People with lymphoma often have painless swelling of their lymph nodes. These are tiny, beanlike structures that trap poisons and waste materials and supply infection-fighting white blood cells. Tubelike vessels carrying milk-colored fluid called lymph connect lymph nodes to each other and to the rest of the body.
Some types of lymphoma are very treatable. Your prognosis depends on the type and stage of lymphoma you have, your general health and other factors.
Lymphoma is a blood cancer, and it affects the lymphatic system, which is the network of tissues, vessels and organs that helps fight infection. It starts in white blood cells called lymphocytes. There are more than 70 different types of lymphoma. They can be fast-growing and aggressive (high-grade), or slow-growing and indolent (low-grade). Hodgkin lymphoma, the most common type of lymphoma, is a very treatable disease that usually responds well to treatment.
It’s also possible for lymphoma to spread from the lymph nodes, the large glands in your neck, armpits and groin, into other parts of the body. This happens in about a third of cases. The chances of a cure depend on where the lymphoma is, what part of the lymphatic system it involves and whether it’s low-grade or high-grade.
There are two main groups of lymphomas: Hodgkin and non-Hodgkin, with more than 60 subtypes within each group. Non-Hodgkin lymphoma starts in B and T lymphocytes, which are white blood cells that help the immune system fight infection. It’s most often seen in the lymph nodes in your neck, armpits, groin and chest, but it can start in other tissues, too. Non-Hodgkin lymphoma can grow quickly or slowly and may affect one or many lymph nodes.
Some forms of lymphoma can be very painful, especially when it spreads to the groin or chest. People with these forms of lymphoma often need palliative care, which aims to ease symptoms but doesn’t aim to cure the disease.
Most kinds of lymphoma are curable. The most effective treatments are chemotherapy, radiation therapy and sometimes stem cell transplant or targeted therapy. Chemotherapy kills cancer cells and reduces their number, while radiation therapy destroys the cancerous tissue and any other affected areas. Targeted therapy uses drugs to stop cancer cells from growing or spreading. Stem cell transplant replaces the cancerous bone marrow with healthy, functioning marrow. It’s also important to see your GP if you have any swollen lymph nodes, or signs or symptoms of cancer. The GP can refer you to a specialist who will arrange treatment.
In some types of lymphoma (especially Hodgkin lymphoma and non-Hodgkin lymphoma), treatment can put the cancer into remission or even cure it. In others, the cancer can come back and it may grow more quickly or spread to other parts of the body. There are over 70 different types of lymphoma and symptoms vary from one person to another. They also depend on the type and stage of the lymphoma.
Swollen lymph nodes (lymphadenopathy) are often the first symptom. The lymph nodes are small glands throughout the body, but they can be most obvious in the neck, armpits or groin. They may swell, but they are usually painless. If they are enlarged, they can squeeze or press on other organs, bones and tissues. This can cause pain, tightness or heaviness in the area. It can also lead to a build-up of fluid called lymphoedema, which affects mainly one or both arms and legs. This can make it hard to move because of a feeling of being “heavy”.
Fatigue is another common symptom, especially at the start of treatment. It can be caused by many things, including changes in hormone levels and trouble sleeping. Sometimes it can be so severe that people find it difficult to carry on with daily life. It can be hard to get enough to eat, and weight loss is common.
Itching is a common symptom in many kinds of lymphoma, particularly skin lymphoma. It is a reaction to chemicals produced by the cancer cells and can be a very unpleasant sensation. It tends to be worst at night when the person is lying in bed and it can cause a burning sensation.
Some kinds of lymphoma cause problems with the stomach or bowels. Lymphoma that affects the spleen may cause pain behind the left ribs and a bloated feeling in the tummy. If the lymphoma is in the liver, the tummy might become tender and have a yellow colour (jaundice).
Cancer cells are known to suppress the immune system, so it is not uncommon for people with lymphoma to have frequent infections. They can range from cold-like symptoms to more serious ones, such as pneumonia.
In the early stages of lymphoma, your doctor will do a physical exam and ask you about your past health. You may also have blood tests. These can help your doctor find out what kind of lymphoma you have and whether it is low or high grade.
