Lymphoma

Lymphoma is a type of cancer that affects the lymphatic system, which is part of the body's immune system that helps fight infections and diseases. It develops when lymphocytes (white blood cells) grow abnormally and form tumors in lymph nodes or other parts of the body. There are two main categories: Hodgkin lymphoma (characterized by the presence of Reed-Sternberg cells) and non-Hodgkin lymphoma (which encompasses many different subtypes with varying behaviors). Non-Hodgkin lymphoma is more common, accounting for about 90% of cases. Lymphomas can range from slow-growing (indolent) types that may not require immediate treatment to aggressive forms that need prompt intervention. With advances in diagnosis and treatment approaches, many patients with lymphoma now have excellent prognosis and long-term survival.

Causes

Immune system deficiencies - Congenital or acquired immune disorders increase lymphoma risk
Autoimmune disorders - Conditions like rheumatoid arthritis, Sjögren's syndrome, or lupus are associated with higher lymphoma risk
Infections - Certain viruses and bacteria, including Epstein-Barr virus (EBV), human T-cell leukemia/lymphoma virus (HTLV-1), Helicobacter pylori, hepatitis C virus, and HIV may increase risk of specific lymphoma types
Age - Risk increases with age for many lymphoma types, though some forms affect younger people
Family history - Having a first-degree relative with lymphoma slightly increases risk, suggesting genetic factors
Chemical exposures - Certain herbicides, pesticides, and industrial chemicals have been associated with increased lymphoma risk
Previous cancer treatments - Prior chemotherapy or radiation therapy increases risk of developing lymphoma later
Obesity - Associated with increased risk of certain lymphoma types
Chronic inflammation - Long-term inflammation from infections or autoimmune conditions may contribute to lymphoma development
Genetic factors - Certain inherited genetic variations may increase susceptibility

Signs and Symptoms

Painless swelling of lymph nodes in neck, armpits, or groin
Persistent fatigue that doesn't improve with rest
Unexplained weight loss - losing weight without trying
Fever without obvious infection, often coming and going
Night sweats - often severe enough to soak bedding
Itchy skin without rash or obvious cause
Shortness of breath or cough if lymphoma affects chest lymph nodes
Abdominal pain or swelling if lymphoma affects abdominal lymph nodes or organs
Loss of appetite
Increased susceptibility to infections
Swollen spleen (may cause fullness after eating small amounts)
Alcohol-induced pain in lymph nodes (rare but distinctive in Hodgkin lymphoma)
Symptoms vary widely depending on lymphoma type and location

Diagnosis

Lymph Node Biopsy

The definitive diagnostic test involves removing all or part of an enlarged lymph node for examination. An excisional biopsy (removing the entire node) is preferred when possible, but needle biopsies may be used in certain situations. The tissue is examined by a pathologist to determine if lymphoma is present and, if so, which specific type.

Immunophenotyping

This technique identifies specific proteins (markers) on the surface of lymphoma cells using methods like flow cytometry or immunohistochemistry. The pattern of markers helps classify the lymphoma type and subtype, which is crucial for treatment planning.

Genetic and Molecular Testing

Tests like fluorescence in situ hybridization (FISH), polymerase chain reaction (PCR), and next-generation sequencing identify genetic abnormalities in lymphoma cells. These may include chromosomal translocations, gene mutations, or changes in gene expression that help confirm diagnosis, provide prognostic information, and guide treatment decisions.

Imaging Studies

CT scans, PET scans, MRI, and ultrasound help determine the extent of disease (staging). PET-CT is particularly valuable in lymphoma as it can distinguish between active lymphoma and scar tissue from previous treatment or infection.

Bone Marrow Biopsy

A sample of bone marrow is removed, typically from the hip bone, to check for lymphoma cells that may have spread there. This is an important part of staging for many lymphoma types.

Blood Tests

Complete blood count (CBC), lactate dehydrogenase (LDH) level, liver and kidney function tests, and tests for certain viral infections help assess overall health, provide prognostic information, and guide treatment decisions.

Lumbar Puncture

For lymphomas with risk of central nervous system involvement, a sample of cerebrospinal fluid may be collected and examined for lymphoma cells.

Treatment Options

Watchful Waiting

For slow-growing (indolent) lymphomas that aren't causing significant symptoms, treatment may be delayed until necessary. This approach, also called "active surveillance," involves regular monitoring with physical exams and imaging studies. It avoids treatment side effects until they're warranted by disease progression, and many patients with indolent lymphomas can go years before requiring active treatment.

Chemotherapy

Drugs that kill rapidly dividing cells remain a cornerstone of lymphoma treatment. Combinations of several chemotherapy drugs (regimens) are typically used, with specific combinations chosen based on lymphoma type, stage, and patient factors. Common regimens include R-CHOP for B-cell non-Hodgkin lymphomas and ABVD for Hodgkin lymphoma. Treatment is usually given in cycles with rest periods in between to allow for recovery from side effects.

Immunotherapy

Treatments that harness the immune system to fight lymphoma. Monoclonal antibodies like rituximab target specific proteins on lymphoma cells, flagging them for destruction by the immune system. Immune checkpoint inhibitors like pembrolizumab and nivolumab remove brakes on the immune response, particularly useful in certain Hodgkin lymphomas. CAR-T cell therapy, where a patient's T cells are engineered to target lymphoma cells, has shown remarkable results in certain aggressive B-cell lymphomas that have failed other treatments.

