Cancer Types
Lymphoma
Information about the blood cancer lymphoma.
What is lymphoma?
Lymphoma involves white blood cells called lymphocytes. There are two types of lymphocytes, B cell and T cell lymphocytes.
Cancer occurs when the lymphocytes no longer behave as they should, and they also lose their ability to fight infection. Lymphoma cells multiply and can form tumours (lumps).
Lymphoma normally starts in the lymph nodes but can start in any part of the lymphatic system. The lymphatic system is made up of lymph nodes as well as other ‘lymphoid tissue’ including the spleen, tonsils and bone marrow. Many parts of the body have lymphoid tissue so lymphoma can start in any of them, and can also spread to other parts of the body such as the lung or liver.
What types of lymphoma are there?
The two main types of lymphoma are:
- Hodgkin lymphoma
- Non-Hodgkin lymphoma (NHL)
Each of these two broad types of lymphoma are divided into sub-types.
Most Hodgkin lymphoma is classical Hodgkin lymphoma which includes four further subtypes:
- Nodular sclerosis
- Mixed cellularity
- Lymphocyte-rich
- Lymphocyte depleted Hodgkin’s
Non-Hodgkin lymphoma is divided into subtypes based which type of white blood cell is mainly affected and on how the abnormal cells look under the microscope. Non-Hodgkin lymphoma can start in B-lymphocytes or T-lymphocytes.
B-cell lymphomas include:
- Diffuse large B cell lymphoma
- Follicular lymphoma
- Burkitt’s lymphoma
- Mantle cell lymphoma
- and others
T-cell lymphomas include:
- T-lymphoblastic lymphoma
- Peripheral T-cell lymphomas
Non-Hodgkin lymphoma is more common than Hodgkin lymphoma in New Zealand, but Hodgkin lymphoma is one of the most common cancers in the adolescent and young adult age group.
Who can be affected by lymphoma?
Hodgkin lymphoma is more common in people who are 20-34 years old or over 70 years old.
Non-Hodgkin lymphoma can occur at any age but is most common in those over 50 years old.
Can I pass lymphoma on to my children?
Lymphoma is not a cancer that is inherited through whānau. Most people who are diagnosed with lymphoma do not have any close family members (e.g. mother, father, brother or sister) who have had lymphoma. Lymphoma is not infectious and you cannot pass it on to other people.
Risk factors
Anything that can increase your risk of developing lymphoma is called a risk factor. Having one or more of these risk factors doesn't mean that you will develop lymphoma. Even if you have no risk factors at all you can still develop lymphoma.
Personal risk factors
- Infection such as HIV, Hepatitis B and C, and glandular fever
- Autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis and Sjogren’s syndrome
- Medications or therapy that supresses the immune system following an organ transplant
- Smoking
Signs and symptoms
The most common early sign is swelling of the lymph nodes either in the neck, under the armpits or in the groin. This swelling is often felt as a lump that is not sore but can be uncomfortable. It is important to know that swelling of lymph nodes is common, and is usually not due to lymphoma. However, if your glands are enlarged for a long time or are very enlarged, you should see your doctor.
Other signs and symptoms of lymphoma may also include:
- Fevers
- Drenching night sweats
- Unexplained weight loss
- Fatigue/ tiredness
- Difficulty fighting infections
- Bruising or bleeding
- Continuous itching of the skin
Diagnosis
Blood tests will be taken, and you will be referred to see a haematologist (a specialist in blood diseases).
The most important test for the diagnosis of lymphoma is a tissue biopsy (a small piece of tissue is taken, usually from a lymph node, to look at under a microscope). The tissue biopsy will be done using an ultrasound or CT scan. This may be performed under sedation or anaesthetic. Occasionally the diagnosis is made because you have tissue removed for other reasons, especially in the bowel where it may present as a blockage requiring surgery.
Once the diagnosis of lymphoma is confirmed you may require others test such as a PET scan or CT scan, to see if the lymphoma is in one small area or whether it has spread to other lymph node regions. The amount the disease has spread is called the ‘stage’ of disease, with Stage 1 being the least spread, and Stage 4 being the most.
Treatment of lymphoma
The treatment will depend on the type of lymphoma you have, the stage of your disease, how fast growing or aggressive the lymphoma is (the grade of the lymphoma), your general health and your preference for treatment.
Many treatments can be given as an outpatient (at home or in a chemotherapy unit during the day).
The types of treatment that you may have could include the following:
- Chemotherapy
- Steroids
- Immunotherapy
- Radiotherapy
- Targeted therapy (drugs that attack cells through specific a metabolic pathway (or pathways) used for lymphoma cell growth and division)
- Blood stem cell (bone marrow) transplantation – usually only considered for relapsed or treatment-resistant disease