Lymphoma is cancer of the lymph system (or lymphatic system or the lymphocytes), which is part of our immunity. Lymphocytes are a type of white blood cells which circulates with blood and also reside in almost every organ in body like lymph nodes, intestine, skin, bone marrow etc. Lymphoma occurs when the lymphocyte get transformed to a cancer cell and then grow/ multiply uncontrollably and form a mass/ bulk of these abnormal cancerous lymphocytes.
Lymphoma is the most common blood cancer. The two main forms of lymphoma are Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Amongst NHL, 2 major classes of lymphomas are B-cells lymphoma and T/NK cell lymphoma. B cell lymphomas are much commoner than T cell lymphomas. Lymphomas can be classified on basis of their clinical behavior into 2 categories: aggressive (high grade) and indolent (low grade).
Common symptoms of lymphomas are:
- Nodular swellings, most commonly in neck and any other parts of body
- Pain in affected area like spine/ back pain, leg pain or weakness in legs, bone pains
- Intestinal symptoms like pain stomach, constipation/ obstruction
- Symptoms related to brain like paralysis of limbs or face, headache, unconsciousness (if lymphoma is affecting brain)
- Fever which is not improving after adequate treatment with antimicrobials
- Weight loss without any reason
- Excessive sweating specially in night
Common high grade lymphomas are Diffuse Large B Cell Lymphoma (DLBCL) while common low grade lymphomas are Follicular Lymphoma (FL), CLL/SLL and Marginal Zone Lymphoma (MZL).
Treatment depends upon type of lymphoma. Sometimes a low grade lymphoma in which patient is not having any symptom is not even treated and just kept under observation/ check up at regular interval. Symptomatic low grade lymphomas and all of the high grade lymphomas are treated with multi-agent chemotherapy alone or the chemotherapy followed by bone marrow/ stem cell transplantation. A high dose chemotherapy coupled with stem cell transplant is usually the treatment of choice for lymphoma patients whose cancer has returned or relapsed. The majority of patients undergoing a stem cell transplant will receive their own stem cells (known as an autologous stem cell transplant). Occasionally, a patient will receive stem cells from a donor (known as an allogeneic stem cell transplant). For patients who are not candidates for stem cell transplant, or who relapse even after stem cell transplantation, the options are investigational therapy/ clinical trials or palliation.
It is critical to remember that today’s scientific research is continuously evolving. Treatment options may change as new treatments are discovered and current treatments are improved. Therefore, it is important that patients check with their physician for any treatment updates that may have recently emerged.