Lymphoma

Lymphoma is a cancer that starts in cells originating from the body's immune system.

What is Lymphoma?

The lymphatic system is a segment of the circulatory system and an important part of the immune system, comprising a network of lymphatic vessels that carry a clear fluid called 'lymph' towards the heart. In Malaysia, lymphoma is the 6th most common cancer among Malaysians.

The lymph system is predominantly made up of cells called lymphocytes, a type of white blood cells.

Types of lymphoma

There are two main types of lymphoma, known as Hodgkin Lymphoma and Non-Hodgkin Lymphoma (NHL). Generally NHL is more common than Hodgkin Lymphoma.

Hodgkin lymphoma usually starts in B lymphocytes.

Non-Hodgkin Lymphoma can develop from either type of lymphocyte, but B-cell lymphomas are much more common

Hodgkin Lymphoma

Hodgkin Lymphoma can begin with a painless swelling of the neck, armpit or groin. These are swollen (enlarged) lymph nodes.

Lymph nodes can swell when an infection sets in but will usually go back to normal over a short period of time. With lymphoma, the lymph nodes typically swell up over a long period of time and usually at a slow pace. It may take months or years before being noticed. In some cases, however, they grow very quickly.

While swollen lymph nodes typically do not hurt, there are cases where they can be painful.

General symptoms

About a quarter of patients display the following symptoms:

  • heavy sweating, especially at night
  • high temperatures that come and go with no obvious cause (often overnight)
  • loss of weight over a short period of time
  • itching which may worsen after alcohol intake
  • cough or shortness of breath
  • tummy (abdominal) pain or vomiting after alcohol intake

Other possible symptoms*

Other symptoms may arise depending which areas are affected. Swollen lymph nodes can:

  • press on the nerves and cause pain
  • cause swelling in arms or legs by blocking the flow of lymphatic fluid around the body
  • cause yellowing of the skin and eyes (jaundice) by blocking the flow of bile from the liver

*The above are not common symptoms but they can happen. You may also have small lumps (nodules) on your skin, usually near the swollen lymph nodes.

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma can develop from either type of lymphocytes, but B-cell lymphomas are much more common. Different types of lymphoma can develop from each type of lymphocyte based on how mature the cells are when they become cancerous as well as other contributing factors.

Symptoms may include*:

  • coughing, difficulty swallowing or breathlessness (if the lymphoma is in the chest area)
  • indigestion, tummy pain or weight loss (if the lymphoma is in the stomach or bowel).
  • If NHL spreads to the bone marrow, it can reduce the number of blood cells. This can cause:
    • tiredness (too few red blood cells)
    • difficulty fighting infections (too few white blood cells)
    • bruising or bleeding (too few blood-clotting cells, called platelets)

*Other symptoms may be similar to Hodgkin Lymphoma.

Risks of lymphoma

Age

Although NHL can happen at any age, most cases (60%) are diagnosed in people aged 65 and over. Overall, NHL is slightly more common in men than in women.

Hodgkin Lymphoma occurs most often in early adulthood (between ages 15 - 40, and especially in the 20s)

Weakened immune system

People whose immune system are compromised are more likely to develop lymphoma. The immune system can be adversely affected by taking drugs to stop organ rejection after a transplant, contracting HIV or AIDS, being born with a rare medical condition that affects immunity or having any autoimmune diseases.

Infections

There have been some infections that have been recorded to increase the risk of lymphoma, namely:

  • T cell lymphoma virus 1 (HTLV1)
  • Epstein Barr virus
  • Helicobacter pylori

Family history

Having a parent, brother or sister diagnosed with NHL slightly increases your risk. The general risk is still small.

Previous cancer and treatment

Some other types of cancer and treatment may also increase your risk of NHL. You might also be at a higher risk if you have had melanoma.

Diagnosing lymphoma

The most important initial assessment is a thorough history background check and a complete physical examination, paying attention to other medical and surgical issues in the individual. Physical examination also aids in looking for the best possible site for lymph node biopsy, with minimal morbidities.

After a solid pathological diagnosis is achieved, the individual will have the following tests performed for completion of clinical staging and risk stratification:

  • Blood test to determine organ function
  • Imaging, commonly whole-body CT scan and occasionally PET scan
  • Bone marrow examination

The initial assessment will give the treating doctor a complete view of the disease, considering the stage of disease, co-morbidities, and prognostic factors. Such information is vital in designing a treatment plan.