What Is Lymphoma?

Lymphoma is a type of cancer that affects your lymphocytes—or, white blood cells in your immune system. Lymphoma occurs when cancer cells develop and grow in your body’s lymphatic system, which helps your immune system fight infections. The exact cause of lymphoma is unknown but possible risk factors include age, assigned sex at birth, having a family history of the condition, and a personal history of certain infections. 

The two main types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL), which is a group of lymphomas. NHL is also more common than Hodgkin lymphoma. Lymphoma can sometimes be hard to recognize because you don't typically experience symptoms in the early stages. The most common symptom is a swollen lymph node, but other symptoms may include fever, fatigue, night sweats, and unintentional weight loss.

Fortunately, there are several treatment options available for lymphoma, so it's important to visit your healthcare provider if you begin to notice signs of the cancer, start to feel unwell, or have a history of the condition. Your primary care provider will often work with a hematologist-oncologist (or a doctor who specializes in blood cancers) to get you an accurate diagnosis. 

Types of Lymphoma 

There are different types of lymphoma, and each type has its own unique symptoms and treatment options. Lymphoma can start anywhere in the body, but the most common areas where cancer cells can grow are in your lymph nodes, spleen, bone marrow, throat, and digestive tract.

Hodgkin Lymphoma 

Hodgkin lymphoma is one of the most curable forms of cancer. It typically spreads from one group of lymph nodes to another group of nearby lymph nodes.

There are different types of Hodgkin lymphoma. Classic Hodgkin lymphoma makes up more than 90% of cases of Hodgkin lymphoma. 

The four subtypes of classic Hodgkin lymphoma include: 

• Nodular sclerosis Hodgkin lymphoma: Most common type 
• Mixed cellularity Hodgkin lymphoma: Second most common type
• Lymphocyte-rich Hodgkin lymphoma: Uncommon type found in the upper part of the body
• Lymphocyte-depleted Hodgkin lymphoma: Rare and aggressive type
  

Non-Hodgkin Lymphoma 

Non-Hodgkin lymphoma (NHL) is a term that encompasses a group of different types of lymphomas that are not classified as Hodgkin lymphoma. Cancers that fall under the NHL type tend to spread through the lymphatic system in a nonorderly pattern. These types of cancer may not cause any signs or symptoms until cancer cells have started to spread to other areas of the body.

Most people with NHL have B-cell lymphoma. The other types include T-cell type and NK-cell type. Each type of NHL is classified by different immune cells, which include:

• B lymphocytes (cells): These cells protect your body from infection by making antibodies (or proteins that help fight infections)
• T lymphocytes (cells): These cells help destroy germs and harmful cells in your body
  

Symptoms

Lymphoma may not cause symptoms in the early stages. Once symptoms develop, the most common sign is noticing a swollen lymph node. A swollen lymph node feels like a painless lump just below the skin. It is usually located in the area of the body where the lymphoma started. As lymphoma spreads, you may feel swollen lymph nodes in other areas of the body. While swollen lymph nodes are usually painless, they may start to ache after drinking alcohol.

Although swollen lymph nodes are the most common lymphoma symptom, other, less serious conditions can cause swollen lymph nodes as well—which is it can be hard to notice the difference between symptoms of lymphoma and symptoms of other infections. If you experience swollen lymph nodes, it's best to err on the side of caution and visit your healthcare provider to understand what may be causing them.

Lymphoma also causes a group of symptoms known as "B symptoms," which include:

• Night sweats: Waking up feeling wet and drenching your sheets or clothes
• Weight loss: Losing 10% of your body weight over 6 months without trying
• Fatigue: Feeling tired or lethargic all of the time, even if you're getting enough rest

B symptoms are important to note because they help your healthcare provider determine what stage of cancer you are in. Other possible symptoms of lymphoma include frequent infections and easy bleeding or bruising. Lymphoma symptoms can also vary based on where your cancer occurs or starts in the body. People with lymphoma may experience symptoms in their abdomen, chest, brain, or skin. 

Causes

Lymphoma occurs when cancer cells grow and start to spread in an area of the lymphatic system—usually in the lymph nodes. However, the lymphatic system also includes your spleen and bone marrow, so cancer cells can develop in those areas too. Researchers are not certain what causes the initial cancer cells to form but believe that some factors can raise your risk of developing the condition.

There is a possible link between Hodgkin lymphoma and the Epstein-Barr virus (EBV). Having EBV can raise the risk of DNA changes or genetic mutations in your B lymphocytes (white blood cells). These changes can lead to the development of Reed-Sternberg cells, which are cells that begin to grow if you have Hodgkin lymphoma. Experts do not yet understand why EBV leads to these changes in your cells, but research remains ongoing. 

Risk Factors

Risk factors are factors that raise the risk of developing a certain disease like lymphoma. It is important to note that having one or more risk factors does not guarantee that you will develop lymphoma—it just means you may have a higher risk of developing the condition than those who have no risk factors. 