The type of lymphoma you have depends on the type of white blood cells in your body, which are called lymphocytes. Cancerous lymphocytes grow in the lymphatic system, which is part of the immune system and helps your body fight infections. You may have swollen lymph nodes (lymphadenopathy). These may be painful or not. Swollen lymph nodes are common in the neck, armpits, groin, and abdomen. They often appear after an infection, such as a cold. But if you’ve had many infections and your swollen lymph nodes don’t go away, it’s important to see your doctor.
Your doctor will use the results of your blood and imaging tests to make a diagnosis. They will refer you to a specialist, such as a hematologist, if they suspect lymphoma.
There are different types of lymphoma, and each has its own characteristics about how fast it grows and spreads. Some grow and spread more slowly than others, but they all have symptoms and can cause serious problems if not treated.
Your treatment plan will depend on the type of lymphoma you have, its stage and whether it is Hodgkin or non-Hodgkin lymphoma. Your team will also decide what the best course of action is if your lymphoma has spread beyond the lymphatic system to other parts of your body.
To diagnose lymphoma, your healthcare provider will do a biopsy to remove a sample of a swollen lymph node or lump for examination by a pathologist. Alternatively, they will do a bone marrow biopsy to check the blood cells in your bone marrow. The results from these and other tests will help your doctors understand what type of lymphoma you have and whether you have a low or high grade, which can affect your prognosis.
Other diagnostic tests may include chest X-rays, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan, where you are given a radioactive substance and a scanner uses a computer with magnets and radio waves to make images of your body. These can look for lymph nodes and other structures, and show how your organs are working. Blood tests can also check for certain genes and proteins that are important to lymphoma.
A person diagnosed with lymphoma may see a specialist, such as a hematologist, a doctor who treats blood conditions. He or she will review the patient’s family and personal medical history, do a physical exam and check for lymph node enlargement. The doctor will also ask about the person’s symptoms and how long they have been present. A sample of a lymph node may be taken for a biopsy. The samples are tested for cancerous cells. A chest x-ray, blood tests, an MRI and/or a bone marrow biopsy can help determine the type of lymphoma.
Treatment depends on the type of lymphoma and how far it has spread. Some lymphomas are slow growing and do not cause any symptoms. In these cases, the doctor may not recommend any treatment and just monitor the person’s condition. This is called active surveillance. Other lymphomas are treated with chemotherapy, radiation therapy or a combination of both. Targeted therapy or biologic therapies can be used to treat lymphoma, as well. These treatments attack specific types of cancer cells with fewer side effects than standard chemotherapy drugs.
Some people with lymphoma need radiation therapy to kill cancer cells and relieve pain and other symptoms. They can also receive chemotherapy with or without a stem cell transplant. A stem cell transplant uses healthy blood-forming cells to replace damaged ones. It can be done with either your own cells or those from a donor.
If standard treatment does not work or the cancer comes back, it is known as relapsed lymphoma. There are newer treatments for this type of lymphoma, and people who have relapsed should talk to their doctors about the best options for them.
It is important to get support from family and friends when dealing with lymphoma. People who have been diagnosed with a disease like this may also find it helpful to seek support from groups for people who have lymphoma or other blood diseases. These groups can offer support, education and resources to help cope with the disease. It is also a good idea to bring a friend or family member with you to appointments with your doctor for support and to take notes.
Many of the symptoms of lymphoma are the same as those for other illnesses, including infections like the flu or a common cold. That’s why it’s important to talk to your doctor about any new or unusual symptoms.
Swollen lymph nodes (especially in the neck, armpits and groin) are the most common early symptom of lymphoma. You may also get a fever, a rash or extreme fatigue.
Swollen glands (lymph nodes) are a common symptom of lymphoma. Lymph nodes are small, round or bean-shaped clusters of cells that sit in the body’s lymphatic system (the group of vein-like structures that carries fluid through the body). The lymphatic system combines with the thymus, spleen and tonsils to form the immune system. This system protects the body from germs and other threats by filtering lymphatic fluid as it flows through. The fluid contains blood cells called lymphocytes that attack and destroy germs or immobilize cancer cells.
When a person’s lymph nodes swell, they may feel hard and tender. They may also look bigger than usual and appear red or swollen and have a yellowish color. Swollen glands are usually painful and last for more than two weeks (as opposed to a cold or flu, which will typically go away within a few days).
