Lymphoma is the 5th most common type of cancer in the UK. It can occur at any age, including in children. Lymphoma is nearly always treatable; most people live for many years after their diagnosis.
There are different types of lymphoma. Depending on its type and where it is in the body, lymphoma can cause many different symptoms. Some people have no symptoms at all, and their lymphoma is discovered when they have tests for another condition.
Lymphoma is a cancer of lymphocytes. Lymphocytes are a type of white blood cell that fights infection. Healthy lymphocytes travel around your body in your lymphatic system, which is part of your immune system.
Lymphoma develops when lymphocytes become out of control. They divide in an abnormal way or do not die when they should.
What is the lymphatic system?
The lymphatic system runs throughout your body and includes lymph nodes (glands that contain lymphocytes) as well as organs of your immune system like your thymus and your spleen.
Where does lymphoma develop?
When you have lymphoma, abnormal lymphocytes can collect almost anywhere in your body. They usually collect in lymph nodes, which are found throughout your body, often in groups.
Lymphoma commonly develops in the lymph nodes in the neck, armpit or groin. It can also develop in lymph nodes and tissues deeper inside your body. In some people, lymphoma develops in the bone marrow.
Less commonly, lymphoma starts in other areas of your body, such as the breast, stomach, bowel, skin, brain or liver.
Development of cancer
Your body is made up of many different types of cell, for example skin, bone and blood cells. As part of day-to-day life, cells grow and divide to form new cells. New cells replace cells that are older, as well as cells that have become damaged and die. Cell division is carefully controlled by chemical signals.
A cancer can develop when a genetic change happens within a cell. This might cause the cell to stop ‘listening’ to these chemical control signals. When this happens, cells can divide and multiply in an abnormal way, or old or damaged cells might not die as they should. This breakdown in control leads to the build-up of a large number of abnormal cells, which may form a cancer.
In most cases, the cause of lymphoma is not known. There is no evidence that anything you have or haven’t done caused your illness.
Some people with conditions that affect their immune system have a higher risk of developing lymphoma. This includes, for example, people with HIV and those who have had an organ transplant.
Swollen lymph nodes
The most common symptom of lymphoma is a lump or several lumps. These are enlarged (swollen) lymph nodes and are usually painless. They are often noticed in the neck, armpit or groin.
Fatigue means you are exhausted for no obvious reason or feel washed out after doing very little.
Unexplained weight loss
Unexplained weight loss means losing a lot of weight quite quickly without dieting.
Sweats and infections
Lymphoma can cause sweats that often happen at night and make your nightclothes and bed sheets soaking wet. Night sweats are often described as ‘drenching’. Some people get fevers (temperature above 37.5°C). Fevers often occur together with night sweats and weight loss, but they can occur separately. Repeated or persistent infections (that you can’t shake off) can also be a symptom of lymphoma.
Itching, with or without a rash, can be a symptom of lymphoma. It can be very troublesome, particularly in hot weather.
Nearly 2,000 people are diagnosed with Hodgkin lymphoma each year in the UK. It affects slightly more males than it does females. Hodgkin lymphoma can occur at any age, although most people diagnosed are between the ages of 15 and 34, or over 60.
Non-Hodgkin lymphoma (NHL)
More than 13,000 people are diagnosed with NHL each year in the UK. In addition, more than 3,000 people each year are diagnosed with chronic lymphocytic leukaemia (CLL), which is sometimes considered to be a form of NHL.
The risk of developing NHL increases with age. Most people who are diagnosed are over 55. It affects slightly more men than women.
NHLs are divided into 2 main types:
• B-cell non-Hodgkin lymphomas, which develop from B cell lymphocytes. B cell lymphocytes produce antibodies to fight infection.
• T-cell non-Hodgkin lymphomas, which develop from T cell lymphocytes. T cell lymphocytes protect you from viruses and cancers by attacking them directly.
A biopsy is a sample of tissue taken from your body and looked at under a microscope to check for abnormal cells. In most cases, a biopsy is the only way to confirm a diagnosis of lymphoma.
Sometimes a whole lymph node is removed. You might hear this called an ‘excision’ biopsy. An excision biopsy is a minor operation. It usually involves having a general anaesthetic. You go to hospital as an outpatient and the visit takes a few hours. Sometimes a smaller sample of the lymph node is taken under a local anaesthetic. This is called a ‘core’ biopsy. It can take a number of weeks for a biopsy to be arranged and for the results to come back.
In a blood test, a sample of your blood is taken and tested in a laboratory. Blood tests help doctors find out more about your general health and how well your organs are working. Your general health can affect what treatment you can have.
Bone marrow tests
Bone marrow is the spongy tissue in the centre of some of your large bones. It is where blood cells are made.
You might have a bone marrow biopsy to check if there are lymphoma cells in your bone marrow.
A special needle is used to take a sample of the bone marrow from your hip bone. Before it is taken, the area is numbed using a local anaesthetic. Even with an anaesthetic, a bone marrow biopsy can be painful. Sedatives sometimes help. Painkillers are not usually needed afterwards; however, your doctor will advise you what to take should you have any pain.
Scans and X-rays
Scans give more detailed pictures of the organs and lymph nodes in your body. There are several different kinds of scan that work in different ways.
• A CT or CAT scan uses X-rays
• A PET scan measures uptake of radioactive sugar
• An MRI scan uses magnetic waves
• An ultrasound uses sound waves.
The most common scans used in lymphoma are CT scans and PET scans – often combined into a PET/CT scan. Few people have an MRI scan.
An X-ray uses a form of radiation to take pictures of the inside of your body. You may have a chest X-ray to see if there are any enlarged lymph nodes in your chest. If you have had problems with your bowels, you might have an X-ray of your abdomen (tummy).
Staging of lymphoma
‘Staging’ is the process of working out which parts of your body contain lymphoma. Doctors use tests and scans to tell which stage your lymphoma is: 1, 2, 3 or 4. You might also see the stage written in Roman numerals (I, II, III or IV). Staging helps doctors to plan your treatment.
Most people with stage 1 or 2 lymphoma are said to have ‘early-stage’ lymphoma. People with stage 3 or 4 lymphoma are often said to have ‘advanced-stage’ lymphoma. The lymphatic system is spread throughout the body so it is not uncommon for lymphoma to be advanced when it is diagnosed. Lymphomas at any stage can be treated successfully.
As well as the numbers 1–4, the letters ‘A’ or ‘B’ are often used to describe the stage of lymphoma.
• ‘B’ means that you have unexplained weight loss, night sweats or fevers.
• ‘A’ means that you have not had any of these symptoms.
Sometimes, the letter ‘E’ (for ‘extranodal’) is also used. This means that the lymphoma started in an organ that is not part of the lymphatic system, for example, in the digestive system or salivary glands.
Lymphoma can be treated with drugs (chemotherapy, steroids and targeted therapies), radiotherapy or a stem cell transplant. The type of treatment you need depends on the type and stage of your lymphoma.
For some people, an approach known as ‘watch and wait’ is recommended. This means that you do not have active treatment straightaway