Lymphomas are cancers of the lymphatic system
When you have lymphoma, some of your lymphocytes (specialised white blood cells that normally fight infection) are ‘out of control’. They divide in an abnormal way, or do not die when they should. These abnormal lymphocytes can collect in the lymph nodes, which are small oval swellings arranged in groups at various points along the course of the lymphatic drainage system.
Lymphoma can affect lymph nodes in all parts of your body. It can also involve other organs, such as the spleen (part of the immune system) or your bone marrow.
Like other cancers, lymphoma can affect the function of the tissue involved. For example, if the lymphoma is in your bone marrow (where your blood is made) you might not be able to make new blood cells.
Although lymphoma is a disease of the lymphatic system, it can also arise in other parts of your body. For example, lymphoma can affect your breast, stomach, bowel, skin or liver. Lymphoma that occurs in areas such as these is said to be ‘extranodal’, meaning ‘outside of lymph nodes’.
The two main forms of lymphoma are Hodgkin lymphoma (HL) and nonHodgkin lymphoma (NHL). Lymphoma occurs when lymphocytes, a type of white blood cell, grow abnormally. The body has two main types of lymphocytes that can develop into lymphomas: Blymphocytes (Bcells) and Tlymphocytes (Tcells).
Staging helps to describe where the Hodgkin lymphoma is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis. There are different stage descriptions for different types of cancer.
When staging Hodgkin lymphoma, doctors evaluate the following:
The stage of lymphoma describes the extent of the spread of the tumor, using the terms stage I through IV (1 through 4). Each stage may also be subdivided into “A” and “B” categories, based on the presence or absence of specific symptoms.
Stage I. The cancer is found in 1 region of a lymph node.
Stage II. Either one of these conditions:
Stage III. There is cancer in lymph node areas on both sides of the diaphragm, meaning above and below it (stage III). In addition, there may be involvement of an extralymphatic organ (stage IIIE), involvement of the spleen (using the letter “S,” stage IIIS), or both (stage IIIES).
Stage IV. The lymphoma has spread throughout more than one area of the body. Common places Hodgkin lymphoma usually spreads include the liver, bone marrow, or lungs.
Recurrent. Recurrent lymphoma is lymphoma that has come back after treatment. Lymphoma may return in the area where it first started or in another part of the body. Recurrence may occur shortly after the first treatment or years later. If the lymphoma does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.
The common tests for lymphoma are described in this chapter. You may not have all the tests. When the tests are done, your doctor or doctors will tell you what they have learned about your cancer, and suggest the best treatment for you.
Your doctor will begin by examining your body, especially the areas where there are lymph nodes. Your doctor will also discuss your medical history and ask about symptoms.
If you have swollen lymph nodes that your doctor thinks may be cancerous, they will take some tissue from a swollen lymph node. This is called a tissue biopsy. The whole node may be removed or only a part of the node. This tissue will be sent to a pathology laboratory to be examined in detail to see if it has cancer cells in it.
You could have either a general or a local anaesthetic when you have your biopsy. This will depend on where the lymph node is that the doctor wishes to biopsy. If the biopsy shows that you have lymphoma, other tests will be done to find out whether the cancer has spread, and if so, to where. This is called ‘staging’ the cancer.
Your doctor may take some blood from your arm using a needle and syringe. This will be sent to a pathology laboratory to be examined. These tests will also tell the doctors how well your other organs such as liver and kidneys are working.
Lymphoma cells can spread to bone marrow. In a bone marrow biopsy, a sample from your bone marrow is taken with a needle. The bone marrow is usually taken from the back of your hipbone. You will have a local anaesthetic and possibly some sedative so you do not feel pain during the biopsy. The sample will be looked at under a microscope to see if the lymphoma has spread to the bone marrow.
Computerised tomography (CT) scan
A CT scan is a special type of xray that gives a threedimensional (3D) picture of the organs and other structures in your body. It usually takes about 30 to 40 minutes to complete this painless test. You will be asked to lie on a table while the CT scanner, which is large and round like a doughnut, moves around you. Before the scan, you may have an injection of a dye that shows up body tissues more clearly. You will be asked not to eat or drink for a while before you have your scan. Most people are able to go home as soon as their scan is over.
A child with a nonHodgkin lymphoma will also have an ultrasound scan of their abdomen.
In this test your whole body is checked. You will have an injection of radioactive gallium, a sort of metal. After a few days, when it has had time to circulate around your body, you will return to the hospital to have pictures of your body taken with a special camera (a gamma camera). If gallium is seen outside body areas that normally would take it up, a cancer may be present at that site.
Positron emission tomography (PET) scan
A PET scan builds up clear and detailed pictures of the body. You will have an injection of a glucose solution containing a very small amount of a radioactive substance. The scanner can ‘see’ this substance, which shows where the glucose is being used in the body. Cancer cells show up as areas where glucose is being used by actively growing cells.
