Lymphoma: Symptoms, Causes, Diagnosis, and Treatment Options

What is Lymphoma?

The lymphatic system is a network of tissues, vessels, and organs that help maintain fluid balance, defend the body against disease, and remove waste. It includes lymph nodes, which are small, bean-shaped structures that filter lymph fluid and trap harmful substances like bacteria and viruses.

Lymph vessels are tubes that carry lymph fluid throughout the body, while lymph fluid itself is a clear liquid that circulates through the lymphatic system, containing lymphocytes that help fight infections.

Lymphoma develops when lymphocytes grow uncontrollably, forming tumors in the lymph nodes or other parts of the lymphatic system, such as the spleen, thymus, tonsils, bone marrow, abdomen, chest, neck, or even behind the knee. This uncontrolled growth disrupts the normal functioning of the immune system.

Types of Lymphoma

Hodgkin Lymphoma

Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells, which are large, abnormal lymphocytes. A study published by StatPearls indicates that Hodgkin lymphoma is a rare form of cancer, with an estimated incidence rate of 2.6 cases per 100,000 people in the United States. This type of lymphoma often begins in the lymph nodes of the upper body, such as the neck, chest, or armpits.

Hodgkin lymphoma is generally considered more treatable than non-Hodgkin lymphoma, particularly when diagnosed early. It typically affects younger adults aged 20-39 and older adults over 65.

This type of lymphoma is more common in men than women and often presents with painless swelling of lymph nodes.

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma is a diverse group of blood cancers that includes more than 70 different subtypes. The American Cancer Society reports that non-Hodgkin lymphoma (NHL) is among the most frequently diagnosed cancers in the United States, representing approximately 4% of all cancer cases. Unlike Hodgkin lymphoma, it can arise in various parts of the lymphatic system and behaves differently depending on the subtype.

Non-Hodgkin lymphoma can be aggressive (fast-growing) or indolent (slow-growing). It more frequently affects adults over the age of 60.

Symptoms can vary widely depending on the subtype and location of the lymphoma.

Symptoms of Lymphoma

General Symptoms

Lymphoma symptoms can be subtle and often resemble those of less serious conditions. However, some common signs to watch for include:

• Painless swelling of lymph nodes in the neck, armpits, or groin.
• Persistent fatigue, even after adequate rest.
• Fever that doesn’t subside.
• Night sweats that soak your clothes and bedding.
• Unexplained weight loss, particularly if you've lost 10% or more of your body weight over six months.

If you're experiencing any of these symptoms, it’s crucial to seek medical advice. Early detection can significantly improve treatment outcomes. 

You can also use Symptom Checker to help identify potential health issues based on your symptoms. Remember, this tool is not a substitute for professional medical advice, diagnosis, or treatment.

Symptoms by Type

Hodgkin lymphoma typically presents with specific symptoms that may include:

• Painless swelling: Often in the lymph nodes of the neck, armpits, or groin.
• B Symptoms: Fever, night sweats, and weight loss are common indicators.
• Itchy skin: Some patients experience unexplained itching.

Symptoms of Non-Hodgkin lymphoma can be more varied and may include:

• Abdominal pain or swelling: Caused by enlarged lymph nodes or organs.
• Chest pain, coughing, or shortness of breath: If the lymphoma affects the chest area
• Frequent infections: Due to a compromised immune system.

Causes and Risk Factors

Causes of Lymphoma

The exact cause of lymphoma is not fully understood, but it involves genetic mutations in lymphocytes that cause these cells to grow uncontrollably. Several factors may contribute to the development of these mutations, including:

• Genetic Mutations: Changes in the DNA of lymphocytes can lead to the uncontrolled growth that characterizes lymphoma.
• Viral Infections: Certain viruses, such as the Epstein-Barr virus (which causes mononucleosis) and HIV, are linked to a higher risk of developing lymphoma.
• Immune System Disorders: Conditions that weaken the immune system, whether from chronic infections, autoimmune diseases, or immunosuppressive medications, can increase the likelihood of lymphoma.

Risk Factors

Certain factors can increase the risk of developing lymphoma. These include:

• Age: The risk of lymphoma increases with age. Hodgkin lymphoma is more common in younger adults, while Non-Hodgkin lymphoma often affects those over 60.
• Family History: Having a family member with lymphoma slightly increases your risk.
• Gender: The MD Anderson Cancer Center notes that both types of lymphoma are slightly more prevalent in men.
• Previous Radiation Therapy: Individuals who have undergone radiation therapy for other cancers have a higher risk of developing lymphoma later in life.

Diagnosis of Lymphoma

Diagnosing lymphoma typically begins with a thorough physical examination, during which a healthcare provider checks for swollen lymph nodes and other symptoms. If lymphoma is suspected, further tests are conducted to confirm the diagnosis.

