Lymphomas

Overview

Lymphoma is a hematologic (blood) cancer that arises in the lymphatic system, which is a critical part of the immune system. Blood cancers affect the blood, bone marrow and lymph nodes, and they may or may not create solid tumors. Lymphoma is the most common blood cancer in the United States.

Lymphoma develops when normal lymphocytes (a type of white blood cell) transform into abnormal cancer cells that reproduce uncontrollably. As these cancer cells multiply, they collect in the lymph nodes, bone marrow, spleen, tonsils, adenoids or thymus. The cancer cells begin to outnumber normal cells, which can cause the lymph nodes, spleen or other organs to enlarge.

Hodgkin and non-Hodgkin lymphoma are the two main types of lymphoma. Both types begin in the lymphatic system, but Hodgkin lymphoma is less common than non-Hodgkin lymphoma. Hodgkin lymphoma can begin in any lymphoid tissue, such as lymph nodes, spleen, bone marrow, thymus, adenoids, tonsils and the digestive tract. It most commonly begins in the lymph nodes in the upper half of the body, including the neck, chest and under the arms. Hodgkin lymphoma is characterized as a cancer that spreads from one group of lymph nodes to others in an orderly progression.

Non-Hodgkin lymphoma (NHL) is the most common cancer of the lymphatic system. NHL occurs when T-cells, B-cells and natural killer (NK) cells grow uncontrollably. It may be found in any of the lymphoid tissues, and it spreads in a less orderly way than Hodgkin lymphoma. More than 60 subtypes of NHL exist. These subtypes vary in microscopic appearance, molecular features, how they affect the body and how they are treated. They also grow and spread at different rates. Slow-growing types are called indolent lymphomas while fast-growing types are called aggressive lymphomas.

The Lymphatic System

To fully understand lymphoma, it’s important to have a general knowledge of the lymphatic system. The lymphatic system is a network of tissues and vessels that carry fluid, called lymph, throughout the body. Lymph contains lymphocytes, a type of white blood cell, that attack infectious agents. The lymphatic system is composed of lymph nodes, spleen, thymus, adenoids and tonsils. Lymph nodes are located throughout the body with larger concentrations near the abdomen, groin, pelvis, underarms and neck.

The two main types of lymphocytes that can develop into lymphomas are B-lymphocytes (B-cells) and T-lymphocytes (T-cells):

  • B-cells produce protein antibodies that attach to infectious organisms, such as bacteria and viruses, marking them for destruction.
  • T-cells attack infectious organisms directly and play a part in controlling the immune system.

Both B-cells and T-cells can transform into lymphoma cells. However, in the United States, B-cell lymphomas are much more common.

 

How Lymphoma is Treated

Treating lymphoma depends on the stage of the disease, including the extent of the lymphoma, the disease subtype, presence of symptoms and other general factors, such as the patient’s age, gender and overall health. A variety of treatment options exist (see Common Forms of Lymphoma).

  • Watchful waiting is common for people who do not currently have symptoms and includes regular doctor visits along with frequent communication to discuss any new symptoms. This approach is sometimes used with women who are pregnant and have been diagnosed with a lymphoma.
  • Chemotherapy may be used alone or in combination with radiation therapy, depending on the type and stage of the lymphoma. It is also often given in high doses before stem cell transplantation.
  • Immunotherapy is a type of treatment that uses the body’s own immune system to find and destroy cancer cells. Your body's immune system isn't always able to handle something as intense as cancer on its own, so doctors build on the healing capabilities of your immune system with immunotherapy.
  • Radiation therapy may be used to treat some early-stage lymphomas or in combination with chemotherapy for more advanced disease. It can also be used before stem cell transplantation.
  • Targeted therapy is treatment with drugs or other substances that stop cancer growth by interfering with the specific molecules involved in the development of tumor cells.
  • Stem cell transplantation may be appropriate for some people with lymphoma and is usually given after high-dose chemotherapy or radiation therapy.
  • Surgery may be appropriate for some types of lymphoma either to remove a tumor that has developed or to remove the spleen. This is not used for the majority of lymphomas.

Following are other complementary procedures that your doctor may recommend for your type of lymphoma.

  • Antibiotic therapy uses medications to treat infections and the cancer.
  • Plasmapheresis uses a machine that filters plasma out of the blood. Normal blood cells, either from a donor or a plasma transplant, are returned to the patient’s blood. This procedure is recommended when the blood becomes too thick with antibodies.

Additional Resources

 

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