What is lymphoma?
Lymphomas refers to types of cancer that begin in the lymphatic system (the various lymph glands around the body).
When you have lymphoma, large numbers of abnormal lymphocytes are made. These abnormal lymphocytes replace some of your normal lymphocytes. This can affect your immune system and the way your body fights infections.
There are two main types of lymphoma, which spread and are treated differently:
- Non-Hodgkin lymphoma
- Accounts for about 90 per cent of lymphomas
- Most commonly occurs in a lymph node but it can also occur in the liver, spleen, stomach or bones. There are more than 60 sub-types of non-Hodgkin lymphoma and they vary in how fast they grow and spread, and how sick people feel.
- There are two classifications of non-Hodgkin lymphoma: B-cell lymphomas which account for around 80 per cent of lymphomas, and T-cell lymphomas.
- Hodgkin lymphoma
- Sometimes called Hodgkin disease.
- There are two types of Hodgkin lymphoma: classical Hodgkin lymphoma which makes up about 95 per cent of cases and nodular lymphocyte-predominant Hodgkin lymphoma.
Lymphomas are the sixth most common form of cancer overall (excluding non-melanoma skin cancer).
The risk of being diagnosed with non-Hodgkin lymphoma by age 85 is one in 39. The risk of being diagnosed with Hodgkin lymphoma by age 85 is one in 414.
What are the symptoms?
Common symptoms include:
- unexplained fever;
- swelling of one or more lymph glands such as in the neck, armpits, or at the angles of the legs;
- swollen abdomen;
- abnormal sweating, especially at night;
- fatigue;
- loss of appetite;
- bruising or bleeding easily;
- weight loss; and
- rash or itching.
What are the risk factors?
The causes of lymphoma are not yet known. There are many different types of lymphoma, and it is likely that there is no single cause of all lymphoma.
Risk factors for lymphoma include exposure to radiation and certain chemicals (benzene and some agricultural chemicals). For people whose immune system is suppressed, exposure to the human immunodeficiency (AIDS) virus and the Epstein-Barr virus is a risk.
How is lymphoma diagnosed?
If your GP suspects lymphoma, you will have a physical examination. The doctor will feel the lymph nodes in your neck, underarms and groin for signs of swelling, and feel your abdomen to check for swollen organs.
The doctor will also organise other tests.
Biopsy
The most common way to diagnose and classify lymphoma is to remove some cells and tissue from an enlarged lymph node. This is called a biopsy and it is done in one of two ways: an excision biopsy (whole lymph node removed) or a core biopsy (needle inserted into the lymph node to remove a small piece of tissue).
Blood tests
Your doctor will take a blood sample to see how well your blood, kidneys and liver are working, and to check your general health.
Bone marrow biopsy
A sample from your bone marrow is taken with a needle to check whether lymphoma has spread to the bone marrow. It is usually done as an outpatient procedure and you may be offered light sedation to help you feel relaxed.
Imaging tests
You will usually have at least one of the following to check if the lymphoma has spread.
- chest x-ray;
- CT (computerised tomography) scan;
- PET (positron emission tomography)-CT scan;
- Ultrasound; or
- MRI (magnetic resonance imaging).
The staging and prognosis of lymphoma
Staging
The tests undertaken to diagnose lymphoma help your specialist work out how far the cancer has spread. This is known as staging, and it helps your health care team recommend the best treatment for you.
In Stage 1, lymphoma, cancer is found in only one lymph node area or one area/organ outside the lymph nodes.
In Stage 2, cancer is found in two or more lymph node areas on the same side of the diaphragm. Cancer is found in one area/organ outside the lymph nodes and in the lymph nodes around it. Other lymph node areas on the same side of the diaphragm may be involved.
In Stage 3, cancer is found in lymph node areas on both sides of the diaphragm. It may have spread to an area/organ near the lymph node area, or to the spleen, or both.
In Stage 4, cancer has spread in more than one spot, within or outside the lymphatic system (for example, liver, lung, bone marrow or bone).
Prognosis
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for any doctor to predict the exact course of the disease. Instead, your doctor can give you an idea about the general prognosis for people with the same type and stage of cancer.
