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Lymphoma is a serious form of cancer affecting the lymphatic system. The lymphatic system is composed of lymph vessels and lymphocytes (white blood cells) that are found in your lymph nodes, spleen, tonsils, but also in your bone marrow and intestine. It contains a watery clear fluid (lymph) that distributes immune cells throughout your body. The role of this fluid is to assure the natural defense of your organism against microorganisms (viruses, bacteria or fungi), tissues and foreign bodies that invade your body. Sometimes, however, the cells of the lymphatic system can be abnormally multiplied and causing a medical condition called lymphoma.
The term lymphoma refers to any cancerous proliferation in the lymphoid tissue, and particularly in the lymph nodes. The lymphoid tissue allows formation of blood cells and cells involved in the immune system. Once affected, the entire immune system of your body becomes weak.
There are two types of lymphatic cancers: Hodgkin lymphoma and Non-Hodgkin’s lymphoma
Hodgkin lymphoma – Hodgkin lymphoma is a malignancy of the lymphatic system observed particularly among the older children, adolescents and young adults. It is characterized by the presence of large malignant cells also called Reed-Sternberg cells.
Non-Hodgkin’s lymphoma – Non-Hodgkin’s lymphoma (also known as lymphosarcoma) is a heterogeneous group of tumors associated with an abnormal and malignant proliferation of lymphoid cells without the presence of Reed-Sternberg cells. It includes all malignancies of the lymphoid tissue. These lymphomas develop from T cells or B cells. The B-cell tumors account for 75% of cases in developed countries. Each year there are more than 287 000 new cases of non-Hodgkin’s lymphoma.
Lymphoma Causes and Risk Factors
The causes of lymphoma are still unknown, but some factors seem to have a role in its development:
Immunosuppressive therapy – when intensive or very prolonged, an immunosuppressive treatment can lead to a deficiency of one or more immunological functions and the development of lymphoma.
Family history of lymphoma – if your parents had/ have the disease, you are more at risk to develop it.
Toxic exposure – lymphoma can occur due to exposure to certain toxic chemicals such as dioxins, pesticides, benzene, and organic solvents.
Virus – The Epstein-Barr virus may play a role in the occurrence of malignant lymphoma. Its role in cancer development has been established for the first time in Africa. The Epstein-Barr virus is also incriminated in cancer of the nasopharynx (nasopharyngeal cancer).
HIV / AIDS – the acquired immunodeficiency syndrome (AIDS) may also facilitate the occurrence of non-Hodgkin’s lymphoma. In addition, the following viruses can also be involved in the occurrence of the disease:
- Hepatitis C virus (HCV)
- Helicobacter pylori (H. pylori)
- Human herpesvirus 6 and Human herpesvirus 8 (HHV 6 and HHV 8)
- Helicobacter pylori Human T lymphoma/leukemia virus (HTLV-1).
Immunodeficiency – certain immune disorders are able to cause hyperplasia of your bone marrow and in a number of cases, give rise to a lymphoid tumor. Some of those diseases include:
- Lupus
- Sarcoidosis
- Celiac disease
- Sjögren’s Syndrome
- Hashimoto thyroiditis
- Rheumatoid arthritis
- Scleroderma.
Lymphoma Symptoms
At the genesis of the disease, lymphoma can have flu-like symptoms; these symptoms are passed unnoticed most of the times.
Swollen lymph nodes in the neck, armpits or groin are the first symptom of non-Hodgkin lymphoma. Among other possible symptoms include unexplained fever, night sweats, weight loss and pain in the stomach and intestines. As the tumor increases in size, you can develop anemia associated with fatigue and weakness
The nature of the symptoms varies depending on the location of the tumor; thus lymphoma in the chest can result in:
- Swelling of the face
- Breathing difficulties
- Accumulation of fluid in your lungs (pleural effusion)
If the lymphoma s in your abdomen or small intestine, it can cause:
- Diarrhea
- Constipation
- Loss of appetite
- Abdominal pain
- Weight loss
- Bloating
A lymphoma in your groin or on your skin can cause:
- Itching
- Edema of the legs
- Skin discoloration or Darkening of the skin
How lymphoma is diagnosed?
Early detection of lymphoma is not easy when there is no clinical evidence. When the tumor presents swollen nodes and paleness, your physician can do a physical exam… Other tests that are needed include:
Blood test – your oncologist can recommend a complete hematological exam to determine the quantitative and qualitative of the red blood cells, white blood cells and platelets. This exam helps your physician to detect anemia and infections.
X-ray – a chest X-ray examination is essential in the exploration of the lymphoma. It allows your doctor to detect if the lymphoma has spread to lymph nodes in your lungs.
