Lymphoma is a type of cancer that affects the lymphatic system, which is part of the body's immune system.
What is lymphoma?
Lymphoma is a type of cancer that begins in infection-fighting cells of the immune system, called lymphocytes. These cells are in the lymph nodes, spleen, thymus, bone marrow, and other parts of the body. When you have lymphoma, lymphocytes change and grow out of control.
There are two main types of lymphoma:
- Non-Hodgkin lymphoma (NHL): A diverse group of lymphomas that do not have Reed-Sternberg cells. There are many different subtypes.
- Hodgkin lymphoma: Less common than Non-Hodgkin lymphoma, this type has the presence of large, abnormal cells called Reed-Sternberg cells.
Receiving any type of cancer diagnosis can feel scary. Fortunately, many blood cancers are very treatable. In fact, it’s often possible to live a full life despite having lymphoma. Living well after a cancer diagnosis requires a team of dedicated, experienced hematologists (blood disease specialists) devoted to managing every aspect of treatment. At the AHN Cancer Institute, we provide the personalized, sophisticated care you need and deserve.
AHN Hematological Oncology Center of Excellence
Our Hematological Oncology Center of Excellence includes physicians dedicated to malignant and benign disorders of the blood. We provide both inpatient and outpatient services and can offer treatment at AHN cancer institute sites throughout the region. The team also includes support from:
- Physician assistants
- Nurse practitioners
- Nurses
- Medical assistants
- Pharmacists
- Administrators
Lymphoma care at AHN: Why choose us?
The AHN Leukemia, Lymphoma, and Myeloma Cancer Leadership team meets regularly to discuss and confirm the right combination of therapies for a patient. We work with you to get an accurate diagnosis and to create an effective strategy for your treatment. With the new AHN Cancer Institute Research Hub, we’re driving the future of cancer care and delivering it at a location that’s convenient for you.
Lymphoma symptoms and signs
It's important to remember that many of the symptoms associated with lymphoma can also be caused by other more common and less serious conditions. Early detection is key, so be mindful and seek medical advice if you are concerned with new or worsening health issues or symptoms. Some things to look for include:
- Swollen lymph nodes: You might notice lumps under your skin, especially in your neck, armpits, or groin. These are usually painless.
- Feeling tired: More than just a little tired; this is an ongoing, unexplained fatigue that doesn't go away with rest.
- Losing weight without trying: If you're losing weight without changing your diet or exercise habits, it's worth paying attention to.
- Fevers: Having fevers that come and go or seem to happen for no reason.
- Night sweats: Waking up in the middle of the night drenched in sweat to where the sheets are soaked, even if the room isn't hot.
- Itchy skin: Feeling itchy all over, without a rash or other obvious cause.
- Cough or trouble breathing: If lymphoma affects the chest area, you might experience coughing or difficulty breathing.
- Stomach discomfort: Abdominal pain or swelling can occur.
Causes and risk factors
While the exact causes of most lymphomas are not fully understood, research has identified several risk factors that may increase a person's chances of developing the disease. It's important to remember that having one or more of these risk factors does not guarantee that you will develop lymphoma. Many people with risk factors never get the disease, while others with no known risk factors do. Potential risk factors of lymphoma include:
- Age: Certain types of lymphoma are more common in specific age groups. For example, Hodgkin lymphoma is more common in young adults (20s–30s) and older adults (over 55). Non-Hodgkin lymphoma is more common in older adults.
- Sex: Some types of lymphoma are slightly more common in those assigned male at birth.
- A weakened immune system: Autoimmune diseases like rheumatoid arthritis, lupus, and Sjogren’s syndrome can increase the risk of developing lymphoma. Additionally, being the recipient of an organ donation or having an HIV/AIDS diagnosis can also increase the risk of lymphoma.
- Certain infections: Having certain virus types like Epstein-Barr Virus and Human T-cell Leukemia/Lymphoma Virus Type 1 increases the chance of having lymphoma.
- Exposure to certain chemicals: Exposure to high levels of certain pesticides, herbicides, and solvents has been linked to an increased risk of lymphoma in some studies.
