What is Lymphoma

English हिन्दी Bengali

What is Lymphoma? 

Lymphoma is a type of cancer of the body’s germ-fighting network known as the Lymphatic system. It begins in T cells and B cells (white blood cells) which are the cells of the immune system. These cells work to protect humans from diseases by increasing their immunity. These cells are present in the lymph nodes, bone marrow, and other parts of the body. 

When these T and B cells become cancerous, they spread to different parts of the body and also to the lymphatic system organs like spleen, bone marrow, blood, lymph nodes and other organs. These cancerous B and T cells then accumulate there and form tumors.

There are more than 70 different types of Lymphomas. These can be slow growing or highly aggressive (rapidly spreading). According to some health organizations, 5 percent of lymphoma cases are reported every year in India. In this, both men and women are affected equally. Therefore, when the initial symptoms appear, one should immediately contact the doctor to prevent further complications. 

Let us tell you in detail about lymphoma through today’s article.

• What are the types of Lymphomas?
• What are the causes of Lymphoma?
• What are the symptoms of Lymphoma?
• What are the stages of Lymphoma?
• How do you diagnose Lymphoma? 
• What are the treatments for Lymphoma?
• What are the factors that decide the prognosis of patients with Lymphoma?
• Statistics & Figures About Lymphoma
• What is the cost of Lymphoma treatment in India?

What are the types of Lymphomas?

Broadly the Lymphomas can be grouped into 2 types which are as follows-

• Hodgkin lymphoma – This is also known as Hodgkin’s disease. It usually begins from a type of B cells that are present in the bone marrow. Hodgkin’s Lymphoma is one of the most curable types of cancer if it is diagnosed at an early stage. Different types of treatments are available for the treatment. It is usually present in young adults between the ages of 20 to 35 years. 

Hodgkin’s lymphoma has 2 main types- Classical Hodgkin’s lymphoma and Nodular Lymphocytic variant.  90 percent of the patients have classical variants of Hodgkin’s lymphoma.

• Non-Hodgkin lymphoma (NHL) – This is the most common type of lymphoma and usually occurs at an older age. This type is more fatal than Hodgkin lymphoma. These are of 2 main types- B cell and T cell lymphomas. 

B cell lymphomas are further of the following types-

• Diffuse large B- cell lymphoma
• Primary mediastinal B cell lymphoma
• Follicular lymphoma
• Small lymphocytic lymphoma and Chronic lymphocytic leukemia
• Marginal zone lymphoma
• Mantle cell lymphoma
• Waldenstrom’s macroglobulinemia
• Burkitt’s lymphoma

T cell lymphomas are of the following types-

• Peripheral T cell lymphoma
• Anaplastic large cell lymphoma
• Angioimmunoblastic lymphoma
• Cutaneous T cell lymphoma

What are the causes of Lymphoma?

The exact causes of lymphoma are not known. The following are risk factors for lymphoma:

• Weak immune system due to HIV infection, an organ transplant, etc
• Males are more prone to lymphomas than females
• Chemical exposure like benzene or other chemicals that kill insects and weeds.
• Previous history of Hodgkin or Non-Hodgkin lymphoma
• Family history- Having a close relative who has or had lymphoma
• History of Cancer treatment or Radiotherapy ( Know more about- What is Cancer? )
• Immune system diseases- Having an immune system disease such as arthritis, lupus, or celiac disease, etc increases the risk of developing lymphomas
• Age factor- There is a high risk of developing Hodgkin lymphoma if you are between 20 and 40 years of age. People older than 55 years have a higher risk for developing Non-Hodgkin’s lymphoma.

What are the symptoms of Lymphoma?

The following symptoms can occur which include –

• Painless swelling of lymph nodes in the armpits, neck or groin, etc present for unexplained and prolonged durations.
• Fever
• Bone pain
• Unexplained weight loss
• Persistent fatigue
• Abdominal pain ( Know more about- Home remedies for Stomach pain in kids )
• Skin rashes/Itchy skin
• Breathlessness
• Cough  
• Itching
• Night sweats

What are the stages of Lymphoma?

The current staging system in adults is the Lugano classification. There are four major stages.

– Stage I – The disease is present in only one group of lymph nodes or in a single organ that does not belong to the lymphatic system.

– Stage II – Cancer is found in 2 or more groups of lymph nodes on the same side of the body with respect to the diaphragm. (The diaphragm is a thin muscle that separates your chest from the abdomen).

– Stage III – Cancer is present in lymph nodes on both sides of the diaphragm. Occasionally there may be involvement of other adjacent organs. 

– Stage IV – In stage IV the liver, bone marrow, the lungs and other organs become involved. 

How do you diagnose Lymphoma?

To diagnose lymphoma, your doctor will first do a physical examination to check for swollen lymph nodes. Apart from this, some other tests may be done to find out the stage of lymphoma.

