Lymphoma

What is lymphoma?

Doctors are not sure about the cause of lymphoma. Lymphoma is a type of cancer that begins in lymphocytes (T cells or B cells). Those are white blood cells- a part of immune system fighting against diseases. In lymphoma, there are abnormal number of lymphocytes in lymph nodes, lymphatic vessels and other organs of body.

Lymphoma is the cancer of lymphatic system which is the germ-fighting network of body.

Lymphatic system includes the lymph nodes, spleen, thymus and bone marrow. Lymphoma may affect all these and other body organs.

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What are the types of lymphoma?

There are many types of lymphoma. Basic categories are as follows:

  • Hodgkin’s lymphoma
  • Non-Hodgkin’s lymphoma

The best treatment option depends on the type and severity of lymphoma. Treatment may include chemotherapy, immunotherapy drugs, radiation therapy or bone marrow transplant.

What are lymphoma types?

  1. Chronic lymphocytic leukemia
  2. Cutaneous B-cell
  3. Cutaneous T- cell
  4. Hodgkin (Hodgkin’s disease)
  5. Non-Hodgkin
  6. Waldenstrom macroglobulinemia

What are the symptoms of lymphoma?

Signs and symptoms of lymphoma include the following:

  • Enlarged lymph nodes that can occur in any part of body, most likely in neck, armpit or groin
  • Fatigue
  • Fever
  • Nocturnal sweating
  • Shortness of breath
  • Weight loss

What are the causes of lymphoma?

Doctors are not sure about the cause of lymphoma.

Lymphoma occurs when genetic code of a white blood cell fighting against diseases, namely lymphocyte, develops a mutation. This mutation triggers the cell to multiply fast and causes the existence of many diseased lymphocytes that continue multiplying.

Mutations also ensure that those cells continue living while others die. This leads to presence of too many diseased and ineffective lymphocytes in lymph nodes and swelling in lymph nodes.

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What are the risk factors of lymphoma?

Factors increasing risk of lymphoma include the following:

  • Advanced age. Risk increases parallel to aging; however, this disease may develop at any age. Some types are more common amongst young adults.
  • Being male. Lymphoma is more common in men comparing to women.
  • Impaired immune system. The disease is more likely to occur in individuals with immune system disorder or the ones using immunosuppressive drugs.
  • Development of specific infections. Some infections like Epstein-Barr virus and Helicobacter pylori are related to increased risk of lymphoma.

Chronic lymphocytic leukemia

Overview

Chronic lymphocytic leukemia (CLL) is a type of cancer in blood and bone marrow –which is the spongy tissue inside the bones-.

The term “chronic” in chronic lymphocytic leukemia is used because it progresses slowly than the other leukemia types.  The term “lymphocytic” in chronic lymphocytic leukemia refers to the cells affected by the disease- a group of white blood cell which helps your body to fight against infection.

Chronic lymphocytic leukemia most commonly affects the elders. There are treatments that help controlling this disease.

Signs of Chronic Lymphocytic Leukemia:

Many people with chronic lymphocytic leukemia do not show any sign at early stage. Individuals developing signs and symptoms may experience the following:

  • Enlarged, although painless, lymph nodes
  • Fatigue
  • Fever
  • Pain at left upper region of abdomen which can be caused by enlarged spleen
  • Nocturnal sweating
  • Weight loss
  • Frequent infection

Causes of Chronic Lymphocytic Leukemia:

Doctors are not sure about the factors that start the process leading to chronic lymphocytic leukemia. Doctors are aware of the fact that there is something that causes a genetic mutation in DNA of blood producing cells.  This mutation makes the blood cells produce abnormal, ineffective lymphocytes – a type of white blood cell that helps the body fight against infection-.

Those abnormal lymphocytes not only are ineffective but they also continue living and multiplying after the normal lymphocytes die. The abnormal lymphocytes accumulate in blood and specific organs and lead to complications. They may push the healthy cells outside the bone marrow and affect normal blood cell production.

Doctors and researches work to understand the certain mechanism causing chronic lymphocytic leukemia.

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What are the risk factors of lymphoma?

Factors that can increase the risk of chronic lymphocytic leukemia include the following:

  • Your age. Most of the people who are diagnosed with chronic lymphocytic leukemia are above the age of 60.
  • Your race. Whites more commonly develop chronic lymphocytic leukemia comparing to individuals of other races.
  • Familial history of blood and bone marrow cancer. Familial history of chronic lymphocytic leukemia or other blood and bone marrow cancers may increase your risk.
  • Exposure to chemicals. Specific herbicides and insecticides, including Agent Orange which was used in Vietnam War, are related to increased risk of chronic lymphocytic leukemia.

