Lymphoma
Lymphoma is a type of blood cancer that starts in white blood cells called lymphocytes, affecting the lymphatic system that helps protect your body from infection. It’s the fifth most common type of cancer, with over 14,000 people diagnosed each year in the UK alone, but thanks to modern treatments, many patients can live long and healthy lives.
Table of contents
- What is lymphoma?
- Main types of lymphoma
- Common symptoms
- Causes and risk factors
- How lymphoma is diagnosed
- Treatment options
- Outlook and survival
- Living with lymphoma
What is lymphoma?
Lymphoma is a blood cancer that develops when lymphocytes – a type of white blood cell – grow out of control. Lymphocytes are part of your immune system, which helps your body fight infection[1][2].
These cells travel around your body in the lymphatic system, which includes lymph nodes (glands) found in your neck, armpits, groin, chest, and abdomen. The lymphatic system carries a fluid called lymph and produces cells that help protect you from disease. Because lymphocytes travel throughout your body, lymphoma can develop in many different places[3][5].
In lymphoma, something goes wrong with how your lymphocytes develop. The cells don’t work properly and can multiply without control. These abnormal cells may build up and cause tumors in the lymph nodes or collect in other parts of the body[1][3].
Lymphoma represents approximately 5% of all cancers. While it can affect people at any age, the overall survival rate is estimated to be 72% at five years, and outcomes continue to improve with advances in treatment[4][2].
Main types of lymphoma
There are two main categories of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma, with more than 70 different subtypes in total. The type of lymphoma you have affects your treatment and outlook[2][3].
Hodgkin lymphoma
Hodgkin lymphoma accounts for about 10% of all lymphoma cases. It is identified by the presence of specific abnormal cells called Reed-Sternberg cells. This type usually begins in lymph nodes of the neck, chest, or under the arms, and tends to progress in an orderly and predictable way to other lymph node sites[1][4].
Hodgkin lymphoma most commonly affects people between the ages of 20 to 39 and those at or over age 65. Men are slightly more likely to develop it than women. Thanks to significant advances in treatment, Hodgkin lymphoma has been transformed from a once fatal disease into a highly curable condition. The five-year survival rate in the United States is 85%[2][8].
Non-Hodgkin lymphoma
Non-Hodgkin lymphoma represents about 90% of all lymphoma cases. If Reed-Sternberg cells are not detected, the lymphoma is considered non-Hodgkin. This category includes many different subtypes, most of which are B-cell lymphomas, named after the type of white blood cell affected[2][8].
Non-Hodgkin lymphoma typically affects people between ages 60 to 80 and is more common in men than in women. Individual subtypes behave, spread, and respond to treatment differently from one another. The five-year survival rate for non-Hodgkin lymphomas in the United States is 69%[2][10].
Aggressive versus indolent lymphomas
For treatment purposes, lymphomas are also described as either aggressive (fast-growing) or indolent (slow-growing). Aggressive lymphomas develop quickly and require prompt treatment, while indolent forms grow slowly over time. Although indolent lymphomas are not currently curable, patients may live for 20 years or more following diagnosis, and treatment may not be necessary immediately[2][13].
Common symptoms
Many lymphoma symptoms are similar to symptoms of other, less serious illnesses. Having these symptoms doesn’t mean you have lymphoma, but you should talk to a healthcare provider if you notice changes in your body that don’t go away within a few weeks[2].
A common symptom of lymphoma is painless swelling of one or more lymph nodes. You may notice lumps in your neck, collarbone, armpits, groin, or other parts of your body that don’t go away within a few weeks. Sometimes these swollen lymph nodes can press on organs inside your body, causing pain in your chest, coughing, breathlessness, or pain in your stomach area[2][3].
Other common symptoms include:
- Persistent fatigue – feeling very tired day after day even after getting enough sleep
- Fever – a temperature that stays above 103 degrees Fahrenheit (39.5 degrees Celsius) for more than two days, or a fever that keeps coming back
- Drenching night sweats – sweating so intense that you wake up to find your pajamas and sheets soaking wet
- Unexplained weight loss – losing 10% of your total body weight over six months without dieting or exercise
- Shortness of breath – feeling as if you can’t get enough air into your lungs
- Itching skin
- Loss of appetite
The sweats are most common at night, and enlarged lymph nodes are usually painless[2][10].