Some risk factors for Hodgkin lymphoma include:

• Epstein-Barr virus (EBV): The virus that causes mononucleosis (mono)
• Age: Hodgkin lymphoma is most common in teens and young adults between the ages of 15 and 39 or in late adulthood (after age 75)
• Sex: The condition is more common in men than women
• Family history: There is a higher risk of developing Hodgkin lymphoma if an immediate family member (e.g., parent or sibling) has the condition
• Weakened immune system: Conditions like HIV or taking medications that suppress the immune system can also boost your risk
  

There are different risk factors for non-Hodgkin lymphoma. These include: 

• Age over 60 years old
  
• Male sex
• Being white
• Having a family history of NHL
• Chemical or drug exposure
• Radiation exposure 
• Weakened immune system
• Receiving a diagnosis for an autoimmune disease (e.g., lupus, rheumatoid arthritis, etc.)
• Obesity
• History of breast implants
  

Diagnosis

To diagnose lymphoma, your healthcare provider will recommend several diagnostic tests. A swollen lymph node is often the earliest symptom and sometimes the only symptom in people with the cancer. Because several infections and other conditions can cause swollen lymph nodes, it is important for your provider to first rule out less serious causes. 

Your healthcare provider will start with performing a physical exam and taking a thorough medical history to understand your symptoms and any potential risk factors. During the physical exam, your provider will closely examine your lymph nodes, spleen, and liver to look for signs of swelling. 

Because swollen lymph nodes are often caused by an infection, your provider may recommend a course of antibiotics before undergoing further testing. If your lymph node swelling does not improve with antibiotics, a biopsy (or, a surgical procedure to remove a tissue or skin sample) is usually the next step. 

Your healthcare provider may use one of the following types of biopsies to learn more about your condition:

• Excisional biopsy: Removal of the entire lymph node
• Incisional biopsy: Taking out a small part of the lymph node
• Fine needle aspiration biopsy: Withdrawing a small amount of fluid using a thin, hollow needle into your body
• Core needle biopsy: Retrieving a larger tissue sample from a bigger needle
• Bone marrow aspiration: A test that occurs to determine if the lymphoma has spread to your bone marrow, which usually comes after you've already received a diagnosis for lymphoma

Other tests that may be used to diagnose lymphoma include:

• Blood tests: Complete blood count (CBC) to check white blood cell count, erythrocyte sedimentation rate (ESR) test to measure inflammation in the body, and liver and kidney function tests
• Immunohistochemistry: Looks for certain proteins on cells and can detect the presence of Reed-Sternberg cells for Hodgkin lymphoma
• Chest x-ray: Examines enlarged lymph nodes in the chest
• Computed tomography (CT) scan: Inspects signs of lymphoma in your neck, chest, abdomen, or pelvis 
• Magnetic resonance imaging (MRI): Rarely used but might be needed to detect the spread of cancer cells to your spinal cord or brain
• Positron emission tomography (PET) scan: Detects cancer cells via imaging
• Bone scan: Can be used to search for cancer cells in your bones if you are experiencing bone pain
  

Treatment

Lymphoma is treatable and remission (or, a period where symptoms partially or completely go away) is possible. When caught early, the goal of lymphoma treatment is to reach remission. In the later stages of lymphoma, the goal of treatment is to reduce symptoms and improve quality of life.

The treatment options that are available to you will depend on the type of lymphoma you have, which symptoms you're experiencing, and what stage of cancer you are in. The most common treatments include:

• Chemotherapy: Anti-cancer drugs that you receive through intravenous (IV) infusion
• Radiation therapy: Shrinks the presence of any large lymph nodes or tumors
• Immunotherapy: Boosts your immune system's response to fighting cancer cells, which is available via IV infusion, oral tablets, or topical creams
• Stem cell transplant: Helps your body rebuild bone marrow and is a treatment typically used only if chemotherapy and radiation have not been effective in treating your condition
  

Prevention

Lymphoma is difficult to prevent. Many of the risk factors that lead to the disease cannot be changed, such as your age or whether you have a family history of the condition. In addition, many people who receive a diagnosis of lymphoma don't always have certain risk factors that boosted their likelihood of getting the condition.

While the cause of lymphoma remains unknown, some infections such as human T-cell lymphotropic virus (HTLV-1) or Helicobacter pylori (H. pylori) can increase your risk of lymphoma. If you are at risk for these infections, talk with your healthcare provider about what you can do to prevent them from occurring.

Living With Lymphoma  

Receiving a lymphoma diagnosis is a life-changing experience and often feels devastating. It is normal for every area of your life to be affected during the diagnostic process and your treatment journey.

It’s common to experience feelings of overwhelm, anger, fear, sadness, and loneliness. If you are concerned about your mood, talk with your healthcare provider and consider meeting with a mental health professional for additional support. Keep in mind: don't feel pressured to remain upbeat and positive during your treatment period. Living with cancer is challenging and you're allowed to feel however you feel. 

In addition to talking to a mental health professional and learning stress management techniques, it may be helpful to stay as active as possible. Try to schedule light activities that you enjoy and participate in hobbies that you can look forward to.

A lymphoma diagnosis will also likely affect your family and friends. Lean on your loved ones for help with your daily activities, medical appointments, food preparation, and money stress. Remember: you might be experiencing lymphoma on your own but you don't have to undergo treatment and life with cancer by yourself.