Lymphoma

Author: Dr. Arun Karanwal

Lymphoma is a cancer that begins in infection-fighting immune system cells, called lymphocytes. These cells are in the lymph nodes, spleen, thymus, bone marrow, and other body parts.

Two main groups of lymphoma:

• Hodgkin lymphoma (most diagnosed in people aged15-30 years), and
• Non-Hodgkin lymphoma (more common in people aged 50+ years), comprising 80-90% of all lymphomas.
  • The most common symptom - firm, painless swelling in a lymph node, often in the neck or armpits but also in the groin (which may cause swelling in the legs or ankles), abdomen (which may cause cramping and bloating), or chest (which may cause coughing, discomfort or difficulty in breathing). 

Symptoms

• Other symptoms include night sweats, weight loss, chills, a lack of energy, or itching.

Diagnosis

• The most important test is biopsy- from lymph nodes or any other possible site.
• FNAC is not recommended due to non-confirmatory results and lack of material for important tests like IHC or molecular tests.
• Staging requires imaging- USG/CT scan/PETCT scan & bone marrow biopsy.

Treatment

• Treatment depends on the subtype of lymphoma and its stage of development.
• Some lymphomas grow slowly, and the need for treatment is not urgent like CLL and follicular lymphoma. Others grow quickly and need to be treated as soon as possible after diagnosis.
• Chemotherapy, monoclonal antibodies, and immunotherapy are the main forms of treatment.
• Some patients may need additional radiotherapy treatment to achieve better cure results.
• Surgery has no role in lymphoma treatment.
• Stem cell transplantation is used occasionally (for refractory and relapsed cases). 

Outcome

• Lymphoma is very treatable, and the outlook can vary depending on the type of lymphoma and its stage.
• Hodgkin lymphoma- 80 to 90 % cure rates for young patients. For elderly patients, 50 to 60%.
• Non-Hodgkin lymphoma- variable results as per subtype, DLBCL overall results in 60 to 70 %.
  • Lymphoma treatment can cause side effects. Talk to your medical team about ways to relieve any symptoms you have.

Taking Care of Yourself

• Also, ask your doctor about changes to your diet and exercise to help you feel better during your treatment. Ask a dietitian for help if you're unsure what food to eat. 
• Exercises like walking or swimming can relieve fatigue and help you feel better during treatments like chemotherapy and radiation. 
• You might also try alternative therapies like relaxation yoga to help relieve pain.