Causes and risk factors
Lymphoma happens when white blood cells in your lymphatic system change (mutate) into rapidly growing cancer cells that don’t die. Like most cancers, the genetic changes that cause lymphoma usually happen spontaneously, without an identifiable cause. However, research has identified several factors that may increase your risk[2][4].
Infections and viruses
Certain infections may increase the risk of developing lymphoma. These include viruses such as HIV (human immunodeficiency virus), Epstein-Barr virus (which causes mononucleosis), and human T-cell lymphotropic virus. Bacteria like Helicobacter pylori and persistent infections with other microorganisms have also been linked to specific types of lymphoma[2][4].
Weakened immune system
Your risk increases if your immune system is weakened by other conditions or medical treatments. For example, people who have organ transplants take immunosuppressant medication to keep their bodies from rejecting the transplanted organ. People living with HIV/AIDS or those with genetic immunodeficiency disorders also have an increased risk[2][4].
Autoimmune diseases
Having an autoimmune disease – a condition where your immune system accidentally attacks your body instead of protecting it – may increase your risk. Examples include inflammatory bowel disease, rheumatoid arthritis, and Sjögren’s syndrome[2][4].
Other risk factors
Additional factors that may increase risk include:
- Older age
- Being male (men are slightly more likely than women to develop lymphoma)
- Family history of lymphoma
- Occupational exposure to herbicides, pesticides, or certain chemicals
- Tobacco smoking
- Diet high in meats and fats
- Geographic location (some types are more common in specific regions)
Having a family history suggests there may be some genes that make you more susceptible, but lymphoma is not a disease that’s passed down directly in families[2][4][10][11].
How lymphoma is diagnosed
Healthcare providers diagnose lymphoma through several steps. They will start with a physical examination to evaluate potential symptoms, particularly checking for swollen lymph nodes in your neck, armpits, groin, and other areas[2].
Biopsy
If enlarged lymph nodes are present, diagnosis is usually confirmed by a lymph node biopsy. This involves removing tissue from a lymph node for examination by a specialist called a pathologist. The pathologist looks at the tissue under a microscope to determine if cancer cells are present and, if so, what type of lymphoma it is[2][10].
Additional tests
Once lymphoma is diagnosed, additional tests help determine if and where the cancer has spread. These may include:
- Blood tests – to check your overall health and look for signs of how the disease is affecting your body
- Bone marrow biopsy – to see if lymphoma has spread to your bone marrow
- Medical imaging – such as CT scans, PET scans, or ultrasound to see detailed pictures of the inside of your body and identify where lymphoma is located
- Urine tests
Lymphoma most often spreads to the lungs, liver, and brain. Understanding the extent of the disease helps your healthcare team determine the best treatment plan[2][8].
Treatment options
Treatment for lymphoma depends on the type and stage of the disease, as well as your age, overall health, and tolerance for specific therapies. Each person’s lymphoma is unique, and your medical care team will recommend a treatment plan specifically designed for you[13][15].
Active surveillance (watch and wait)
If you have a slow-growing lymphoma with no symptoms, your doctor may recommend active surveillance, also called “watch and wait.” This means you don’t receive treatment right away, but your health and disease are carefully monitored through regular checkup visits. Treatment begins only when it becomes necessary. This approach is offered when your doctor believes there’s no added benefit to starting treatment immediately[13][14][17].
Chemotherapy
Chemotherapy uses drugs to kill cancer cells or stop them from growing. It’s a widely used treatment for lymphoma and may be used alone or combined with other treatments. You may receive chemotherapy through a drip into a vein (intravenously), in pill form, or sometimes as an injection. Treatment is usually given over several months with periods of rest in between to allow your body to recover[13][14][17].
Radiation therapy
Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells in a specific area. It’s most often used to treat early-stage lymphoma where the cancer is only in one part of the body. The treatment targets affected lymph nodes or lumps. It’s normally given in short daily sessions, usually for no more than three weeks, and you typically don’t need to stay in hospital between appointments[13][14][16].
Immunotherapy and targeted therapy
These treatments work with or enhance your immune system to fight lymphoma. Immunotherapy uses the body’s own immune system to attack cancer cells. Targeted therapy uses drugs that target specific proteins or genetic changes that cancer cells have, which normal cells don’t have[13][17].
