Lymphoma

Overview

Lymphoma is cancer that affects the lymphatic system. The lymphatic system is made up of organs, glands, tubelike vessels and clusters of cells called lymph nodes. It's part of the body's germ-fighting immune system. Lymphoma can affect lymph nodes, blood, bone marrow, spleen, and other tissues throughout the body, such as in the gastrointestinal system, central nervous system, bones or skin.

Lymphoma gets its name from the kind of cell that makes up the cancer. Lymphoma starts in germ-fighting white blood cells called lymphocytes. There are many types of lymphoma. The main types are:

• Hodgkin lymphoma. This type is characterized by a special kind of cell called the Reed-Sternberg cell. When healthcare professionals look at these cells with a microscope, the cells are larger than healthy cells. The cells often have more than one nucleus. Healthy cells have only one nucleus. Hodgkin lymphoma often is curable.
• Non-Hodgkin lymphoma. Lymphomas that don't have the Reed-Sternberg cell are considered non-Hodgkin lymphomas. Non-Hodgkin lymphoma is more common than Hodgkin lymphoma. The way non-Hodgkin cells look under a microscope varies depending on the type. Whether a non-Hodgkin lymphoma can be cured also depends on the type.

Treatments for lymphomas may include a "watch and wait" approach, chemotherapy, immunotherapy, radiation therapy, targeted therapy, and clinical trials. Treatments also may include CAR-T cell therapy, bone marrow transplant, also called bone marrow stem cell transplant, and treatments for cutaneous lymphomas.

Causes

It's not clear what causes lymphoma. Cancer happens when cells develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells. In lymphoma, the cancer cells can build up in the lymph nodes, blood, bone marrow, spleen and other tissues throughout the body.

Lymphoma gets its name from the kind of cell that makes up these cancers. These cancers start in germ-fighting white blood cells called lymphocytes.

Complications

Complications of lymphoma may include:

• Relapse. Even after successful treatment, lymphoma may come back. This is called a relapse. Sometimes the relapse happens years later. Some people may have multiple relapses.
• Transformation. Some types of slow-growing lymphomas can change into more-aggressive types. These lymphomas often have a worse prognosis and need stronger treatments.

Treatment

Treatments for lymphomas may include a "watch and wait" approach, chemotherapy, immunotherapy, radiation therapy, targeted therapy, and clinical trials. Treatments also may include CAR-T cell therapy, bone marrow transplant, also called bone marrow stem cell transplant, and treatments for cutaneous lymphomas. Which treatment is best for you depends on the type of lymphoma you have and the extent of your cancer, called the stage. Your healthcare team also considers how quickly the cancer is growing, your overall health and what you prefer.

Watch and wait

If your lymphoma doesn't cause symptoms, you might not need treatment right away. Instead, you may have checkups every few months. The checkups help your healthcare team watch your condition to see if your cancer is growing.

Chemotherapy

Chemotherapy treats cancer with strong medicines. There are many chemotherapy medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.

Chemotherapy may be a treatment for some types of lymphoma. You may take a combination of chemotherapy medicines. Chemotherapy also may be combined with immunotherapy or other medicines. Chemotherapy may be an option when other treatments haven't worked, known as refractory lymphoma, or for cancer that comes back after treatment, called relapsed lymphoma.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy may be a treatment for some types of lymphoma. It may be combined with chemotherapy or other medicines. Immunotherapy also may be used for refractory or relapsed lymphoma.

Radiation therapy

Radiation therapy for cancer is a treatment that uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points in your body.

Radiation therapy may be a treatment for some types of lymphoma. It may be combined with chemotherapy or other medicines. Radiation therapy also may be used to ease symptoms and improve quality of life for people with some types of lymphoma.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Targeted therapy may be a treatment for some types of lymphoma. It also may be an option for some refractory or relapsed B-cell lymphomas.

Clinical trials

Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Talk with your healthcare team about the possibility of joining a clinical trial.

CAR-T cell therapy

Chimeric antigen receptor (CAR)-T cell therapy trains the immune system cells to fight lymphoma. This treatment begins with removing some white blood cells, including T cells, from the blood.

