The lymphatic system is largely responsible for maintaining the overall health of the body. It attacks foreign invaders and inflammation by producing white blood cells, which are carried throughout the body by lymph, a yellowish or milky fluid that helps nurture cells while getting rid of harmful substances. The lymph is transported through its network of lymph vessels to all parts of the lymphatic system, including the lymph nodes, bone marrow, adenoids, tonsils, spleen, and thymus. In addition, the lymph nodes, which are located all over the body, have special white blood cells called lymphocytes. These lymphocytes are capable of fighting off infection-causing microorganisms.

Understanding Lymphoma

Like all the other systems of the body, the lymphatic system can be afflicted with cancer. Cancer that originates in the lymphatic system is known as lymphoma.

In a form of the cancer known as Hodgkin’s lymphoma, cancer cells grow rapidly and spread throughout and sometimes outside of the lymphatic system. This impedes an individual’s ability to fight off infections.

Hodgkin’s lymphoma is also characterized by abnormal development of B cells, lymphocytes that keep the immune system strong by fighting invading infections. In Hodgkin’s lymphoma, B cells do not die off normally, instead they transform into cancerous Reed-Sternberg cells that eventually develop into tumors.

The other type of lymphoma, known as non-Hodgkin’s lymphoma, is more common. Abnormal B cells may also be present in non-Hodgkin’s lymphoma, but they do not become Reed-Sternberg cells. Nevertheless, they attack the lymphatic system and compromise its ability to fight off infections.

 

Both Hodgkin’s and non-Hodgkin’s lymphoma are identified by swollen, often painless lymph nodes in the groin, armpit, and neck. Other symptoms of the disease include fatigue, fever, night sweats, sudden weight loss, breathing problems, and coughing. Individuals with Hodgkin’s lymphoma may also become sensitive to alcohol or feel pain in the lymph nodes after consuming it while those with non-Hodgkin’s lymphoma may have swelling or pain in the abdomen.

Cancer cells may be present on any part of the body in both Hodgkin’s and non-Hodgkin’s lymphomas, but those found in Hodgkin’s lymphoma are more likely to spread from the lymph nodes in the upper body (such as the neck, underarms, and clavicle) to the rest of it, and the enlargement of lymph nodes is more likely to occur in one region. Enlarged lymph nodes found in non-Hodgkin’s lymphoma are present in numerous parts of the body.

The exact cause of both Hodgkin’s and non-Hodgkin’s lymphomas is unknown, though there are things that may make individuals more susceptible to them. Hodgkin’s and non-Hodgkin’s lymphomas are more common in individuals with weak immune systems and those who have been infected by certain bacteria or viruses, including the Epstein-Barr virus. Hodgkin’s lymphomas are also more common in teens, adults under the age of 30, and senior citizens whereas non-Hodgkin’s lymphoma is most common in those who are 60 and older.

To diagnose lymphoma, a doctor begins by asking for the patient’s medical family history and performing a complete physical examination to check for enlargements in the lymph nodes, liver, and spleen. Because infections are a common cause of swollen lymph nodes, the doctor may initially try to treat them with antibiotics. Blood and urine tests may also be used to rule out infection as a cause of enlarged lymph nodes.

If it is determined that infection is the not the cause of symptoms, a biopsy may be used to search for abnormal cells. In a biopsy, tissue is extracted and checked for the presence and identification of cancerous cells. If the lymph node is close to the skin, a needle aspiration may be used to obtain a tissue sample. In a needle aspiration, a sample of the node is taken out with a small needle and taken to a lab for thorough testing.  An excisional biopsy can also be performed. It this type of biopsy, a piece of lymph node is extracted by cutting into the skin and removing the sample.

The lymph node will be searched for cancerous cells, including Reed-Sternberg cells. Reed-Sternberg cells are large, have multiple nuclei, and are unique to Hodgkin’s lymphoma. If either Reed-Sternberg or other cancerous cells are found, further testing will need to be done to determine the stage and location of cancer and suggest the best treatment options.