- Family history: Having a close relative (parent, sibling, or child) with lymphoma can slightly increase your risk, but lymphoma is generally not considered to be directly inherited.
- Previous cancer treatment: People who have received chemotherapy or radiation therapy for other cancers may have a slightly increased risk of developing lymphoma later in life.
- Obesity: Some studies have suggested that obesity may be a risk factor for certain types of lymphoma.
It's important to emphasize that many people with these risk factors never develop lymphoma. Risk factors are associated with a higher chance of developing the disease, but they don't directly cause it.
Lymphoma survival
Overall, the survival rates for lymphoma are quite promising. The five-year relative survival rate refers to the percentage of patients who are alive five years after diagnosis, compared to people in the general population who do not have lymphoma. It is "relative" because it compares the survival of lymphoma patients to that of the general population, adjusting for the fact that people can die from other causes. The type of lymphoma impacts the survival rate. It’s important to remember these are just estimates, and your AHN care team will develop a treatment plan that is best for you and your specific health outcomes. The general survival rates are:
- Hodgkin lymphoma: Hodgkin lymphoma generally has a high survival rate. The five-year relative survival rate for all stages of Hodgkin lymphoma is around 89 – 90%. For early stages, the rate is even higher.
- Non-Hodgkin lymphoma (NHL): NHL is a more diverse group of cancers, and survival rates vary widely depending on the specific type. The five-year relative survival rate for all types of NHL combined is around 74 – 75%. However, some types of NHL have much higher survival rates (e.g., some indolent lymphomas), while others have lower rates (e.g., some aggressive lymphomas).
Lymphoma screening and diagnosis
Currently, there are no routine screening tests recommended for lymphoma in the general population. People at higher risk (e.g., those with certain immune disorders, previous cancer treatments, or family history) should be aware of the symptoms and promptly report any concerns to their doctor.
Diagnosis begins with a physical exam. The doctor will check for enlarged lymph nodes in the neck, armpits, groin, and other areas. They may also check for enlargement of the spleen or liver.
Imaging tests
These tests help visualize the lymph nodes and other organs to detect any abnormalities. Main imaging techniques include:
- X-ray: A chest X-ray may be done to look for enlarged lymph nodes in the chest.
- CT scan: A computed tomography (CT) scan uses X-rays to create detailed images of the inside of the body. CT scans can help detect enlarged lymph nodes and tumors in the chest, abdomen, and pelvis.
- Magnetic resonance imaging (MRI): Uses radio waves and a strong magnetic field to create detailed images of the body. MRI can be used to evaluate lymph nodes and other organs.
- PET Scan: A positron emission tomography (PET) scan uses a radioactive tracer to detect areas of increased metabolic activity, which can indicate the presence of lymphoma. PET scans are often combined with CT scans (PET/CT) for more precise localization.
Biopsy
A biopsy is a medical procedure that involves removing a small sample of tissue from the body so it can be examined under a microscope. Local anesthesia is often used to numb the area. In some cases, for deeper or larger biopsies, regional or general anesthesia may be used. The sample is then analyzed by a pathologist, a doctor who specializes in diagnosing diseases by examining tissues and cells.
Lymph node biopsy
A lymph node biopsy is the primary way to diagnose lymphoma. It involves removing a sample of lymph node tissue to examine under a microscope to look for lymphoma cells. Types of lymph node biopsies include:
- Excisional biopsy: The entire lymph node is removed for examination under a microscope. This is often the preferred method, as it provides the most tissue for analysis.
- Incisional biopsy: Only a portion of the lymph node is removed.
- Core needle biopsy: A needle is used to remove a small core of tissue from the lymph node.
- Fine needle aspiration (FNA): A thin needle is used to remove cells from the lymph node. FNA is less invasive but may not provide enough tissue for a definitive diagnosis.
