If you or your loved one is dealing with a diagnosis of lymphoma, our multidisciplinary team of hematologic cancer specialists at West Cancer Center & Research Institute is here to surround you with the latest treatments and technology to design a personalized treatment plan specific to your disease. Our goal is to also provide resources and information to better help you understand and manage your lymphoma.

What is Lymphoma?

Lymphoma is a cancer of the lymphatic system, which is part of the body’s germ-fighting network.

The lymphatic system includes the lymph nodes (lymph glands), spleen, thymus gland and bone marrow. Lymphoma can affect all those areas as well as other organs throughout the body.

Many types of lymphoma exist. The main subtypes are:

  • Hodgkin’s lymphoma (formerly called Hodgkin’s disease)
  • Non-Hodgkin’s lymphoma

Types of Lymphoma

Hodgkin’s Lymphoma

To understand what Hodgkin lymphoma is, it helps to know about the lymph system (also known as the lymphatic system). The lymph system is part of the immune system, which helps fight infections and some other diseases. The lymph system also helps control the flow of fluids in the body. The lymph system is made up mainly of cells called lymphocytes, a type of white blood cell. There are 2 main types of lymphocytes:

  • B lymphocytes (B cells): B cells make proteins called antibodies to help protect the body from germs (bacteria and viruses).
  • T lymphocytes (T cells): There are many types of T cells. Some T cells destroy germs or abnormal cells in the body. Other T cells help boost or slow the activity of other immune system cells.

Hodgkin lymphoma usually starts in B lymphocytes. Although, Hodgkin lymphoma can start almost anywhere, most often it starts in lymph nodes in the upper part of the body. The most common sites are in the chest, neck or under arms. Hodgkin lymphoma most often spreads through the lymph vessels from lymph node to lymph node. Rarely, late in the disease, it can invade the bloodstream and spread to other parts of the body, such as the liver, lungs, and/or bones marrow.

Different types of Hodgkin lymphoma can grow and spread differently, and may be treated differently:

Classic Hodgkin Lymphoma

Classic Hodgkin lymphoma (cHL) accounts for more than 90% of cases of Hodgkin lymphoma in developed countries. It has 4 subtypes: nodular sclerosis Hodgkin lymphoma (NSCHL), mixed cellularity Hodgkin lymphoma (MCCHL), lymphocyte-rich Hodgkin lymphoma, and lymphocyte-depleted Hodgkin lymphoma.

Nodular Lymphocyte-Predominant Hodgkin Lymphoma

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) accounts for about 5% of cases. The cancer cells in NLPHL are large cells called popcorn cells (because they look like popcorn), which are variants of Reed-Sternberg cells. You may also hear these cells called lymphocytic and histiocytic (L&H) cells. NLPHL usually starts in lymph nodes in the neck and under the arm. It can occur in people of any agge, and is more common in men than women. This type of Hodgkin lymphoma tends to grow more slowly and is treated differently from the classic types.

Non Hodgkin’s Lymphoma

This disease does not start in the white blood cells and may originate in the lymph nodes, spleen or bone marrow and spread to other parts of the body. Non-Hodgkin’s Lymphoma is divided into three types, based on cell types, and classified by how quickly it spreads.

  • B-Cell (85% of Non-Hodgkin’s Cases)
  • T-Cell
  • NK-Cell

Classifications of Non-Hodgkin Lymphoma include:

Low Grade:

  • Follicular lymphoma
  • Mantle cell lymphoma
  • Marginal zone lymphoma
  • Mucosa-associated lymphoid tissue (MALT) lymphoma

Intermediate Grade:

  • Anaplastic large cell lymphoma
  • Diffuse large cell lymphoma
  • Primary mediastinal large cell lymphoma

High Grade:

  • Burkett’s lymphoma
  • Lymphoblastic lymphoma

Stages of Lymphoma

Adult Hodgkin Lymphoma

Stage I

Cancer is found in one of the following places in the lymph system:

  • One or more lymph nodes in one lymph node group.
  • Waldeyer’s ring.
  • Thymus.
  • Spleen
  • Outside the lymph system in one organ or area.

Stage II

Cancer is found

  • in two or more lymph node groups either above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen); or
  • in one or more lymph node groups either above or below the diaphragm and outside the lymph nodes in a nearby organ or area.