Monoclonal antibodies are a type of targeted therapy commonly used for lymphoma. These are man-made molecules that recognize and bind to the surface of cancer cells. One example is rituximab, which seeks out and locks onto a protein receptor found on B cells, causing the lymphoma cell to die. Monoclonal antibodies may be combined with chemotherapy drugs or radioactive material to deliver treatment directly to cancer cells[16][17].
CAR T-cell therapy
CAR T-cell therapy is an advanced form of immunotherapy. White blood cells are removed from your body and genetically changed in a laboratory to recognize and kill cancer cells. The re-engineered cells are then infused back into your body to fight the disease. This cutting-edge treatment has shown high success rates and has significantly changed outcomes for patients with aggressive forms of lymphoma[15].
Stem cell transplantation
Stem cell transplant, also known as bone marrow transplant, may be an option if lymphoma returns after initial treatment or doesn’t respond to other therapies. This treatment uses higher doses of chemotherapy or whole-body radiation to destroy as many lymphoma cells as possible. Then, diseased bone marrow is replaced with healthy stem cells (from you or a donor) that help grow new bone marrow[13][16].
Clinical trials
Clinical trials test new treatments and may provide access to cutting-edge therapies. They’re appropriate for patients at all stages of disease. By participating in a clinical trial, you may or may not get access to the newest therapies, but you will receive quality care in a carefully controlled and supportive environment. Talk to your healthcare team about whether joining a clinical trial is right for you[8][13].
Outlook and survival
The outlook for lymphoma depends on the specific type and stage of the disease. Many lymphomas can be successfully treated, and some can be cured. Treatment is highly successful for the majority of patients[1][2].
For Hodgkin lymphoma, the five-year survival rate in the United States is 85%. Hodgkin lymphoma is one of the most curable types of cancer, and most patients with Hodgkin lymphoma can live long and healthy lives following successful treatment[8][13].
For non-Hodgkin lymphoma, the five-year survival rate in the United States is 69%. While some indolent forms are not currently curable, the prognosis is still very good. Patients with slow-growing lymphomas may live for 20 years or more following an initial diagnosis[10][13].
Overall survival rates for lymphoma continue to improve thanks to advances in treatment and ongoing research. The average five-year survival across all types is estimated at 72%, and outcomes are steadily getting better[4].
Living with lymphoma
A lymphoma diagnosis can be overwhelming, bringing a range of emotions from disbelief to anxiety to fear. All these feelings are normal. Although it takes time and may involve making changes to your everyday life, most people adjust well to life with and after lymphoma and find a “new normal”[18][20].
Building your support system
Having a strong support system is crucial. Communicate your fears and concerns with family, friends, doctors, and counselors. Find a medical team you feel comfortable with and that you trust. You’ll spend a great deal of time with your healthcare providers, and you deserve to feel fully heard and understood by them. Always feel comfortable asking questions or getting a second opinion[19][20][23].
Consider joining a support group of people who have had similar experiences. Talking with trusted friends and family, your healthcare team, and others close to you can ease the challenges and make it easier for you to manage the ups and downs of living with lymphoma[23].
Practical planning
Making a plan, even a simple one, can help you feel more in control when so much seems uncertain. Consider planning for transportation to and from appointments, talking to your employer about work accommodations, and arranging childcare if needed for treatment days. Give thought to what would be most helpful when others ask how they can support you[20].
Taking care of yourself
Don’t forget about your basic needs. A healthy lifestyle – including eating a diet rich in fruits and vegetables, staying active with regular exercise, getting enough sleep, and managing stress – has many benefits both physically and emotionally. It can help prepare you for treatment, reduce the risk of side effects, and lower the likelihood of developing other health problems in the future[18][23].
Emotional support
Feeling sad or depressed is not unusual for people living with cancer. Watch for signs of depression, such as sleeping more or less than usual, feeling a lack of energy, crying, or inability to concentrate. If needed, ask for a referral to a mental health professional who can help through talk therapy, medications, or both[23].
After treatment
Be patient with yourself as you adjust to life after treatment. Attend follow-up appointments and routine health checks, and talk to your medical team or healthcare provider if you have concerns. Many people treated for lymphoma go on to lead active, fulfilling lives. Living a healthy lifestyle during and after treatment can improve your quality of life and help reduce the risk of long-term health effects[18][22].
