Q. What is Lymphoma?
A. Lymphoma refers generally to a group of cancers in a person’s lymph nodes, which are which are small bean-shaped organs found in clusters throughout the body, including in the underarms, groin, neck, chest and abdomen, and in the stomach, intestines and skin. The lymph nodes work hard to filter bacteria and fight off disease by dividing and continually replacing themselves. However, when these cells divide too rapidly and grow without any order or control, too much tissue is formed and tumors begin to grow. These lymphomas–-the cancerous growth of these cells--can then spread to other organs.
There are two types of lymphoma:
- Hodgkin's lymphoma (also called Hodgkin’s disease)
- Non-Hodgkin's lymphoma B-Cell and Non-Hodgkin’s Lymphoma T-Cell
In Hodgkin’s lymphoma, one particular abnormal and malignant cell – the Reed-Sternberg cell, named for the scientists who discovered it – is found within the lymph nodes. This cancer has a predictable pattern as it spreads through body. Non-Hodgkin’s lymphoma has two cell types that may become cancerous: B-cells and T-cells.
Q. What are the causes of lymphoma?
A. The cause of lymphoma is not known for certain. However, researchers believe that certain factors, such as exposure to carcinogens, pesticides, herbicides, viruses and bacteria may play a role. Certain individuals may also be at higher risk for getting lymphoma, including those persons who:
- Have a family history of NHL (though no hereditary pattern has been well established)
- Have an existing autoimmune disease (particularly celiac disease)
- Have received an organ transplant
- Have a congenital immune deficiency (particularly Ataxia Teleangectasia)
- Are exposed to carcinogenic chemicals such as pesticides, fertilizers or solvents
- Are infected with viruses, such as Epstein-Barr Virus (EBV), human T-lymphotropic virus type 1 (HTLV-1), HIV, hepatitis C virus (HCV)
- Have psoriasis
- Have a condition called Lymphomatoid Papulosis (LyP)
Q. What are the signs and symptoms of lymphoma?
A. The signs and symptoms of lymphoma vary, however, they may include the following:
- skin rashes
- enlarged lymph nodes or spleen
- night sweats
- weight loss
- bleeding and
- an increased rate of infections
Q. Can lymphoma be prevented?
A. Because there is not yet a certain known cause of lymphoma, there is no identifiable way to prevent its occurrence. However, patients who have conditions associated with a higher risk of NHL in general, or T-cell lymphoma in particular, should see their doctor promptly if they develop symptoms suggestive of lymphoma (enlarged lymph nodes, new skin rash or a skin rash that is different from the usual, night sweats, lack of appetite, unexpected weight loss). This will allow early recognition and treatment.
Q. How will my doctor know if I have lymphoma?
A. The tests to determine your diagnosis will depend on the signs and symptoms you have. Your doctor may conduct any of the following diagnostic tests:
- Biopsies, which involve a surgical removal of suspect tissue inside or outside the body
- Blood tests, to detect and examine abnormal cells and the loss of cell proteins
- X-rays, which use radiation to provide images of the inside of the body
- CT scan, which takes X-ray images from different angles around the body to show a cross-section of body tissues and organs
- MRI (magnetic resonance imaging), which uses magnets around radio frequency waves to provide clear images
- Positron Emission Tomography scan (PET), which involves an injection of a small dose of radioactive glucose (sugar) to produce cross-sectional images of the inside of the body
- A gallium scan, which uses a radioactive material called gallium to detect inflammation, which is an indication of tumors or infections
- Bone marrow examination, which involves inserting a thin needle into the tissue, pelvis or other large bone to withdraw a sample; a local anesthetic is used
- Molecular tests, which examine genetic material (DNA) and proteins from the tissue obtained from biopsies, fine-needle aspirates and sometimes blood
Your doctor may order other tests to assess the health of organs that could be affected by these tests or treatments. These tests include echocardiograms to assess the heart and pulmonary function tests, which evaluate your lung function.
Q. What types of questions should I ask my doctor regarding treatment for lymphoma?
A. The treatment options for lymphoma will depend on the type of diagnosis you receive. Here are a few questions to start the discussion with your doctor:
- What type of lymphoma do I have, what stage is it and what is the prognosis for this type and stage?
- Are your pathologists experts in the diagnosis of lymphoma?
- How many patients with lymphoma are seen and treated at your institution each year?
- What are the treatment options for the type of lymphoma I have, and what type of treatment do you recommend and why?
- Are there any other treatments I should or could consider?
- What are the risks and benefits of each treatment?
- Are clinical trials available for my type of lymphoma?
- How do I get information on these clinical trials?
- Is it urgent for me to start treatment quickly?
- Where can I go for a second opinion?
- Can I continue with my work and daily routine during treatment?
Please also see the Non-Hodgkin’s Lymphoma Cyberfamily Web page for a comprehensive printable question-and-answer sheet for other questions regarding support, pre-treatment, costs and health coverage and palliative care.
Q. What types of treatments exist for lymphoma?
A. The type of treatment you receive will depend on your diagnosis and the stage. Talk with your physician about this. Generally, individuals with lymphoma will receive any of the following types of treatment:
- Chemotherapy, which involves treatment with drugs that are used to kill cancer cells or prevent them from growing
- Radiation therapy, which involves radiating and thus injuring or destroying cells in the area being treated by damaging their genetic material, making it impossible for these cells to continue to grow and divide
- Biologic therapy, which uses materials made by the body or created in a laboratory to boost, direct or restore your body’s natural defenses against disease
Treatment may also involve a combination of these therapies. Bone marrow or stem cell transplantation may sometimes be used. Surgery is typically used only to diagnose NHL, except in some cases of cutaneous T-cell lymphoma (CTCL) where an isolated skin nodule can be completely resected with very little chances of local recurrence
Q. What are some of the side effects of these treatments?
A. Ask your doctor about particular side effects for your particular treatment. Generally, side effects of radiation are limited to the area undergoing radiation. Common side effects include loss of appetite and taste; dry mouth, throat irritation and difficulty eating and swallowing. Talk with your doctor about treatments to ease your discomfort.
See the Lymphoma Research Foundation for tips on how to cope with side effects.
Q. What is the prognosis (chance of recovery) for lymphoma?
A. The prognosis depends on the following factors:
- The stage of the cancer
- The type of T-cell lymphoma
- The person’s age and general health
- Whether the lymphoma has just been diagnosed or has recurred (come back)
Speak with your doctor about your specific diagnosis and the stage of disease the lymphoma is in.
Q. What types of doctors and other health care providers treat lymphoma?
A. The Lymphoma Treatment Team at the James Cancer Hospital is made up of a interdisciplinary group of professionals that include cancer doctors with a specialty in lymphomas, as well as dermatologists, pathologists, radiologists, oncology nurses and patient coordinators.