Stage III

Cancer is found

  • in lymph node groups above and below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen); or
  •  in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area; or
  • in lymph node groups above and below the diaphragm, and in the spleen; or
  •  in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area, and in the spleen.

Stage IV

The cancer:

  • is found outside the lymph nodes throughout one or more organs, and may be in lymph nodes near those organs; or
  • is found outside the lymph nodes in one organ and has spread to areas far away from that organ; or
  • is found in the lung, liver, bone marrow, or cerebrospinal fluid (CSF). The cancer has not spread to the lung, liver, bone marrow, or CSF from nearby areas.

Adult Non-Hodgkin Lymphoma

Stage I

Cancer is found

  • in one lymphatic area (lymph node group, tonsils and nearby tissue, thymus, or spleen); or
  • in one organ or area outside the lymph nodes.

Stage II

Cancer is found

  • in two or more lymph node groups either above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen); or
  • in one or more lymph node groups either above or below the diaphragm. Cancer is also found outside the lymph nodes in one organ or area on the same side of the diaphragm as the affected lymph nodes.

Stage III

Cancer is found

  • in lymph node groups above and below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen); or
  • in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area; or
  • in lymph node groups above and below the diaphragm, and in the spleen.
  • in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area, and in the spleen.

Stage IV

Adult non-Hodgkin lymphoma, the cancer:

  • is found throughout one or more organs that are not part of a lymphatic area (lymph node group, tonsils and nearby tissue, thymus, or spleen), and may be in lymph nodes near those organs; or
  • is found in one organ that is not part of a lymphatic area and has spread to organs or lymph nodes far away from that organ; or
  • is found in the liver, bone marrow, cerebrospinal fluid (CSF), or lungs (other than cancer that has spread to the lungs from nearby areas).

Symptoms of Lymphoma

If you are experiencing any of these symptoms, we urge you to speak to your provider as soon as possible for further examination.

  • Painless swelling of the lymph nodes in your neck, armpits, or groin
  • Persistent fatigue
  • Fever
  • Night sweats
  • Shortness of breath
  • Unexplained weight loss

How to Diagnose Lymphoma

If your provider would like to further investigate the possibility of lymphoma, one or more of the following diagnostic procedures may be performed

PHYSICAL EXAM

Your doctor checks for swollen lymph nodes, including in your neck, underarm and groin, as well as a swollen spleen or liver.

LYMPH NODE BIOPSY

Your doctor may recommend a lymph node biopsy procedure to remove all or part of a lymph node for laboratory testing. Advanced tests can determine if lymphoma cells are present and what types of cells are involved.

BLOOD TESTS

Blood tests to count the number of cells in a sample of your blood can give your doctor clues about your diagnosis.

BONE MARROW TEST

A bone marrow aspiration and biopsy procedure involves inserting a needle into your hipbone to remove a sample of bone marrow. The sample is analyzed to look for lymphoma cells.

IMAGING TESTS

Your doctor 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 (PET).

*Other tests and procedures may be used depending on your situation.

Types of Lymphoma Treatments

What lymphoma treatment is best for you depends on your lymphoma type and its severity. Lymphoma treatment may involve chemotherapy, immunotherapy medications, radiation therapy, a bone marrow transplant or some combination of these.

ACTIVE SURVEILLANCE

Some forms of lymphoma are very slow growing. You and your doctor may decide to wait to treat your lymphoma when it causes signs and symptoms that interfere with your daily activities. Until then, you may undergo periodic tests to monitor your condition.

BONE MARROW THERAPY

A bone marrow transplant, also known as a stem cell transplant, involves using high doses of chemotherapy and radiation to suppress your bone marrow. Then healthy bone marrow stem cells from your body or from a donor are infused into your blood where they travel to your bones and rebuild your bone marrow.

CHEMOTHERAPY

Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells. The drugs are usually administered through a vein, but can also be taken as a pill, depending on the specific drugs you receive.

CLINICAL TRIAL

Ask your physician if you are a candidate for a clinical trial.

OTHER DRUG THERAPY

Other drugs used to treat lymphoma include targeted drugs that focus on specific abnormalities in your cancer cells. Immunotherapy drugs use your immune system to kill cancer cells.

RADIATION THERAPY

Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells.

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