What is Lymphoma?
Lymphocytes are a type of white blood cells that are present in the lymph nodes and other organs like spleen, etc. and are important for local as well as systemic immunity.
The lymphocytes are of two main types:
- B cells
- T cells
The Lymphoma is the cancer of these cells. There is uncontrolled division of these cells as well as the presence of their immature non-functional forms.
Types of Lymphomas
How common is Lymphoma?
Lymphoma is more common in the West as compared to India. However, the incidence in India is found to be more common in urban than rural population, with a mean age of 54 years.
What are the risk factors and causes of Lymphoma?
Lymphoma is caused due to mutation or abnormal biochemical changes in the lymphocytes and its precursor cells. This leads to uncontrolled and excessive division of cells, leading to malignancy.
Risk factors of Lymphoma are:
- Family history
- HIV infection
- Ebstein Barr virus infection
- Celiac Sprue
- Pylori infection
- Occupational exposure to chemicals like hair dyes, herbicides, etc.
- Radiation exposure
- Alcohol consumption
- Tobacco chewing
It is the most common type of Lymphoma. It is more common in males compared to females. Hodgkin’s Lymphoma may occur in two age groups – first being the young adult age group of 20-30 years and the other being age group of more than 50 years or elderly.
What are the symptoms of Hodgkin Lymphoma?
This cancer commonly affects lymph nodes in the neck.
Other common lymph node groups involves are those located in armpits, groin, abdomen, etc.
Symptoms of Hodgkin’s Lymphoma are:
- Lymph node enlargement for e.g. if neck lymph nodes are enlarged then they will appear as a swelling in the neck which may be fixed, hard.
- Enlargement of Liver, characterised by mass on the right side of abdomen which can be painful or painless
- Spleen enlargement characterised by feeling of a mass on the left upper side of abdomen which can be painful or painless
- Jaundice or yellow discolouration of skin and eyes
- Bone pains
- Purplish or reddish spots on the skin, especially on the exposed skin
Symptoms such as fever, night sweats, and dramatic weight loss are called as ‘B’ symptoms which indicate poor outcome. Other symptoms will depend on the lymph node group involved for e.g. Neck lymph nodes when enlarged can cause breathing difficulties as they can put pressure on the windpipe.
What are the investigations for Hodgkin’s Lymphoma?
- Complete blood count
- Fine needle aspiration cytology or FNAC of the involved lymph node
- Biopsy of the involved lymph node
- Chest x-ray
- CT scan of chest, abdomen and pelvis
- PET scan
- Bone marrow biopsy
What is the treatment of Hodgkin’s Lymphoma?
The treatment depends on the staging of the disease which is determined by the number of involved lymph node groups. The greater the involvement of lymph nodes, the severe the disease, the higher the stage.
In spite of receiving complete treatment some patients may develop relapses. These relapses are treated through various modalities like:
- Stem cells transplantation
- High dose chemotherapy
- Combined transplantation and chemotherapy
- Gene therapy
- Tumor vaccination
What are the complications of Hodgkin’s Lymphoma?
- Respiratory discomfort: Breathlessness, etc. can develop due to lung involvement
- Involvement of vertebra
- Risk of other malignancies in the future
What lifestyle modifications are required to prevent Lymphoma?
- People with a family history should get routine check-ups.
- Also, it’s important to take necessary precautions to prevent HIV infections.
- People who are at a risk of exposure to hair dyes, herbicides or other chemicals known to cause biochemical changes in cells, should take protective measures and undergo routine check-ups.
- At the first doubt, the patient should immediately consult a doctor.
This type of Lymphoma has a very good prognosis. 80 % of patients of stage I and II and up to 70% of stage III, have good survival rate. Hence the patient should be motivated to continue with the treatment especially the chemotherapy wherever it is recommended. It is important for the patient to have a positive psychological environment. In severe cases the patients should be given symptomatic care and appropriate care for their routine needs.
This type of Lymphoma is more aggressive and can involve any lymph node group unlike Hodgkin’s where neck is the most common site.
The cancer is more common in middle-aged and elderly age groups.
What are the symptoms of Non-Hodgins Lymphoma?
- Lymph node enlargement which can present as swelling in neck, feeling of mass in abdomen, mass in chest
- Spleen enlargement is not usually seen
- There is liver enlargement characterized by mass in the upper right side of the abdomen
- Involvement of spine leading to paralysis’
- Dramatic weight loss
- Loss of appetite
There are no type ’B’ symptoms in Non-Hodgkin’s Lymphoma.
What are the investigations for Non-Hodgins Lymphoma?
The basic investigations and laboratory workup are the same as Hodgkin’s Lymphoma.
Other special investigations done includes:
- Tumour markers
- Serum LDH (an enzyme) levels
- Serum calcium levels
- Serum CD5 and CD23
What is the treatment for Non-Hodgins Lymphoma?
What lifestyle modifications are required to prevent Non-Hodgins Lymphoma?
This type has a poorer outcome. The preventive as well as post illness lifestyle modifications are same as that for Hodgkin’s Lymphoma.
In case of any symptoms, the patient must consult doctor immediately. In this type of Lymphoma, the survival rate is good, also has very good prognosis. It is advised that the patient should be motivated and continue with treatment, especially with chemotherapy. It is important for the patient to have a positive psychological environment. In severe cases the patients should be given symptomatic care and appropriate care for their routine needs.
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