Bone Marrow Biopsy
A bone marrow biopsy is done to determine if the lymphoma has spread to the bone marrow. This is important for staging the lymphoma and guiding treatment decisions. A needle is inserted into the bone marrow (usually in the hip) to remove a sample of bone marrow tissue. Bone marrow aspiration and biopsy are usually performed at the same time. The bone marrow sample is sent to a hematopathologist, who examines it under a microscope. Special stains and tests are used to look for lymphoma cells and assess the overall health of the bone marrow.
Blood tests
While blood tests alone cannot definitively diagnose lymphoma, they can provide important clues and help narrow down the possibilities. Some blood tests can help determine the stage of the lymphoma. Blood tests are also used to monitor the patient's overall health and response to treatment and identify potential complications.
- Complete blood count (CBC): Measures the levels of different types of blood cells (red blood cells, white blood cells, and platelets).
- Lactate dehydrogenase (LDH): Elevated levels of LDH can indicate tissue damage or cancer.
- Beta-2 microglobulin: Elevated levels can be associated with lymphoma.
- Liver and kidney function tests: To assess the function of these organs.
- Viral testing: To check for infections that can be associated with lymphoma (e.g., HIV, hepatitis C).
Immunophenotyping
This identifies specific proteins on the surface of the lymphoma cells. This helps determine the type of lymphoma (e.g., B-cell lymphoma, T-cell lymphoma) and its subtype. Flow cytometry and immunohistochemistry are commonly used techniques.
Cytogenetic testing
This looks for chromosomal abnormalities in the lymphoma cells. These abnormalities can help diagnose certain types of lymphoma by identifying specific markers that are characteristic of lymphoma cells. It also helps classify lymphoma into specific subtypes (e.g., diffuse large B-cell lymphoma, follicular lymphoma, T-cell lymphoma), which is essential for determining the most appropriate treatment. Karyotyping, fluorescence in situ hybridization (FISH), and polymerase chain reaction (PCR) are used to detect chromosomal abnormalities.
Molecular testing
Molecular testing involves analyzing the DNA, RNA, or proteins of lymphoma cells to identify genetic abnormalities (mutations, translocations, deletions, etc.) Used to identify specific genetic mutations in the lymphoma cells. These mutations can help diagnose certain types of lymphoma and may be targets for therapy. Next-generation sequencing (NGS) and other molecular techniques are used to detect genetic mutations.
After a diagnosis of lymphoma is made, additional tests may be done to determine the stage of the lymphoma, which helps guide treatment decisions.
Types and stages of lymphoma
Lymphoma is broadly divided into two main categories, Hodgkin and Non-Hodgkin lymphoma. There are over 60 different types of Hodgkin lymphoma alone.
Hodgkin lymphoma
The key feature of this type is the presence of Reed-Sternberg cells (specific abnormal cells). Main subtypes include:
- Classical Hodgkin lymphoma (cHL): This is the most common type, accounting for about 95% of Hodgkin Lymphoma cases. There are four subtypes of cHL:
- Nodular sclerosis Hodgkin lymphoma: The most common subtype of Hodgkin lymphoma. It is characterized by the presence of large nodules of lymphocytes separated by bands of collagen. It often presents in the neck or chest.
- Mixed cellularity Hodgkin lymphoma: The second most common subtype. It is characterized by a mixed population of lymphocytes, including Reed-Sternberg cells, eosinophils, and plasma cells. It is more common in older adults and those with HIV infection.
- Lymphocyte-rich Hodgkin lymphoma: A less common subtype. It is characterized by a large number of lymphocytes and fewer Reed-Sternberg cells. It often has a good prognosis.
- Lymphocyte-depleted Hodgkin lymphoma: The least common subtype. It is characterized by a scarcity of lymphocytes and the predominance of Reed-Sternberg cells. It is often associated with advanced-stage disease and a poorer prognosis.
- Nodular Lymphocyte-Predominant Hodgkin lymphoma (NLPHL): This type is less common, accounting for about 5% of Hodgkin lymphoma cases. NLPHL is characterized by the presence of "popcorn cells," which are variants of Reed-Sternberg cells. It typically has a more indolent (slow-growing) course than cHL and may be treated differently.