The cells are sent to a lab. In the lab, the cells are treated so that they make special receptors. The receptors help the cells recognize a marker on the surface of the lymphoma cells. Then the cells go back into the body. They find and destroy lymphoma cells.

CAR-T cell therapy may be an option for some refractory or relapsed lymphomas.

Bone marrow transplant

A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. These cells replace cells hurt by chemotherapy and other treatments. Stem cells can come from your own body, called an autologous transplant. Stem cells also can come from a donor, called an allogeneic transplant.

A bone marrow transplant may only be an option for some types of lymphoma and for people who are younger and in good health. Chemotherapy is typically done before the transplant to suppress the immune system and bone marrow.

Treatments for cutaneous lymphomas

Treatments for cutaneous lymphomas may include topical medicines and phototherapy. Topical medicines are placed directly on the patches or plaques on the skin. They may include corticosteroids, retinoids and topical chemotherapy. Phototherapy uses lights combined with medicines to treat some cancers of the skin.

Monitoring after treatment

After treatment is complete, you may have frequent follow-up appointments to see if the cancer has come back, known as a relapse. You may have repeat blood and imaging tests and, if needed, biopsies, to check for relapse.

Side effects of treatment

Treatments for lymphoma may have side effects. These may include nausea, vomiting, fatigue, fever, rash, diarrhea, infection and more.

Harmful side effects from treatments may include:

• Bone marrow suppression. When the bone marrow is suppressed, it can't produce enough blood cells, including white blood cells. White blood cells help fight infections, so with a lower amount, you are at a higher risk of infections.
• Febrile neutropenia. Febrile neutropenia is a serious condition that can happen in people being treated for cancer. Febrile means having a fever. Neutropenia means having a low number of neutrophils, which are a type of white blood cell that helps fight infections. In febrile neutropenia, the body is trying to fight an infection but doesn't have enough neutrophils.
• Medicine toxicity. Some medicines used to treat cancer can be harmful to the body. They can cause organ damage and other issues. Whether a medicine is toxic depends on the type and how much you take. There are many different medicine options. Your healthcare team can work with you to find the best medicines for you.
• Reactivating viruses. If you have had a viral infection in the past such as hepatitis B or hepatitis C, some treatments can cause the virus to become active again. This can lead to liver inflammation, liver damage and other complications.
• Tumor lysis syndrome. Tumor lysis syndrome is a serious condition that can happen when cancer cells break down quickly after treatment. When these cells die, they release substances into the bloodstream that can overwhelm the body. This can lead to issues with the kidneys and other organs. You may take medicines to treat or prevent harmful side effects.
• Infertility. Some lymphoma medicines can cause issues with fertility. If you are concerned about fertility, talk about your options with your healthcare professional before beginning treatment.

Preparing for an appointment

Make an appointment with a healthcare professional if you have any symptoms that worry you.

If your healthcare professional thinks you might have lymphoma, you may be referred to a doctor who specializes in diseases that affect blood cells, called a hematologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer, called an oncologist.

Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of anything you need to do ahead of time. 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.
• Write down symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down important personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements you're taking and the doses.
• Take a family member or friend along. It can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

For lymphoma, some basic questions to ask include:

• Do I have lymphoma?
• What type of lymphoma do I have?
• What is the stage of my lymphoma?
• Has my lymphoma spread to other parts of my body?
• Will I need more tests?
• What are the treatment options?
• How much does each treatment prolong my life or increase my chances of a cure?
• What are the potential side effects of each treatment?
• How will each treatment affect my daily life?
• Is there one treatment option you believe is the best?
• What would you recommend to a friend or family member in my situation?
• Should I see a specialist?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

Don't hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

• When did your symptoms begin?
• Do your symptoms happen all the time or do you have them now and then?
• How bad are your symptoms?
• What, if anything, seems to make symptoms better?
• What, if anything, seems to worsen your symptoms?
• Have you had any fevers, night sweats or weight loss?
• Have you noticed any lumps, swelling or pain anywhere in your body?
• Have you had any chest pain, coughing or trouble breathing?
• Have you had any recent infections?
• Do you have any other health conditions, such as diabetes, heart disease or kidney disease?
• What are your biggest worries about your diagnosis or treatment?