What are the complications of lymphoma?

Chronic lymphocytic leukemia may cause complications such as the following:

  • Frequent infections. Individuals with chronic lymphocytic leukemia can suffer infections frequently.  For most of the patients, those infections are common upper and lower respiratory tract infections.  However, sometimes, more severe infections may develop.
  • Switching of cancer to a more aggressive form. A few people with chronic lymphocytic leukemia may develop a more aggressive form of cancer which is called diffuse large B-cell lymphoma. Sometimes, doctors call this switch as Richter’s syndrome.
  • Increase in risk of other cancers. Individuals with chronic lymphocytic leukemia may have an increased risk of other cancer types, including but not limited to skin cancers such as melanoma and lung and digestive system cancers.
  • Immune system disorders. A few people with chronic lymphocytic leukemia can develop an immune system disorder that make the cells of immune system fighting against the disease attack red blood cells or platelets by mistake.

How is lymphoma diagnosed?

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Bone Marrow Biopsy:

Tests and procedures for diagnosing lymphoma include the following:

  • Physical examination. Your doctor may examine your body to investigate signs of enlarged lymph nodes.
  • Removal of lymph node for examination. Your doctor may recommend lymph node biopsy procedure for removal of a lymph node –or a part of it- to be examined in laboratory.  Developed tests can determine whether there are lymphoma cells or which cell types are involved.
  • Blood tests. Blood tests determining the cell count in a blood sample of yours may give your doctor a clue for your diagnosis.
  • Collecting bone marrow sample for examination. Bone marrow biopsy and aspiration procedure is performed by inserting a needle into the femur to collect a bone marrow sample.  This sample is analyzed to seek lymphoma cells.
  • Imaging tests. Imaging tests can be used to investigate signs of lymphoma in other body parts. Those tests may include CT, MRI and positron emission tomography (PET).

How is lymphoma treated?

Treatment choices for lymphoma depend on the type, degree of aggression and your treatment targets.

Treatments include the following:

  • Active monitoring. Some lymphoma types grow very slowly. You and your doctor may decide to delay your treatment until the disease shows signs and symptoms that affect your daily activities.  After this stage, you can have periodical tests for monitoring your disease.
  • Chemotherapy is a medication therapy using chemicals to kill cancer cells. Chemotherapy is mostly administered into vein while it can also be used as pills depending on special drugs which you use.
  • Other medication therapies. Other medications of treatment include target-oriented drugs focusing on specific anomalies in cancer cells which help them go on living. Immunotherapy drugs use your immune system to destroy the cancer cells.
  • Radiation therapy. Intense bundles of energy such as x-ray and protons are used for radiation therapy.
  • Bone marrow transplant. Bone marrow transplant, also known as stem cell transplant, includes use of high-dose chemotherapy and radiation to suppress the bone marrow.  Next, healthy bone marrow stem cells obtained from your body or a donor, are transplanted to your blood, they reach your bones and re-build your bone marrow.

Non-melanoma Skin Cancer:

Cutaneous B-cell:

Cutaneous B-cell lymphoma is a rare cancer type which occurs in white blood cells and attacks to skin.  Cutaneous B-cell lymphoma starts in B-cells –a type of white blood cells fighting against diseases called lymphocytes-.

Types of cutaneous B-cell lymphoma are as follows:

  • Primary cutaneous follicle center lymphoma
  • Primary cutaneous marginal zone B-cell lymphoma
  • Primary cutaneous diffuse large B-cell lymphoma, leg type
  • Intravascular diffuse large B-cell lymphoma

Cutaneous B-cell lymphoma may develop as a subcutaneous nodule which can have the same color with your skin or can be pink or purple.

Cutaneous B-cell Lymphoma Diagnosis:

Tests and procedures for diagnosing cutaneous B-cell lymphoma include the following:

  • Physicial examination. Your doctor will carefully examine your skin and investigate other signs that may give clue about your diagnosis such as swollen lymph nodes.
  • Skin biopsy. Your doctor will extract a small part of the skin lesion to investigate lymphoma cells.
  • Blood tests. Your blood sample can be analyzed for lymphoma cells.
  • Bone marrow biopsy. Bone marrow sample can be tested for lymphoma cells.
  • Imaging tests. Imaging tests like computed tomography (CT) and positron emission tomography (PET) scan may help your doctor evaluate your disease.

Treatment:

Treatment of cutaneous B-cell lymphoma depends of the type of your lymphoma.