Non-Hodgkin lymphoma
The biggest difference between Hodgkin and non-Hodgkin lymphoma is the absence of Reed-Sternberg cells. Main subtypes include:
- Diffuse Large B-Cell lymphoma (DLBCL): One of the most common types of NHL, it is an aggressive (fast-growing) lymphoma that arises from B-cells (a type of lymphocyte). Symptoms include a rapidly growing mass in the neck, groin, abdomen, or other locations. It is typically treated with chemotherapy, often in combination with immunotherapy (e.g., rituximab), and can often be cured.
- Follicular lymphoma: The second most common type of NHL, it is usually a slow-growing (indolent) lymphoma that arises from B-cells. Symptoms often present as enlarged lymph nodes. Treatment approaches vary depending on the stage and symptoms. Options include watchful waiting, radiation therapy, chemotherapy, immunotherapy, and targeted therapy. While it may not be curable in some cases, it can often be managed for many years.
- Burkitt lymphoma: A rare form of NHL, it is a very aggressive (fast-growing) lymphoma that arises from B-cells. Symptoms can involve the jaw, central nervous system, bowel, kidney, or other organs. Treating this subtype requires intensive chemotherapy. It can be curable, especially with prompt and aggressive treatment.
- Mantle cell lymphoma (MCL): Relatively uncommon, this is usually an aggressive lymphoma but can sometimes be indolent, and it arises from B-cells. Symptoms often involve the lymph nodes, spleen, bone marrow, and gastrointestinal tract. Treatment options include chemotherapy, immunotherapy, targeted therapy, and stem cell transplant.
- Marginal zone lymphoma (MZL): This is a relatively uncommon, typically a slow-growing (indolent) lymphoma, and it arises from B-cells. There are several subtypes of MZL. Symptoms can involve the lymph nodes, spleen, or tissues outside the lymph nodes (extranodal). Treatment depends on the subtype and stage. Options include radiation therapy, immunotherapy, and chemotherapy.
Lymphoma staging tells us how far the cancer has spread in your body. It's usually described using the Lugano staging system, which ranges from Stage 1 to Stage 4. Generally:
- Stage 1: Lymphoma is found in one lymph node area or lymphoid organ (like the thymus or spleen).
- Stage 2: Lymphoma is in two or more lymph node areas on the same side of the diaphragm (the muscle below your lungs).
- Stage 3: Lymphoma is in lymph node areas on both sides of the diaphragm.
- Stage 4: Lymphoma has spread widely, involving organs outside the lymphatic system, such as the liver, lungs, or bone marrow.
Lymphoma treatment
Lymphoma treatment is highly individualized and depends on the specific type and stage of lymphoma, as well as your overall health and personal needs. The goal of treatment is to achieve remission, meaning there is no evidence of cancer in the body. Treatment options may include chemotherapy, radiation therapy, targeted therapy, immunotherapy, stem cell transplant, or a combination of these.
At AHN, we take a multidisciplinary approach to lymphoma care, bringing together a team of expert hematologists, oncologists, radiation oncologists, pathologists, nurses, and other specialists to develop a personalized treatment plan for each patient. Our focus is on providing comprehensive, compassionate care that addresses not only the cancer, but also the patient's physical, emotional, and social well-being. We use the latest advances in lymphoma treatment and offer access to clinical trials to ensure our patients receive the most innovative and effective care possible.
Chemotherapy
Chemotherapy uses drugs to kill lymphoma cells. These drugs can be administered orally or intravenously. Chemotherapy is often used in combination with other treatments, like immunotherapy. Different chemotherapy regimens exist, and the specific drugs used will depend on the type and stage of lymphoma.
Radiation therapy
Radiation therapy uses high-energy rays to kill lymphoma cells. It can be delivered externally (from a machine outside the body) or internally (using radioactive substances placed near the cancer). Radiation therapy is often used to treat localized lymphoma or to shrink tumors causing specific symptoms.
Targeted therapy
Targeted therapy drugs specifically target vulnerabilities present in lymphoma cells. These drugs can block the growth and spread of lymphoma. Unlike chemotherapy, targeted therapy tends to have a more selective action, potentially reducing harm to healthy cells.
