrocyte sedimentation rate (the speed that red cells settle at the bottom of a test tube?an increased rate can indicate cancer)
  • liver function

Bone Marrow Tests

Your doctor may decide to examine your bone marrow to see whether the disease has spread. If your disease is in an early stage and some signs and symptoms haven’t appeared, you may not need the test.

Bone marrow testing involves two steps usually done at the same time in a doctor’s office or a hospital:

  • a bone marrow aspiration to remove a liquid marrow sample
  • a bone marrow biopsy to remove a small amount of bone filled with marrow

Imaging Tests

Your doctor conducts one or more imaging tests, along with a physical exam, to look for:

  • the location and distribution of enlarged lymph nodes
  • the disease’s effect, if any, on other organs such as the lungs and liver
  • large tumor masses

Imaging tests may include:

  • a chest X-ray
  • a computed tomography (CT) scan of the chest, pelvis and abdomen (stomach area)
  • a magnetic resonance imaging (MRI) scan
  • a positron emission tomography (PET) scan
  • a fluorodeoxyglucose PET (FDG-PET) scan of the entire body with a radioactive tracer (F-18)

Treatment

Cure is the goal of treatment for people who have HL. “Involved field” radiation therapy with chemotherapy (sometimes called “combined modality therapy”) has been the most common treatment approach for HL. Involved field radiation therapy targets the evident HL cell masses, and chemotherapy is used to kill neighboring Clinical trials are under way comparing chemotherapy with radiation to chemotherapy-only to treat patients with stage IA and IIA nonbulky Hodgkin lymphoma.

In general, the goal of treatment for NHL is to destroy as many lymphoma cells as possible and to induce a complete remission. Treatment protocols vary according to the type of disease. Chemotherapy and radiation therapy are the two principal forms of treatment. Although radiation therapy is not often the sole or principal curative therapy, it is an important additional treatment in some cases. Stem cell transplantation and a watch-and-wait strategy are also used to treat some NHL subtypes. Immunotherapy is indicated to treat individuals with specific types of NHL.

Source: Leukemia & Lymphoma Society, © 2011.

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