A swollen gland can be a sign of a variety of conditions, including autoimmune diseases, certain types of cancer and infections like the flu. The swollen glands can be confined to one area, known as localized lymphadenopathy, or spread throughout the entire body, known as generalized lymphadenopathy.
Most of the time, a swollen gland is caused by a temporary illness or infection, such as a viral disease like the Epstein-Barr virus (mononucleosis) or a bacterial disease like strep throat. Some medications, such as phenytoin (Dilantin) and the antimalarial drug chloroquine, can also cause swollen glands.
Doctors often suspect that a person has lymphoma when swollen glands are present for a long time and don’t improve with treatment. The doctor will do a physical exam, and in some cases, the doctor may take a sample of lymph node tissue to look under a microscope for abnormal cells. Doctors may also do other tests to learn how far the cancer has spread, known as staging.
The cause of lymphoma isn’t always clear, but it usually begins when a disease-fighting white blood cell develops a genetic mutation that allows it to multiply quickly and replace normal cells. The extra lymphocytes can overwork the lymph nodes, spleen and liver, causing them to swell up.
Almost everyone with Lymphoma will have a fever. This may be mild or severe and is usually accompanied by chills. It’s a sign that the body is fighting infection. It also helps the body to fight off the cancer cells. Depending on where the lymph nodes are located, some people with lymphoma have other symptoms – for example, stomach pain or a cough. Others have fatigue or problems with their eyesight. Itching is another possible symptom of Lymphoma.
Fatigue is when you feel exhausted for no obvious reason. It can be physical, emotional or mental and it can make you tired even if you are sleeping or resting. Fatigue can be caused by many things including anaemia (a low number of red blood cells), an underactive thyroid gland, depression or anxiety and chronic fatigue syndrome (CFS or ‘ME’). Some people with lymphoma have a feeling that their brain is full, which is called ‘brain fog’. This can be a sign that the cancer is affecting the brain and can cause problems thinking.
Some types of lymphoma develop inside the body’s organs, including the liver and spleen. They can also develop outside the lymphatic system – this is called extranodal lymphoma. Lymphoma in the spleen, for example, can cause itching and sometimes pain when you breathe. Lymphoma in the chest can also cause swollen lymph nodes and fluid collecting around the lungs. This can lead to difficulty breathing and can be a life-threatening condition.
If you have a fever and other symptoms, see your GP as soon as possible. It’s important to find out what’s causing the symptoms so that you can get treatment.
Most of the early signs of lymphoma are similar to those of other, less serious illnesses. This means they might be mistaken for things like the flu or a common cold. However, if your symptoms don’t go away after a few weeks, it’s worth getting them checked. The doctor may recommend a physical exam, blood tests, an X-ray and a biopsy to check for lymphoma. They may also suggest other treatments such as chemotherapy, radiation therapy or targeted and biological therapy.
Pain is common in some forms of lymphoma and can affect different parts of the body. For example, cancer in the lungs may cause chest pain because of swollen lymph nodes pressing on the lungs and airways. Lymphoma in the bones can also cause pain because of the swollen lymph nodes that are pushing on nerves and tissues around them. Pain in the groin is common if the swollen lymph nodes are in the groin area (called oedema). Lymphoma that starts in the abdomen may cause belly pain, nausea or vomiting if the spleen becomes enlarged. If the thymus gland becomes affected, this may lead to chest pain and problems breathing. Symptoms of pain as a result of lymphoma can sometimes be managed with drugs prescribed by your doctor. These can include over-the-counter medications, antidepressants such as duloxetine (Cymbalta) and opiate medicines.
Some types of lymphoma – for example, Hodgkin lymphoma and some high-grade non-Hodgkin lymphomas – can cause swollen lymph nodes in the neck or armpits. These usually don’t cause pain but, if they do, you might have other symptoms too such as fever, tiredness and a feeling of fullness. Some people might not realise they have these signs and could confuse them with other illnesses such as the flu or a viral infection.
If a person has B symptoms, it’s important to see their GP as soon as possible. Having one or more of these symptoms can be a sign that the lymphoma has spread.
Other signs that might suggest that someone has lymphoma are unexplained fevers, excessive night sweats or losing more than 10 percent of their body weight in a month. Some forms of lymphoma can cause anaemia, which can make people feel tired because they’re not getting enough oxygen in their blood.
