Malignant lymphoma: types, causes, treatment, prognosis

“Malignant lymphoma,” or lymphoma, is a general term for cancer that starts from cells in the lymphatic system called lymphocytes. These cells are part of the immune system.

Lymphoma occurs when lymphocytes become abnormal and multiply. It can be diagnosed in children and adults. Most lymphomas start from white blood cells called B lymphocytes (B cells) or T lymphocytes (T cells).

This article will review the types of lymphomas, their causes, treatment, prognosis, and coping.

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Types

There are over 70 different types of lymphoma.

They can be slow growing or very fast growing, and anywhere in between. The two main groups of lymphomas are:

Hodgkin’s lymphoma

Hodgkin’s lymphoma (HL), also called Hodgkin’s disease, is the rarest type of lymphoma, accounting for about 1 in 10 lymphoma diagnoses in developed countries.

It is characterized by large abnormal cancer cells called Hodgkin and Reed-Sternberg cells.

This type of cancer can occur at any age, but is usually diagnosed most often between the ages of 15 and 39, followed by 75 or older.

Non-Hodgkin lymphoma

The treatment and prognosis of non-Hodgkin’s lymphoma (NHL) depends on the subtype, so it’s important to get an accurate diagnosis. The World Health Organization (WHO) groups lymphomas according to:

  • The type of lymphocyte in which the lymphoma starts
  • What does lymphoma look like under the microscope
  • Characteristics of chromosomes in lymphoma cells
  • The presence of certain proteins on the surface of cancer cells

B-cell lymphomas account for approximately 85% of NHLs in the United States.

Types of B-cell lymphoma include:

  • Diffuse large B-cell lymphoma (DLBCL)
  • Follicular lymphoma
  • Chronic lymphocytic leukemia
  • Small lymphocytic lymphoma
  • Mantle Cell Lymphoma (MCL)
  • Marginal zone lymphomas
  • Burkitt’s lymphoma
  • Primary linfome of the central nervous system
  • Primary intraocular lymphoma

T-cell lymphomas can include:

  • Peripheral T-cell lymphomas
  • T-lymphoblastic lymphoma/leukemia

Symptoms

Many signs and symptoms are similar for HL and NHL, although there are some differences. The most common symptom for both is one or more swollen or enlarged lymph nodes.

Symptoms of Hodgkin’s Lymphoma

Symptoms of HL can include:

  • Fatigue that does not go away
  • Cough and shortness of breath
  • Itchy skin
  • Loss of appetite
  • Feeling of fullness or abdominal pain/swelling
  • Pain in the lymph nodes after drinking alcohol

There are also symptoms called B symptoms, which can help with prognosis and staging. These symptoms include:

  • Profuse night sweats
  • Unexpected weight loss of 10% or more of your body weight
  • Unexplained fever

Symptoms of Non-Hodgkin’s Lymphoma

Symptoms of NHL can include:

  • Painless swelling in one or more lymph nodes
  • Fever
  • Profuse night sweats
  • Tired
  • Loss of appetite
  • Cough or chest pain
  • Weightloss
  • Abdominal pain
  • Itchy skin
  • Enlarged spleen or liver
  • Rashes or bumps on the skin

causes

The causes of lymphoma are not definitively known, but there are known links to potential risk factors. These may include:

  • People infected with the human immunodeficiency virus (HIV) have a higher risk of developing lymphoma
  • Some viruses have been associated with certain types of lymphomas, such as human T-cell lymphotrophic virus and Epstein-Barr virus
  • Exposure to large amounts of ionizing radiation has been associated with an increased risk of non-Hodgkin’s lymphoma
  • A family history has been linked to Hodgkin’s lymphoma
  • There is speculation about the ingredients of herbicides and pesticides and their link to lymphoma, but more research is needed

Cancer cells multiply abnormally and rapidly and crowd out healthy cells. Eventually, these cancer cells form tumors or masses, usually in the lymph nodes.

Diagnostic

Since there are many different types of lymphoma, getting an accurate diagnosis is important as it helps guide treatment and provides information about prognosis.

