Lymphoma

Lymphoma is a type of cancer that originates in the lymphatic system, which is part of the body’s immune system. This system includes lymph nodes, spleen, thymus gland, and bone marrow. When lymphocytes, a type of white blood cell, begin to grow and multiply uncontrollably, they can form tumours in the lymphatic tissues, resulting in lymphoma. It is among the most common types of blood cancer.

There are two main categories: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), each with its own subtypes, treatment plans, and prognosis. Despite its seriousness, lymphoma is often treatable, especially with early diagnosis and appropriate medical care.

Lymphoma is a malignancy of lymphocytes, which are white blood cells that play a crucial role in fighting infections. The cancer typically begins in lymph nodes, but it can also affect the spleen, bone marrow, blood, or other organs.

Lymphoma differs from leukaemia in that it mainly impacts the lymphatic system rather than the blood and bone marrow. However, both are classified as haematologic (blood-related) cancers. Lymphoma can either be slow-growing (indolent) or fast-growing (aggressive), influencing treatment approaches and outcomes.

Worldwide:

Globally, lymphoma ranks among the top ten cancers in terms of incidence and mortality. According to the Global Cancer Observatory (GLOBOCAN) 2020 report, there were approximately 627,000 new cases and 284,000 deaths from non-Hodgkin lymphoma alone.

India:

In India, lymphoma is one of the fastest-growing cancers. A study in the Indian Journal of Medical and Paediatric Oncology estimates the age-adjusted incidence rate of non-Hodgkin lymphoma in men is 2.9 per 100,000 and 1.5 in women. Hodgkin lymphoma is rarer but still a significant concern, especially in young adults and children.

There are two primary types of lymphoma:

1. Hodgkin Lymphoma (HL):

This type is characterised by the presence of Reed-Sternberg cells (large, abnormal lymphocytes). HL is more predictable and typically starts in the upper body such as the chest or neck.

Subtypes of HL:

• Nodular sclerosis HL (most common)
• Mixed cellularity HL
• Lymphocyte-depleted HL
• Lymphocyte-rich HL

2. Non-Hodgkin Lymphoma (NHL):

This type includes all lymphomas that are not HL. It has a broader range of subtypes and is more likely to spread unpredictably.

Common NHL subtypes:

• Diffuse large B-cell lymphoma (DLBCL)
• Follicular lymphoma
• Mantle cell lymphoma
• Burkitt lymphoma
• T-cell lymphoma

While the exact cause is often unknown, several factors have been identified that increase the risk of developing lymphoma:

• Genetic mutations: Abnormal changes in DNA can lead to uncontrolled cell growth.
• Immune system deficiencies: Individuals with HIV/AIDS or those on immunosuppressants are at higher risk.
• Infections: Viruses like Epstein-Barr virus (EBV), human T-lymphotropic virus (HTLV-1), and hepatitis C can trigger lymphoma.
• Environmental exposure: Pesticides, herbicides, and industrial chemicals.
• Age and gender: Non-Hodgkin lymphoma is more common in older adults, while Hodgkin lymphoma often affects younger people.
• Family history: A family history of lymphoma may increase susceptibility.

Symptoms may vary depending on the type and stage but commonly include:

• Painless swelling of lymph nodes in neck, armpit, or groin
• Persistent fatigue and weakness
• Fever without infection
• Night sweats
• Unexplained weight loss
• Itchy skin or rashes
• Coughing or chest pain (if lymph nodes in chest are enlarged)
• Abdominal pain or bloating
• Frequent infections

These symptoms are often mistaken for other conditions, making early diagnosis challenging.

Diagnosing lymphoma involves several tests and evaluations:

1. Physical Examination – Checking for swollen lymph nodes or organs.
2. Blood Tests – To detect abnormal blood cell counts.
3. Biopsy – Removing a sample from an enlarged lymph node or tumour for microscopic analysis.
4. Imaging Tests – CT, PET, or MRI scans help identify the extent and spread.
5. Bone Marrow Aspiration – To assess if the cancer has spread to the marrow.
6. Immunophenotyping – Identifies specific types of lymphoma by analysing proteins on cancer cells.

Treatment varies based on the type, stage, and patient health. Common treatments include:

1. Chemotherapy:

The mainstay treatment, especially for aggressive lymphomas. Drugs are administered orally or intravenously. (Brand: Oncogem 200mg Injection)

2. Radiation Therapy:

High-energy rays target cancerous tissues. More common in Hodgkin lymphoma.

3. Targeted Therapy:

Drugs like Rituximab target specific markers on lymphoma cells (e.g., CD20). (Brand: X-MAB 500mg Injection)

4. Immunotherapy:

Helps the immune system recognise and destroy lymphoma cells.

5. Stem Cell Transplant:

High-dose chemotherapy followed by transplanting healthy stem cells to restore bone marrow.

6. CAR T-Cell Therapy:

Genetically modified T-cells are reintroduced into the patient to kill cancer cells. It's approved for some relapsed cases.

Alternative therapies should never replace conventional treatments but may complement them:

• Ayurveda and Homeopathy – Offer supportive care but must be used cautiously.
• Acupuncture – May help relieve nausea and pain.
• Yoga and Meditation – Aid in stress relief and emotional well-being.
• Nutritional Therapy – A balanced diet to maintain strength and reduce side effects.

Always consult a medical professional before starting any alternative treatments.

Several risk factors may predispose individuals to lymphoma:

• Age – NHL is more common in people over 60.
• Gender – Men are slightly more prone.
• Infections – EBV, HIV, hepatitis C.
• Immunosuppression – Post-organ transplant patients or those with autoimmune diseases.
• Family History – Slightly increases the likelihood.
• Occupational Hazards – Exposure to chemicals or radiation.

Lymphoma and its treatments may result in various complications:

• Infections – Due to immune suppression.
• Anaemia and thrombocytopenia – From bone marrow involvement.
• Organ dysfunction – If lymphoma spreads to vital organs.
• Infertility – From chemotherapy or radiation.
• Emotional issues – Depression, anxiety, PTSD.
• Relapse or Secondary Cancers – Especially after aggressive treatments.

• Stay informed about your condition.
• Follow your doctor’s advice diligently.
• Eat a nutritious diet and stay hydrated.
• Join support groups for emotional help.
• Use complementary therapies like yoga.
• Monitor your symptoms and communicate with your healthcare team.
• Create a rest and activity balance.

• Myth: Lymphoma is contagious.
   Fact: It is not infectious.
• Myth: It only affects the elderly.
   Fact: HL is common among young adults and teens.
• Myth: All lymphomas are deadly.
   Fact: Many types are highly treatable.
• Myth: A swollen lymph node means cancer.
   Fact: Most are due to infections.

Consult a doctor if you experience:

• Swollen nodes persisting beyond 2 weeks
• Unexplained fever or weight loss
• Night sweats
• Chronic fatigue
• Recurrent infections
• Early consultation leads to better outcomes.

• What type of lymphoma do I have?
• What stage is it?
• What are my treatment options?
• What side effects should I expect?
• Will treatment affect fertility?
• Can I continue working during treatment?
• Are there clinical trials available?
• What is my long-term outlook?

• Offer emotional and practical support.
• Be available for hospital visits.
• Listen without judgment.
• Help with daily tasks.
• Educate yourself on their condition.
• Encourage healthy habits and positivity.

Lymphoma is a serious but increasingly treatable form of cancer. With advances in diagnostic tools and therapies, the survival rate has significantly improved. Early detection, timely treatment, and emotional support are essential in managing the disease effectively. By understanding its types, symptoms, and treatment options, patients and caregivers can make informed decisions and face the journey with confidence and resilience.