In some cases, lymphoma can cause problems with the brain and spinal cord. This happens when the cancerous lymphocytes start to grow too quickly and enlarge the lymph nodes that sit near the spinal cord or brain. This can lead to problems with thinking processes such as memory and attention, which can be referred to as ‘chemo brain’. It can also lead to weakness, changes in vision or a numbness in the legs or feet.
Fatigue is the most common symptom of lymphoma and a side effect of treatment. It may be due to the cancer using up your body’s energy, changes in hormone levels, low red blood cells or haemoglobin (anaemia), pain from surgery, central line insertion and biopsies, or fatigue-causing medications such as steroids, chemotherapy or monoclonal antibodies.
Fatigue can be overwhelming and affect your quality of life. It is important to learn ways to balance being active with resting and finding things that help you feel more energized. Talk to your health care provider if you are experiencing extreme tiredness that is not improving after rest or sleep.
When your doctor discusses fatigue with you, he or she will want to understand more about your lifestyle and what is going on in your life that might be contributing to it. For example, your job and family demands can increase the stress you experience and that can lead to feelings of fatigue. Your doctor may also ask about any other health issues you are experiencing that could be causing or making it worse, like depression, anxiety or chronic pain.
To determine the cause of your fatigue, your doctor will perform a physical exam. He or she will listen to your heart and lungs, and examine your abdomen, groin and pelvic area. He or she will also take your blood pressure and temperature, and check your pulse. Blood tests and a urinalysis may be ordered to look for signs of an infection, anemia or other blood abnormalities.
The results of these tests will allow your doctor to make a diagnosis and decide on a treatment plan. Depending on your diagnosis, your treatment may include radiation or chemotherapy, or a stem cell transplant. If a cancer-related cause of your fatigue is found, it will be treated and the fatigue should resolve.
Until more research is done, it is hard to say what causes or makes better this type of fatigue. Some researchers have found that a good diet, exercise and sleep are helpful. Other research has shown that psychostimulant drugs, such as methylphenidate or modafinil can help improve feelings of fatigue in some people with lymphoma.
Follicular lymphoma is usually slow growing (indolent). It may not need treatment right away.
If it does, doctors might give chemo plus the monoclonal antibody rituximab. They might also use radiation therapy to the affected area. Other choices for indolent NHL include watchful waiting or drugs that affect how the body’s immune system works, such as kinase inhibitors and immunomodulatory agents.
Chemotherapy uses drugs to destroy fast-growing cells, including cancer cells. It can be given through a vein (intravenously, or IV) or as pills. Different chemotherapy drugs cause different side effects. The side effects depend on the type of drug and the area of the body being treated.
The first treatment for most types of lymphoma is chemo alone or combined with radiation therapy. For example, if the lymphoma is in 1 group of lymph nodes on each side of the diaphragm or in the spleen or liver, you might have a combination of the chemotherapy drugs methotrexate and leucovorin plus radiation to those areas (called involved site radiation). If the lymphoma is spread throughout the body, more intensive chemo may be needed.
If your lymphoma is causing symptoms, you might have other treatments along with chemo, such as radiation to the brain or spine, rituximab, or bone marrow transplant. You also might have targeted therapy or immunotherapy. For example, a new therapy called chimeric antigen receptor (CAR) T cell therapy takes your own body’s germ-fighting immune system cells and modifies them so they can attack lymphoma cells. It was developed at Siteman Cancer Center.
Other types of targeted therapy work by interfering with specific proteins that help cancer cells grow and spread. They are usually given with a chemotherapy agent or as a separate pill.
Depending on your diagnosis, your doctor might recommend other procedures such as a PET scan or a bone marrow biopsy. A PET scan is a procedure that shows a picture of your body’s metabolic activity. It can detect malignant tumor cells that are using more glucose, a sugar used for energy, than normal cells. The result helps your doctor find the best places to treat.
Even after your cancer is in remission, you will need follow-up care. That might include tests, such as blood work and x-rays. It might also involve physical exams, a CT or MRI scan, or a bone marrow transplant. Follow-up care can help you stay in remission and keep the lymphoma from coming back.
Radiation therapy uses high-energy X-rays or other radiation to kill cancer cells and shrink tumors. It is usually given in combination with chemotherapy, but it can be used alone for certain localized lymphomas. Radiation therapy is also helpful for palliative care to reduce symptoms such as pain, obstruction, or bleeding in the area of a tumor, especially when other treatments are not possible.
