Catch Guide to Lymphoma

Description

Lymphomas form in the lymphocytes, white blood cells that make antibodies and fight infection in the body. This cancer can form anywhere lymphatic tissue is present, which includes lymph nodes, lymph vessels, the spleen, bone marrow, the adenoids and tonsils, the thymus, and portions of the digestive tract.

The two primary types of lymphoma are Hodgkin and non-Hodgkin lymphoma. Hodgkin lymphoma is relatively rare–about .2% of people will receive a diagnosis at some point in their lives–and tends to affect younger individuals (the average age at diagnosis is 39). Non-Hodgkin lymphoma is about 10 times more common, and 2.1% of people will be diagnosed at some point, most likely later in life. The average age at diagnosis is 68.

Sometimes, lymphomas cause no symptoms until they’ve grown significantly. As the disease progresses, it may cause:

• Swollen lymph nodes (especially in the neck, underarm, or groin)
• Fatigue
• Unexplained weight loss
• Loss of appetite / feeling full after eating very little
• Swollen or painful abdomen 
• Chest pain or pressure
• Fever without infection (this may come and go for some time)
• Drenching night sweats
• Coughing or shortness of breath
• Frequent or severe infections
• Easy bruising or bleeding
• Itchy skin

When lymphoma is specifically located in the central nervous system (CNS), it may cause headache, confusion, brain fog, personality changes, weakness in one portion of the body, facial numbness, double vision, and seizures.

These symptoms may be caused by any number of health conditions, and should be evaluated promptly by a medical professional. 

Both Hodgkin and non-Hodgkin lymphomas usually start in the B-lymphocytes, and are differentiated by the changes they cause to cells. If Reed-Sternberg cells are present, the cancer is a Hodgkin lymphoma, otherwise it’s classified as non-Hodgkin. Both Hodgkin and non-Hodgkin lymphomas have several subtypes which can be more or less aggressive, and which may influence your prognosis and course of treatment.

Survival Rates and Incidence

Survival rates differ significantly based on the type of lymphoma, but for both Hodgkin and non-Hodgkin lymphomas they are broken down by stage:

• Stage IV: The cancer is diffuse within the body
• Stage I: The cancer is confined to a single region
• Stage II: The cancer involves multiple regions 
• Stage III: The cancer has spread to both sides of the diaphragm

The 5-year survival rate for each relevant stage is shown below:

Below is the overall incidence of lymphoma by age group:

Risk Factors

There are several confirmed risk factors that contribute to an individual’s risk for lymphoma:  

• Smoking & secondhand smoke exposure: Smoking and secondhand smoke increases the risk of lymphoma. Tobacco smoke contains numerous carcinogens that can lead to genetic mutations and uncontrolled cell growth, ultimately resulting in cancer. Quitting smoking at any age can significantly reduce the risk of cancer and other smoking-related diseases. The body begins to repair itself almost immediately after quitting, with the risk of cancer decreasing over time. Even individuals who have smoked for many years can benefit from quitting, as the risk decreases with each year of abstinence.
• Work as a firefighter: Firefighters are exposed to several chemicals and carcinogens that put them at higher risk for multiple forms of cancer, including lymphoma. The risk of this cancer is about 50% higher for a firefighter than for the general population.
• Use of hair dye: Studies show that use of hair dye–particularly long-term use and use of dark colors–increases the risk of developing lymphoma.
• Epstein-Barr virus infection: Infection with the Epstein-Barr virus, responsible for causing mononucleosis (“mono”) increases one’s risk of developing lymphoma.
• Health conditions: 
  • Celiac disease: The chronic digestive and autoimmune disorder raises the risk of developing lymphoma, particularly certain subtypes.
  • Chronic hepatitis C (HCV): Studies have shown that chronic HCV infection raises the risk of developing lymphoma by 20-30%. It’s thought that the increases in lymphocyte production and/or imbalances in the body’s immune system that result from HCV may explain this increase in risk. 
  • Hashimoto’s disease: Hashimoto’s is a chronic autoimmune disease that damages the thyroid. It’s known to increase the risk of developing lymphoma. 
  • Inflammatory Bowel Disease (IBD): Inflammatory bowel disease refers to a group of lifelong diseases of the intestines, including ulcerative colitis and Crohn’s. Inflammatory diseases like IBD can affect the lymphatic system, and lead to an increased risk of lymphoma. 
  • Lupus: Lupus patients have an increased risk for both Hodgkin and non-Hodgkin lymphoma. It’s thought that the progress of the disease–which overstimulates B-lymphocytes, where many lymphomas begin–as well as its impact on the immune system may explain this increased risk.
  • Rheumatoid arthritis (RA): Many studies have shown that individuals with RA have about twice the risk of developing lymphoma. 
  • Sjogren’s syndrome: This autoimmune disease attacks healthy tissues in the body, in particular the salivary and tear glands. It increases one’s lymphoma risk by fivefold.
  • Other immunocompromising conditions: Taking immunosuppressants after an organ transplant, infection with HIV, and other immunocompromising conditions not specifically mentioned above, can all increase one’s risk of developing lymphoma.
• Family history: People with a first-degree relative (parent, sibling, or child) who have had lymphoma have an increased risk for the disease.

