Lymphoma

About lymphoma

Lymphoma is a cancer that involves the lymphatic system. There are two main types of lymphoma, non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma

Hodgkin lymphoma differs from non-Hodgkin lymphoma by how the cancer cells look under a microscope. In some ways they are similar but the treatment for each is different.

Non-Hodgkin lymphoma is one of the most common cancers in Victoria, affecting about 1660 people a year. It can occur in children but is more common in adults. Hodgkin lymphoma is much less common. About 180 Victorians are affected each year.

The lymphatic system and lymphoma

The lymphatic system is part of the immune system, which helps protect our body against infection. It consists of lymph nodes connected by lymph vessels, which branch out into all parts of the body, except the brain and spinal cord.

The lymphatic system also includes the bone marrow, spleen, thymus gland and tonsils. Its main jobs are to:

• drain fluids back into the bloodstream from body tissues
• filter the blood and lymph
• fight infection.

The lymphatic system carries a clear fluid called lymph. This lymphatic fluid contains white blood cells called lymphocytes. The lymphocytes mature within the blood and bone marrow and are stored in the lymph nodes. Lymph nodes are found in many areas of the body, including the neck, armpits, chest, abdomen and groin. Lymphatic fluid is filtered through the lymph nodes. Any foreign organisms (such as bacteria) are trapped and attacked by the lymphocytes.

A person with lymphoma has a large number of abnormal lymphocytes. The abnormal lymphocytes do not function properly and replace some of the normal lymphocytes. This can affect the immune system, how the body fights infection. A build up of the abnormal lymphocytes causes enlarged painless lymph nodes.

The lymphatic system is throughout most of the body. This means you can get lymphoma almost anywhere. It is commonly first seen in the lymph nodes in the neck, but it is also common to find it in the liver or spleen. Lymphoma may also be found in the bowel, stomach, brain, skin, testicles and eyes.

Symptoms of lymphoma

The most common symptom of lymphoma is a swelling of the lymph nodes in the neck, armpit or groin. These enlarged lymph nodes are usually painless.

Other general symptoms include:

• unexplained weight loss (more than one-tenth of your total weight)
• fever that comes and goes without any obvious cause
• heavy sweating, especially at night
• unexplained itching of your skin

Doctors call this group of symptoms ‘B symptoms’. Some people with lymphoma may have them, but many don’t. Sometimes, lymphoma gets into the bone marrow, causing problems with low blood counts.

Most people who have any of these symptoms will not have lymphoma. They will be suffering from a much less serious problem such as an infection. However, it is always important to see your doctor if you have persistent symptoms.

Causes of lymphoma

We don’t know why most people get lymphoma. There are many different types of lymphoma, it is unlikely there is one single cause of all lymphoma.

There are some known risk factors, which include:

• exposure to high levels of radiation
• exposure to certain chemicals over long periods of time
• infections and viruses, including the human immunodeficiency virus (HIV) and the Epstein-Barr virus in people whose immune system is suppressed.

Other risk factors are still being researched.

Diagnosis of lymphoma

At a general examination a doctor will ask you questions about symptoms you are having. They will check for swelling in your lymph nodes, usually your neck, armpits and groin. The doctor will arrange further testing if they suspect you have lymphoma.

The tests to help diagnose lymphoma may include:

• lymph node biopsy – a small amount of tissue is removed with a needle from a swollen lymph node and examined under a microscope
• physical examination and blood tests
• chest x-rays
• computed tomography (CT) scan – a specialised x-ray for building up three-dimensional pictures of the body
• gallium scan – a short-acting radioactive gallium is injected into the body. This injection outlines organs during the scan. The scan identifies infection, inflammation and tumors.
• positron emission tomography (PET) scan – a small amount of radioactive material is injected. This highlights cancerous areas when viewed with a special scanner
• bone marrow biopsy –a small sample of bone marrow is collected from the hip bone and examined under a microscope for cancer cells.

Test results can take a few days to a week to come back. It is very natural to feel anxious while waiting to get your results. It can help to talk to a close friend or relative about how you are feeling. You can also contact the Cancer Information and Support Service on Tel. 13 11 20 and speak with an experienced cancer nurse.

Stages of lymphoma

The disease is ‘staged’ according to its location and spread. This is important to determine the type of treatment you will need. The stages are:

• Stage I – cancer is found in one lymph node area or one area or organ outside the lymph nodes.
• Stage II – cancer is found in two or more lymph node areas. Or in one area or organ outside the lymph nodes on the same side of the diaphragm (the sheet of muscle slung beneath the lungs that enables breathing).
• Stage III – cancer is found in lymph node areas on both sides of the diaphragm.
• Stage IV – cancer has spread outside the lymphatic system to one or more organs, such as the spleen, liver or skin.

