Introduction
Lymphomas are cancers that develop from cells of the lymphatic system. The lymphatic system drains fluid away from the body tissues through a network of tiny vessels or tubes and lymph nodes. It helps to protect the body against infections and foreign material.
There are two main groups of lymphomas - Hodgkin's and Non-Hodgkin's lymphomas.
Each year in Europe, approximately 95,000 people are diagnosed as suffering from a lymphoma. Non-Hodgkin's lymphoma is about four times as common as Hodgkin’s lymphoma.
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The Lymphatic System
The lymphatic system includes a complex network of vessels that drain fluid from the body’s tissues. This fluid, known as lymph, eventually drains into the blood. The lymph vessels pass though lymph nodes (or lymph glands) which are found all over the body, especially in the gut. Lymph nodes contain cells which fight infections by engulfing and digesting foreign material including bacteria, as well as producing antibodies to specific infections.
The lymphatic system also includes the bone marrow, tonsils and spleen as well as a large number of small patches of lymphoid tissue found in sites around the body. The lymphocytes initially develop in the bone marrow from stem cells, and then develop in either the thymus or the bone marrow. Lymphocytes that develop in the thymus are the T-cells, and those that develop in bone marrow are called B-cells.
B-cells make antibodies. T-cells identify and attack foreign cells, such as bacteria.
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Lymphomas
All cancers are uncontrolled growths of cells. Lymphomas develop from cells of the lymphatic system.
There are two main groups of lymphoma:
The World Health Organisation has developed a classification of Non-Hodgkin's lymphomas according to their similarity to normal B- or T-lymphocytes. This system is helpful in determining the best treatment options for patients, and has been adopted across the world.
B-cell lymphomas including large B-cell lymphoma and follicular lymphoma are more common than T-cell lymphomas.
The main T-cell lymphomas are peripheral T-cell lymphoma, skin lymphomas – including Mycosis Fungoides, anaplastic large cell lymphoma and lymphoblastic lymphoma.
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Lymphoma Risk Factors
Risk factors are things which make you more likely to develop lymphoma.
Lymphoma is a disease of both children and adults, but the majority of people diagnosed with lymphoma are over the age of 60.
Immune system diseases such as HIV infection and AIDS weaken the immune system and make the body more susceptible to some forms of lymphoma.
Lymphomas are not hereditary.
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Preventing Lymphoma
There are no practical steps that can be taken to reduce the chances of developing lymphoma.
Patients in at risk groups – those with HIV infection or taking immunosuppressant drugs following a transplant - should consult a doctor quickly if they develop any suspicious symptoms.
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Symptoms of Lymphoma
The classical symptoms of lymphoma are:
- Swelling of the lymph nodes, usually most noticeable in the neck, armpit or groin. The swelling is usually painless but swollen glands can be sore. Painful swollen glands are more likely to be due to infections.
- Pain in the lymph nodes after drinking alcohol is a peculiar symptom, more common in Hodgkin’s lymphoma.
- Fever and sweating are common symptoms especially with infections but in lymphoma this typically occurs at night and is also more common in Hodgkin’s lymphoma.
- Persistent itching is another symptom that occurs in a wide range of conditions.
- Abdominal swelling and pain. In lymphoma, this is due to an enlarged spleen and/or lymph glands.
- Weight loss, poor appetite and tiredness are all very general symptoms which can be due to a number of causes, but also commonly occur in lymphoma.
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Diagnosing Lymphoma
A physical examination is likely to show enlarged glands in one or more parts of the body and sometimes an enlarged spleen in the abdomen. Although these findings may alert doctors to the possibility of a lymphoma they do not prove the diagnosis.
Taking a sample of tissue from the enlarged lymph nodes for examination under the microscope is the only way to tell the various forms of lymphoma apart and so make the diagnosis.
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Treating Lymphoma
Different treatments will be recommended for different forms of lymphoma at different stages, so it is impossible to provide more than a general outline of the treatment options available. These include:
Chemotherapy
Chemotherapy simply means treatment with drugs. In cancer treatment, drugs are used to kill cells in a number of ways and as cancer cells grow and divide more quickly than normal cells, the effect of the drug on the cancer cells is much greater, and unlike normal cells, cancer cells cannot repair themselves after chemotherapy as well as normal cells can.
