Lymphoma

Cancer is a disease that is caused by the uncontrolled growth of the cells in your body. The type of cancer you have depends on which part of your body is experiencing this abnormal growth. Lymphoma is a form of blood cancer. Specifically, it is a cancer that is caused by the uncontrolled growth of a type of white blood cell called a lymphocyte.

White blood cells help the body fight off infection and come in a few different varieties. The three main categories are granulocytes, monocytes, and lymphocytes. There are two types of lymphocytes: B lymphocytes and T lymphocytes. When you have lymphoma, either or both types replicate uncontrollably. This is what is making you sick.

The following sections will discuss the signs and symptoms of lymphoma, the various types of disease, as well as the causes, risk factors, and what you can do to screen for lymphoma. There will also be sections on treatment, lifestyle changes, myths, and more.

The following are the most common symptoms of lymphoma:

• Enlarged lymph nodes (especially in your neck, armpits, and groin)
• Night sweats
• Tiredness
• Unexplained weight loss
• Anemia

However, it should be noted, that some people with lymphoma show no signs of the disease, at least at first. Others may experience less common symptoms, such as stomach pains, constipation, or decreased libido.

There are over 70 different types of lymphoma; however, all of these can be divided into two main categories: Hodgkin lymphoma non-Hodgkin lymphoma. Non-Hodgkin lymphoma is, by far, the most common.

Hodgkin lymphoma often strikes younger people. There are four types of Hodgkins lymphomas:

• Nodular sclerosis Hodgkin lymphoma (NSHL) – This lymphoma, which is the most common of the Hodgkin lymphomas, primarily affects people under the age of 30.
• Mixed cellularity Hodgkin lymphoma (MCCHL) – This type of lymphoma makes up anywhere between one-fifth and one-quarter of all cases on non-Hodgkin lymphoma. It usually occurs in people over the age of 50, but it can strike younger people, as well.
• Lymphocyte-rich classical Hodgkin lymphoma (LR-CHL) – This is a relatively rare cancer and usually affects older men.
• Lymphocyte-depleted classical Hodgkin lymphoma (LDCHL) – This is also a very rare type of lymphoma and almost always affects people who have HIV, the virus that causes AIDS.

Non-Hodgkin’s lymphomas vary widely, but the most common are as follows:

• Diffuse large B-cell lymphoma (DLBCL) – This is, by far, the most common type of lymphoma. While it is mostly found in people who are over the age of 60, people from any age group can be affected. DLBCL has a very high survivability rate.
• Burkitt lymphoma (BL) – This is a fast-acting lymphoma and is usually caused by an infection from either the Epstein-Barr virus or HIV virus. Sometime, a chromosomal abnormality will cause this disease.
• Follicular lymphoma (FL) – This is a slow-growing (indolent) lymphoma. While this type of lymphoma cannot at present be cured, treatment allows people to live with their disease for many years or decades.
• Mantle cell lymphoma (MCl) – This is one of the rarest types of lymphoma. It is very aggressive and requires immediate treatment.

• The following are some major risk factors that increase one’s chances of developing lymphoma:
• Having an autoimmune disease (such as lupus or Still’s disease)
• Being infected with certain viruses (Epstein-Barr virus and HIV)
• Exposure to radiation
• Exposure to pesticides and fertilizers (farmers have an unusually high rate of lymphoma)
• Exposure to carcinogenic chemicals. A carcinogen is a chemical known to cause cancer. One example is benzene.

Despite these risk factors, most cases of lymphoma are idiopathic in nature. This means that there is no definitive cause or any known way to reduce one’s chances of developing the disease, aside from avoiding radiation and the substances mentioned above.

Some studies have linked diet and exercise to a reduced risk of lymphoma, but there is no conclusive evidence to establish a firm link between diet, lifestyle, and lymphoma.

Most of the time, there is no way to know if someone will get lymphoma. If you work in an occupation that exposes you to pesticides, fertilizers, radiation, or certain toxic chemicals, you may want to discuss being regularly screened for lymphoma with your doctor. This not only includes farmers but people engaged in a number of other occupations, as well. Additionally, people with autoimmune diseases, HIV, or Epstein-Barr infection may also want to be regularly screened.

Most lymphomas are treatable at any stage. However, the earlier a lymphoma is diagnosed, the more likely it is that it will be successfully treated. Lymphomas are divided into four stages.

• Stage 1 – In this stage, the lymphoma is limited to a single lymph node.
• Stage 2 – Stage two lymphomas have spread from the original site to nearby lymph nodes.
• Stage 3 – In stage 3, the lymphoma has spread to more distant lymph nodes.
• Stage 4 – Stage four lymphomas have spread throughout much of the body.

The likelihood that you will survive your cancer varies greatly depending on the type of lymphoma, the stage of the disease, your age, and your overall physical health.

Only a doctor can determine if you have lymphoma, but there are some things that you can do to check yourself if you suspect that you might have this form of cancer. One of the most useful is to check your neck, armpits, and groin area for hard, immovable lumps. If you feel a lump of this sort, it is imperative that you make an appointment with your physician as soon as possible. You should also make an appointment if you have night sweats, fevers, unexplained weight loss, or are feeling unusually ill.