Radiation can cause side effects that affect the whole body or specific parts of it. Some of these side effects are temporary, but others can last for months or longer. For example, some people have trouble keeping up with work or school during treatment because of fatigue. Getting enough restful sleep and eating enough protein may help. Some people lose their hair, especially in the head or neck where radiation is delivered.
For most people, radiation treatment is not painful. But it is important to sit still for the whole treatment session, which usually takes about 30 minutes. This is because if you move during the treatment, your healthy cells will also be exposed to radiation and might not recover as well. The radiation therapists will make sure you are in the right position before starting your treatment. They will then leave the room and close the door. You can see them on a screen and talk to them through an intercom.
Some people need to be sedated during their radiation treatment. This is especially true for children.
Modern radiation therapy techniques and the use of computer-generated imaging (CT scans, MRIs, or PET/CT scans) allow doctors to pinpoint exactly where the lymphoma is located within the body and target that area with the highest dose of radiation. They can also limit the amount of radiation that is absorbed by normal tissues.
Because of this, most patients can receive radiation treatment without being sedated. However, some younger children and people with other health conditions might need to be sedated during their treatment. Radiation can cause many side effects, but they are usually less severe than the side effects of chemotherapy.
A stem cell transplant is a treatment that replaces blood-forming cells damaged by cancer or radiation therapy. Stem cells are basic cells that develop into different types of cells, such as red blood cells that carry oxygen, white blood cells that fight infection, and platelets that form clots to stop bleeding. The transplanted stem cells grow and multiply, producing more healthy blood cells and replacing the ones that were damaged by chemotherapy or radiation. A stem cell transplant is a very risky and complex procedure that can only be done in specialized transplant centers or hospitals.
Your blood stem cells are usually in the bone marrow, a spongy tissue inside some bones. High doses of chemotherapy and radiation can also damage the bone marrow and other blood-forming tissues in your body. Because of the way they work, this can make it harder for your body to produce enough healthy blood cells. A stem cell transplant can help restore your blood-forming tissues and give you more time to live with lymphoma.
To get the transplanted stem cells to grow and produce more healthy blood cells, your care team will first need to collect them from your body. This is done using a process called pheresis or bone marrow harvest. Before the stem cells are collected, your donor will receive chemotherapy to kill any diseased blood cells in their body and to prepare them for the transplant.
The collected stem cells are then infused into your bloodstream. They will travel to your bone marrow and other blood-forming tissue, where they will start producing new, healthy blood cells. The transplanted stem cells can also kill any cancer cells that remain in your body. This is known as the graft-versus-cancer effect.
After the transplant, your care team will monitor you closely for months, and you may have daily or weekly appointments to check your blood and marrow levels. You will also need blood transfusions to treat low blood counts and medicines to prevent rejection or graft-versus-host disease. These medications can weaken your immune system, so you will need to wash your hands often and avoid people who are sick.
Unlike traditional cytotoxic chemotherapy drugs that affect all cells in the body, targeted therapy targets cancer cells specifically. These drugs attack certain proteins in cancer cells that help them grow and survive. They can be used on their own or in combination with other treatment options. There are many different types of targeted therapy drugs and they all work in different ways. Your doctor will explain the drug that is best for you.
There are two main categories of targeted therapy: small molecules and monoclonal antibodies. Small molecules are made of chemicals that target specific enzymes or proteins in cancer cells and block their action. They can be given by mouth or injection into a vein (IV).
Examples of small molecule inhibitors include ibrutinib, idelalisib and venetoclax. These are used to treat some types of low-grade non-Hodgkin lymphoma and can also be given with chemotherapy.
Monoclonal antibodies are laboratory-made proteins that attach to the surface of cancer cells and can kill them or prevent them from spreading. They can be given by infusion or with chemotherapy. Rituximab (Rituxan) is used to treat diffuse large B-cell lymphoma and some other types of non-Hodgkin lymphoma. Another antibody that is being used in clinical trials is obinutuzumab (Velcade).
Some targeted therapies, such as proteasome inhibitors and immunomodulators, change the way your immune system works. They can cause side effects like fatigue and rashes. Others, such as rituximab and obinutuzumab, affect protein production in the cancer cells. This makes the cells unable to function properly and they die.