Treatment options may include the following:

  • Surgery to remove the cancer. If you have cutaneous lymphoma in a single or several area(s), your doctor may suggest the procedure of removing cancer and some amount of healthy tissue around the cancer. Surgery may be the only treatment or your doctor may recommend extra treatments.
  • Radiation therapy. Intense bundles of energy such as x-ray and protons are used for radiation therapy.  Radiation therapy can be solely used to treat cutaneous lymphoma or it can be used postoperatively to destroy residual cancer cells.
  • Chemotherapy is a medication therapy using chemicals to kill cancer cells. Chemotherapy drugs can be injected into tumor via skin to treat the cutaneous lymphoma. Chemotherapy can be infused into a vein for more advanced stage cutaneous lymphomas.  Chemotherapy can be an option if the cutaneous lymphoma is aggressive or advanced.

Cutaneous T- cell Lymphoma :

Overview:

Cutaneous T-cell lymphoma is a rare cancer type which occurs in white blood cells and attacks to skin.  Cutaneous T-cell lymphoma is one of the several lymphoma types which are jointly called as non-Hodgkin lymphoma.

Cutaneous T-cell lymphoma can cause rash-like redness and sometimes skin tumors. Treatments may include skin creams, light therapy, drugs and radiation therapy.

Cutaneous T-cell lymphoma has several types including mycosis fungoides and Sezary syndrome.

Hodgkin’s Lymphoma (Hodgkin’s disease):

Parts of immune system:

Hodgkin’s lymphoma, which was formerly known as Hodgkin’s disease, is the cancer of lymphatic system which is a part of your immune system.

In Hodgkin’s lymphoma, cells of lymphatic system grow abnormally and can spread beyond the lymphatic system. As Hodgkin’s lymphoma grows, it impairs the ability of body to fight against infection.

Hodgkin’s lymphoma is one of the most common cancer types of lymphatic system. Non-Hodgkin’s lymphoma, which is the other type, is much more common.

Advancements in diagnosis and treatment of Hodgkin’s lymphoma have helped the individuals with this diagnosis heal completely. Improvement of prognosis is continuing for individuals with diagnosis of Hodgkin’s lymphoma.

Non-Hodgkin’s lymphoma:

Non-Hodgkin’s lymphoma is a type of cancer that originates from your lymphatic system fighting against diseases spreading your whole body. In non-Hodgkin’s lymphoma, tumors develop from lymphocytes –a type of white blood cell-.

Non-Hodgkin’s lymphoma is much more common comparing to Hodgkin’s lymphoma which is the other general type of lymphoma.

There are many subtypes of non-Hodgkin’s lymphoma. Diffuse large B-cell lymphoma and follicular lymphoma are among the common subtypes of non-Hodgkin’s lymphoma.

Waldenstrom macroglobulinemia:

Overview:

Waldenstrom macroglobulinemia is a rare cancer type that starts in white blood cells.

If you have Waldenstrom macroglobulinemia, your bone marrow produces too many abnormal white blood cells that they exceed the healthy blood cells in number.  Abnormal white blood cells produce a type of protein that accumulates in blood, impairs the circulation and causes complications.

Waldenstrom macroglobulinemia is considered a type of non-Hodgkin’s lymphoma. Sometimes, it is called as lymphoplasmacytic lymphoma.

Symptoms:

Waldenstrom macroglobulinemia grows slowly and it may not cause any sign or symptom for years.

When this condition occurs, signs and symptoms may include:

  • Bruising easily
  • Bleeding from nose and gingiva
  • Fatigue
  • Weight loss
  • Numbness in hands or feet
  • Fever
  • Headache
  • Shortness of breath
  • Changes in vision
  • Confusion

Causes:

Causes of Waldensrom macroglobulinemia are not known for sure.

Doctors know that the disease starts with an abnormal white blood cell that causes errors (mutations) in genetic code. Those errors make the cell continue multiplying fast.

As the cancer cells do not grow and die like normal cells, they accumulate in body and they finally dominate the production of healthy cells. Waldenstrom macroglobulinemia removes the healthy blood cells from bone marrow which produces blood and fills the centers of many of your bones.

Waldenstrom macroglobulinemia cells continue trying to produce antibody as the healthy white blood cells do; however, they produce abnormal proteins that are not used by the body. Immunoglobulin M (IgM) protein accumulates in blood, impairs the circulation and causes complications.

Risk Factors:

Factors that can increase the risk of Waldenstrom macroglobulinemia include the following:

  • Being elderly. Waldenstrom macroglobulinemia may develop at any age; however, it is diagnosed most commonly in adults at the age of 65 or older.
  • Being male. Men are more commonly diagnosed with Waldenstrom macroglobulinemia.
  • Being white. Whites more commonly develop this disease comparing to individuals of other races.
  • Familial history of lymphoma. If you have a relative with diagnosis of Waldenstrom macroglobulinemia, you may have an increased risk.