A pathology report is a medical document prepared by a pathologist, a physician that specializes in diagnosing diseases. A pathologist will use blood tests and tissue samples (usually taken from a biopsy) to determine if you have lymphoma. A pathology report is ordered by your physician. Most patients only receive their pathology reports after these reports have been seen by their doctors. However, if you do see your pathology report beforehand, your diagnosis will usually be stated towards the top or bottom. More detailed information about the physiology of your cancer will be found in the body of the document.

Most people with lymphoma will have an abnormal white blood cell count (WBC). A normal WBC is usually 4.5 to 11.0 × 109/L. The WBC will usually be included in a test called a CBC. WBCs are subdivided into separate measurements for the various types of white blood cells, including lymphocytes. A normal lymphocyte count is usually 1000-4000 per mm3 (20–40%) Other values that may be abnormal include your red blood cell count (RBC) and ferritin level.

The treatment you receive depends on the type of lymphoma you have, the stage of the cancer, your age, and some other factors, including your genetic profile. Many lymphomas can be treated with radiation during the early stages. However, most later stages of lymphoma will require chemotherapy, or a combination of chemotherapy, radiation, and immunotherapy.

Immunotherapies are the newest type of treatment for lymphoma. They started being used in the 1990s and are increasing in popularity. Immunotherapy unutilized a genetically modified cell or a protein that either destroys cancer cells directly or allows your body’s immune system to attack the cancer. Some people receive a combination of immunotherapies and other therapies (including chemotherapy and radiation). However, under some circumstances, you may be given immunotherapy as your sole treatment.

Some patients may also need a transplant. This could be either of two types: an autologous stem cell transplant or a bone marrow transplant. These are rather aggressive treatments that involve destroying your own immune system and replacing it with healthy donor cells. During transplants, a patient is severely immunocompromised and is susceptible to infections. Patients undergoing transplants are monitored closely by their physicians.

In addition to the treatments that directly affect your cancer, it is likely that you will be given other medicines that help with pain, alleviate nausea, or stimulate white blood cell counts to protect you from infection. All these medications will be explained to you by your healthcare team.

Continuous testing is a normal part of any cancer treatment. You will almost certainly be given regular blood tests. You may also have regular x-rays, MRIs, PET scans, and other diagnostic procedures. Some people may even need a bone marrow biopsy. Regular testing is needed to make sure you remain as healthy as possible during treatment and to determine if your treatment is working.

Some people may wish to participate in a clinical trial. A clinical trial is a type of experiment where a patient is given a medicine that has not been approved by the FDA (a branch of the federal government that approves medications and medical devices). Trials such as these are needed to determine if a new medication or treatment really works. You can always ask your doctor about clinical trials. Sometimes, if your doctor feels that you are a good candidate for a clinical trial, they may mention it to you during one of your visits. Clinical trials have strict protocols that must be followed. These will be explained to you if you choose to participate. All clinical trials are voluntary. You will not receive experimental medication without your consent.

While you are receiving the above-mentioned treatments, you will almost certainly have to modify your diet and daily routine. This is done to prevent infections during your treatment. Your doctor will explain any changes that need to be made.

Sometime after your treatment you will be given a series of tests, including blood tests, PET scans, and others that will determine if your treatment has been successful. Even if your cancer is eradicated, most people will still suffer some side-effects after their treatment ends. This includes loss of hair, weakened immune systems, etc. This is why patients are regularly monitored by their oncologists for five years or more after their treatment ends.

For most people, life usually returns to normal sometime after their treatment ends. They enjoy the same foods they’ve always enjoyed and engage in their daily routines just as before. Life after lymphoma is usually just as good as life before you became sick.

When a person develops lymphoma, many of their personal relationships come into question. It is important that you inform family and friends about your condition and explain to them that you will be undergoing treatment that will most likely affect your physical appearance and mood.

Patients should ask their doctors if they should use protection during sexual activity. They should also ask if it is advisable to hug and kiss people, wear masks, go to restaurants, etc. Some of these activities may be restricted depending on the treatment you are receiving. It is important that your spouse or other sexual partner be informed about your condition and the course of your treatment so that they can navigate this journey with you and modify their behavior to keep you healthy.

The following are some common myths about leukemia:

• Myth #1 – Hodgkin lymphoma is the “good” lymphoma. 
  There is no such thing as a good lymphoma. All lymphomas are bad. Hodgkin lymphoma does, however, have a higher survival rate than non-Hodgkin lymphoma. 

• Myth #2 – Stage 4 means I’m going to die.  
  Most lymphomas are treatable, even those at stage 4. 

• Myth # 4 – Only old people get lymphoma.  
  Lymphoma can strike at any age, although non-Hodgkin lymphoma tends to affect the elderly more than younger people. 

• Myth #5 Hodgkin lymphoma only affects the young 
  Hodgkin lymphoma can strike at any age, but it is more common in younger people.

• Myth #6 Only people I’m related to can donate blood, marrow, or stem cells. 
  No, blood, marrow, and stem cells can be donated by relatives or non-relatives. The important factor is finding a genetic match. 

• Myth # 7 All lymphomas are curable. 
  While most lymphomas are treatable, many people still die from this form of cancer.  

• Myth # 8 I can treat my lymphoma with diet, exercise, and alternative medicine. 
  No, diet, exercise, and herbs will not cure lymphoma. People who refuse radiation, chemotherapy, or immunotherapy will almost always die.