This treatment increases your body’s natural ability to fight cancer. It does this by giving a boost to your immune system.There are several kinds of biologic therapy:
This treatment uses drugs to kill cancer cells and reduce the size of cancer tumors. Chemotherapy drugs may also affect healthy cells and cause side effects like hair loss or mouth sores.There are many types of chemotherapy drugs. Many drugs are often used together for chemotherapy.
This treatment uses radiation (high energy xrays) to kill cancer cells.The treatment often only takes place in the part of your body where the lymphoma is located.
Sometimes high doses of chemotherapy destroy the lymphoma cells and your bone marrow, which is the “factory” for blood cells. To help your bone marrow make new healthy blood cells, some stem cells (immature cells that will grow up into red blood cells, white blood cells, and platelets) may be taken with a special machine before chemotherapy is given.
These cells are then transplanted (put back) into the body. These transplanted cells will then find their way to the bone marrow and restore it, so that it can build healthy new blood cells.
There are two types of transplants:
Lymphoma is a type of cancer. It starts in the infectionfighting lymphatic system. There are 2 main types of lymphoma. They are Hodgkin and nonHodgkin. With either type, cells in lymphoid tissue grow out of control.
The lymphatic system is part of the immune system. It helps the body fight disease and sickness. The lymphatic system consists of a series of thin tubes and clusters of lymph nodes throughout the body. These tubes carry fluid, called lymph, through the lymph nodes and back into the bloodstream. This colorless, watery fluid is rich in white blood cells. Lymphocytes are the main type of cells. They help the body fight off infection. A lymph node is about the size of a pea and has large numbers of lymphocytes. Groups of lymph nodes are found in the stomach, chest, groin, and neck. Some of the body’s internal organs are also part of the lymphatic system. These organs include the bone marrow, spleen, thymus, and tonsils. Other organs,like parts of the digestive tract, also contain lymph tissue. Lymphoma can start in any part of the body where there is lymphatic tissue.
The cells of each of these diseases look different under a microscope. They also spread differently. Hodgkin tends to spread in a more predictable way and typically not as much as nonHodgkin.
A fine needle aspiration (FNA) is a type of biopsy. A biopsy is a test to check for cancer. To do an FNA, the healthcare provider takes a small sample of cells from the tumor or suspicious place. For an FNA, the healthcare provider inserts a very thin, hollow needle into the tumor to collect cells. Then the cells are looked at under a microscope for cancer cells. With lymphoma, sometimes an FNA doesn’t give the healthcare provider enough cells to look at for a clear diagnosis. Because of this, healthcare providers often prefer to use other types of biopsies to diagnose lymphoma.
An excisional biopsy is when a surgeon takes out the whole lymph node. An incisional biopsy is when a surgeon takes out only a part of the lymph node or tumor. In both cases, a specialized healthcare provider called a pathologist looks at the cells under a microscope to check for cancer cells. Both of these types of biopsies almost always give the pathologist enough tissue to confirm whether there is cancer, as well as what type it is.
One of the most common symptoms of lymphomas is swelling of the lymph nodes in the neck, groin, and/or underarms. If the lymphoma is in other organs or tissues, you may have other symptoms, like headaches, cough, shortness of breath, swelling in the stomach, or nausea. You may also experience generalized symptoms, like fever, itchy skin, night sweats, and unexplained weight loss. People may have only some of these symptoms. It is important to remember that all of these symptoms can be caused by other medical problems. But if you have any of these, see your healthcare provider.
There are many different types of nonHodgkin lymphoma. The treatment of any lymphoma depends on the type of lymphoma and on its stage, which is how far the cancer has spread. In a very early stage, radiation may be the main treatment. A combination of chemotherapy drugs is the most common treatment. There are many different regimens available. There’s also immunotherapy. This uses drugs like monoclonal antibodies, as well as other drugs called targeted therapies. Often, several types of treatment are used together. In rare cases, a surgeon may take out a diseased spleen. In cases when treatment stops working, a healthcare provider may suggest highdose chemotherapy and stem cell transplantation. This is also called bone marrow transplant.
There are many reasons someone might want to ask for a second opinion. Here are some:
Here are ways to find someone for a second opinion:
Ask the healthcare provider for the name of a specialist. Call the Cancer Information Service. The number is 8004CANCER (8004226237). Callers can learn about centers and programs supported by the National Cancer Institute. Get names of healthcare providers from the local medical society. Get names of healthcare providers from a hospital, medical school, or cancer advocacy group. Ask people who have had the same kind of cancer for healthcare providers’ names.
Remember, it is more important to make an informed decision about your healthcare team and treatment than to make a quick decision. Give yourself time to get all the information you need to make the best choice for yourself.