Lymphoma cancer

What is lymphoma cancer?

Lymphoma cancer is a cancer originating from lymph nodes or lymph tissues with cell overgrowth in the lymphatic system. The role of the body’s lymphatic system is to fight against pathogens by delivering lymph throughout the body. Lymph is composed of

  • Lymphocyte: a kind of white blood cell. Its role is to produce antibodies and destroy pathogens.
  • Lymph node: Has a bean-like shape. Composed of lymphocytes. Lymph nodes can be found all over the body, obviously seen at the throat, armpits, breasts, or groin.

Lymphatic vessels: composed of lymph which connects to each lymph node. There are other organs which are included in the lymphatic system as well, e.g. tonsils, spleen, and thymus gland. When lymph nodes function abnormally, immunity will be lower, making it easier to become infected.

Types of lymphoma cancer

Lymphoma cancer is categorized into two main types, namely Non-Hodgkin lymphoma (NHL) and Hodgkin disease (HD). In Thailand, NHL is most commonly found. Since lymph nodes can be found all over the body, Non-Hodgkin lymphoma can occur in every organ, but it usually originates from the lymph nodes, spleen, liver, or even the stomach.

Hodgkin Lymphoma

is considered to be a rarely encountered lymphoma cancer. Diagnosis requires examination and confirmation of cells with special characteristics that are called Reed-Sternberg cells, which are not found in non-Hodgkin lymphoma. Each year, 62,000 patients are diagnosed with non-Hodgkin lymphoma worldwide. Of this total, 60% are men and 40% are women. Worldwide, 25,000 patients die from Hodgkin lymphoma. With Hodgkin lymphoma patients, the symptoms and disease generally progress rather slowly.

Non-Hodgkin Lymphoma

This type of lymphoma can be categorized into more than 30 subgroups. By considering cancer growth rate, non-Hodgkin lymphoma can be classified into 2 types including:

  1. Indolent type: characterized by a slow proliferation rate and slow progression of symptoms. Patient life expectancy may be up to ten years, thus, most patients usually come to see a doctor when the disease metastasized widely. This type of lymphoma responds well to treatment, but is subject to frequent relapse. No treatment is needed in some patients, only monitoring of symptoms. However, this type of cancer is not completely cured by currently available chemotherapy.
  2. Aggressive type: characterized by a fast proliferation rate. Patients usually present with severe symptoms. If treatment is not received, patients may die within 6 months to 2 years. The difference from the indolent type is that the aggressive type can be completely cured, if patients receive full treatment.

Each year 286,000 patients worldwide die from Non-Hodgkin Lymphoma. Of this total, 58% are men and 42% are women. Currently, Non-Hodgkin Lymphoma can be categorized into 35 subgroups, with each subgroup requiring a different treatment. Sometimes further investigation is needed to determine the actual type of such lymphoma cancer in order to plan further treatment.

B-cell lymphoma

Is found in 90% of Non-Hodgkin lymphoma cases. It can be classified into

1. Diffuse large B-cell lymphoma

– The most common type of lymphoma cancer, approximately 30% of Non-Hodgkin lymphoma. Approximately 40% of the time, disease pathology is found outside lymph nodes. It is considered to be a severe type of lymphoma cancer. – Treatment for this type of lymphoma includes chemotherapy, radiation in some patients, monoclonal antibodies.

2. Follicular lymphoma

– This lymphoma cancer is the second most common type following B-cell lymphoma. Disease pathology starts at the lymph nodes, and tumors gradually become enlarged. This cannot be completely cured. Most patients can live 8-10 years after diagnosis. – Treatments include chemotherapy, radiation, monoclonal antibodies, or monitoring symptoms in some patients without starting treatment. – This type of cancer may change to become a more serious type of lymphoma over time.

3. Small lymphocytic lymphoma

– This type of lymphoma is found in approximately 5% of patients. It is considered to be a non-serious type.

4. Splenic marginal zone lymphoma

– This type of lymphoma usually starts from the spleen. It is a rare type. It usually progresses slowly and does not require treatment; however, spleen removal might be needed in some individuals.

5. Extranodal marginal zone B-cell lymphoma of mucosa-associated tissue (MALT)

– This type of lymphoma usually starts from the stomach, but can be found in other organs as well, including lungs, thyroid gland, salivary gland, or eyes. – A part of this subgroup of patients has a history of autoimmune disease. – In cases where stomach lesions are found, it is usually associated with Helicobacter pylori infection. – Treatment for this type of lymphoma is similar to treatment of diffuse large B-cell lymphoma.

6. Nodal marginal zone lymphoma

– This type of lymphoma is only found in 1% of all lymphoma cancer. – Treatment of this type of lymphoma is similar to treatment of diffuse large B-cell lymphoma.

7. Lymphoplasmacytic lymphoma

– Only found in 1% of all lymphoma cancer. It is considered to be a non-serious type. Frequently it is found that the cancer is metastasized to bone, lymph nodes, or spleen. – Patients in this group may be found to have a complication caused by hyperviscosity syndrome. – Treatments include chemotherapy, radiation, or symptom monitoring.