Many different combinations of drugs are used to treat lymphomas, including doxorubicin, vinblastine, vincristine, bleomycin, etoposide and steroids, but for B-cell lymphomas treatment with rituximab is now the first line treatment.
Chemotherapy and radiotherapy can be used in combination to increase the effectiveness of treatment.
Chemotherapeutic drugs have side effects which normally go away once the treatment is finished, and can usually be helped by other medication.
Common side effects include nausea and sickness, hair loss, feeling tired or run-down and mouth ulcers.
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Radiotherapy
External beam radiotherapy uses high energy X-ray beams generated from machines to kill cancer cells. Some normal cells will also be affected, but the treatment is planned so that the radiation is focused on the affected areas from a variety of different angles, so normal tissues receive a smaller dose, and in addition normal cells are better at repairing themselves than cancer cells.
External beam radiotherapy is normally given as a series of short regular treatments in a radiotherapy department (each treatment may be referred to as a fraction).
All radiotherapy treatment is delivered to an area that follows the shape of the cancer, so a higher dose of radiation can be more precisely targeted at the cancer, avoiding neighbouring healthy tissue and resulting in fewer side effects.
Radiotherapy can be combined with chemotherapy in the treatment of lymphoma.
Radiotherapy does cause some side effects which normally go away once the treatment is finished, and can usually be helped by medication. Common side effects include feeling tired or run-down, sometimes nausea and sickness and local effects such as skin burns, diarrhoea due to bowel inflammation or having to pass urine more often due to inflammation of the bladder.
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Monoclonal Antibody Therapy
Monoclonal antibodies are a form of immunotherapy, which has now become the first line treatment for B-cell lymphomas. Antibodies made in a laboratory are used to recognise cancer cells and affect their ability to grow and function.
Stem Cell (Bone Marrow) Transplant
Bone marrow transplants are sometimes used in the treatment of lymphoma so that high dose chemotherapy can be given to destroy lymphoma cells.
Before treatment, some of the patient’s own bone marrow is removed and stored. After the chemotherapy has finished the bone marrow is replaced. Using the patient’s own bone marrow means that there is no fear of rejection.
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Looking after Yourself
Radiotherapy is highly effective as part of the treatment of many forms of lymphoma, but all treatments can cause some side effects. Some patients will not experience any side effects, whilst others may find several troublesome. Fortunately, many of these side effects disappear soon after the treatment ends and the symptoms can usually be treated, so if you do experience any problems it is important to mention them to your doctor or nurse, so they can give you the treatment you need.
Feeling sick can be a problem at the start of treatment but usually stops quite quickly. Sometimes there is also some sickness but this usually settles after a couple of days, and if needed both nausea and sickness can be treated with medication.
Diarrhoea is another potential problem, but very rarely severe. Medication can be prescribed if necessary.
Skin irritation in the treated areas is usually mild but if it occurs can be treated with moisturising cream or a weak hydrocortisone cream or ointment.
Hair loss in the treated areas is common but usually grows back quickly after treatment.
Not having much energy is a common side effect that can last for several weeks following treatment, so you have to be realistic about how much you can do during this time.
Whatever the problem, do not assume that nothing can be done about it – ask your doctor or nurse: do not just grin and bear it.
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Questions for Your Doctor
Before making up your mind about the best treatment option for you, you will need information about your cancer, the treatments available in your area, what this will involve, what to expect from the treatment, what side effects you might experience and how these may change over time as well as what your doctors believe would be most effective in combating your cancer.
For different patients the answers will be different, so it is important to discuss all these issues with your doctor so that you make the right choice for you.
You will have your own questions but some issues you might want to raise are:
- What does the treatment involve?
- What are the benefits I might get?
- How good are my chances of getting those benefits?
- Could having the treatment make me feel worse? If so, in what way?
- Are there other treatments?
- What are the risks of the treatment?
- Are the risks minor or serious? How likely are they to happen?
- What care will I need after treatment?
- What happens if something goes wrong?
- What may happen if I don’t have the treatment?
- What will my quality of life be like during and after treatment?
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Conclusion
Lymphomas are a group of diseases which have some common characteristics but are not all treated in the same way.
Research is helping to improve treatments all the time. For clinical and personal reasons, particular treatments will suit some patients better than others so patients should ask for comprehensive information so that they can make the right decision for them.
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