Lymphoma: Types, Symptoms, and Treatment Options
This article explores types of lymphoma, including the signs, symptoms, and possible risk factors. It also defines the stages of lymphoma, explores the treatment options, and discusses the outlook for people with the condition.
Lymphoma is the result of cancer-causing changes in white blood cells. The medical name for white blood cells is “lymphocytes.” They help the body defend itself against infection and disease.
There are T lymphocytes (T cells) and B lymphocytes (B cells). There are several types of T cells that play different roles in the immune system. B cells make antibodies to fight off germs.
Lymphocytes are part of the lymphatic system. As the National Cancer Institute (NCI) explains, this system includes lymph organs and vessels that move lymphatic fluid through the body. Lymphatic fluid has some of the same components as blood plasma. Lymph vessels take up extra fluid, including white blood cells, from blood vessels and other tissues in the body. Lymphoma is a type of blood cancer, but it starts in the lymphatic system.
In general, lymphoma is most treatable and curable in the earliest stages of the condition. Without treatment or with advanced lymphoma, lymphoma spreads through the lymphatic system. Lymphoma cells crowd out normal white blood cells and other cells the bone marrow makes.
Lymphoma can also spread to other areas, such as the spleen, liver, and kidney.
Lymphoma can lead to life threatening complications, but treatment may offer a chance to cure the condition or put it into remission for some time.
Signs and symptoms of lymphoma include:
- swollen lymph nodes, which may first appear in the neck, groin, or armpit
- bone and joint pain
- easy bruising and bleeding
- fatigue, weakness, and malaise
- a loss of appetite or unexpected weight loss
- fever or night sweats
- pale skin
- shortness of breath
- slow healing of wounds
Lymphoma symptoms result from the high number of abnormal white blood cells and the substances they produce. They also crowd out normal white blood cells and red blood cells. The abnormal cells are also not able to fight infection as effectively as the normal cells, which results in frequent infections. Having fewer red blood cells results in anemia symptoms, including fatigue and shortness of breath.
Lymphoma that spreads to the bone marrow also reduces the number of platelets in the blood. Platelets are necessary for normal clotting. Having a lower number of platelets results in easy bleeding and bruising.
There are many types of lymphoma, but the two main categories are Hodgkin lymphoma and NHL.
NHL starts in T cells or B cells. Most people with NHL have the B cell type, according to the Leukemia & Lymphoma Society (LLS). Doctors also classify NHL as aggressive (growing and spreading quickly) or indolent (growing but spreading slowly). There are more than 90 types of NHL.
Hodgkin lymphoma is the less common form of lymphoma. It usually starts in B cells. When doctors diagnose it in the early stages, it can be easier to treat and cure than aggressive forms of NHL.
Cancer develops when cells grow out of control. Mutations or changes in the genes that control cell growth can lead to cancer.
In lymphoma, the mutations affect lymphocytes. The cause of the mutations is not always known. However, there are risk factors — including certain infections and exposure to harmful chemicals — that can increase a person’s likelihood of acquiring mutations and developing lymphoma.
The abnormal lymphocytes grow and divide rapidly. These abnormal cells are ineffective at doing their normal jobs. The mutations also allow the abnormal lymphocytes to live longer than they should instead of dying out. They accumulate in lymph nodes and lymph organs, such as the spleen, and crowd out normal cells. They may also make irregular proteins that affect blood circulation.
Strategies to prevent cancer focus on modifying factors that are known to increase the risk of the condition. However, the few known risk factors for lymphoma are not easy to control. Most people seem to develop lymphoma for random reasons.
Some factors thought to increase the risk of developing lymphoma include:
- a family history of lymphoma
- Helicobacter pylori infection
- human T cell lymphotropic virus infection
- mononucleosis (Epstein-Barr virus infection)
- exposure to glyphosate-based chemicals, such as Roundup
- a weakened immune system due to such factors as taking immune-suppressing drugs for an organ transplant, receiving treatment for other cancers, or having HIV
Keep in mind that having one or more of these factors does not mean that you will develop lymphoma. In addition, many people with lymphoma have none of these risk factors.
Doctors consider a person’s medical and symptom history and test results in diagnosing lymphoma.
During the physical exam, the doctor checks for enlarged lymph nodes, especially in the neck, underarms, and groin. They will also feel the abdomen to check for a swollen spleen or liver.
Lymphoma tests include:
Staging refers to determining how much cancer is present in the body. It is important for treatment decisions. Both Hodgkin lymphoma and NHL use the same staging system: the Lugano classification. It consists of four stages.
The stages of lymphoma are:
- Stage 1 lymphoma: This is present in only one lymph node area or one lymph system organ, such as the tonsils. Cancer may be present in an organ outside of the lymph system.