Gallium scan – During this medical procedure, a specialist injects a radioactive gallium in your body to obtain images of a specific type of tissue with a scanner. Gallium always binds in infection site, and areas of rapid cell division (tumor). Therefore, the injection allows your healthcare provider to take image of tumor, inflammation or chronic infection found in your body.
PET scan – the positron emission tomography (PET) scan is a recent medical imaging method that your doctor can use to detect lymphoma. This technique is performed through a radioactive tracer injected previously in your body that allows a medical specialist to take pictures of any lymphoid tumor in your body.
Computerized tomography (CT) scan – The Ct scan is a part of the chest X-ray exams used in the diagnosis of lymphoma; through this examination, your physician can obtain images of your thoracic and abdominal part, which allows him to detect a tumor and to assess its damage in your body.
Lymph-node biopsy – this exam is very important in the diagnosis of lymphoma. Performed during surgery, a surgeon takes a sample of lymph node tissue for examination. This procedure will help your oncologist to determine the characteristics of the tumor cells and the stage of the lymphoma (stage I to stage IV). This exam is necessary for your doctor to determine what treatment is best for you.
Bone marrow biopsy – the bone marrow biopsy is done under local anesthesia, with a solid trocar about 2-3 millimeters. Your surgeon will remove a small sample of a few millimeters in length for examination. This exam allows your doctor to specify the stage of the tumor, and determine if it has spread or not.
If the tumor has severe symptoms, your oncologist may recommend a liver and kidney assessment, a lumbar puncture and organ function tests.
Lymphoma Treatment
Your body contains two types of white blood cells: T lymphocytes (T cells) and B lymphocytes (B cells). If you have a cancer of B lymphocytes, you are more likely to be cured than those with a cancer of T lymphocytes. Moreover, the chances of recovery are much higher for all non-Hodgkin lymphomas where the cancer is still in its early stage before it spread to other parts of the body.
Therefore, the treatment depends not only on the type of lymphoma , but also on various prognostic factors such as stage, number of nodes affected, spreading to other organs; your oncologist may also consider your age and general health.
Lymphoma treatment may involve a single method (chemotherapy for instance) or a combination of methods, chemotherapy, radiation therapy, biotherapy, etc. For the early stages of the disease, radiotherapy is used to destroy the cancerous tumor. To treat non-Hodgkin’s lymphoma reached an advanced stage, chemotherapy and other therapies are usually used. In general, the treatments used against lymphoma include:
Chemotherapy – Chemotherapy is an important tool in the treatment of lymphoma. It helps to destroy cancer cells by preventing their proliferation. The protocol varies depending on the stage of the lymphoma and your health. In general, the elderly receive lower doses. It is often necessary to prescribe to young adult high doses of chemotherapy to improve their chance of cure. In addition, these chemotherapeutic agents can be administered alone or in combination. When many drugs are used, the treatment becomes more aggressive and can cause many side effects. In addition, chemotherapy is often used in combination with radiation therapy.
Chemotherapy always causes adverse effects; these side effects depend on the medications used and the reaction of your to the them.
Radiation therapy – radiotherapy is a loco treatment of cancer, using ionizing radiation to destroy cancer cells by blocking their ability to multiply. Radiation of the lymph nodes can be very effective in less severe lymphoma or if the tumor that has not spread. In fact, some people can be completely cured after radiography if the tumor is detected early.
As in chemotherapy, radiation therapy can cause short or long term effects. Depending on the part of your body that has been irradiated, the therapy can cause infertility. If your reproductive organs are going to be exposed to the radiation, talk to your doctor about freezing your sperm or conserving your ova before performing the treatment.
Biotherapy – also called immunotherapy, biotherapy consists of the use of monoclonal antibodies, growth factors, and vaccines to boost or restore the ability of your immune system to fight the cancer. Rituximab is a drug approved by the FDA often used in the treatment of lymphoma. Interferon alpha is sometimes used in certain types of lymphoma. However, its effectiveness is not approved yet.
Bone marrow transplant – depending on the effects and/or the treatment, your doctor may perform a bone marrow transplant. As chemotherapy destroys both the cancerous cells and normal cells, during the treatment, you may have decreased blood cells. I fact, the lymphoma itself can decrease your white blood cells. A bone marrow transplant helps to replace lost blood without waiting for your organism to produce others. Your surgeon can take the healthy bone narrow from a compatible donor ( ) or from your own body ( ). The bone marrow transplants have the best success rate among young adults.
What are the complications of lymphoma?
People with non-Hodgkin’s lymphoma can also develop leukemia if the cancerous cells pass into the blood.
References:
1 – Institut national du cancer : ensemble contre le cancer ; Lymphome non Hodgkinien
2 – Science direct – Lymphome de Burkitt révélé par une invagination intestinale aiguë chez l’enfantBurkitt’s lymphoma revealed by acute intussusception in children ; Annales de Chirurgie Volume 126, Issue 7, September 2001, Pages 649-653