• Blood tests: Evaluate the levels of various blood cells and can indicate the presence of lymphoma. A complete blood count (CBC) measures the levels of different types of blood cells, while the erythrocyte sedimentation rate (ESR) detects inflammation that might suggest lymphoma.
• Imaging tests: These help visualize the extent of the disease. CT scans provide detailed images of lymph nodes and other organs to detect abnormalities. PET scans are often used alongside CT scans to identify areas of active lymphoma.
• Lymph node biopsy: This involves removing a small sample of tissue from a swollen lymph node. This tissue is then examined under a microscope to confirm the presence of lymphoma cells.

Staging Lymphoma

Once lymphoma is diagnosed, the next step is to determine its stage, which helps guide treatment decisions. The staging process assesses how far the cancer has spread within the lymphatic system and beyond.

• Stage I: Lymphoma is found in a single lymph node region or a single organ outside the lymphatic system.
• Stage II: Lymphoma is in two or more lymph node regions on the same side of the diaphragm, or in one organ and its nearby lymph nodes.
• Stage III: Lymphoma is found in lymph node regions on both sides of the diaphragm, possibly involving one organ or area outside the lymphatic system.
• Stage IV: Lymphoma has spread to multiple organs or tissues outside the lymphatic system, such as the liver, bone marrow, or lungs.

Treatment Options for Lymphoma

Treatment by Type

Treatment for Hodgkin lymphoma often involves a combination of therapies, depending on the stage and specific characteristics of the disease:

• Chemotherapy: The primary treatment for Hodgkin lymphoma, chemotherapy uses powerful drugs to kill cancer cells throughout the body.
• Radiation Therapy: Often used after chemotherapy, radiation targets specific areas where lymphoma is present.
• Stem Cell Transplant: In cases where the lymphoma returns after initial treatment, a stem cell transplant may be recommended.

Non-Hodgkin lymphoma treatment varies widely based on the subtype and stage of the disease:

• Chemotherapy: Commonly used, especially for aggressive forms of Non-Hodgkin lymphoma.
• Targeted Therapy: Uses drugs or other substances to precisely identify and attack cancer cells without harming normal cells.
• Immunotherapy: Helps boost the body's natural defenses to fight the cancer.
• CAR T-Cell Therapy: A newer treatment where a patient's T-cells are modified to attack cancer cells more effectively.

Side Effects of Treatment

Lymphoma treatments can cause a variety of side effects, which vary from person to person:

• Fatigue: A common side effect of both chemotherapy and radiation.
• Nausea and Vomiting: Often managed with medications prescribed by the healthcare provider.
• Hair Loss: Common with chemotherapy, though usually temporary.
• Increased Risk of Infections: Due to weakened immune system from treatment.

Managing these side effects is crucial for maintaining overall well-being.

• Stay hydrated to help reduce nausea.
• Rest and manage fatigue by balancing activity with periods of rest.
• Maintain a healthy diet to support your overall health.

Prognosis

The prognosis for lymphoma varies depending on several factors, which can influence the outcome and guide treatment decisions:

• Type of Lymphoma: Hodgkin lymphoma generally has a better prognosis than many types of Non-Hodgkin lymphoma, especially when detected early.
• Stage at Diagnosis: Early-stage lymphoma (Stage I or II) often has a more favorable prognosis than advanced-stage lymphoma (Stage III or IV).
• Patient Age and Overall Health: Younger patients and those with good overall health typically respond better to treatment and have higher survival rates.
• Response to Treatment: The effectiveness of initial treatment plays a significant role in determining the long-term outlook.

Living with Lymphoma

Managing lymphoma often continues beyond the initial treatment phase. Long-term management strategies include:

• Regular Check-Ups: Frequent follow-up appointments are essential to monitor for any signs of recurrence or late side effects of treatment.
• Managing Stress: Techniques such as meditation, deep breathing exercises, or yoga can help reduce anxiety.
• Healthy Lifestyle Choices: Focus on a balanced diet rich in fruits, vegetables, lean proteins, and whole grains to support recovery and overall health. Engage in regular physical activity to help reduce fatigue and improve mood.
• Monitoring for Late Effects: Some treatments can have long-term side effects, such as heart or lung issues, so regular monitoring is crucial.

When to Seek Medical Attention

Certain symptoms should prompt immediate medical attention, as they could indicate a more serious condition or complications related to lymphoma:

• Persistent Swelling: Lymph nodes that remain swollen for more than a few weeks, especially if they are painless, should be evaluated by a healthcare provider.
• Unexplained Fever: A fever that lasts more than a few days or recurs without an obvious cause.
• Severe Fatigue: Fatigue that doesn’t improve with rest and interferes with daily activities.
• Rapid Weight Loss: Losing 10% or more of your body weight over six months without trying could be a sign of lymphoma or another serious condition.