Overview of lymphoma
Lymphoma is a type of blood cancer that begins in the anti-infection cells of the immune system in the body (lymphatic system), called lymphocytes.
About half of all blood cancers that occur each year are lymphoma or lymphoma.
These cells are located 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) : Spread in an orderly lymphatic system. Most people with lymphoma have this type.
- Hodgkin lymphoma (HL) : Spread in an orderly manner from a group of other lymph nodes.
Lymphoma can occur at any age, but it is one of the most common causes of cancer in children and young people aged 15 to 24 years.
What is Hodgkin lymphoma?
Lymph tissue is available in many places on your body, so Hodgkin’s lymphoma can start anywhere in the lymphatic system and grow in many parts of the body at the same time. Hodgkin’s lymphoma usually begins in B lymphocytes
Although Hodgkin’s lymphoma can begin almost anywhere in the body, most often begin in the upper lymph nodes of the body. The most common lymphoid tissue is in the chest, neck or under the arm.
Hodgkin’s lymphoma usually spreads through nearby lymph vessels. It can invade the bloodstream and spread to other parts of the body, such as the liver, lungs or bone marrow.
Types of Hodgkin lymphoma
Different types of Hodgkin’s lymphoma can grow and spread differently and can be treated differently.
Hodgkin’s classic lymphoma
The cancer cells in cHL are called Reed-Sternberg cells. These cells are usually an abnormal type of B lymphocyte. Enlarged lymph nodes in people with cHL often have a small number of Reed-Sternberg cells with lots of normal immune cells around them. Other immune cells cause most swelling in the lymph nodes.
There are 4 types of Hodgkin’s classic lymphoma:
- Hodgkin’s sclerosis ( NSCHL ) : This is the most common type of Hodgkin’s disease that usually begins in the lymph nodes of the neck or chest. This disease develops most commonly in adolescents and young adults.
- Mixed cell Hodgkin’s lymphoma ( MCCHL ) : This is the second most common disease that usually begins in any lymph node but usually occurs in the upper half of the body. It is seen primarily in people with HIV infection.
- Hodgkin’s lymphoma is rich in lymphocytes: It is uncommon that it usually occurs in the upper half of the body and is rarely found in more than a few lymph nodes.
- Hodgkin’s lymphoma has lymphocyte depletion: This is a rare form of the disease that is seen mainly in the elderly and people with HIV. It is more aggressive than other HL types and can evolve when first found. It is most common in the abdominal lymph nodes as well as in the spleen, liver and bone marrow.
Hodgkin lymphoma predominates
Hodgkin lymph nodes predominate lymphocytes (NLPHL) in about 5% of cases. The cancer cells in NLPHL are large cells called popcorn cells because, like the popcorn, are variants of Reed-Sternberg cells. It is also called lymphocytic and histiocytic (L&H) cells.
NLPH usually begins in the lymph nodes in the neck and under the arms. It can occur in people of all ages, and is more common in men than women. This HL type tends to grow more slowly and is treated differently than the classical type.
What is non-Hodgkin’s lymphoma?
Non-Hodgkin’s lymphoma (NHL) is a type of cancer that starts in white blood cells called lymphocytes, and is part of the body’s immune system. NHL is a term used for many different types of lymphoma, all of which share some characteristics.
NHL affects the body’s lymphatic system. It can begin anywhere in the body where lymph tissue is found, the main lymphatic tissue is the lymph nodes, spleen, bone marrow, thymus, digestive tract, adenoids & tonsils.
It usually starts in the lymph nodes or other lymphatic tissue, but sometimes it can affect the skin.
Types of non-Hodgkin’s lymphoma
Treatment for NHL depends on the type, so it’s important to find the exact type of lymphoma you have. The type of lymphoma depends on the type of lymphoma affected, how the cells mature when they become cancerous and other factors.
The lymphatic system is made up primarily of lymphocytes, a type of white blood cell that helps the body fight infections. There are 2 main types of lymphocytes:
- B lymphocytes: B cells make proteins called antibodies that help protect the body from germs. Antibodies attach to germs, flagged to destroy them by parts of the immune system.
