Lymphoma

Lymphoma is a type of cancer that starts in infection-fighting white blood cells called lymphocytes which are part of the body’s immune system. There are two primary types of lymphocytes: B cells and T cells. Both are designed to recognize and destroy infections and abnormal cells. Lymphoma occurs when either lymphocyte B or T cell undergoes a malignant change and multiplies, eventually crowding out healthy cells and forming tumours. These tumours can form anywhere in the lymphatic system and affect the normal functioning of the immune system.

There are two principal kinds of lymphoma – Hodgkin and non-Hodgkin lymphoma:

• Hodgkin lymphoma (HL, also known as Hodgkin's disease) is more common in young adults aged between 15 and 30 years, and adults over the age of 50.
• Non-Hodgkin lymphoma (NHL) is common in older people.

The different types of lymphoma will in turn determine the symptoms and ultimately the treatment prescribed.

• Age: Getting older is a strong risk factor for lymphoma overall. Most cases are found in people in their sixties or older. However some types of lymphoma are more common in younger people.
• Weakened immune system from a variety of factors including people who are taking certain drugs after undergoing organ transplant.
• People who are infected with certain viruses such as the human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV).

*People who think they may be at risk should discuss this with their doctor.

Patients who have lymphoma may not pay attention to some of the signs that are presented at the beginning as the warning signs are so subtle that it may take some time before they realise that there is anything seriously wrong. Below is a list of the common symptoms of lymphoma:

• Painless lumps in your neck, armpits or groin
• Loss of appetite or rapid weight loss for no known reason
• Excessive sweating at night
• Fever for no known reason
• Skin rash or itchy skin
• Persistent fatigue or weakness
• Coughing, trouble breathing or chest pain
• Pain in the chest, abdomen, or bones for no known reason

Most often these symptoms can also be caused by problems other than cancer, only a doctor can tell for sure. For an accurate diagnosis, a doctor should be consulted if the symptoms above occur.

If you experience any of the symptoms mentioned, the doctor will need to run some tests to find out what is causing the problems. Your doctor may ask about your personal and family medical history.

You may have one or more of the following tests.

Physical Examination

Your doctor checks for swollen lymph nodes in your neck, underarms and groin. He/she may also check for a swollen spleen or liver.

Blood Tests

Your doctor will do a complete blood count to check the number of white blood cells, other cells and substances such as lactate dehydrogenase (LDH). Lymphoma may cause a high level of LDH to be detected.

Chest X-Rays

Your doctor will look out for X-ray pictures indicating swollen lymph nodes or other signs of the disease in your chest.

Bone Marrow Aspiration and Biopsy

A biopsy is the removal of tissue or fluid to look for cancer cells. Your doctor may suggest to either a bone marrow aspiration (removing samples of the bone marrow fluid) or a bone marrow biopsy (removing a small piece of tissue or bone). After the samples are taken, the tissue will be checked for lymphoma cells.

Lymph Node Biopsy

Your doctor may remove an entire lymph node (excisional biopsy) or only part of a lymph node (incisional biopsy). The doctor will then check the lymph node for lymphoma cells through a microscope. Reed-Sternberg cells which are large, abnormal cells may be found in people with Hodgkin lymphoma. People with non-Hodgkin lymphoma do not have Reed-Sternberg cells.

Lumbar Puncture (Spinal Tap)

Your doctor will place a spinal needle (a long, thin needle) into the lower part of your spinal column to remove cerebrospinal fluid (CSF), a liquid around the brain and spinal cord. The fluid drawn will be sent to the lab to look for signs of cancer or if lymphoma has affected the central nervous system.

If lymphoma cells are found, the next step is to run other tests to determine what type and stage of lymphoma. Staging of lymphoma is necessary as the doctor will find out the extent of the cancer spread and this will impact the treatment options prescribed and the patient's outlook for survival.

The doctor may do one of the following imaging tests to learn how widespread lymphoma is in your body:

• CT Scan (Computed Tomography) - The CT scan is a special type of x-ray test that makes detailed pictures of the body. The doctor may use the CT scan to look for lymphoma in the abdomen, pelvis, chest, head and neck.
• PET Scan (Positron Emission Tomography) - Your doctor may use the PET scan to look for lymphoma all over the body as it will be able to tell whether a swollen lymph node has cancer in it