Depending on your diagnosis and the type of targeted therapy you receive, you may need regular blood tests and X-rays or computed tomography (CT) scans to monitor how well the treatment is working. Your doctor will tell you how often these tests should be done and what to expect.
Your doctor will talk to you about the side effects of the drug you are being treated with. This will include how they may affect you and ways to manage them. You will also need to visit your doctor regularly so they can check how you are doing and perform any other tests they think are important.
Doctors find out if you have lymphoma by doing a physical exam, blood tests and x-rays. They may also remove a sample of tissue for further tests.
Lymphomas can be indolent or aggressive. Indolent lymphomas grow and spread slowly and often cause few signs or symptoms. Diffuse large B-cell lymphoma (DLBCL) is a fast-growing type that can be found in people with AIDS.
Natural killer (NK) cells are a type of white blood cell that help the body fight infection. Lymphomas are cancers that start in lymphocytes, which are part of the lymphatic system. The lymphatic system is made of lymph nodes, the spleen, the tonsils, and other organs that help remove bacteria, waste, and excess fluid from the body tissue. The immune system also protects the body from disease and foreign material. Lymphoma is a type of cancer that starts in lymphocytes and can spread to other tissues.
NK/T-cell lymphoma is a rare, specific subtype of peripheral T-cell lymphoma (PTCL), and is most often seen in Pacific Rim countries. It makes up about 10% of all PTCL worldwide and over 20% in Japan, and is very rare in North America. It most commonly affects people in their 50s and 60s, but can occur at any age.
In this type of lymphoma, the abnormal NK cells grow out of control and multiply, forming tumors that spread to surrounding tissues through the lymphatic system. The tumors typically develop in the skin and mucous membranes, but can occur in almost any other area of the body. They can be very painful, and can cause fevers, fatigue, weight loss, and other symptoms.
The diagnosis is made by obtaining an adequate biopsy, which is reviewed by an expert hematopathologist. X-ray and CT may be helpful to evaluate the extent of the disease, although direct visualization by ear, nose, and throat (ENT) exam and biopsies is often helpful as well. Often, these lesions are seen to be highly elevated in EBV (Epstein-Barr virus) levels, which is a hallmark of the disease.
Treatment for NK/T-cell lymphoma usually includes radiation and chemotherapy, with stem cell transplant sometimes added in patients with advanced disease. Despite the low survival rates for untreated cases, five-year overall survival is about 50 percent with most current treatment approaches.
For patients with relapsed or refractory NK/T-cell lymphoma, experimental immunotherapies are being evaluated to improve outcomes. For example, the antibody daratumumab is being studied in combination with a combination of chemotherapy, such as pegaspargase, gemcitabine, and oxaliplatin (P-GemOX), to treat these patients.
Mycosis fungoides is a rare type of skin lymphoma, also known as cutaneous T-cell lymphoma or granuloma fungoides. It starts in the skin and often looks like a rash. It can progress slowly or stop and stay at a stage for years. It can spread to other parts of the body in later stages.
T cells are part of your immune system and travel throughout the body to help protect you from disease, including traveling to the skin to heal cuts or clear infections. Sometimes these cells can go haywire and grow into cancerous T cells. These cancerous T cells build up in the skin and can form sores, called lesions, that are usually itchy. In some cases, these lesions become patches of flat, scaly, pink or red skin. Some people with mycosis fungoides have these patches on the lower abdomen, upper thighs or buttocks. In other cases, these patches develop into plaques on the skin that may bleed or get sore.
Doctors don’t know what causes mycosis fungoides, but they think genetic mutations — changes in the DNA inside cells — are important. People with mycosis fungoides have missing or incorrect genetic material in their T cells that causes them to become malignant. These genetic mutations don’t seem to be inherited from parents. They occur over a person’s lifetime (acquired).
A doctor can diagnose mycosis fungoides by examining the skin and looking for signs of the condition, such as patches or plaques. They can also use blood tests and imaging procedures to see how far the cancer has spread. A doctor can stage mycosis fungoides on a scale of I to IV, which helps them plan treatment.