- T lymphocytes: There are many types of T cells. Some T cells kill germs or abnormal cells in the body. Other T cells help strengthen or slow down the activity of other immune system cells.
Non-Hodgkin’s lymphoma may begin in one of two types of lymphocytes, but B-cell lymphoma is the most common.
Types of NHLs can also be grouped based on their rate of growth and spread:
- Unclear lymphoma grows and spreads slowly. Some unclear lymphomas may not need immediate treatment, but may instead be closely monitored. The uncommon type of lymphoma is follicular lymphoma.
- Invasive lymphomas grow and spread rapidly and often need to be treated immediately. The most common type of invasive lymphoma is large diffuse B cell lymphoma (DLBCL).
Some types of lymphoma, such as cell lymphoma, are not suitable for either.
No matter how fast they grow, all non-Hodgkin lymphoma can spread to other parts of the lymphatic system if left untreated and they can also spread to other parts of the body, such as liver, brain or bone marrow.
Differences between Hodgkin and Non-Hodgkin lymphoma
The difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma is the occurrence of Reed-Sternberg cells. A Reed-Sternberg cell is a cell derived from B lymphocytes and is unique to Hodgkin’s lymphoma.
- Reed-Sternberg cells were found when the tumor was examined under a microscope, diagnosed with lymphoma.
- Without Reed-Sternberg cells in lymphoma, the diagnosis is most likely non-Hodgkin’s lymphoma.
Among all diagnosed lymphoma cases, 90% of them are non-Hodgkin lymphoma and 10% of Hodgkin lymphoma.
Distinguishing between Hodgkin lymphoma and non-Hodgkin lymphoma is important.
Causes and Risk Factors
Lymph tissue is connected throughout the body. If cancerous cells that grow in the lymphatic system called lymphocytes develop gene mutations, they can easily spread from their original position to the tissues and include other parts of the body size.
The cause of lymphoma is unclear, but there are some high risk factors for lymphoma.
Two different types of lymphoma have different risk factors.
Risk factors for non-Hodgkin’s lymphoma include:
- Age: Most lymphomas occur in people age 60 and older, but some types are more likely to affect children and young people.
- Gender: Some types are more likely in women, others are more likely in men.
- Ethnicity and geographic location: In the US, African-Americans and Asian-Americans have a lower risk of non-Hodgkin’s lymphoma than white Americans, and it is more common in developed countries.
- Chemicals and radioactivity: Nuclear radiation and some chemicals used in agriculture can cause non-Hodgkin’s lymphoma.
- Weak immune system: A person with a weak immune system is at a higher risk. For example: people with HIV & AIDS, drugs used after organ transplantation.
- Autoimmune disease: This is when the immune system attacks the body’s own cells. Examples include rheumatoid arthritis and celiac disease.
- Infections: Certain viral and bacterial infections that alter lymphocytes increase the risk, such as Epstein-Barr virus (EBV), which causes glandular fever.
- Weight and diet: Obesity is associated with the development of lymphoma, although more research is needed to confirm the link.
Risk factors for Hodgkin’s lymphoma include:
- Infectious mononucleosis: EBV infection can cause mononucleosis, which increases the risk of lymphoma.
- Age: People between the ages of 20 and 30 and those over 55 are at higher risk.
- Gender: It is slightly more common in men.
- Geographical location: Hodgkin’s lymphoma is most common in the USA, Canada and Northern Europe. It is the least common in Asia.
- Family history: If someone in your family is diagnosed with this type of cancer, your risk of developing it is also higher.
- HIV infection: This can weaken the immune system and increase the risk of lymphoma.
Signs and symptoms
People with lymphoma may experience other signs and symptoms such as:
- Fever and chills
- Night sweats
- Weight loss
- Loss of appetite
- Pain in the neck or ribs
- Painless swollen glands in the armpits, neck or groin.
- Enlargement of the spleen.
