About Lymphomas

What is lymphoma?

Lymphoma is cancer of the lymphatic system. The lymphatic system consists of a network of lymphatic vessels throughout the body, and whose main purpose is to fight infection by lymphocytes (a type of white blood cell) and filter lymph fluid, bacteria, viruses and other foreign substances. The lymphatic system includes your lymph nodes, bone marrow, thymus, spleen, tonsils, and lymphoid tissue in the digestive tract.

When a person develops lymphoma, their lymphocytes become abnormal cancerous cells and grow uncontrollably. This can cause your immune system to be compromised. As these cells move throughout the lymphatic system, they lodge into lymph nodes and cause them to swell. They also have the potential to cause harm to different organs in your body.

Taken from the patient information website of Cancer Research UK.

Main symptoms of lymphoma include:

At least one swollen lymph node
Fever
Drenching night sweats
Unexplained weight loss

Swollen lymph nodes are not usually painful, but may cause discomfort depending on where they are located. Sometimes patients may not even be aware of them, or present with any symptoms. Sometimes lymphomas located in or near different organs in the body can cause symptoms. For example, lymphomas in the stomach or intestine may cause abdominal discomfort. Lymphomas involving the brain or spinal cord may cause neurological symptoms such as confusion, numbness or weakness in the arms or legs. Lymphomas in the chest can cause cough, shortness of breath, or chest pain.

Types of Lymphoma

Hodgkin and non-Hodgkin lymphomas are cancers derived from immune system cells, and include well over 60 distinct subtypes. The lymphomas, like ice cream, come in many "flavors", each of which has a unique natural history and treatment. Some lymphoma subtypes are indolent, or slow growing, and may not require treatment at the time of diagnosis. In fact, some patients with these lymphomas will never experience symptoms or problems related to their lymphoma, and may not require treatment in their lifetime. In contrast, other lymphomas are more aggressive and warrant treatment at the time of diagnosis.

There are two main types of lymphomas:

Hodgkin Lymphoma:
This is a B cell lymphoma that arises from a Reed-Sternberg cell (named after the doctors who first discovered this cell). Your doctors determine whether your lymphoma is a Hodgkin or Non-Hodgkin Lymphoma based different tests and what your cancer cells look like under the microscope. Hodgkin lymphomas have different therapy options than Non-Hodgkin Lymphomas.

Non-Hodgkin Lymphoma:
This type comprises of all other lymphomas that are not Hodgkin lymphomas, and is the most common type. There are multiple subsets of Non-Hodgkin Lymphoma which include:

Marginal Zone Lymphoma
Follicular Lymphoma
Small Lymphocytic Lymphoma
Diffuse Large B-Cell Lymphoma
Mantle Cell Lymphoma
Burkitt’s Lymphoma

T Cell Lymphoma
HIV+ Lymphoma
Adult T Cell Leukemia Lymphoma
Cutaneous Lymphoma

Lymphoma Risk Factors

Some identified risk factors include infections that weaken the immune system such as HIV infection, an inherited disorder, or medications used in transplant patients to prevent rejection. Most patients do not have an identified risk factor. Exposure to certain chemicals and history of high radiation exposure may also increase the risk for non-Hodgkin lymphomas.

Diagnosis

We're fortunate at the University of Michigan to work with a team of pathologists with expertise in lymphoma diagnosis and classification. This is critically important, as approximately 25-33% of lymphoma biopsies will be reclassified upon expert pathology review. At times, subtle changes in lymphoma classification following expert pathology review do not influence treatment decisions. However, many times, they do. Recognizing that treatment decisions are dependent upon an accurate diagnosis, we routinely ensure that your biopsy material is retrieved and reviewed by a University of Michigan pathologist with expertise in this area. For this reason, you may notice that your first visit is a few weeks away. If a biopsy has not yet been obtained, then we may recommend that your physicians arrange an appropriate biopsy prior to your initial visit. On your initial clinic visit, you may have already undergone tests to diagnose your lymphoma, or you may need additional studies to confirm a diagnosis or complete staging. Common ways lymphoma may be diagnosed are:

Lymph Node Biopsy:
Part or all of a swollen lymph node will be removed and then analyzed to determine if it is cancerous.
Bone Marrow Biopsy:
A small sample of bone marrow will be taken and analyzed to see if cancer is present.

Other Biopsy:
Another tissue sample may be removed from the body if see if cancerous cells are present.

Treatment

There are many different ways doctors may treat your lymphoma. The list provided contains a few of the possible treatment options, and there may be other treatments that your physician may recommend. Sometimes treatment is not needed at first. Treatment will also depend on the type of lymphoma, the stage, age, and other health problems.

Chemotherapy:
A combination of chemicals that have a specific toxic effect upon cancer cells, usually given through infusions.
Radiation Therapy:
This involves using radiation to kill cancer cells at their site of involvement.
Immunotherapy:
These are therapies which boost or restore a patients’ immune system to fight their cancer cells
Targeted Therapy:
These are therapies directed at targets specifically found in cancer cells in order to inhibit their growth, and may be used alone or in combination with chemotherapy.
Bone Marrow Transplant:
This uses high doses of chemotherapy followed by replacement of your bone marrow with your own cells or with donor cells. This may be considered if multiple treatment options have failed previously.
Skin directed therapies for cutaneous lymphoma:
There are special skin directed therapies that may be considered for cutaneous lymphoma, including photopheresis and phototherapies, which are determined in consultation with our dermatologists.

What happens during treatment

During the follow-up visits, your doctor will perform physical examinations, take blood tests, as well as talk to you about your treatment. If your treatment requires several cycles of treatment, you will be seen in clinic prior to each cycle. They will direct you to schedule a follow-up appointment and will give you information on whether or not imaging or tests will be done at the next visit. During the period of time between visits, it is important that you watch for any reoccurring symptoms, and communicate them to your doctor.