Lymphoma refers to a group of white blood cell cancers in the lymphatic system — the part of the immune system that includes the lymph vessels, lymph nodes, spleen, thymus, and tonsils. The diseases can form tumors and are found in children, teens, and adults, though some types are more common at certain ages.
There are two major kinds of lymphoma:
Hodgkin's disease, also known as Hodgkin's lymphoma, is a less common form of lymphoma. It is a malignant cancer of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. The diagnosis of Hodgkin's lymphoma depends on having abnormal cells called Reed-Sternberg cells.
The causes of Hodgkin's lymphoma remain unknown, but an impaired immune system and exposure to carcinogens, pesticides, herbicides, viruses, and bacteria may be a factor. There may be a higher risk for people infected with the Epstein-Barr virus (which causes mononucleosis) and who have a family history of Hodgkin's disease.
The first sign of this cancer is often an enlarged lymph node that appears without a known cause. The disease can spread to nearby lymph nodes and later may spread outside the lymph nodes to the lungs, liver, bones, or bone marrow.
Risk factors for Hodgkin's lymphoma
Risk factors for Hodgkin's lymphoma include:
Age: The disease is more common from 15 to 40 (especially in the 20s), and again after 55
Virus Infection: The risk is higher if you are infected with human immunodeficiency virus (HIV) or mononucleosis (mono), caused by the Epstein-Barr virus (EBV)
Family History: While most patients do not have a family history of the disease, having a close relative (parent or sibling) with it can increase your risk
Inherited Diseases: Certain inherited immune system diseases can raise your risk
Non-Hodgkin's lymphoma is a cancer of lymphoid tissue (lymph nodes, spleen, and other organs of the immune system).
Non-Hodgkin's lymphoma can be slow-growing or rapidly growing. For most patients, the cause is unknown, but lymphoma can develop in people with a suppressed immune system, such as after organ transplantation.
Non-Hodgkin's tumors occur more frequently than Hodgkin's lymphoma. More often, non-Hodgkin's lymphoma affects people older than 50. High-risk groups include organ transplant recipients and immunosuppressed people. Environmental factors, including exposure to certain chemicals, including some pesticides, solvents, or fertilizers could be a risk factor.
The most common symptom of non-Hodgkin's lymphoma is painless swelling of the lymph nodes in the neck, underarm, or groin. Other symptoms may include:
Unexplained weight loss
Reddened patches on the skin
Risk factors for non-Hodgkin's lymphoma
Risk factors for non-Hodgkin's lymphoma include:
- Age: While some types of the disease are more common in younger people, most cases occur in people over 60
- Gender: The risk is higher among men overall, but certain types are more common in women
- Race: Whites are more likely than African-Americans and Asian-Americans to develop the disease
- Chemical Exposure: Exposure to certain chemicals increases risk
- Suppressed Immune System: Taking immunosuppressant drugs after an organ transplant raises risk
- Certain Medical Conditions: Medical conditions that can increase risk include:
- An inherited immune disorder like hypogammaglobulinemia or Wiskott-Aldrich syndrome
- An autoimmune disease like rheumatoid arthritis, psoriasis, or Sjögren syndrome
- Human T-lymphotrophic virus type I (HTLV-1) or Epstein-Barr virus (EBV)
- Infections that chronically stimulate the immune system
Lymphoma symptoms include:
- Unexplained fever
- Painless lymph node swelling in the neck, underarm, groin, chest, or stomach
- Unexplained weight loss
- Night sweats
- Itchy skin
- Unexplained pain in the chest, abdomen, or bones (adult NHL)
- Trouble breathing (pediatric NHL)
- Coughing (pediatric NHL)
- Trouble swallowing (pediatric NHL)
- Painless testicle lump or swelling (pediatric NHL)
Other symptoms can cause these problems, too, so it’s important to see a doctor.
Successful lymphoma treatment depends on a complete and accurate diagnosis. Each of our patients receives a thorough evaluation so we can create an individualized plan. We diagnose lymphoma with:
- History and Physical Examination: We complete a thorough examination and take a full personal and family medical history
- Blood and Urine Work: We may take blood and urine samples to test your complete blood count (CBC), blood chemistry, and other factors
- Lymph Node Biopsy: We use a needle or an incision to remove all or part of a lymph node, then examine the sample with a microscope
We may use additional tools to determine if the cancer has spread:
- CT (CAT) Scan: Computed tomography takes a series of X-rays from different angles, then stitches them together into 3D images
- MRI: Magnetic resonance imaging uses a powerful magnetic field and radio waves to create detailed 3D images at higher contrast than CT scans — useful for clarifying other test results
- PET Scan and CT: After a substance called radionuclide glucose is injected into one of your veins, a positron emission tomography scanner rotates around your body and creates a map of cancer cells, which take in more glucose and show up brighter. The test is combined with a CT scan
- Bone Marrow Biopsy: We use a hollow needle to remove a small sample of bone marrow, blood, and bone from the hipbone or breastbone. The samples are studied under a microscope and may get other testing, including analysis for genetic changes
- Laparotomy/Laparoscopy: The organs inside the abdomen are checked for disease, using either one larger incision (laparotomy) or smaller incisions and special tools (laparoscopy). Diseased tissue or organs may get removed, or samples taken for examination with a microscope
- Mediastinoscopy: An incision is made at the top of the breastbone, and a thin, lighted instrument (mediastinoscope) is inserted to check for abnormal tissue in the organs, tissues, and lymph nodes between the lungs. We may remove tissue or lymph node samples
- Ultrasound: Sound waves create a picture of the suspicious area