The lymph system (otherwise also called as the lymphatic system) is a major part of our body’s immunity that helps to keep infections and other diseases at bay. It also aids in fluid movement, throughout the body. It consists of both tissues and cells.
The lymphatic system consists mainly of:
- Lymphoid Tissue: This is mainly the lymph nodes and related organs, such as thymus, spleen and tonsil that are part of both immune and blood-producing systems.
- Lymph: A clear fluid circulating in the lymph system, transporting waste by-products and surplus fluid from tissues, in addition to lymphocytes and other immune system cells as well.
- Lymphatic Vessels: Vessels that resemble to blood vessels, except that they carry lymph through the lymphatic system.
The cells are the lymphocytes. These are white cells found in the lymph nodes, the spleen, the lymphatic channels, as well as in blood, each playing their key part in the functioning of the immune system. There are three chief types of lymphocytes:
- The T- lymphocytes (T- cells) : Some T cells can themselves destroy and kill bacteria or cells with viruses or fungi. Other types of T cells are complementary to other immune cells.
- The B-lymphocytes (B- cells) : B cells help protect the body from germs (bacteria and viruses) by making proteins called antibodies.
- The natural killer (NK) cells.
What are lymphomas ?
These are cancers of lymphoid origin, seen consisting of anomalous and abnormal proliferation of B or T cells in lymphoid tissue. It characteristically causes lymphadenopathy.
What are the types of lymphomas ?
There are 2 main kinds of lymphomas:
- Hodgkin’s disease or Hodgkin’s lymphoma (HL) : Hodgkin’s Lymphoma is distinguished from other types of lymphoma by the presence of the characteristic “Reed-Sternberg cell”. Reed-Sternberg cells are typically B-cells with differences and variations to them.
- Non-Hodgkin’s lymphoma (NHL) : Non-Hodgkin lymphoma is a cancer that initiates in the immune cells called lymphocytes, which are essential elements of the body’s immune system.
These two types of lymphomas vary in their behaviour, the way they spread, and response to treatment, so it is really imperative to differentiate between them. Doctors can usually differentiate them by studying the cancer cells microscopically or by using specific & sensitive lab tests.
Hodgkin’s lymphoma is further divided into these sub-types :
1) Classical Hodgkin lymphoma
- Nodular Sclerosis Hodgkin Lymphoma
- Mixed cellularity Hodgkin Lymphoma
- Lymphocyte-depleted Hodgkin Lymphoma
- Lymphocyte-rich Classical Hodgkin Lymphoma
2) Nodular Lymphocyte-predominant Hodgkin Lymphoma
Non Hodgkin’s Lymphoma is further divided into these sub-types :
There are many types of Non Hodgkin’s lymphoma. The most commonly seen types are the diffuse large B-cell lymphoma and the follicular lymphoma.
Lymphomas may be divided by how rapidly they are likely to grow.
1) Indolent (or low-grade) lymphomas grow slowly and cause fewer symptoms.
2) Aggressive (or intermediate-grade/ high-grade) lymphomas grow faster and spread quickly.
How are lymphomas caused ?
Genetic alterations, Infection, Antigen stimulation & Immunosuppression are possible causes for lymphomas.
There is some amount of familial clustering, and there is an increased incidence in siblings of diseased patients. Genetic predisposition is under investigation.
Patients who have a history of mononucleosis have a much higher risk of developing Hodgkin’s Lymphoma. People with Epstein Barr Virus or Helicobacter Pylori infection are at a higher risk of developing Non Hodgkin’s Lymphoma. People with human T-cell lymphocytotropic virus (HTLV) or human immunodeficiency virus (HIV) infection have increased likelihood of developing both types of Lymphoma.
What are the clinical features of lymphomas ?
These are variable based on site affected. The severity can vary from asymptomatic to extremely ill. The evolution of the disease could be over weeks, months, or years.
Systemic manifestations include fever, night sweats, loss of weight, anorexia or pruritis.
Local manifestations include lymphadenopathy, splenomegaly most commonly, but any tissue could be potentially infiltrated.
A common beginning sign of the Lymphomas is a painless swelling (or enlargement) of one or more lymph nodes. Most have affected lymph nodes either in the upper body— that is the neck or upper chest, or the groin.
How are lymphomas diagnosed ?
- A complete physical examination of the body is mandatory.
- Complete Blood Count (CBC): Usually a small, representative amount of blood is collected from the person’s forearm with a needle and syringe. The blood is then put in tubes and sent to a hematology lab. A complete blood count or CBC is a test that is used to diagnose and monitor the lymphocyte counts. The lab also will screen for lactate dehydrogenase (LDH). Lymphoma may show elevated levels of LDH.
