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Lymphoma: Symptoms, Diagnosis and Treatment

  • A cancer of the lymphatic system that causes white blood cells to reproduce uncontrollably
  • Symptoms include swollen lymph nodes, fever, and chills
  • Treatment includes chemotherapy, radiation therapy, surgery, and immunotherapy
  • Involves hematology and Yale cancer center

Overview

The lymphatic system, an important part of your immune system, is a network of vessels (tubes) and glands (called lymph nodes) that allow waste, toxins and other unwanted substances to leave your organs. White blood cells that fight infections and promote healing circulate throughout the lymphatic system. Lymphoma is a type of cancer that affects the lymphatic system. It arises when white blood cells, called lymphocytes, reproduce rapidly and uncontrollably, for no useful purpose.

There are two primary categories of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma. Together, these account for more than half of all diagnosed blood cancer cases in the United States. Lymphomas are the third most common cancer for children under the age of 14, and the most common cancer for children ages 15 to 19. Though a diagnosis of cancer is never good news, lymphoma is one that can be treated. Effective treatments include chemotherapy, radiation therapy, immunotherapy and other targeted therapies.

Yale medical professionals and support teams are available around the clock to answer questions and provide solutions to issues that arise before, during and following treatment. Our goal is to listen to patients and their families and provide the best care for people with cancer.

What is lymphoma?

Lymphoma is cancer of the lymphatic system, particularly lymph nodes. Lymphoma occurs when abnormal white blood cells, known as lymphocytes, irregularly reproduce and take up space in the body’s lymph nodes, disrupting their normal function. Lymph nodes are located all over your body, including your neck, armpits, groin, chest and abdomen. Because of this, lymphoma can develop anywhere in your body.

How many kinds of lymphoma are there?

There are two primary categories of lymphoma: Hodgkin lymphoma, named after the doctor who discovered the disease, and non-Hodgkin lymphoma, a category that includes over 60 different types of lymphoma.

  • Hodgkin lymphoma (HL) is rare, affecting only about 12 percent of people with lymphoma. It rarely spreads to other organs in your body, and is considered to be a very treatable type of lymphoma. Among other features, HL can be identified by the presence of Reed-Sternberg cells, which are large, abnormal lymphocytes that increase in number as disease severity increases.
  • Non-Hodgkin lymphoma (NHL) is a category of cancers that affect three types of white blood cells in the lymphatic system: B-lymphocytes (B cells), T-lymphocytes (T cells), and natural killer cells (NK cells). B-cell lymphomas are the most common, representing as much as 85 percent of all NHL. NHL can sometimes spread to other parts of the body including the liver, brain and bone marrow. Slower-progressing NHL is referred to as indolent NHL, while rapidly progressing NHL is referred to as aggressive NHL. 

Who is at risk for lymphoma?

The risk factors for lymphoma are not fully understood, though it is believed that blood cancers develop from a combination of genetic and environmental factors. In general, lymphoma is more common in men than in women. In the U.S., white men and women are more likely to be affected than other races. Epstein-Barr, HIV, and human T-cell lymphoma/leukemia virus infections are known risk factors for developing lymphoma. Age can also play a role—young adults in their 20s and people over the age of 55 are most likely to develop HL, whereas older adults over the age of 60 are more likely to develop NHL. Additional risk factors for NHL include exposure to certain chemicals (including benzene and chemotherapy drugs), radiation, a weakened immune system, autoimmune disease, and a high-fat diet and/or obesity. 

What are the symptoms of lymphoma?

Symptoms of lymphoma include painless, swollen lymph nodes, fever, chills, night sweats, itchy skin, fatigue, weight loss, and cough or shortness of breath. NHL may present additional symptoms, including pain in the chest, abdomen and bones, a swollen abdomen and the sensation of feeling full even after eating only a small amount. 

How is lymphoma diagnosed?

Collecting a thorough past, present and family medical history is the first step in diagnosing lymphoma. During the physical exam, your doctor will feel for swollen lymph nodes and other commonly affected areas, including your spleen and liver. If lymphoma is suspected, a lymph node biopsy will be performed by a surgeon to remove the affected node. A biopsy will not only confirm whether you have lymphoma, but also what type you have. Additional tests including bone marrow tests, blood tests and imaging procedures (e.g., chest X-ray, CT scan, PET scan, and MRI) can provide further information on the type and spread of lymphoma. 

What are the treatments for lymphoma?

Treatments for lymphoma have improved significantly over the last several decades. Treatment for your lymphoma will depend on the type of lymphoma you have, your age, how fast the cancer is progressing, and whether the cancer has spread to other parts of your body. Treatments include the following:

  • Chemotherapy refers to anticancer drugs that are given to kill and halt the production of cancer cells. These drugs are often used in various combinations to attack the cancer cells using different mechanisms.
  • Radiation therapy uses high-energy rays to target and kill cancer cells.
  • Other targeted therapies use drugs introduced specifically to kill cancerous blood cells without harming normal cells.
  • Hematopoietic stem cell transplantation (previously called bone marrow transplantation) refers to healthy blood stem cells that are infused into your body to trigger production of healthy blood following therapy that has killed cancer cells.
  • Surgery, though rare, is sometimes used to remove affected lymph nodes or lymph organs that contain too many cancer cells for other therapies to be effective.
  • Immunotherapy is used to activate the immune system to specifically kill cancer cells.

What is Yale Medicine’s approach to treating lymphoma?

Yale Medicine has a collaborative team of medical professionals who provide patients with comprehensive lymphoma care from diagnosis through treatment, with the goals of comfort and cure.

A typical lymphoma treatment team includes experts trained in both adult or pediatric cancer care who are oncologists, oncology nurses, surgeons, radiologists, pathologists, geneticists, social workers, psychologists, radiation oncologists, pharmacists, child life experts, technicians, complementary care providers and therapists.