What is Lymphoma (Lymph Ca.)? Causes, symptoms and treatment

Lymphoma is the general name of more than 70 types of cancers that develop in the lymphatic system which is a part of the immune system. When you have lymphoma, lymphocytes (white blood cells) change and grow out of control. These tumor cells are nestled especially in the lymph nodes, spleen, thymus, bone marrow. Warning signs of lymphoma include fever, sudden weight loss, night sweats, fatigue, and dry cough. Basic treatment methods are chemotherapy, radiotherapy, and immunotherapy. Although the exact cause of lymphoma is not known, people with certain types of infections, such as a weakened immune system or hepatitis C, are at increased risk of developing this disease. The type of the disease, growth rate of the cancer and stage are the determining factors in the patient’s lifetime.

What is Lymphoma?

Causes of lymphoma

Although the lymphoma can occur when the genes that control the cell growth no longer functioning properly, it is not known exactly what causes it. However, some of the identified risk factors are:

• Suppression of the immune system: Organ or bone marrow transplantation, treatment with immunosuppressive drugs and the presence of autoimmune diseases can bear a risk for certain types of lymphoma.
• Exposure to certain infections: Some of these are infections caused by hepatitis C, HIV, AIDS, HTLV-1, Epstein-Barr viruses.
• Being an autoimmune patient: Patients with certain autoimmune diseases such as rheumatoid arthritis and celiac disease have an increased risk of lymphoma
• Chemical and radiation exposure: Especially in agriculture and dyeing industry it is determined that the risk of developing this disease is high.
• Obesity: In general, high weight is a risk for all types of cancer.

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Symptoms of lymphoma

• Fever, Night sweats
• Unexplained Weight loss
• Permanent Fatigue
• Cough, Shortness of breath
• Bone pain
• Enlarged spleen
• Swollen glands (lymph nodes), often in the neck, armpit, upper chest, stomach or groin. The swellings are normally painless, but can be felt under skin by the enlarged glands press on.
• Rash in skin folds
• Stomach pain and diarrhea or constipation like digestive problems

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Types of lymphoma

Most of the lymphomas originate from B and T cells that are two main white blood cells, and are grouped into two main groups:

• Hodgkin Lymphoma (HL)
• Non-Hodgkin Lymphoma (NHL)

What is Hodgkin’s Lymphoma?

It often spreads from the lymph nodes to the lymph nodes. In rare cases, it may spread to the other parts of the body, such as the lungs and bone marrow, especially in the final stage of the disease. It is usually seen in young adults between 20-34 years of age. But it can also be seen in children and adults. There are two main subtypes:

• Classical Hodgkin lymphoma (more common)
• Nodular lymphocyte-predominant Hodgkin Lymphoma (rare type)

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What is Non-Hodgkin Lymphoma (NHL)?

The most common type of lymphoma. Most of the defined lymphoma types are grouped under this group and can be expressed as direct lymphoma. It usually starts in the lymph nodes or tissues but sometimes also affects the skin. It may occur at any age, but is generally tend to develop in older adults. It can be categorized into two main types:

• B-Cell Lymphoma (much more common)
• T-Cell Lymphoma (%80 of the cases are belong to this type and more dangerous)

NHL Types can be grouped as they grow and growth rate:

• Slow growing (Indolent) lymphoma: The cells grow and spread slowly. The most common type of indolent lymphoma is follicular lymphoma and chronic lymphocytic lymphoma.
• Aggressive lymphoma: The cells grow and spread quickly, and usually need to be treated right away. The most common type of aggressive lymphoma is diffuse large B cell lymphoma (DLBCL).

The type of treatment is varied Depending on the type and severity of the lymphoma.

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Lymphoma Diagnosis

Physical Examination

Tissue Biopsy

Biopsy is the process of taking tissue samples from the area suspected of cancer and since it is more than 70 different types of lymphoma, it is very important to make a correct diagnosis in pathological examination. To do this, two different types of methods are used:

• Core needle biopsy: After local anesthesia is performed, a hollow needle is inserted into the lymph node or the tumor and a small amount of tissue or fluid is drawn. This method sometimes may not be sufficient to get enough samples for diagnosis.
• Surgical (open) biopsy: Local or general anesthesia is applied depending on the situation. A section of the lymph node or diseased tissue is removed by cutting the suspected area.

Tissue samples removed by both methods are examined under the microscope by pathologists.

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Bone Marrow Biopsy and Aspiration

It is made for the purpose of investigating Lymphoma cells. It is usually taken from the hip bone anesthetized by local anesthesia. Sometimes pain can be felt during this procedure. The sample can be analyzed in the laboratory to determine the size of the lymphoma.

Blood Tests

It can help to determine the size of lymphoma by evaluating the number and appearance of different blood (red blood cells, white blood cells and platelets) cells by analyzing the patient’s blood sample.

Imaging Tests

PET (positron emission tomography), CT scan and MRI (magnetic resonance imaging) can be performed to investigate where the lymphoma is located and how far it has spread.

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Genetic Tests

Genetic structures of the cells which determined to be lymphoma are also analyzed to ensure that the subtype is correctly identified. This result is extremely important for the success of lymphoma treatment.

Stages of Lyphoma

The condition of lymphoma, which is classified in four stages, is determined by the region where the cancer develops and the growth rate.

