Lymphocytes, found in the blood and lymph tissue, are a type of white blood cells that provide immunity and help protect the body against pathogens. The lymphatic system consists a network of lymphatic vessels, lymph and lymph nodes and performs vital functions, including the one related to producing immune cells. Hence, lymphoma is a type of blood cancer that affects lymphocytes of the lymphatic system.
Lymphoma is classified into two types:
Hodgkin’s lymphoma: It is characterized by the presence of a particular type of cell called Reed-Sternberg cell in the blood. This kind of lymphoma is one of the most curable cancers, particularly when detected early.
Non-Hodgkin’s lymphoma: The majority of lymphomas are non-Hodgkin’s lymphoma. In this type, the body produces abnormal levels of T and B lymphocytes (immunity booster cells). The lymphoma can be slow-growing (indolent) or fast-growing (aggressive)
The extent to which a cancer has developed is classified and determined by a method termed staging. It considers the location, spread, and symptoms of the tumor. Ann Arbor staging is the method used for staging lymphomas. The cancer is classified into four main stages depending on how extensive the tumor is and on the location of the tumor.
Stage I – tumor located in a single lymph node and the surrounding area with no symptoms
Stage II – tumor located in multiple lymph regions on the same side of diaphragm, either above or below
Stage III – tumor located in multiple lymph regions on both sides of the diaphragm
Stage IV tumor is widespread involving one or more organs (liver, bone marrow, lungs) beyond lymph node (extranodal)
This staging system further classifies lymphoma into various categories and is denoted by suffixing different letters:
A – absence of symptoms
B – presence of symptoms
In cancer, there is abnormal, and uncontrolled cell growth. In a healthy body the cells grow, die and are replaced in a very well-ordered way. Environmental or internal factors may damage or change the genetic material of cells resulting in cells that don’t die and continue to multiply until a massive cancer or a tumor develops. Here’s everything you need to know about cancer. Blood cancers usually start in the bone marrow and affect blood cell production. The typical process of development of blood is hindered by abnormal cells. In lymphoma, the cancerous cells prevent the blood from performing the routine function of fighting off infections.
Cancer like any other disease has both intrinsic and extrinsic causes. Tobacco use, drinking, exposure to harmful radiation, genetics, a sedentary lifestyle, obesity, aging and even unsafe sex can cause cancer. The exact cause of lymphoma is unknown.
Non-Hodgkin’s lymphoma has been observed to develop in people with weakened immune system, including people with HIV.
Factors which increase the likelihood of non-Hodgkin’s lymphoma are B-cell–activating autoimmune diseases, hepatitis C virus–positive status, family history, and greater body mass index (BMI) as a young adult. Factors like higher socioeconomic status, medical history of any atopic disorder and increased recreational sun exposure have been significantly associated with decreased risk of the cancer1. An increase in the incidence of lymphoma has also been noticed in individuals who had Q fever2.
Many studies have now established a link between substances in everyday products and cancer. Lindane is widely used in agriculture and in treating human lice and scabies. A new WHO study has now linked insecticide lindane to non-Hodgkin Lymphoma. There was strong evidence it can lead to oxidative stress that damages cells in the body and can suppress the immune system to a certain extent. Hair dyes and DDT (dichlorodiphenyltrichloroethane) too have been linked to non-Hodgkin’s lymphoma3, 4. Dry cleaning has side effects too! Dry cleaning workers are at a larger risk of suffering from non-Hodgkin’s lymphoma, sperm and menstrual disorders, lowered fertility and spontaneous abortion. A study published in the Journal of Occupational and Environmental Hygiene in 2013 suggests that continuous occupational exposure to dry cleaning solvents may increase the risk of genetic damage in dry cleaning workers.
Awareness of the symptoms of cancer could be life-saving. Lymphoma is characterized by solid tumors in the body’s lymphatic system. Both types of lymphoma can occur in children as well as in adults. The most characteristic symptom of a lymphoma is painless swelling of the lymph nodes usually in the neck, groin, or the armpit that appear without a known cause. It can spread to nearby lymph nodes and later to the spleen, liver, bone marrow or other organs. According to a study, large, painless and persistently swollen neck glands indicate a high risk of lymphoma. Other symptoms may include fatigue, loss of appetite, night sweats, fever and chills that come and go, itching all over the body that cannot be explained and unexplained weight loss. Non-Hodgkin lymphoma may also show signs and symptoms of coughing or shortness of breath, abdominal pain or swelling, personality changes, headache, concentration problems, or even seizures if the brain is affected.
The diagnosis depends on the stage of lymphoma and nature of the existing symptoms. Doctors may inspect lymphoma with a physical examination. A biopsy can help in definitive diagnosis.
The best course of action in the management of lymphoma depends on the stage of the cancer. Certain types of non-Hodgkin’s lymphoma may require no treatment at all. In most cases, treatment usually involves chemotherapy or radiotherapy or both. In some cases, stem cell transplant and immunological therapy with monoclonal antibodies are the other treatment options. Surgery may also be useful in some. Blood or platelet transfusions may be required if blood count is low.
In chemotherapy, anticancer drugs are used to destroy cancer cells, stop them from spreading and slow their growth. Radiotherapy uses ionizing radiation to kill cancer cells and shrink tumors. Stem cells are the ‘basic cells’ of our body they have the power to mature into any kind of tissue cell in the body. In stem cell therapy, the harvested stem cells are administered into the body. These cells migrate to the site of the injury and transform themselves to form new tissue cells that can replace the damaged ones. Monoclonal antibodies are made in a lab and used in the treatment of cancer. They may be used alone or with chemotherapy drugs/radioactive substances. They hunt for antigens unique to cancer cells and deliver the drugs directly to the cells. This pursuit kills the cancer cells without harming the healthy ones.
About 37 anticancer drugs are claimed to induce second cancer in survivors. According to studies, the risk of second cancers in survivors of Hodgkin’s lymphoma is 2-3 times greater than other cancer survivor patients. The chances are also higher than 20 percent in the first 20 years after treatment. There may be a risk of several cancers like lung cancer, kidney cancer and melanoma (skin cancer) in survivors of non-Hodgkin lymphoma (NHL).
The content is been verified by Dr. Anupam Sachdeva, Chairman, Pediatrics, Director, Pediatric Hematology Oncology and Bone Marrow Transplantation Institute For Child Health, Sir Ganga Ram Hospital, New Delhi.