Understanding Lymphoma: Most of these Immune System Cancers are Curable
Hodgkin’s lymphoma and non-Hodgkin’s lymphoma are cancers of the lymphatic system, which is part of the body’s immune system. According to the American Cancer Society, about 9,300 cases of Hodgkin’s lymphoma occur in the U.S. each year. Non-Hodgkin’s lymphoma is far more common, with about 69,700 cases diagnosed each year, accounting for about four percent of all cancers.
“The good news is, in most cases, lymphomas are curable,” said Vandana B. Sharma, M.D., Ph.D., a medical oncologist and medical director of the Cancer Genetics Program at Washington Hospital.
“Lymphomas start in cells called lymphocytes – a type of white blood cell,” Dr. Sharma explained. “The lymphatic system is like a highway with ‘rest stops’ called lymph nodes along the highway. These nodes become swollen as the white blood cells that help the body fight infections stop at the nodes. But a person can also develop swollen lymph nodes if the lymphocytes become cancerous and grow abnormally. A diagnosis of lymphoma may be suspected when a person has swollen lymph nodes in the neck, armpit or groin in the absence of infection.”
Dr. Sharma notes that people may develop additional symptoms with lymphoma, including:
- Recurrent fevers and chills
- Unexplained weight loss, as much as 10 percent or more of body weight
- Drenching night sweats, generally more severe than night sweats commonly experienced during menopause
“Fatigue can also be a symptom of lymphoma, but fatigue can be a symptom of so many other things,” she added. “Diagnosing lymphoma requires a physical exam to determine the size of the lymph nodes and whether or not the liver and spleen are enlarged. Blood and urine tests help rule out infections or other diseases, and imaging tests and lymph node biopsies are used to confirm a lymphoma diagnosis. Other types of cancer can spread to the lymph nodes, but cancers that start elsewhere and spread to the lymph system are not lymphomas.”
Lymphomas can affect men and women across a wide range of ages. There are some people who are more at risk of developing lymphoma, however.
“People who have a compromised immune system may be more at risk for lymphoma,” said Dr. Sharma. “That includes people with HIV or chronic immune disorders such as lupus. Also, people who underwent an organ transplant or use medications that suppress the immune system are more susceptible to lymphoma. Some rare familial disorders may also lead to lymphoma, but they are not well understood yet, and there is no genetic testing currently available for them.”
Because Hodgkin’s lymphoma and non-Hodgkin’s lymphoma involve different cell types, they behave and respond to treatment differently. In addition, there are three main subtypes of non-Hodgkin’s lymphoma: aggressive, intermediate and indolent (a synonym for “lethargic” or “inactive”).
“Indolent lymphoma usually lays dormant for a while and then becomes active,” Dr. Sharma said. “People who have indolent lymphoma may go for many years with a painless swollen lymph node and no other symptoms, so they don’t realize there is a problem.”
People with indolent lymphoma may not require treatment for years, and a wait-and-see approach with regular checkups may be recommended. For aggressive or intermediate lymphoma, however, early treatment is key. Treatment options depend on the type of lymphoma and the extent – or stage – of the disease.
“Many chemotherapy drugs are very useful in treating lymphoma,” Dr. Sharma explained. “We may also use radiation therapy in combination with chemotherapy. In cases of lymphoma that recur, the physician may decide to use high-dose chemotherapy followed by a stem cell transplant. The stem cells can come either from the patient’s own body or from a donor whose tissue type matches the patient’s very closely – usually a sibling or other close family member.”
Surgery is seldom used to treat lymphoma. However, in rare cases, surgery may be used to treat lymphomas that start in the spleen, thyroid gland or stomach that are outside of the lymphatic system.
“The key to successful treatment of lymphomas is early diagnosis,” Dr. Sharma emphasized. “If you notice a hard, swollen lymph node larger than one centimeter in diameter, or any other changes in your lymph nodes over the last month in the absence of infection, consult your doctor right away.”
For people who would like to learn more about lymphoma, Dr. Sharma recommends the websites of the American Cancer Society at www.cancer.org and the Leukemia & Lymphoma Society at www.lls.org. To learn more about Washington Hospital’s Cancer Genetics Program, visit http://www.whhs.com/cancer/cancergenetics.