- Stage 2 lymphoma: This is present in two or more groups of lymph nodes that are either above or below the diaphragm. Lymphoma is also present in an organ outside the lymph system.
- Stage 3 lymphoma: This is present in lymph nodes both above and below the diaphragm or in lymph nodes above the diaphragm and in the spleen.
- Stage 4 lymphoma: This has spread outside of the lymph system and may be affecting the bones, liver, or lungs.
The stage may also have an A or B with the number. The letter B indicates the presence of any symptoms called B symptoms, which include:
- soaking night sweats
- unexplained fever of 100.4°F (38ºC) or higher
- unintended weight loss of more than 10% of your body weight over the past 6 months
The goal of lymphoma treatment is to cure the cancer or bring about a complete remission of the condition. Remission means that there is no longer any sign of the cancer in the body, though it may recur or relapse later.
Doctors base lymphoma treatment plans on the type and stage of the lymphoma and your age and medical history. Specialists involved in the treatment of lymphoma include hematology oncologists and registered nurses who specialize in cancer and lymphoma care.
Lymphoma treatment may include some combination of the following:
- radiation therapy
- targeted therapy
- stem cell transplants
- blood transfusions
- medications that increase normal blood cell production
- palliative care
- physical therapy
- dietary counseling
Slow-growing lymphomas may not require treatment right away. Doctors may recommend active surveillance instead. This approach closely monitors the condition for signs and symptoms of progression. Treatment starts when blood tests or symptoms indicate that the condition is becoming a problem.
Treatment may also include participation in a clinical trial.
Complementary treatments for lymphoma
Complementary treatments may help some people better cope with lymphoma and its treatment. These treatments are for use in conjunction with traditional medical care.
Be sure to notify your doctor if you are using supplements or homeopathic remedies. They may interact with your prescribed medical therapy.
Complementary treatments may include:
- massage therapy
- nutritional dietary supplements
When lymphoma progresses and is not responding to treatment, the goal of treatment may shift from curing the condition. It may change to keeping a person comfortable and maximizing their quality of life.
Hospice care involves controlling pain and other symptoms. It also provides psychological and spiritual support to the person and services to support the person’s family.
The rapid growth of abnormal white blood cells can interfere with the normal function of the circulatory and lymphatic systems.
Some complications of lymphoma include:
- frequent infections
- the spread of cancer cells to other organs and organ dysfunction
- the recurrence of lymphoma
- the development of a second (non-lymphoma) cancer, which is often related to the earlier use of chemotherapy or radiation therapy to treat the lymphoma
Work with your doctor to design a treatment plan with the greatest chance of success and a low risk of complications.
A person’s outlook varies considerably depending on the type and subtype of lymphoma they have, the stage at diagnosis, the treatment they receive, and more.
The outlook can be very good for a person with Hodgkin lymphoma. This is considered one of the most curable forms of cancer, according to the LLS. For NHL, the outlook can depend on if it is a slow-growing or aggressive type.
In oncology, a doctor may talk about your outlook in terms of a 5-year relative survival rate. This rate looks at people with the same type and stage of cancer 5 years after diagnosis. It compares them with people of the same age and sex in the general population. The comparison shows how much cancer can shorten life.
Based on cases from 2011 through 2017, the overall 5-year relative survival rate is 73% for NHL and 88% for Hodgkin lymphoma, according to the NCI’s Surveillance, Epidemiology, and End Results Program.
Keep in mind that survival rates are only statistics. They cannot tell you how long you will live. Several things influence outlook. Talk with your doctor about what to expect long term. Your doctor is the best source of information.
The following are some commonly asked questions on lymphoma.
What is follicular lymphoma?
Follicular lymphoma is a type of non-Hodgkin lymphoma. It starts in the B cells in the white blood cells. These help the body protect itself from infection.
How quickly does lymphoma grow?
Different types of lymphomas grow at different rates. Slow-growing lymphomas include follicular lymphoma, which may not immediately require treatment. Diffuse B-cell lymphoma spreads more quickly, requiring prompt treatment. Some types of lymphomas vary in how quickly they can grow.
Is lymphoma fatal? What is the survival rate for lymphoma?
Lymphoma can be fatal, but it can also be slow-growing, curable, and symptomless. The growth rate, severity, and survival rate of lymphoma will depend on its type.
Lymphoma is a type of blood cancer that develops in the lymphatic system. Symptoms can include swollen lymph nodes and fatigue. Certain infections, a suppressed immune system, and exposure to chemicals are known to increase the likelihood of developing it.
There are several types of lymphoma. For many people with lymphoma, the outlook is good, and a cure is possible. Some types of lymphoma can be more challenging to treat and are likely to relapse after initial remission.
Treatment options include chemotherapy, targeted therapy, and stem cell transplants.