A biopsy will be performed. This involves removing a small piece of fabric. There are two ways to do this:

  • Operation: Part or all of a lymph node or piece of tissue is removed
  • Core biopsy: A hollow needle is placed into a lymph node or tumor to extract a piece of tissue or fluid

After the tissue or fluid is removed, it is examined under a microscope to examine the cells to identify types and subtypes.

Other tests that may be ordered include imaging tests like positron emission tomography (PET), computed tomography (CT) or magnetic resonance imaging (MRI), and bone marrow biopsy or blood tests. This is to see how much and where lymphoma is in your body, which helps with staging.

Processing

The treatment you have depends on the type and subtype of lymphoma you have. This can vary considerably.

Other elements taken into consideration include:

  • General health, age
  • fitness status
  • Purposes of treatment
  • Personal preferences

If you have very slow-growing lymphomas, called indolent lymphomas, and you don’t have any symptoms, you may just be monitored.

Hodgkin Lymphoma Treatment

The majority of people with Hodgkin’s lymphoma can be cured.

If you have just been diagnosed, your treatment may consist of radiation therapy and chemotherapy, or chemotherapy alone. One of the most commonly used chemotherapy regimens for HL is called ABVD, which stands for:

  • Adriamycin (doxorubicin)
  • Blenoxane (bleomycin)
  • Velban or Alkaban-AQ (vinblastine)
  • DTIC-Dome (dacarbazine)

If you have relapsed HL or HL that is not responding to treatment, your treatment may include chemotherapy, radiation therapy, new drugs, and stem cell transplantation. Immunotherapy may also be an option, as well as participation in clinical trials.

Treatment of non-Hodgkin’s lymphoma

For people with aggressive B-cell NHL, chemotherapy is often recommended, as part of a regimen called R-CHOP, which includes:

  • Rituxan (rituximab)
  • Neosar (cyclophosphamide)
  • Adriamycin or Rubex (doxorubicin)
  • Oncovin or Vincasar Pfs (vincristine sulfate)
  • Deltasone, Liquid Pred, Meticorten and Orasone (prednisone)

You might also have other treatments like radiation therapy or surgery.

Targeted therapies, immunotherapy, CAR T-cell therapy, stem cell transplantation, and radiation therapy are also potential treatment options.

Prognosis

The prognosis for lymphoma depends on the type of lymphoma you have, as well as its stage and various prognostic factors. Other factors like your age and general health can also influence the prognosis.

For HL, overall, the five-year survival rate is 87%. This means that at the time of initial diagnosis, overall, people diagnosed with HL have about an 87% chance of living five years after diagnosis than those without the diagnosis.

If you break down the five-year survival rate for HL by stage, it looks like this:

  • localized (a lymph node/an organ outside the lymphatic system/a lymphoid organ): 92%
  • Regional (spread to an organ near one lymph node area/two or more lymph node areas on the same side of the diaphragm/mass disease): 94%
  • Far (in the bone marrow/spread to distant parts of the body/spread above and below the diaphragm): 82%

For NHL, there are so many different types of NHL that the five-year survival rate can vary. For the NHL as a whole, the five-year relative survival rate is 73%.

Since the prognosis depends on so many individual factors and disease characteristics, talk to your treatment team about your prognosis and why.

To face

Living with cancer and surviving cancer can be difficult, both physically and mentally. There are steps you can take to help you cope. This may include:

  • Make sure you understand your diagnosis, as this can help reduce anxiety around strangers and can help you to be actively involved in your treatment.
  • Ask your treatment team about an oncology social worker. These are often on staff at hospitals and cancer centers and can help direct you to various things you may need, emotionally and practically.
  • Seek counseling or support groups, if needed.
  • Do not isolate yourself: reach out to your family and friends and let them take care of you.
  • Go easy on yourself. You are dealing with a lot of things right now.

Summary

Lymphoma is a cancer of the cells of the lymphatic system, with two main groups: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Within these two categories, there are many subtypes, and their treatment and prognosis can vary widely. Talk to your healthcare team about your specific diagnosis, as each type and subtype can be very different from each other.

A word from Verywell

Lymphoma and its treatment can be overwhelming. Don’t be afraid to ask your healthcare team questions, that’s what they’re here for. If you get nervous or emotional during appointments, write down your questions ahead of time and bring them with you. Your team is there to help you, every step of the way.

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