• Molecular test – This test is used to look for changes in genes, proteins, and other substances in the cancer cells so that the doctor can diagnose the type of lymphoma.
• Blood Test – It helps to check the condition of the liver and kidney by examining blood. Also, the number of red blood cells, white blood cells and platelets may become low when lymphoma spreads to the bone marrow.
• Bone marrow aspiration or biopsy – In this test, the doctor uses a needle to remove fluid or tissue from your bone marrow to look for cancerous lymphoma cells. This procedure is usually performed after lymphoma has been diagnosed to find out if the disease has spread to the bone marrow.
• Lumbar Puncture (spinal tap) – A minimally invasive test that involves the removal of a small amount of cerebrospinal fluid (CSF) so that it can be analyzed for the presence of lymphoma cells. This test is usually only performed for certain types of lymphoma or if the patient presents with symptoms that suggest that the lymphoma may have reached the brain.
• Chest X-ray – This is done by using low doses of radiation to create images of the inside of your chest. It is used to look for enlarged lymph nodes.
• MRI – In this, technicians use powerful magnets and radio waves to create pictures of organs and structures inside your body. It is used to check if the lymphoma has spread to the spinal cord or brain.
• PET scan – This test uses a radioactive substance to identify cancer cells. It can show if an enlarged lymph node is cancerous and detect cancer cells throughout the body that may not be seen on a CT scan.
• Abdominal Ultrasound – Abdominal ultrasound is used to examine enlarged lymph nodes in the abdomen.

What are the treatments for Lymphoma? 

Treatment of lymphoma depends on the stage of cancer and how far cancer has spread.

• Chemotherapy – In this therapy, cancer-killing drugs are administered via mouth or injection to destroy cancer cells. Chemotherapy is either used alone or in combination with radiation therapy and is one of the main methods of treatment for lymphoma.

(Know more about – Why is Chemotherapy done?)

• Radiation therapy – High energy X-rays are generated by a machine outside the patient and directed at the tumor and cancerous lymph nodes to eventually kill them.
• Immunotherapy – Immunotherapy involves using man-made immune proteins to fight the body’s own immune system or cancer cells.
• Monoclonal Antibody Therapy (targeted therapy) – This is a treatment involving laboratory-produced molecules called monoclonal antibodies that are engineered to recognize and bind to the surface of cancer cells. They mimic naturally produced antibodies in the body that attack invading foreign substances, such as bacteria and viruses. They may be combined with a chemotherapy drug or radioactive material. This allows the antibody to deliver a direct dose of the cancer-killing agent to the cancer cell.
• Bone Marrow Transplant or Stem Cell Transplant – This procedure uses bone marrow or stem cells from a compatible donor, preferably closest relatives, to replace the bone marrow affected by cancer cells. A stem cell transplant may be an option if lymphoma returns after treatment. ( Know more about- Bone Marrow Transplant Surgery )
• Biologic Therapy – This treatment uses natural or laboratory-made substances designed to boost, direct or restore the body’s natural defenses against cancer. They can also interfere with specific biologic pathways within the lymphoma cells.

What are the factors that decide the prognosis of patients with Lymphoma?

The factors that determine the long term treatment effectiveness or prognosis and life of patients with lymphomas are- 

• Patient’s age: Age above 60 years is a bad factor whereas less than 60 years of age has good prognosis.
• Stage of the lymphoma: Stage I or II has better prognosis.
• Whether the lymphoma is present in the organs of the lymphatic system or has spread to other organs of the body. If lymphoma has spread outside the lymph nodes and to other body parts, it is a bad prognostic factor.
• How well the patients are able to perform their day to day activities after the treatment. If patients need a lot of help performing daily activities, it is a poor prognostic factor.
• The LDH (Lactate Dehydrogenase) levels in the blood that rises up in patients of lymphoma. High serum LDH levels are a bad prognostic factor.

Depending of these 5 factors, patients are grouped as-

1. Low-risk patients
2. Low- intermediate-risk patients
3. High- intermediate-risk patients
4. High-risk patients

Statistics & Figures about Lymphoma

The following data is based on Globocan 2012 data:

Hodgkin Lymphoma – 

• Rate of occurrence – The incidence of Hodgkin lymphoma among Indian males was 5,677 per 1,00,000 and 2,938 per 1,00,000 in Indian females. 
• Rate of mortality (death) – Amongst Indian males is 2,938 males per 1,00,000 dead and 1,404 per 100,000 Indian females dead. 

Non-Hodgkin Lymphoma – 

• Rate of occurrence – The incidence of Non-Hodgkin lymphoma among Indian males was 15,884 per 100,000 and 7,918 per 1,00,000 among Indian females. 
• Rate of mortality (death) – Among Indian males the rate of mortality was 11,071 per 1,00,000 and 5,526 per 1,00,000 for Indian females.

What is the cost of Lymphoma treatment in India?

The total cost of lymphoma treatment in India can range from around INR 3,50,000 to INR 5,00,000. There are many doctors in India who specialize in lymphoma treatment, but the cost varies among different hospitals. 

If you are coming from abroad, apart from the cost of the lymphoma treatment itself, there will be an additional cost of staying in a hotel, the cost of living, and the cost of local travel. After the surgery, the patient is kept in the hospital for 5 days and in the hotel for 7 days for recovery. So, the total cost of lymphoma treatment in India comes to a total of INR 4,00,000 to INR 6,00,000. 

We hope that we could answer your questions regarding Lymphoma through this article.

If you want to get more information and treatment of Lymphoma, you can contact a Hematologist.

We only aim to give you information through this article. We do not recommend medication or treatment in any way. Only a qualified doctor can give you the best advice and treatment plan.