To come up with a prognosis, your doctor will consider:
- test results;
- the type of lymphoma you have;
- the rate and extent of tumour growth; and
- other factors such as age, fitness and medical history.
These details will also help your doctor advise you on the best treatment options.
Treatment for Non-Hodgkin Lymphoma
The treatment options for non-Hodgkin lymphoma varies and is dependent on three things:
- the exact type of B or T-cell lymphoma you have;
- where it has spread in your body; and
- how fast it is likely to grow.
Usually, the treatment for lymphomas includes chemotherapy or radiotherapy and surgery. Peripheral blood stem cell transplantation, steroid therapy and biotherapies may also be used.
Low-grade lymphomas (indolent)
Some types of lymphoma are slow growing, relatively symptom free and do not require urgent treatment. These types of lymphoma are known as low-grade (or indolent) lymphomas.
For low-grade lymphomas, your doctor may recommend regular check-ups to carefully monitor your health. If your lymphoma is confined to a small group of lymph nodes, radiotherapy alone may be able to cure some low-grade lymphomas or keep them under control for a long time.
If a low-grade lymphoma is more widespread, the decision to start treatment or not depends on where the lymphoma has spread to. In some instances, chemotherapy is given, either in tablet form or intravenously, which is usually highly effective.
Intermediate and high-grade lymphomas
Intermediate-grade and high-grade lymphomas are fast growing and require treatment upon diagnosis. Chemotherapy is the main form of treatment and is usually combined with rituximab in B-cell lymphomas to give the best results. If the lymphoma responds well to chemotherapy, they can sometimes be cured.
Chemotherapy
Chemotherapy uses drugs to kill or slow the growth of cancer cells while doing the least possible damage to healthy cells. Chemotherapy is given through a liquid drip into a vein (intravenously), an injection into a muscle or as tablets. You will probably have chemotherapy as a course of several sessions (cycles) over approximately 6 months. Your cancer specialist will explain your treatment schedule.
Improved results in treating non-Hodgkin lymphoma have been achieved by combining chemotherapy with monoclonal antibody therapy which is specifically designed to target lymphoma cells. Once antibodies bind to these cells, a patient’s own immune system is then able to recognise lymphoma cells as foreign and kill them.
Side effects of chemotherapy
People react to chemotherapy differently – some people have few side effects, while others have many. The side effects depend on the drugs used and the dose. Your cancer specialist or nurse will discuss the likely side effects with you, including how they can be prevented or controlled with medicine.
Common side effects include fatigue; changes in appetite, taste and smell; constipation or diarrhoea; mouth sores and ulcers; and hair loss.
Keep a record of the doses and names of your chemotherapy drugs handy. This will save time if you become ill and need to visit the emergency department.
During chemotherapy, you will have a higher risk of getting an infection or bleeding. If you have a temperature over 38°C, contact your doctor or go to the emergency department. Tell your doctor if you feel more tired than usual, or if you bruise or bleed easily.
Radiation therapy
Also known as radiotherapy, this treatment uses a controlled dose of radiation, such as focused x-ray beams, to kill or damage cancer cells. The treatment is carefully planned to do as little harm as possible to your normal body tissue near the cancer.
Radiation therapy is usually given in small doses (also known as fractions) over a few weeks in the radiotherapy department of a hospital.
During treatment, you will lie on a treatment table under a machine called a linear accelerator. Each treatment takes only a few minutes, but a session may last 10–20 minutes because of the time it takes to set up the machine.
Side effects of radiation therapy
The side effects of radiation therapy vary. Most are temporary and disappear a few weeks or months after treatment.
Common side effects include fatigue; skin reaction (redness, dry or itchy) in the treatment area; mouth problems and local hair loss. Radiation therapy can cause the skin or internal tissue to become less stretchy and harden (fibrosis).
Treatment for Hodgkin Lymphoma
The type of treatment you receive for Hodgkin lymphoma depends on a number of things, including:
- The stage or extent of lymphoma
- The exact type of Hodgkin lymphoma you have
- How old you are
- Your overall health.
Thanks to advances in research and improved treatment options, most people treated for Hodgkin lymphoma are able to be cured or remain cancer-free and well for a long period of time.