Treatment for lymphoma

Treatment for lymphoma depends on the location and severity of the cancer. Treatment for Hodgkin lymphoma is often very successful, with many people being cured. Non-Hodgkin lymphoma is also curable, but it can be harder to treat.

Treatments are different for Hodgkin lymphoma and non-Hodgkin lymphoma. Some people only need one treatment. Others will need a combination.

Options include:

• Watch and wait – some forms of slow-growing non-Hodgkin lymphoma may not need active treatment when first diagnosed. Regular check-ups will be necessary.
• Chemotherapy – medication to treat cancer by destroying or slowing the growth of fast-growing cancer cells. Either tablets or injections of anti-cancer medication are used. It is usually given as a combination of drugs over several courses.
• Radiotherapy – x-rays are used to target and kill cancer cells. This is used in adults, but rarely used to treat children with lymphoma.
• Steroids – tablets or injections can improve how well your chemotherapy works.
• Targeted therapies (Immunotherapy and Monoclonal antibodies) –.- Immunotherapy is sometimes called biologic therapy. It is a type of cancer treatment that uses part of your immune system to fight blood cancer cells. Monoclonal antibodies are a type of immunotherapy. They work by attaching to specific cancer cells to tell your immune system to destroy those cells. They also slow down cancer cell growth.
• Stem cell (or bone marrow) transplantation – stem cells are the cells that blood cells evolve from. a transplant allows you to have much higher doses of chemotherapy than usual. This helps improve the chances of curing some types of lymphoma or of prolonging remission. The high doses of chemotherapy, sometimes given with total body irradiation (TBI), destroy the bone marrow and stem cells. After the high-dose treatment, you will be given a drip (infusion) of either your own stem cells (autologous transplant) or stem cells from a donor (allogeneic transplant). An autologous transplant may be suggested if the lymphoma comes back or does not respond to the first treatment. Allogeneic transplants have more side effects and complications and this treatment is not suitable for everyone. For further information on stem cell transplants go to Leukaemia Foundation here
• Chimeric Antigen Receptor (CAR) T-cell therapy - is a type of immunotherapy and gene therapy. It involves changing the genetic make-up of some of your own normal T-cells (immune cells). This is so the T-cells recognise proteins on the surface of the cancer cells and attempt to kill them. For further information on CAR T-cell therapy read the Leukaemia Foundation’s factsheet here
• Supportive Care – prevents and treats symptoms. Some examples are blood and platelet transfusions
• Complementary and alternative therapies – when used alongside your conventional cancer treatment, some of these therapies can make you feel better and improve your quality of life. Others may not be so helpful and in some cases may be harmful. The Cancer Council Victoria booklet called Understanding complementary therapies can be a useful resource.

All treatments have side effects. These will vary depending on the type of treatment you are having. Many side effects are temporary, but some may be permanent. Your doctor will explain all the possible side effects before your treatment begins.

Your sexuality and lymphoma

Having lymphoma and its treatment can affect:

• the way you feel about your body
• who you are
• your relationships
• the way you express yourself sexually
• your sexual feelings (your ‘sexuality’)

These changes can be very upsetting.

Your medical team should discuss these issues with you before and during your treatment. If you feel you would like to discuss things further, ask your doctor for a referral to a counsellor or call the Cancer Information and Support Service on Tel. 13 11 20.

If you have a partner, it helps to be as open as possible with them about how you are feeling. The Cancer Council Victoria booklet called Sexuality, intimacy and cancer may also be helpful to read. Read the Leukaemia Foundation’s factsheet about sexual health and blood cancer.

Research into lymphoma

Early detection and better treatment have improved survival for people with lymphoma. Research for lymphoma is ongoing. The Cancer Research UK website has information about research into Hodgkin lymphoma and non-Hodgkin lymphoma.

Caring for someone with cancer

Caring for someone with cancer can be a difficult and emotional time. If you or someone you know is caring for someone with lymphoma, there is support available. The Cancer Council Victoria booklet called Caring for someone with cancer may also be helpful to read.

When a cure isn't possible

If lymphoma has been diagnosed in its later stages, the cancer may have spread to the point where a cure is no longer possible. Treatment then focuses on improving quality of life by relieving the symptoms (this is called ‘palliative’ treatment). Medications can be used to relieve pain, nausea and vomiting. The Cancer Council Victoria booklet called Living with advanced cancer may be helpful to read.

Where to get help

• Your GP (doctor)
• Cancer Council Victoria, Information and Support Service Tel. 13 11 20
• Multilingual Cancer Information Line, Victoria Tel. 13 14 50
• Cancer Council Victoria, My Cancer Guide - Find support services that are right for you.
• WeCan website helps people affected by cancer find the information, resources and support services they may need following a diagnosis of cancer.
• Leukaemia Foundation Tel. 1800 620 420 or (03) 9949 5800