8. Mantle cell lymphoma

– This type of lymphoma is classified as a serious type that can be found in 7% of all patients. It is usually found to have metastasized to bones, lymph nodes, or spleen. – This type of lymphoma tends to not respond very well to treatment. At present there is still not a standard treatment for it. – In some institutes they may consider treatment with high-dose chemotherapy followed by stem cells transplantation in patients.

9. Mediastinal large B-cell lymphoma

– This lymphoma is categorized as a serious type. Large tumors are typically found in the chest area and may press on the large vein in the neck, resulting in superior vena cava syndrome. – This type of cancer is usually found in women aged 30-40. – Treatment for this type of lymphoma is composed of chemotherapy, or radiation may be necessary in some patients.

10. Primary effusion lymphoma

– The type of cancer is usually found in HIV-infected patients or patients with immune system deficiency disorders. It is considered to be a serious type. – Symptoms of this type of lymphoma come from increased fluid in the body cavity, e.g., pleura or pericardium.

11. Burkitt’s lymphoma

– This type of lymphoma is rare, but serious. It is commonly found in Africans and is associated with EBV infection.

T-cell lymphoma

is found in approximately 10% of non-Hodgkin lymphoma, which can be divided into

1. Precursor T lymphoblastic lymphoma

– This type of lymphoma cancer can be found 15% in children and 25% in adults. It is more common in men than women. – Large tumors are found in the chest area in most patients and it rapidly metastasizes to the bones. – It is considered to be a serious type of lymphoma cancer. Treatment is composed of high-dose chemotherapy followed by stem cells transplantation.

2. Adult T-cell lymphoma/leukemia

– This type of lymphoma cancer is caused by HTLV-1 infection. It is considered to be serious and it is usually found in the blood stream. – Treatment response to this type of lymphoma is low; however, anti-viral medications along with interferon may be effective in some patients.

3. Extranodal NK/T-cell lymphoma

– This type of lymphoma cancer is usually found in Asia, and is common in children and adolescents. Patients usually present with tumors inside the nose cavity, but it can also be found all over the body. – Treatment is composed of chemotherapy or radiation followed by chemotherapy.

4. Enteropathy type T-cell lymphoma

– This is considered to be a very serious type of lymphoma cancer. Disease pathology starts at the intestine and metastasizes to the intestinal epithelium. This type of lymphoma is most commonly found in patients with celiac disease.

5. Gamma/delta hepatosplenic T-cell lymphoma

– It is usually more common in men than women. – Treatment is the same as for diffuse large B-cell lymphoma.

6. Subcutaneous panniculitis-like T-cell lymphoma

– Disease lesions initially occur on the skin. Sometimes it may be incorrectly diagnosed as skin inflammation. – Treatment is the same as for diffuse large B-cell lymphoma.

7. Anaplastic large cell lymphoma

– Disease lesions only occur on the skin. – This type of lymphoma cancer responds well to chemotherapy containing doxorubicin.

8. Peripheral T-cell lymphoma

– It is usually diagnosed when the disease is in a late stage. It is more common in people aged older than 60. – Treatment is the same as for diffuse large B-cell lymphoma.

9. Angioimmunoblastic T-cell lymphoma

– It is considered to be a moderately serious type. Special characteristics include enlarged lymph nodes, fever, weight loss, skin rash, and increased blood protein. Most patients experience infection as a complication. – Treatment is the same as for diffuse large B-cell lymphoma.

Risk factors of lymphoma cancer.

Risk factors are conditions that increase the chance of a disease occurrence. This does not mean the presentation of one factor will always contribute to disease occurrence. To date, the causes of lymphoma cancer have not been clearly identified in all patients, but correlation with many conditions has been found, including:

  • Age: Incidence of lymphoma cancer is increased when people get older. The highest incidence is between 60-70 years of age.
  • Gender: Lymphoma cancer is more commonly found in men than women.
  • Infection: Association has been found between certain types of lymphoma and infections, e.g. Helicobacter pylori infection and MALT lymphoma, EBV infection and Burkitt lymphoma.
  • Immunodeficiency status: It has been found that the incidence of lymphoma cancer is increased in HIV-infected patients.
  • Autoimmune disease: It has been found that the incidence of lymphoma cancer is increased in SLE patients.
  • Chemical exposure: Pesticides increase the risk of lymphoma cancer.

Diagnosis of lymphoma cancer

  Diagnosis of lymphoma cancer begins with collection of a patient’s personal history and physical examination. Further investigations include:

  1. Biopsy.
  2. Bone marrow examination to assess the occurrence of bone metastasis.
  3. Computerized Tomography scan (CT scan).
  4. Magnetic Resonance Imaging (MRI).
  5. Bone examination (Bone scan).
  6. PET scan.
  7. All examination results will be used to assess the stage of the disease and used as prognosis and treatment guideline accordingly.

