Lymphoma, a type of blood cancer, is the fifth most common cancer in the UK. Lymphomas can be hard to diagnose and with sixty different types, the treatments vary hugely from a ‘watch and wait’ option to intensive chemotherapy, radiotherapy and even stem cell transplants. People can live for many years with lymphomas so let’s look at how they present and what the treatment options are.
What is lymphoma?
Lymphoma is a cancer of lymphocyte cells. Lymphocytes are one of our white blood cells and they play an important role in helping our body to fight off infection. They are present in lymph fluid which circulates around the body via a network of lymph nodes and lymph vessels which form the lymphatic system.
It is common for lymph nodes (also called lymph glands) to swell up when you have an infection. For example, you may notice swollen glands in your neck when you have a sore throat. The glands shrink back down again as the infection clears.
In lymphoma, something happens to the DNA of the lymphocytes which results in the lymphocytes behaving abnormally, they reproduce and multiply in an uncontrolled way. Large numbers of lymphocytes mean that the lymph nodes become congested and swollen without the presence of infection.
Types of lymphoma
There are different type of lymphocyte cells and around sixty different types of lymphoma but they can be divided into two groups:
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
Non-Hodgkin can be further divided into:
- Low grade - where nodes grow slowly and may get smaller at times.
- High grade – a faster growing and more aggressive type of lymphoma
Who gets lymphoma?
People of any age can get lymphoma, including children. Hodgkin lymphoma occurs most commonly in people in their early twenties and in the over seventies. It affects around 2,000 people each year in the UK. Non-Hodgkin lymphoma is more common affecting around 14,000 people each year, a third of whom are over the age of 75.
The causes of lymphoma are largely unknown. There may be an inherited genetic mutation which causes the DNA to wrongly instruct the lymphocytes to multiply but it’s not known for certain if lymphoma runs in families.
Whilst it doesn’t point to the cause, certain people are at higher risk of developing lymphoma. These include people who have a suppressed immune system. The suppression may come from the presence of a medical condition which directly affects the immune system such as HIV or from taking an immune suppressing medication. People who have previously been infected by the Epstein Barr virus (responsible for glandular fever) also seem to be at higher risk of lymphoma.
Because some of the symptoms of lymphoma such as swollen nodes and fatigue are common, it can be hard to diagnose lymphoma. Superficial lymph nodes in the neck and armpits are easy to feel but many nodes lie deep within the chest or abdomen and can’t be seen or felt.
The most common symptoms of lymphoma are:
Swollen lymph nodes
These are most commonly in the neck, armpits and groin area. Smooth, rubbery lumps can be felt. They aren’t usually painful and gradually enlarge although they may go up and down in a low grade, non-Hodgkin lymphoma.
If you have swollen glands that have persisted for over two to three weeks or are getting progressively bigger, then see your doctor.
The following generalised symptoms, also called systemic symptoms may be present:
- Unintentional weight loss
- Drenching night sweats
- Fevers, without the presence of infection
- Itching skin, also called pruritus, without the presence of a rash
- Frequent infections
When lymph nodes become enlarged they can press on the body tissues surrounding them resulting in a variety of symptoms depending on the location of the nodes. These include:
- Shortness of breath
- Abdominal pain and bloating
- Diarrhoea or constipation
- Fits and funny turns
- Skin changes
Some people may have only one symptom, whereas others will have multiple. Similarly, some people may become rapidly very unwell whilst others have a slower, milder form of lymphoma. The variety is huge due to the many different types and locations of lymphoma.
Getting a diagnosis of lymphoma
When you feel unwell or notice swollen glands, your first contact is usually with your GP. He or she will not be able to make a diagnosis of lymphoma but may have suspicions based on listening to your explanation of your symptoms and after examining you.
Blood tests will usually be ordered. These include a Full Blood Count (FBC) which gives details of the number of white blood cells, including lymphocytes in your blood. It cannot however give a diagnosis of lymphoma. To reach this you will be referred to a specialist who will arrange specific tests to not only confirm lymphoma but also to work out how advanced the lymphoma is. These include a biopsy where a sample of the tissue from a gland (or commonly a whole gland) is removed and examined under the microscope. Scans such as CT scans, ultrasound scans and X-rays all help to diagnose lymphoma and determine the best treatment plan.
Staging of lymphoma
Once the diagnosis has been made, the doctor will find out what stage the lymphoma is at. This means working out which parts of the body are affected and how advanced the disease is. Staging helps to plan the right treatment.
The following staging is for adults with Hodgkin and non-Hodgkin lymphoma. The staging is different in children
Stage 1 – only one group of lymph nodes is affected
Stage 2 – two groups of lymph nodes are affected but they are both on the same side of the diaphragm e.g. in the neck and armpit
Stage 3 – Lymph nodes on both sides of the diaphragm are affected e.g. neck, armpit and groin
Stage 4 – Lymphoma has spread to organs outside of the lymphatic system e.g. lungs, liver
The treatment plan for lymphoma varies according to the type and stage of lymphoma however factors such as age, other medical conditions and general health can influence how effective and well tolerated treatment is.
Treatment plans are usually drawn up after a Multi-Disciplinary Team meeting. This is a discussion between a collection of specialists who all use their expertise and previous experience to determine the best course of action for each individual patient.
The aim of treatment is to push the lymphoma into complete remission where there is no evidence that it is still present in the body and to prevent relapses. Sometimes where the lymphoma is a low grade, non-Hodgkin type, the aim is for a partial remission, quietening the disease. In this situation, sometimes treatment isn’t offered immediately and a ‘watch and wait’ approach is taken.
Treatment options include:
- Chemotherapy – drugs which kill cancer cells and stops them dividing.
- Radiotherapy – X-rays and radiation are used to damage cancer cells so they die.
- Immunotherapy – antibodies given to try to target the lymphoma cells and cause minimal damage to healthy cells.
- Targeted drugs – similar to chemotherapy but targeted at the lymphoma cells so they are usually more effective and have less side effects.
- Steroids – might be used as treatment to destroy the lymphoma cells but also to help with symptoms such as increasing appetite and reducing side effects of chemotherapy.
- Stem cell transplant – used when lymphomas have relapsed or are at high risk of doing so or those that are not responding to treatments.
- Maintenance therapies – after successful initial treatment, ongoing therapies may be given to prevent relapse, these include medications, immunotherapies and even chemotherapy.
Lymphoma complementary therapies
The charity Lymphoma action states, ‘In the UK, no alternative therapies are registered for the treatment of lymphoma. There is no evidence that they are effective and they are not recommended by the NHS. Although not recommended as a treatment, many patients gain benefit from complementary therapies alongside their medical treatment. Therapies such as massage, aromatherapy, meditation and mindfulness, can all help to lower stress and anxiety and improve wellbeing and quality of life.
Most cases of lymphoma are treatable.
In England, approximately 75 per cent of people with Hodgkin lymphoma will survive for ten years or more. Younger people and those who are diagnosed earliest have the best survival rates.
The survival rate for non-Hodgkin lymphoma has tripled in the last 40 years in the UK and almost two thirds of people will survive beyond ten years. The survival rates are highest in young people and 9 in 10 people diagnosed with non-Hodgkin lymphoma between the ages of 15 and 39 will survive for more than five years.
*stats from Cancer Research UK https://www.cancerresearchuk.org
Last medically reviewed: 08-07-2020
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