Protective Factors

Some factors have been shown to have protective effects against multiple myeloma:

• Maintaining a healthy weight: Numerous studies have linked higher BMI to increased risk of various types of cancer, including lymphoma. Excess body fat can lead to higher levels of estrogen and insulin, as well as increased production of insulin-like growth factors. Higher BMI is also associated with chronic low-level inflammation, which can cause DNA damage over time and contribute to the development of cancer. Maintaining a healthy weight helps you to avoid these risks. 
• Physical activity: Regular exercise can reduce your risk of several types of cancer, including lymphoma, through a combination of physiological, hormonal, and immunological changes. It can reduce inflammation, improve immune function, improve hormonal regulation, and lower insulin levels. The American Cancer Society recommends engaging in at least 150 minutes of moderate activity or 75 minutes of vigorous activity each week. Furthermore, data indicates that individuals can see significant incremental benefit with additional exercise.
• Aspirin: Several studies have shown an association between daily aspirin use and a reduced risk for several types of cancer, including lymphoma. The exact mechanisms by which aspirin may reduce cancer risk are not fully understood but may involve its anti-inflammatory and antiplatelet effects. Aspirin inhibits the production of prostaglandins, which are involved in inflammation and tumor growth, and it also reduces the aggregation of platelets, which may play a role in the spread of cancer. While daily aspirin use may offer benefits in reducing cancer risk, it is not without potential risks. Aspirin can increase the risk of gastrointestinal bleeding and other bleeding-related complications, particularly in older adults or those with a history of gastrointestinal ulcers or bleeding disorders.
• Limiting processed meat consumption: Diets high in processed meats have been tied to higher rates of lymphoma. In general, diets lower in salt, processed meat, and red meat are correlated to lower risk for multiple types of cancer.

Screening

Early detection of lymphoma has a dramatic impact on prognosis. The 5-year survival rate for localized non-Hodgkin lymphoma is 87% (92% for Hodgkin lymphoma), but drops to just 64.2% (81.2% with Hodgkin lymphoma) once the cancer has spread to distant parts of the body.

Depending on your age and risk factors, the optimal lymphoma screening will vary:

• Regular physical exams / medical history: Because so many symptoms of lymphoma are non-specific, regular physicals with your doctor are valuable in catching the disease. Examination of your lymph nodes, discussion of any new or changing symptoms, and knowledge of your medical history will help your doctor determine whether lymphoma may be present. If they do suspect lymphoma, they will likely recommend a biopsy, as lymphoma can’t be diagnosed via standard blood tests.
• Lymph node biopsy: Biopsy is the only way to confirm that swelling of the lymph node is the result of lymphoma. Because enlarged lymph nodes most often indicate infection, a doctor may prescribe antibiotics and wait for some time to determine their effectiveness before removing part (or all) of a lymph node for further testing. Depending on the location of the affected lymph node, you may be given either local or general anesthetic during this procedure.
• Complete blood count (CBC): This test determines the values of different types of cells in the blood. While this test is not used to diagnose lymphoma, low blood cell counts on a CBC may indicate that lymphoma has penetrated the bone marrow and is affecting blood cell production.
• Heart, lung, and kidney function tests: These tests will not be used to diagnose lymphoma, but may be ordered to determine how far the disease has progressed, to determine the course of treatment, and to follow up on the effectiveness of treatments.
• Imaging tests: CTs, PET scans, MRIs, ultrasounds, and X-rays can all be used to look for the cause of any symptoms (which may be the result of an enlarged lymph node or lymphatic organ that cannot be readily examined during a physical, such as one in the chest cavity), as well as to determine spread of a previously diagnosed lymphoma or effectiveness of any prescribed treatments. CTs and PET scans are the most informative when dealing with lymphoma, though MRIs, ultrasounds, and x-rays may all be ordered to determine whether the lymphoma has spread to regions less well-visualized with these forms of imaging.
• Liquid biopsy: Liquid biopsy is an investigational cancer-detection technique which looks for DNA fragments in the blood to determine whether cancer is present. Though still in its infancy, this technology is promising, particularly in screening for hard-to-detect cancers or cancers whose symptoms are minimal or tend to appear only after they’ve spread. Lymphoma is one of many cancers which can be screened for via this method.