Disease stage assessment

The treating physician will collect all data from additional investigations to determine which stage of disease patients are in and to use as a guide for planning treatment. Staging of lymphoma cancer is categorized into 4 stages:

  1. Stage 1: A lesion is found in either a lymph node or only one area outside the lymph node.
  2. Stage 2: Lesions are found in two or more locations lymph nodes either in the lymph node or outside lymph node area on the same side of the diaphragm.
  3. Stage 3: Lesions are found either at a lymph node or outside a lymph node on both sides of the diaphragm and/or spleen.
  4. Stage 4: Lesions are spread throughout the body beyond the original area. Lymphoma most often spreads to the liver, bone marrow, or lungs.

In addition to disease staging assessment, the treating physician will also utilize other patient data to calculate the Prognostic Index. This will enable patients to be categorized into two groups: high risk and low risk. 

Treatment of lymphoma cancer

Patients should receive continuous treatment. Therefore, patients should come to see doctors as scheduled, even if their symptoms are improved. Treatment given depends on disease stage and overall health status. Treatment is categorized into 4 main groups including: Disease monitoring: This treatment method will be considered in patients with non-serious types of lymphoma cancer who do not require treatment. A doctor will schedule patients for follow up periodically and will consider treatment when metastasis or symptoms occur from the disease.

  • Chemotherapy: Using drugs to destroy cancer cells in the body. The drugs may be available in oral form or injection. Chemotherapy regimens depend on type and stage of the disease.
    • Standard chemotherapy regimen for lymphoma cancer is the CHOP regimen, which contains 4 drugs consisting of: cyclophosphamide, adriamycinn, vincristine, and prednisolone.
    • Side effects of chemotherapy may vary. They are the result of drugs destroying normal cells in the body other than cancer cells. Individual patients may experience different side effects, e.g. nausea, vomiting, peripheral neuropathy, constipation or diarrhea, leukopenia resulting in risk of infection, bleeding caused by thrombocytopenia. These side effects generally disappear when chemotherapy is discontinued. As for long-term side effects, infertility or increased risks of other cancers may be found.
  • Radiation therapy: Using high-dose radiation to destroy cancer cells in each area. This treatment procedure is usually considered in patients with the early stage of lymphoma cancer.
    • Radiation side effects include skin irritation, sore throat or stomach pain. Most side effects can be reduced by administering symptomatic drugs.
  • Monoclonal antibody: Using a synthetic drug binding with proteins on the surface of cancer cells, resulting in increased destruction of cancer cells. Monoclonal antibody is available as monotherapy or in combination with chemotherapy.
  • Stem cell transplantation – Using high-dose chemotherapy to destroy residual cancer cells following with administration of stem cells. This treatment method is usually considered in patients with resistant lymphoma or relapse patients.
    • Stem cells may be derived from autologous or allogeneic transplantation.

Self-care

  • Food consumption: Choose to eat clean and freshly cooked foods. Do not eat foods that have been stored a long time without being reheated or boiled or dried foods if unsure they are freshly cooked, e.g. bakery. Patients should consume peeled fruits, e.g. oranges, banana, and should wash them every time and should avoid taking thin peeled fruits, e.g. guava, grapes, or fruits that are cannot be cleaned thoroughly, e.g. pineapple. Another important thing is hand washing every time before taking foods.
  • Exercise: Patients can exercise as much as they can tolerate but avoid over exercise. Exercise capability may not the same as before, but it will recover after receiving treatment. For patients with a sedentary lifestyle, they should not just stay in their bedrooms. They should take walks to support lung expansion. Regular exercise will help patients recover faster.
  • Skin: Shower at least 2 times per day, morning and night. Scrub with soap, especially in moist areas such as the armpits, under the breasts, and the groin (with baby soap). Showering will help prevent germ growth on the skin. After bathing, dry the skin and apply skin lotion to prevent dryness. Unperfumed lotion is recommended, but avoid using powders, as they will introduce germs into the lungs.
  • Mouth: Take care to always maintain good oral hygiene. Use a soft toothbrush and gently brush the teeth in the morning and at night, at a minimum. Rinse the mouth every time after meals. Stop brushing teeth if the gums are bleeding. Use clean damp gauze to clean the mouth and teeth, and rinse with cool boiled water regularly.
  • Rectal care: Clean every time after passing stool, especially diarrhea. Wipe gently because it could cause lesions. Soft tissue should be used. Most importantly, wash hands every times after using the bathroom.
  • In this stage, patients may also have anemia resulting in tiring easily, fatigue, and fainting. In addition, thrombocytopenia may be found that may cause bleeding easily. Patients should be aware of possible accidents. If patients notice subcutaneous bleeding or bleeding gums, they should come to see the doctor.
  • However, if a patient has serious conditions such as fever > 38.5 °C, severe bleeding, subcutaneous bleeding, or frequent fainting , they should come to see the doctor as soon as possible.
  • Mental health care: Good mental health contributes to positive treatment results. Doctors should explain the treatment plan to patients and make sure that they understand to avoid treatment withdrawal.
  • Sleeping and rest: Adequate rest will help increase the body’s immunity.