- Imaging Tests: To determine the disease and its extent, imaging tests need to be performed so doctors can view, assess and judge the cancer and determine how far it has progressed or spread. These tests may include the following such as X- rays, CT Scan, MRI Scan or PET Scans. The imaging test(s) can show enlarged or swollen lymph nodes in the chest or abdomen or sometimes, both. Tumour masses can be seen exterior to the lymph nodes sometimes, in the lungs, bones or other body tissues.
- Lymph Node Biopsy: A hematopathologist (a doctor who is a specialist in diagnosis and interpretation of diseases of the blood and bone marrow) will have to be consulted. A biopsy of an involved lymph node or outside tumour site is needed to substantiate and confirm the diagnosis. It is better if the entire lymph node or part of it is surgically removed so that the hematopathologist has sufficient tissue to establish a firm diagnosis.
Removed tissue examined under a microscope by a pathologist is the only sure-shot way to make a definitive cancer diagnosis.
How are lymphomas staged ?
Physical examination is most definitive if carried out when the patient is under general anaesthesia. There is a local & distant staging.
Grade and Stage describe the tumour, helping to provide guidance for the oncologist in choosing the best treatment option(s). Staging is a careful attempt to find out the exact extent and spread of the cancer. The higher the stage the more the cancer has spread and progressed.
Grade refers to what the cancer cells look like, and how much they resemble their cell of origin or differentiation. The higher the grade, the more aggressive the tumour is.
How are lymphomas treated ?
Choose a doctor who is a lymphoma specialist and knows about the latest, up-to-date treatments. This type of specialist is usually called a hematologist/oncologist. Or your local cancer specialist can work in-tandem with a lymphoma specialist. Speak to your doctor to find out what treatment is best for you.
Treatment options for lymphomas include either a single treatment option or two or more treatments in combination (used more commonly).
- Chemotherapy : A kind of cancer treatment that uses either drugs or chemical substances (hence the name chemotherapy) to kill cancer cells and prevent them from dividing. Patients who need treatment may receive chemotherapy or monoclonal antibody therapy alone or in combination. Stem cell transplantation is also a treatment option for certain patients. Some patients with indolent lymphomas may not need treatment for long periods of time after diagnosis, based on the “watch and wait” policy.
- Radiation Therapy : A cancer treatment that utilizes high-energy x-rays or basically radiation to eradicate cancer cells.
- Immunotherapy or Biological Therapy : Immunotherapy works by utilizing your own body’s immune system to fight cancer cells.
- Bone Marrow Transplantation/ Stem Cell Transplantation : When the bone marrow acts as the source for stem cells in a patient, it becomes a bone marrow transplant. When the bloodstream, acts as the source for stem cells in a patient, it becomes a blood stem cell transplant also otherwise known as a stem cell transplant. Whether the terms “stem cell transplant” or “bone marrow transplant,” is used, they mean the same transplantation procedure. The only thing that varies is the source of the stem cells. Autograft is when the patient’s own bone marrow or stem cells are used and Allograft is when the bone marrow from another person (donor) is used.
Cure is the goal of treatment for patients with Hodgkin’s Lymphoma. The cure rate is excellent with current treatment approaches for Hodgkin’s Lymphoma, even more so in young patients and those with early disease.
What is the care to be taken after the removal of a lymphoma ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans because of the risk of recurrence of lymphoma.
All lymphoma patients in remission, need to see their doctors regularly and routinely for examination and blood tests. People with lymphoma need medical follow-up after they have completed treatment. It is important to see and note if more therapy is needed.
The doctor may recommend longer periods of time between follow-up visits if a patient continues to be disease free. Each type of lymphoma has to be followed differently. Speak to your doctor to find the best care plan for you.
Patients and caregivers should talk with their doctors about both short-term and long-term effects of cancer treatment. Cancer-related fatigue is one common long-term effect, so it important to be aware of that.
How to find and reach cancer specialists for lymphoma treatment ?
Now you can find and reach cancer specialists for lymphoma treatment from different cancer hospitals and destinations on a single platform, Hinfoways. You can avail opinions and information from multiple cancer specialists, cost estimates for lymphoma treatment from different cancer hospitals, compare things and then choose a cancer specialist or a cancer hospital for lymphoma treatment.
Find, reach and choose a cancer specialist for lymphoma treatment on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