Targeted Therapy

Drugs that target specific vulnerabilities in lymphoma cells while sparing normal cells. Examples include BTK inhibitors (ibrutinib, acalabrutinib) for certain B-cell lymphomas, PI3K inhibitors for follicular lymphoma, and proteasome inhibitors. These treatments often have fewer side effects than traditional chemotherapy and are increasingly important in lymphoma management.

Radiation Therapy

High-energy X-rays target lymphoma cells in specific areas. Modern techniques like intensity-modulated radiation therapy (IMRT) precisely shape radiation beams to minimize damage to surrounding healthy tissue. Radiation may be used alone for early-stage lymphomas, particularly Hodgkin lymphoma, or in combination with other treatments for more advanced disease. It's also valuable for palliation of symptoms in advanced cases.

Stem Cell Transplantation

Autologous transplants use the patient's own stem cells, collected before high-dose chemotherapy that destroys bone marrow, then reinfused to rebuild the immune system. This approach is often used for relapsed or refractory aggressive lymphomas. Allogeneic transplants use stem cells from a donor and may provide additional benefit through the "graft-versus-lymphoma" effect, where donor immune cells help fight remaining lymphoma cells.

Home Remedies

Managing Fatigue

Prioritize activities, plan rest periods, and maintain light physical activity as tolerated. Short naps (less than an hour) can help, but too much daytime sleep may disrupt nighttime sleep. Proper nutrition and staying hydrated are important for energy levels. Discuss persistent fatigue with your healthcare team, as it may be treatable.

Preventing Infections

Wash hands frequently, avoid crowds and people with contagious illnesses, especially during treatment periods when your immune system is weakened. Ensure food safety by thoroughly washing fruits and vegetables and properly cooking meats. Keep skin clean and moisturized to maintain this important barrier against infection. Get recommended vaccinations (though live vaccines may be contraindicated during certain treatments).

Nutrition Support

Eat small, frequent meals if appetite is poor. Focus on nutrient-dense foods and adequate protein to support healing and maintain strength. Stay hydrated by drinking plenty of fluids. Manage treatment-related taste changes by experimenting with different foods, seasonings, and temperatures. Consider working with a dietitian who specializes in oncology nutrition.

Skin Care for Itching

Use mild, fragrance-free soaps and moisturizers. Apply moisturizer while skin is still damp after bathing. Take lukewarm (not hot) showers or baths. Wear loose, soft clothing made of natural fibers. Cold compresses may provide temporary relief. Discuss persistent itching with your healthcare team as medications may be helpful.

Managing Emotional Health

Connect with others through support groups specifically for lymphoma patients. Practice stress reduction techniques like meditation, deep breathing, or gentle yoga. Maintain communication with loved ones about your needs and feelings. Consider professional counseling or therapy if feelings of anxiety or depression persist. Many cancer centers offer psychosocial support services.

Preventive Care

Maintain a healthy immune system through balanced nutrition, regular physical activity, adequate sleep, and stress management
Avoid known risk factors such as exposure to certain chemicals, including benzene, agricultural chemicals, and some industrial solvents
If you work with potentially hazardous chemicals, follow safety guidelines and use protective equipment
Get vaccinated against infections associated with increased lymphoma risk when vaccines are available, such as hepatitis B
Practice safe sex and avoid intravenous drug use to reduce risk of HIV and hepatitis C, which are associated with certain lymphoma types
Get regular medical check-ups to monitor overall health and address any immune system issues promptly
If you have a medical condition that increases lymphoma risk (such as an autoimmune disorder or HIV), follow treatment plans to manage these conditions effectively
If you've had previous cancer treatment, attend all recommended follow-up appointments for monitoring
Be aware of lymphoma symptoms and seek medical attention for persistent unexplained lymph node swelling, fatigue, weight loss, or night sweats
Consider genetic counseling if you have a strong family history of lymphoma or related cancers

Surgical Options

Diagnostic Surgery

Surgery in lymphoma is primarily performed for diagnosis rather than treatment. Excisional biopsy, where an entire lymph node is removed, provides the pathologist with sufficient tissue to make an accurate diagnosis and classification. This is typically done under local anesthesia as an outpatient procedure unless the lymph node is in a difficult location.

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Splenectomy

Removal of the spleen may occasionally be performed in specific lymphoma scenarios: for diagnosis when lymphoma is primarily in the spleen, for relief of symptoms from an enlarged spleen (like pain or early satiety), or rarely as part of treatment for certain splenic lymphomas. This can be done through traditional open surgery or laparoscopically. Following splenectomy, patients need vaccinations against certain bacteria and lifelong vigilance regarding infections.

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Surgical Management of Complications

Surgery may be needed to address complications of lymphoma or its treatment, such as bowel obstruction from enlarged abdominal lymph nodes, perforation from lymphoma involving the intestines, or management of treatment-related complications. These procedures are performed as needed based on specific clinical situations.

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Central Venous Access Device Placement

While not treatment for the lymphoma itself, surgical placement of a central venous catheter or port is commonly performed to facilitate chemotherapy administration, blood draws, and other intravenous treatments. These devices can remain in place throughout the treatment course, reducing the need for repeated needle sticks and protecting peripheral veins from damage by certain chemotherapy drugs.

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Lymphadenectomy

In rare cases, surgical removal of multiple lymph nodes in a specific area (regional lymphadenectomy) may be considered for very localized lymphomas or to relieve symptoms caused by large nodal masses. However, this is uncommon as lymphoma typically responds well to chemotherapy, immunotherapy, and radiation, which are the mainstays of treatment.

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