An X-ray and CT scan can be used to check lymph nodes in the chest and abdomen and a MRI scan may be used to reveal whether cancer has affected the spinal cord and brain. Non-Hodgkin’s lymphoma can be seen using a positron emission tomography (PET) scan of the whole body or just parts of it. Bone marrow biopsies may be performed to make sure cancer has not spread to the bone marrow, and immunophenotyping can determine whether cancer originated in B-lymphocytes or T lymphocytes.

Lymphoma treatment plans are assembled based on the stage of the disease, the lymph nodes that are affected, the age and overall health of the patient, which symptoms are apparent, and whether or not the patient is pregnant. If symptoms are not present but cancer cells are, a doctor may initially suggest an active surveillance approach (previously known as waiting and watching). Otherwise, the following may be used for treatment:

 

• Chemotherapy: To kill cancerous cells, chemotherapy drugs are administered either orally or through an injection. Chemotherapy can be recommended as a stand-alone regimen or combined with other treatments. This is the main treatment for patients with non-Hodgkin’s lymphoma and is typically used in the treatment of Hodgkin’s lymphoma.

 

• Radiation: Radiation therapy is designed to shrink tumors that are present in the body. This treatment involves placing a patient on a table and using an overhead machine to concentrate high doses of radiation on the tumors. In early stages of Hodgkin’s and non-Hodgkin’s lymphoma, radiation may be the only treatment used, but as the cancer progresses, either chemotherapy or radiation in conjunction with chemotherapy is utilized.

 

• Stem cell transplant: Patients with lymphoma in unfavorable stages or ones who relapse after treatment may be given a stem cell transplant. In this treatment, healthy stem cells are injected into the body where they can form a new immune system that is healthy and strong. Stem cells can be taken from the bone marrow of a donor or the healthy parts of a patient.

 

• Radioimmunotherapy: Radioimmunotherapy aims to deliver radiation directly to the cancer cells. Drugs like tositumomab and ibritumomab carry radioactive isotopes that help the medication’s antibodies attach to the cancerous cells.

 

Side Effects of Treatment

Because most cancer treatments are so powerful, lymphoma sufferers run the risk of developing serious infections that cannot be fought off by the body’s weakened immune system. With chemotherapy, patients may experience short-term side effects such as lethargy, nausea, vomiting, skin color change, hair loss, and a low blood cell count. Infertility is the most common long-term side effect. Others include excess bleeding, thyroid problems, kidney damage, heart disease, lung problems, and other cancer development later in life. Radiation therapy puts recipients at risk of side effects like cataracts, thyroid problems, malfunction of the ovaries or testicles, appetite loss, fatigue, skin reactions, and, in children and adolescents, impaired growth.

One positive aspect of Hodgkin’s lymphoma is that it may be eliminated even during its later stages, making it different from most other types of cancer. In fact, 90 percent of patients who have late-stage Hodgkin’s lymphoma survive at least five years. Of those who begin treatment for Hodgkin’s during its earlier stages, 90 percent survive at least ten years.

For non-Hodgkin’s lymphoma, 63 percent of patients survive for five years or more, while 51 percent live for at least a decade. Poorer prognoses are found in people whose bodies do not respond well to treatments or therapy or those who suffer a relapse of the disease within a year.

Coping with Lymphoma

Coming to grips with a lymphoma diagnosis can be difficult and frightening. You will need the emotional support of your friends and family to help you through this turbulent time in your life. It also helps to join a support group or cancer survivor group so you can interact with people who know exactly what you are going through. To find one of these groups in your area, contact the Leukemia and Lymphoma Society or the National Cancer Institute.

To get your mind off of the stress of the disease and the side effects of treatment, try to take up a hobby or engage in an outdoor activity. Always remember to eat healthy foods, and try to remain as active as you can. Most importantly, never give up on yourself.