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Lymphoma

Overview

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

The lymphatic system includes the lymph nodes (lymph glands), spleen, thymus gland and bone marrow. Lymphoma can affect all those areas as well as other organs throughout the body.

Many types of lymphoma exist. The main categories of lymphoma are:

  • Hodgkin's lymphoma
  • Non-Hodgkin's lymphoma

What lymphoma treatment is best for you depends on your lymphoma type and its severity. Lymphoma treatment may involve chemotherapy, immunotherapy medications, radiation therapy or a bone marrow transplant.

Parts of the immune system

Your body's lymphatic system is part of your immune system, which protects you against infection and disease. The lymphatic system includes your spleen, thymus, lymph nodes and lymph channels, as well as your tonsils and adenoids.

Symptoms

Signs and symptoms of lymphoma include:

  • Enlarged lymph nodes that can occur in any part of the body but most often occur in the neck, armpit or groin
  • Fatigue
  • Fever
  • Night sweats
  • Shortness of breath
  • Weight loss

When to see a doctor

Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.

Causes

Doctors aren't sure what causes lymphoma.

Lymphoma begins when a disease-fighting white blood cell called a lymphocyte develops a mutation in its genetic code. The mutation tells the cell to multiply rapidly, causing many diseased lymphocytes that continue multiplying.

The mutations also allow 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.

Risk factors

Factors that may increase your risk of lymphoma include:

  • Increasing age. Your risk of lymphoma increases as you age, though it can occur at any age. Some types of lymphoma are more common in young adults.
  • Being male. Lymphoma is more common in men than it is in women.
  • 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 systems.
  • Developing certain infections. Some infections are associated with an increased risk of lymphoma, including Epstein-Barr virus and Helicobacter pylori infection.

Diagnosis

Tests and procedures used to diagnose lymphoma include:

  • Physical exam. Your doctor may examine your body to look for signs of enlarged lymph nodes.
  • 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 biopsy and aspiration 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. Imaging tests may be used to look for signs of lymphoma in other areas of your body. Tests may include CT, MRI and positron emission tomography (PET).
Bone marrow biopsy

In a bone marrow aspiration and biopsy, a doctor or nurse uses a thin needle to remove a small amount of liquid bone marrow, usually from a spot in the back of your hipbone (pelvis). A bone marrow biopsy is often taken at the same time. This second procedure removes a small piece of bone tissue and the enclosed marrow.

Treatment

Your lymphoma treatment options will depend on your type of lymphoma, its aggressiveness and your treatment goals.

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 is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is 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 within your cancer cells that allow them to survive. Immunotherapy drugs use your immune system to kill cancer cells.
  • Radiation therapy. Radiation therapy uses powerful beams of energy, such as X-rays and protons, to kill cancer cells.
  • Bone marrow transplant. 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.

Preparing for an appointment

Make an appointment with your family doctor if you have any signs or symptoms that worry you. If your doctor suspects you have lymphoma, you may be referred to a doctor who specializes in diseases that affect the blood cells (hematologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
  • Note down any symptoms you're experiencing, even if they seem unrelated to the reason you have scheduled the appointment.
  • Make a note of key personal information, including things like recent life changes, or major stresses.
  • Make a list of all medications, vitamins or supplements you're taking.
  • Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down a list of questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For lymphoma, some basic questions to ask your doctor include:

  • Do I have lymphoma?
  • What type of lymphoma do I have?
  • What stage is my lymphoma?
  • Is my lymphoma aggressive or slow growing?
  • Will I need more tests?
  • Will I need treatment?
  • What are my treatment options?
  • What are the potential side effects of each treatment?
  • How will treatment affect my daily life? Can I continue working?
  • How long will treatment last?
  • Is there one treatment you feel is best for me?
  • If you had a friend or loved one in my situation, what advice would you give that person?
  • Should I see a specialist? What will that cost, and will my insurance cover it?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions as they come up during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Coping and support

A lymphoma diagnosis can be overwhelming and scary. With time you'll find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helps to:

  • Learn enough about lymphoma to make decisions about your care. Ask your doctor about your lymphoma, including your type, your treatment options and, if you like, your prognosis. As you learn more about lymphoma, you may become more confident in making treatment decisions.
  • Keep friends and family close. Keeping your close relationships strong will help you deal with your lymphoma. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.
  • Find someone to talk with. Find a good listener with whom you can talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

    Ask your doctor about support groups in your area. You might also contact a cancer organization such as the National Cancer Institute or the Leukemia & Lymphoma Society.

Last updated: June 1st, 2017

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