Early stage (1 and 2)
Treatment is usually a form of chemotherapy, radiotherapy or a combination of both.
Advanced-stage disease (stages 3 and 4)
This type of Hodgkin lymphoma is often treated with a longer course of chemotherapy which, in most patients, will continue for six months or even longer. Occasionally radiotherapy is also used in this stage.
Chemotherapy
Chemotherapy uses drugs to kill or slow the growth of cancer cells while doing the least possible damage to healthy cells. Chemotherapy is given through a liquid drip into a vein (intravenously), an injection into a muscle or as tablets. You will probably have chemotherapy as a course of several sessions (cycles) over approximately 6 months. Your cancer specialist will explain your treatment schedule.
Side effects of chemotherapy
People react to chemotherapy differently – some people have few side effects, while others have many. The side effects depend on the drugs used and the dose. Your cancer specialist or nurse will discuss the likely side effects with you, including how they can be prevented or controlled with medicine.
Common side effects include fatigue; changes in appetite, taste and smell; constipation or diarrhoea; mouth sores and ulcers; and hair loss.
Keep a record of the doses and names of your chemotherapy drugs handy. This will save time if you become ill and need to visit the emergency department.
During chemotherapy, you will have a higher risk of getting an infection or bleeding. If you have a temperature over 38°C, contact your doctor or go to the emergency department. Tell your doctor if you feel more tired than usual, or if you bruise or bleed easily.
Radiation therapy
Radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread. The radiation is usually in the form of focused x-ray beams. It can also be in other forms such as electron beams, proton beams, or gamma rays from radioactive sources. Radiation therapy is a localised treatment, which means it generally affects only the area being treated. Treatment is carefully planned to do as little harm as possible to the normal body tissue near the cancer.
The side effects of radiation therapy vary. Most are temporary and disappear a few weeks or months after treatment.
Common side effects include fatigue; skin reaction (redness, dry or itchy) in the treatment area; mouth problems and local hair loss. Radiation therapy can cause the skin or internal tissue to become less stretchy and harden (fibrosis).
Life after treatment
For most people, the cancer experience doesn’t end on the last day of treatment. Life after cancer can present its own challenges. You may have mixed feelings when treatment ends and worry that every ache and pain means the cancer is coming back.
Some people say that they feel pressure to return to ‘normal life’. It is important to allow yourself time to adjust to the physical and emotional changes and establish a new daily routine at your own pace. Your family and friends may also need time to adjust.
Cancer Council 13 11 20 can help you connect with other people who have had cancer and provide you with information about the emotional and practical aspects of living well after cancer.
Follow-up appointments
Whether treatment ends or is ongoing, you will have regular appointments to monitor your health. During these check-ups, you will usually have a physical examination and you may have blood tests, x-rays or scans.
How often you will need to see your doctor will depend on the level of monitoring needed for the type and stage of the lymphoma. Between follow-up appointments, let your doctor know immediately of any health problems.
What if the cancer returns?
For some people, lymphoma does come back after treatment, which is known as a relapse or recurrence. It is important to have regular check-ups, so that if cancer does come back, it can be found early.
Lymphoma that has relapsed can still be treated, with the aim of causing remission or relieving symptoms. Treatment for recurrence usually includes further chemotherapy, targeted therapy and sometimes with radiation therapy. If the cancer is more advanced or aggressive, your doctor may recommend a stem cell transplant combined with high-dose chemotherapy.
Dealing with feelings of sadness
If you have continued feelings of sadness, have trouble getting up in the morning or have lost motivation to do things that previously gave you pleasure, you may be experiencing depression. This is quite common among people who have had cancer.
Talk to your GP, as counselling or medication—even for a short time—may help. Some people are able to get a Medicare rebate for sessions with a psychologist. Ask your doctor if you are eligible. Cancer Council SA operates a free cancer counselling program. Call Cancer Council 13 11 20 for more information.
For information about coping with depression and anxiety, call Beyond Blue on 1300 22 4636 or visit beyondblue.org.au. For 24-hour crisis support, call Lifeline 13 11 14 or visit lifeline.org.au.