Immunotherapy
Immunotherapy uses the body's own immune system to fight lymphoma. This can be achieved by stimulating the immune system to recognize and attack lymphoma cells or by providing immune system components, like antibodies, to target the lymphoma directly.
Stem Cell Transplant (SCT)
SCT involves replacing the patient's bone marrow with healthy stem cells. This is typically used in patients whose NHL has relapsed after initial treatment or is unlikely to be cured with standard treatment. High-dose chemotherapy is given to kill the lymphoma cells, and then the stem cells are infused to rebuild the bone marrow and immune system. SCT can have serious side effects, including infection, graft-versus-host disease (in allogeneic transplants), and organ damage.
Types of SCT may include:
- Autologous SCT: Uses the patient's own stem cells, which are collected before high-dose chemotherapy and then reinfused after.
- Allogeneic SCT: Uses stem cells from a donor (usually a matched sibling or unrelated donor). This carries a higher risk of complications, but can be more effective in some cases.
Lymphoma FAQs
A lymphoma diagnosis or being at greater risk for developing lymphoma can bring about questions. Rest assured, your AHN care team is here to help and is in your corner. They will be available to discuss your options with you, answer questions, and be a tremendous resource throughout treatment. In the meantime, we’ve provided some frequently asked questions to help you feel informed and ready when you do meet with your care team.
How long can you live with lymphoma blood cancer?
Life expectancy with lymphoma varies greatly depending on the type and stage of lymphoma, the patient's overall health, and how well the lymphoma responds to treatment. Some lymphomas are slow-growing and patients can live for many years, while others are more aggressive. With advancements in treatment, many lymphomas are now highly treatable, and a significant number of patients achieve long-term remission or even a cure. It's essential to discuss your individual prognosis with your oncologist.
What are the chances of lymphoma coming back?
The chance of lymphoma recurrence (coming back after treatment) depends on several factors, including the type and stage of lymphoma, the initial treatment received, and how well the lymphoma responded to that treatment. Some lymphomas have a higher risk of recurrence than others. Regular follow-up appointments with your oncologist are crucial to monitor for any signs of recurrence.
Which lymphoma is most aggressive?
Diffuse large B-cell lymphoma (DLBCL) is one of the most common and aggressive types of non-Hodgkin lymphoma. However, even aggressive lymphomas can often be effectively treated with modern therapies. Burkitt lymphoma is another aggressive type of non-Hodgkin lymphoma that grows very quickly.
How to detect lymphoma?
Lymphoma can be detected through various methods:
- Physical exam: A doctor may feel for swollen lymph nodes in the neck, armpits, or groin.
- Blood tests: Blood tests can help assess overall health and identify abnormalities that may suggest lymphoma.
- Imaging tests: CT scans, PET scans, and MRIs can help visualize lymph nodes and other organs to detect signs of lymphoma.
- Lymph node biopsy: Removing a lymph node or a sample of tissue for examination under a microscope is the most definitive way to diagnose lymphoma.
What is the progression of lymphoma?
The progression of lymphoma varies depending on the type and grade of lymphoma. Some lymphomas are slow-growing (indolent) and may not require immediate treatment, while others are fast-growing (aggressive) and require prompt treatment. If left untreated, lymphoma can spread to other parts of the body, including the bone marrow, liver, and lungs. Treatment can often control or cure lymphoma, preventing further progression.
Contact us
Call 412-578-4484 for the Division of Hematology and Cellular Therapy. Once scheduled, our staff will instruct you on what is needed so that our doctors get access to your medical records.
To schedule an schedule an appointment, select Hematology on our online scheduling page.
Second opinions
If you have cancer, you have a team of oncology specialists ready to review your medical records and offer you a second opinion. After completing their review, they’ll talk with you about your goals to determine a course of treatment that’s right for you. To get started, fill out our Second Opinion Request form. A nurse navigator will contact you within the next 24 to 48 hours to discuss next steps and schedule.