If the affected lymph node is located in the chest, it may affect the person’s breathing; If it is in the abdomen, it may cause abdominal discomfort.
Lymphoma can sometimes be difficult to diagnose because these signs and symptoms are usually mild. Some people may not have noticeable signs while others may have a mild fever. Usually there are swollen lymph nodes, they are located throughout the body usually in the neck, groin, abdomen or armpits.
Stages of lymphoma
Both NHL and HL can be classified into four stages. The status of lymphoma is determined by the location of the cancer and its spread or not.
- Stage 1: Cancer is located in a lymph node or a citing organ.
- Stage 2: The cancer is located in two nearby lymph nodes and on the same side of the body or the cancer is in an organ and nearby lymph nodes.
- Stage 3: At this time, cancer is located in the lymph nodes on both sides of the body and in many lymph nodes.
- Stage 4: Cancer can stay in an organ and spread to nearby lymph nodes. As NHL progresses, it may begin to spread. The most popular sites for advanced NHL include the liver, bone marrow and lungs.
However, stage 4 lymphoma progresses, it can still be treated.
The doctor will perform a lymph node biopsy to diagnose lymphoma. Additional tests that are then conducted to determine the stage of lymphoma include:
- blood tests,
- Bone marrow biopsy
- imaging tests, such as CT scans or PET scans.
The decision about treatment is then determined by your doctor, taking into account age, general health, stage and type of lymphoma. Hodgkin’s lymphoma is one of the most curable cancers.
Treatment options include:
- Chemotherapy and radiation directly target lymphoma
- Biological therapies, such as antibodies, target lymphoma cells
- Stem cell transplant
For some patients, taking part in a clinical trial is also using experimental therapies.
If you have been diagnosed with lymphoma, talk to your doctor about whether clinical trials are right for you.
Because the cause of lymphoma is unknown, there is no real way to prevent it. However, if you think you may have signs of lymphoma, be aware of your risk factors and symptoms and talk to your doctor is important for early diagnosis and treatment.
It is especially important if you have a family history of lymphoma to find symptoms and share your family’s and your medical conditions with your doctor.
Source of Lymphoma Reference:
- Source mayoclinic.org Lymphoma article : https://www.mayoclinic.org/diseases-conditions/lymphoma/diagnosis-treatment/drc-20352642 , updated October 17, 2019 .
- Source en.wikipedia.org Lymphoma article : https://en.wikipedia.org/wiki/Lymphoma , updated February 8, 2018.
- A reputable source thuoclp.com summarizes the article What is lymphoma?: https://index-china.com/lymphoma/, updated 13/3/2020.
Assoc.Prof.Dr. Tran Ngoc Anh is currently Hanoi Medical University Hospital, Associate Professor, Department of Internal Medicine, Gastroenterology and Head of Department of General-Uematology of Hanoi Medical University. Consulting doctor at ThuocLP Vietnamese health.
Professional qualifications, Academic degrees – Education:
Graduated from General Practitioner System, Hanoi Medical University
Graduated with a Master degree in Internal Medicine, Hanoi Medical University
Graduated from the training program specialized in Gastrointestinal, Henri Mondor Institute Center, University of Paris 6, French Republic 1996-1997; 1999
Graduated from the training program specialized in Gastrointestinal, North Royal Sydney Hospital, Australia; 2002
Graduated from a training program specialized in chronic liver diseases, Pizza, Italy 2009
Graduated with a PhD in Gastrointestinal, Hanoi Medical University
Associate Professor, Gastroenterology, Hanoi Medical University
Training and Scientific Research:
Published more than 200 articles in domestic and international specialized journals
Editor of many monographs and participates in compiling 2 textbooks.
Guide many students and graduate students of Hanoi Medical University
Manager of many grassroots research projects
Certificate of Good Clinical Practice (GCP: 2012, 2015), Ministry of Health
Specialized certificates: General gastrointestinal endoscopy, Interventional gastrointestinal endoscopy, General gastrointestinal ultrasound, Interventional gastrointestinal ultrasound (Bach Mai BV), Chronic liver disease.