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lymphoma-cancer-treatment

What is Lymphoma?

Lymphoma is a cancer of the lymphatic system, which is part of the body's germ-fighting network.

The body is made up of cells that need to be replaced as they age or are damaged. This happens through cell division, which is when a cell divides and makes new copies of itself.

Normally, cell division is carefully controlled. But sometimes this process can get out of control. Too many cells may be made and a cancer, such as lymphoma, can develop.

In lymphoma, blood cells called lymphocytes become abnormal. These are the lymphoma cells. Usually the body’s immune system destroys abnormal cells. But lymphoma cells are often able to avoid the immune system. This means they can keep dividing and grow out of control. Over time, there are enough lymphoma cells to form a lump. The most common place for this to happen is in the lymph nodes. But lymphoma can start growing in other parts of the body.

Lymphocytes travel around the body. This means that lymphoma can spread from where it first started. It can spread through the lymphatic system from lymph nodes in one part of the body to lymph nodes elsewhere. Lymphoma cells can also travel in the bloodstream to organs such as the bone marrow, liver or lungs. The cells may then keep dividing to form a new area of lymphoma.

Types of Lymphoma

There are many types of lymphoma. Different types develop and are treated in different ways. A doctor can only find out your lymphoma type by collecting some lymphoma cells and examining them under a microscope.

The two main sub-types are

 

  1. Hodgkin lymphoma
  2. non-Hodgkin lymphoma.

Other sub-types of Lymphoma

  1. Chronic lymphocytic leukemia
  2. Cutaneous B-cell lymphoma
  3. Cutaneous T-cell lymphoma
  4. Hodgkin's lymphoma (Hodgkin's disease)
  5. Non-Hodgkin's lymphoma
  6. Waldenstrom macroglobulinemia

 

Stages of lymphoma

Both NHL and Hodgkin’s lymphoma can be classified into four stages. The state of lymphoma is determined by where the cancer is and how far it has or has not spread.

Stage 1. Cancer is in one lymph node or one organ cite.

Stage 2. Cancer is in two lymph nodes near to one another and on the same side of the body, or the cancer is in one organ and nearby lymph nodes.

Stage 3. At this point, cancer is in lymph nodes on both sides of the body and in multiple lymph nodes.

Stage 4. The cancer can be in an organ and spread beyond nearby lymph nodes. As NHL progresses, it may begin to spread. The most common sites for advanced NHL include the liver, bone marrow, and lungs.

While stage 4 lymphoma is advanced, it’s still treatable.

Signs and Symptoms of Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma (NHL) can cause many different signs and symptoms, depending on the type of lymphoma and where it is in the body. Sometimes it might not cause any symptoms until it grows quite large.

Having one or more symptoms doesn’t mean you definitely have lymphoma. In fact, many of the symptoms listed here are more likely to be caused by other conditions, such as an infection. Still, if you have any of these symptoms, have them checked by a doctor so that the cause can be found and treated, if needed.

Some common signs and symptoms include:

  1. Enlarged lymph nodes
  2. Chills
  3. Weight loss
  4. Fatigue (feeling very tired)
  5. Swollen abdomen (belly)
  6. Feeling full after only a small amount of food
  7. Chest pain or pressure
  8. Shortness of breath or cough
  9. Severe or frequent infections
  10. Easy bruising or bleeding

Some people with Non-Hodgkin lymphoma have what are known as B symptoms:

  1. Fever (which can come and go over several days or weeks) without an infection
  2. Drenching night sweats
  3. Weight loss without trying (at least 10% of body weight over 6 months)

 

Swollen lymph nodes

Non-Hodgkin lymphoma can cause lymph nodes to become enlarged. Enlarged lymph nodes close to the surface of the body (such as on the sides of the neck, in the groin or underarm areas, or above the collar bone), may be seen or felt as lumps under the skin. These are usually not painful.

Although enlarged lymph nodes are a common symptom of lymphoma, they are much more often caused by infections. Lymph nodes that grow in reaction to infection are called reactive nodes or hyperplastic nodes and are often tender to the touch.

Symptoms from lymphoma in the abdomen

Lymphomas that start or grow in the abdomen (belly) can cause swelling or pain in the abdomen. This could be from lymph nodes or organs such as the spleen or liver enlarging, but it can also be caused by the build-up of large amounts of fluid.

An enlarged spleen might press on the stomach, which can cause a loss of appetite and feeling full after only a small meal.

Lymphomas in the stomach or intestines can cause abdominal pain, nausea, or vomiting.

Symptoms from lymphoma in the chest

When lymphoma starts in the thymus or lymph nodes in the chest, it may press on the nearby trachea (windpipe), which can cause coughing, trouble breathing, or a feeling of chest pain or pressure.