• 1st Stage: Cancer is in a lymph node or in an organ.
• 2nd Stage: Cancer is especially in two lymph nodes close to each other in the abdominal region or in an organ and nearby lymph nodes.
• 3rd Stage: At this point, the cancer is present on both sides of the body and in many lymph nodes or in a region or organ outside the lymph node.
• 4th Stage: Cancer may be in an organ and may spread beyond nearby lymph nodes.

• Category A: Fever, excessive sweating and weight loss are not observed.
• Category B: The above symptoms are seen in the patients. These patients are treated more aggressively.

Treatment of Lymphoma

Active Survaillance

If there is no symptoms of slow growing (indolence) lymphoma, the patient is recommended active surveillance. In this method, physical examinations, blood tests and imaging tests are performed at the periods determined and no treatment may be needed for years. However, if lymphoma is activated, a new treatment plan may be developed suitable for the patient.

Chemotherapy

In this method, to kill the cancerous cells, chemical medications are usually given to the patient by dripping from the veins. How chemotherapy is applied depends on the course of the disease and different drug combinations are used. During treatment, due to the healthy cells can also be damaged, side effects such as gastrointestinal disorders, hair loss, appetite and weight loss, and weakness may occur.

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Radiotherapy (Phototherapy)

With this method, cancerous cells are killed but applied to a limited or large area.  Sometimes it can be used as support therapy for chemotherapy depending on the course of the disease. Sometimes it can be used to relieve the pressure created by growing lymph nodes without relieving the purpose of treatment.

Side effects include hair loss, loss of appetite, fatigue, nausea, dry mouth, cough, irritation in the throat, and skin rashes. These effects may vary depending on which part of the body is treated.

Immunotherapy

In order to make the treatment of lymphoma more effective, medications named monoclonal antibodies, which vary depending on the type of present lymphoma, can be used together with chemotherapy. These drugs bind themselves to the surface of cancerous cells to stimulate the immune system to attack and kill cells.

Treatment with Smart Medications

These medications, also called targeted medications, can be used in combination with chemotherapy as well as can be used alone. It can be given by intravenous or oral route. Small molecules in these drugs directly enter the cell, inhibit the mechanisms of tumorization process and minimally affect healthy cells. Its side effects are light and can be controlled.

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Bone Marrow (Stem Cell) Transplantation

It is usually used to treat conditions in which the bone marrow is damaged and can no longer produce healthy blood cells. It can also be performed to replace blood cells that have been damaged or destroyed by too much cancer treatment. This process is done in two ways:

• Allogeneic transplantation: It is the transplantation process using another stem cell. It is usually transmitted by a close member with the same or similar tissue type.
• Autologous transplantation: The stem cell from the healthy area of the individual’s body is transported to the place where the damaged cells are removed.

Bone marrow transplantation is performed according to the result of the treatment with chemotherapy, radiotherapy and immunotherapy.

Surgical Intervention

Surgical Intervention can be used in only skin (cutaneous) lymphomas to remove some healthy tissue around the cancerous area.

How long Lymphoma treatment takes?

Since the duration of treatment may vary according to the type of lymph cancer, the stage of the disease and the response of the patient to the methods to be used in the treatment process, it is not possible to give a definite treatment period. After successful treatment, the patient is regularly examined by the doctor on a periodic basis against the risk of recurrence of lymphoma.

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Complications of Lymphoma

Weak Immune System

It is a common complication of lymphoma and may be more serious during the treatment process. It can usually heal months or years after treatment. This process is likely to develop infection. In some cases the doctor may prescribe antibiotics to prevent possible infections.

Infertility

Chemotherapy and radiotherapy in the treatment of lymphoma may cause infertility. This is a temporary condition but can sometimes be permanent. The sperm samples of men and the women’s eggs can be stored before treatment.

The Risk of Developing another Cancer

There may be risk of developing another cancer during or after lymphoma treatment. Especially chemotherapy and radiotherapy damage the healthy cells, the affected cells can turn into cancer years after treatment. A second risk of cancer can be reduced by not smoking, eating well, exercising regularly, and not becoming overweight.

Other possible health issues:

• Cardiovascular Disease
• Pulmonary Diseases- dyspnea (shortness of breath)
• Kidney Problems
• Thyroid Disease
• Diabetes
• Cataract
• Depression

How long is the life expectancy in lymphoma?

In the case of slow-progressing lymphomas, the patient may experience an average of 15-20 years of lifetime even if no treatment is taken. However, because the aggressive lymphomas spread rapidly, the patient may die within months or weeks if not treated.

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Recommendations for patients with lymph cancer

• Keep a diary to help you keep track of which activities make you feel tired or energetic, depending on your treatment process. Thus you can organize your work.
• Do not deny the support of your family and immediate environment.
• When you feel energetic, include activities that you love and make you feel good. High morale is extremely important in the treatment process of this disease.
• Organize your living space. Put items where you need them most easily.
• Your fatigue may also be caused by depression, anemia, and thyroid hormone levels. Your doctor may prescribe additional medications.
• Eat healthy. Avoid foods that will lower your energy. For example, too much caffeine can trigger your fatigue. Also do not forget to drink plenty of water.
• Learn and apply stress relief techniques such as breathing methods and yoga.
• Do simple and relaxing exercises that your doctor will recommend.
• Pay attention to your sleep setting and do not spend too much time in bed. If you have difficulty sleeping, your doctor will provide you with the appropriate solutions. Short sleep during the day will help you refresh your energy.