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Perhaps you’ve known people with lymphoma but didn’t quite understand all that the disease entailed. Likely you have heard of two major types of lymphomas: Hodgkin lymphoma (also called Hodgkin disease) and non-Hodgkin lymphoma.
But unknown to many people, there aren’t just two kinds of lymphomas. Rather, there are dozens of subtypes. And these categories help determine which treatment is best.
“It’s really unfair to put all the diseases that are lymphomas in one category,” says J.C. Villasboas, M.D., a Mayo Clinic hematologist with expertise in lymphoma. He says it is the same with the term “cancer.” It’s hard to put everything under one umbrella.
Lymphomas are cancers of the lymphoid cells, an important component of the immune system that defends against germs and infection. Lymphomas may be found nearly anywhere in the body, but are more commonly found in areas such as the lymph nodes, liver, spleen and bone marrow.
To help sift through the variety of lymphomas, Dr. Villasboas likes to use another categorization: aggressive versus slow-growing (indolent) lymphomas. Aggressive lymphomas “find you” when symptoms show up, Dr. Villasboas says. Slow-growing lymphomas may not have obvious symptoms and may only be “found by accident.” While aggressive lymphomas typically require prompt treatment, your health care provider may advise a “watch and wait” approach for slow-growing lymphomas.
Below, Dr. Villasboas answers common questions and offers key insights into lymphomas.
Q: What are the symptoms of lymphoma?
A: It depends on the type of lymphoma. For aggressive lymphomas, symptoms can include fevers that may be recurrent and night sweats. This is not a subtle type of sweat. I’m talking about drenching night sweats. When I’m treating someone, I always ask, “Have you ever had to change your sheets, pillowcase or pajamas?” These lymphomas can also cause unintentional weight loss. So, you’re not trying to diet or exercise but you’re losing pounds.
Sweating and weight loss are called constitutional symptoms. However, these symptoms are not unique to lymphomas, and many people with lymphoma never have them.
Because lymphomas can happen in virtually any part of the body, you can have more-specific symptoms associated with the site of the lymphoma or growing mass. For example, a lymphoma in your abdomen or chest can lead to abdominal pain, shortness of breath or chest pain.
Slow-growing lymphomas typically don’t come with many symptoms. If anything, there may be an enlarged lymph node. So someone goes to the emergency room with a kidney stone, gets a computerized tomography (CT) scan and doctors find a tumor that may have been sitting there for years.
Q: What causes lymphoma?
A: Unlike some other cancers with a clear provoking factor — for example, the clear association between smoking and the development of lung cancer — there’s not a strong link or cause of lymphoma. But there are very rare exceptions. For example, the presence of Helicobacter pylori (H. pylori) infection in the stomach is strongly associated with a very specific type of lymphoma of the stomach.
There are themes, however. Aging increases the risk of developing lymphoma. People accumulate genetic errors in their DNA as time goes on. These errors can make people prone to the development of lymphomas. Another theme is immunity, which is tightly related to lymphoma. People with impaired or dysfunctional immune systems — for example, due to autoimmune diseases or an organ transplant that requires immune-suppressing medication — are at increased risk of lymphoma.
Agent Orange and some pesticides also seem to be associated with lymphoma. However, those are only associations so far; they have not been proved to cause lymphoma.
Q: When do people typically develop lymphoma?
A: Hodgkin lymphoma typically develops in two peaks. One peak is between ages 15 and 35 — and that’s when you often hear about people with Hodgkin lymphoma, because that’s quite a dramatic event in a young person’s life. And then there’s a second peak later in life — after age 50.
That’s not the case for non-Hodgkin lymphoma: The risk just keeps growing with age.
Q: How is lymphoma diagnosed?
A: One of the first steps is to get a blood count test and make sure there’s nothing circulating in the blood that points to a different issue, such as an infection. And then it’s important to get an adequate tissue sample to make the diagnosis. I stress “adequate,” because many times patients will come to me after having been through two or three needle biopsies in which a very small piece of tissue was taken or a small amount of liquid and cells was obtained (aspirated) from a tumor with a fine needle. That’s not usually sufficient to diagnose lymphoma or to accurately identify the subtype. An adequate amount of tissue is needed to look at the architecture of the tumor. Where are the cancer cells and where are they in context with surrounding cells? This information is crucial for an accurate diagnosis.
Q: How is lymphoma treated?
A: After diagnosis, we stage the lymphoma. This involves trying to find out whether the lymphoma is localized to that one lymph node area or whether it can already be seen in other lymph nodes or tissues. Typically, a scan is done, such as a combined positron emission tomography and computerized tomography (PET/CT) scan. In some cases, we also need to perform a bone marrow biopsy to find out whether lymphoma is in the bone marrow.
Finally, we’ll come up with a management plan for the lymphoma. With some indolent lymphomas, we may decide to actively follow the lymphoma without treatment. We commonly use chemotherapy to treat aggressive lymphomas and certain indolent lymphomas. And sometimes we combine chemotherapy with additional tools such as radiation and immunotherapy. Immunotherapy uses drugs that won’t necessarily kill the lymphoma directly. But the drugs can use or modify the immune system to help get rid of the lymphoma. There are also targeted therapy drugs, which usually act on a specific gene, metabolic pathway or part of the cell to treat the cancer.
If a lymphoma is aggressive or doesn’t get better after treatment — or if it returns after the initial treatment — specialized treatments may be needed. One such option is stem cell transplantation. More recently, we are using a new treatment called CAR-T cell therapy, which stands for chimeric antigen receptor T cell therapy. This is a way to genetically modify a person’s immune system to best fight the lymphoma.
Q: Is there anything that helps prevent lymphoma?
A: Immunity is important. So keeping your immune system as strong as possible, at least in theory, could help prevent lymphoma.
A study done here at Mayo Clinic showed that people who were physically active before their diagnosis of lymphoma did better than those who were not as active. The same was true for people who were active after a diagnosis. The chance of dying of lymphoma was decreased in those with higher activity. And although studies are still underway to explore this link, I have to believe it’s mediated by the immune system. People who exercise may have healthier immune systems, and this might allow their bodies to keep the lymphoma under control and prevent the lymphoma from returning.
Q: How do you know you’re getting the best care for lymphoma?
A: First of all, it’s not as common as some other cancers. Each year in the U.S., there are over 250,000 cases of breast cancer but only about 90,000 cases of lymphoma combined (of all types). Most cancer doctors will not see many people with lymphoma in any given month or year. And having so many different types inside one simple label of “lymphoma” means that it’s a good idea to have your diagnosis verified by a medical center with a high volume of cases — with an expert who actually sees this type of disease day in and day out. It’s important to seek care or at least an opinion from a medical center with a high volume of people with lymphoma. The Lymphoma Research Foundation helpline at 800-500-9976 or helpline@lymphoma.org can guide you to treatment centers, specialists and clinical trials.
Many lymphomas are curable. That’s why it is important to make sure you have the accurate diagnosis and accurate staging, because that will give you the best chance of a positive outcome.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
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