Some treatments include medicines that kill cancerous T cells or block them from growing. Your healthcare provider will decide what treatment is best for you based on your wishes, the stage of the disease and the availability of treatment options near you. These may include chemotherapy, radiation therapy and monoclonal antibodies. For example, you might receive the medicine mogamulizumab-kpkc or brentuximab vedotin (Adcetris). You can also try an allogeneic stem cell transplant, but this is only an option for advanced mycosis fungoides.
Follicular lymphoma develops when a group of white blood cells called B lymphocytes grows out of control. These cells travel around the body in your lymphatic system and blood, fighting infections and helping you to fight cancer. The lymphoma cells may also grow into enlarged lymph nodes, or follicles.
Most follicular lymphomas are slow-growing, and most people with the disease have a good outlook. They usually live for many years, with periods of time without symptoms or needing treatment. However, the disease often comes back (relapses) and needs further treatment.
Doctors use a number of tests to diagnose follicular lymphoma, including CT and PET scans, a swollen lymph node biopsy and a bone marrow biopsy. These tests help doctors define the stage and tumor burden of the lymphoma. The stage and tumor burden help doctors predict your prognosis (outlook).
The lymph node biopsy and bone marrow biopsy give doctors a sample of cells to look at under a microscope. These samples are tested for certain proteins and gene changes that can help identify the lymphoma. This helps doctors decide on a treatment plan for you.
Some follicular lymphomas have a genetic change that makes them grow faster. This is called a’mutant’ or ‘transformed’ lymphoma. Several new treatments are now available for patients with transformed follicular lymphoma, and these improve the outlook for some patients.
Your doctor will use a combination of drugs to treat follicular lymphoma. These are referred to as a chemotherapy regimen. The drugs are usually given intravenously in cycles. Each cycle lasts four weeks. The doctors will monitor you carefully for signs of the lymphoma regrowing between cycles.
Sometimes follicular lymphoma turns into a faster-growing type of NHL, called diffuse large B-cell lymphoma. If this happens, you will be treated as if you had high-grade non-Hodgkin lymphoma.
Some people with advanced-stage follicular lymphoma have low tumor burden and few symptoms, so their doctors might not start treatment straight away. This is called active monitoring and means you will have regular check-ups to see if the lymphoma is growing. If it does, your doctors will give you a short course of the monoclonal antibody drug rituximab. They might also use the chemotherapy combination of bendamustine and rituximab, or R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, Oncovin and prednisone).
Non-Hodgkin lymphoma forms in the body’s lymphatic system, a network of vessels and glands throughout the body. Clear fluid called lymph runs through this system and contains infection-fighting white blood cells known as lymphocytes. Non-Hodgkin lymphoma develops when lymphocytes grow and multiply abnormally. These cancerous cells can collect in the lymph nodes (glands) of the lymphatic system or in other organs, such as the spleen, thymus and bone marrow.
The most common type of non-Hodgkin lymphoma affects the B cells of the immune system. B lymphocytes are responsible for making antibodies that fight infection. Most non-Hodgkin lymphomas start in B cells, but some, such as diffuse large B-cell lymphoma and Burkitt lymphoma, start in T cells or other cell types.
Most non-Hodgkin lymphomas involve the lymph nodes, but sometimes they can spread to other parts of the body. In some cases, the cancerous cells can get into other organs such as the skin, lungs and intestines. The cancer can also cause infections.
Treatment for non-Hodgkin lymphoma depends on the subtype and stage of the disease. Doctors can determine the type by looking at a sample of lymph node tissue under a microscope. They will look for the presence of lymphocytes that are abnormal in size, shape and behavior. They will also analyze the DNA of these cells to make a diagnosis.
Some of the most common treatments for non-Hodgkin lymphoma are chemotherapy and radiation therapy. They may be used on their own or in combination. Chemotherapy can reduce the number of cancerous lymphocytes and may help prevent them from growing and spreading. Other treatments for non-Hodgkin lymphoma include natural killer cell therapy and stem-cell transplants. Stem-cell transplants use your own blood to replace the damaged blood cells that produce antibodies and fight infection.
Other treatments for some lymphomas include steroids and other drugs that prevent inflammation. They can also be given to help prevent a low blood count (anemia), which is a side effect of some chemotherapy drugs. Doctors may also give patients intrathecal chemotherapy to lessen the chance that lymphoma cells will go to the brain and spinal cord.