The superior vena cava (SVC) is the large vein that carries blood from the head and arms back to the heart. It passes near the thymus and lymph nodes inside the chest. Lymphomas in this area may push on the SVC, which can cause the blood to back up in the veins. This can lead to swelling (and sometimes a bluish-red color) in the head, arms, and upper chest. It can also cause trouble breathing and a change in consciousness if it affects the brain. This is called SVC syndrome. It can be life-threatening and must be treated right away.

Symptoms from lymphoma affecting the brain

Lymphomas of the brain, called primary brain lymphomas, can cause headache, trouble thinking, weakness in parts of the body, personality changes, and sometimes seizures.

Other types of lymphoma can spread to the area around the brain and spinal cord. This can cause problems such as double vision, facial numbness, and trouble speaking.

Symptoms from lymphoma in the skin

Lymphomas of the skin may be seen or felt. They often appear as itchy, red or purple lumps or bumps under the skin.

What are the causes of lymphoma?

Doctors aren't sure what causes lymphoma. But it begins when a disease-fighting white blood cell called a lymphocyte develops a genetic mutation. The mutation tells the cell to multiply rapidly, causing many diseased lymphocytes that continue multiplying.

The mutation also allows the cells to go on living when other cells would die. This causes too many diseased and ineffective lymphocytes in your lymph nodes and causes the lymph nodes to swell.

What are risk factors for lymphoma?

Factors that can increase the risk of lymphoma include:

Your age: Some types of lymphoma are more common in young adults, while others are most often diagnosed in people over 55.

Being male: Males are slightly more likely to develop lymphoma than are females.

Having an impaired immune system: Lymphoma is more common in people with immune system diseases or in people who take drugs that suppress their immune system.

Developing certain infections: Some infections are associated with an increased risk of lymphoma, including the Epstein-Barr virus and Helicobacter pylori infection.

How is lymphoma diagnosed?

Tests and procedures used to diagnose lymphoma include:

Physical exam: Your doctor checks for swollen lymph nodes, including in your neck, underarm and groin, as well as a swollen spleen or liver.

Removing a lymph node for testing: Your doctor may recommend a lymph node biopsy procedure to remove all or part of a lymph node for laboratory testing. Advanced tests can determine if lymphoma cells are present and what types of cells are involved.

Blood tests: Blood tests to count the number of cells in a sample of your blood can give your doctor clues about your diagnosis.

Removing a sample of bone marrow for testing: A bone marrow aspiration and biopsy procedure involves inserting a needle into your hipbone to remove a sample of bone marrow. The sample is analyzed to look for lymphoma cells.

Imaging tests: Your doctor may recommend imaging tests to look for signs of lymphoma in other areas of your body. Tests may include CT, MRI and positron emission tomography (PET).

Other tests and procedures may be used depending on your situation.

Many types of lymphoma exist, including rare forms that are difficult for inexperienced pathologists to identify. An accurate diagnosis is key to developing a treatment plan. Research shows that review of biopsy tests by pathologists who aren't experienced with lymphoma results in a significant proportion of misdiagnoses. Get a second opinion from a specialist.

Treatments for lymphoma

Which lymphoma treatments are right for you depends on the type and stage of your disease, your overall health, and your preferences. The goal of treatment is to destroy as many cancer cells as possible and bring the disease into remission.

Lymphoma treatments include:

Active surveillance: Some forms of lymphoma are very slow growing. You and your doctor may decide to wait to treat your lymphoma when it causes signs and symptoms that interfere with your daily activities. Until then, you may undergo periodic tests to monitor your condition.

Chemotherapy: Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells. The drugs are usually administered through a vein, but can also be taken as a pill, depending on the specific drugs you receive.

Other drug therapy: Other drugs used to treat lymphoma include targeted drugs that focus on specific abnormalities in your cancer cells. Immunotherapy drugs use your immune system to kill cancer cells.

Radiation therapy: Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells.

Bone marrow transplant: A bone marrow transplant, also known as a stem cell transplant, involves using high doses of chemotherapy and radiation to suppress your bone marrow. Then healthy bone marrow stem cells from your body or from a donor are infused into your blood where they travel to your bones and rebuild your bone marrow.

Team Of Consultants

Dr. Dharma Choudhary

Dr.Dharma Choudhary

Director - BLK Centre for Bone Marrow Transplant

Dr.Dharma Choudhary

Director - BLK Centre for Bone Marrow Transplant
Dr Rahul Bharqava

Dr. Rahul Bhargava

Director & head - Fortis Hospital, Gurgaon

Dr. Rahul Bhargava

Director & head - Fortis Hospital, Gurgaon
Dr. Sunil Kumar Gupta

Dr. Sunil Kumar Gupta

Director & HOD - Venkateshwar Hospital, Delhi

Dr. Sunil Kumar Gupta

Director & HOD - Venkateshwar Hospital, Delhi
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