What is lymphoma? An expert explains

Learn more from hematologist Stephen Ansell, M.D.

Hi. I'm Dr. Stephen Ansell. I'm a hematologist at Mayo Clinic. In this video, we're going to cover the basics of lymphoma. What is it? Who gets it? The symptoms. Diagnosis and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. Lymphoma is an overarching term for a kind of cancer that starts in the lymphatic system. Cancer diagnosis of any kind can be very difficult to deal with. But recent advances in how we treat lymphoma and ongoing research means there's a lot of hope. Treatment is highly successful for the majority of patients. First, what exactly is the lymphatic system? Well, it's actually a crucial part of the immune system. The lymphatic system produces lymphocytes, or white blood cells, which fight off pathogens, bacteria and the like. There are two types of lymphocytes, T cells and B cells. And lymphoma occurs when one of these types of lymphocytes grow and multiply uncontrollably. Often, these abnormal cells will build up and cause tumors in the lymph nodes, which are actually present throughout your body. And so lymphoma cells can collect anywhere.

There are different types of lymphoma, but really two main categories. Firstly, Hodgkin lymphoma. This is an uncommon form of lymphoma identified by the presence of rare large cells, which are called Reed- Sternberg cells. And it usually begins in lymph nodes of the neck, the chest, under the arms, and progresses in an orderly fashion and predictable fashion to other lymph node sites. This often means that it can be detected and treated early. And it's actually considered one of the most treatable forms of cancer. Non-Hodgkin lymphoma, while more common than Hodgkin lymphoma, is still very uncommon and a relatively rare disease overall. This category includes any cancer of lymphocytes that doesn't involve Reed- Sternberg cells.

Like all cancers, lymphoma is the result of mutations in DNA that instruct the cells on how to grow, and the cells often grow out of control and live longer than they should. These disease cells then continue to multiply at a rapid rate, producing more disease cells. These particular DNA mutations affect lymphocytes, which accumulate in the lymph nodes and other parts of the lymphatic system to form tumors, crowding out healthy tissue and limiting its ability to function. We don't always know exactly what caused that initial mutation, but we know the effects that it has downstream. There are, however, a variety of things that can increase your risk. Although both Hodgkin and non-Hodgkin lymphoma can occur at any age, they do have a pattern. For non-Hodgkin lymphoma, the risk increases as you get older, with about half the people diagnosed over the age of 65. In Hodgkin lymphoma, cases are predominantly seen in two peaks, often in young adults 20 to 40, and again in older people over 55. Whether because of an immune disease or immune suppressive drugs, lymphoma is more common in people with an impaired immune system. Certain infections can be connected with higher rates of lymphoma. These infections include Epstein-Barr virus infections and helicobacter pylori infections.

Common symptoms of having lymphoma include swelling of lymph nodes in your neck, in your armpits or your groin. This is often but not always painless and often could be associated with fevers, or unexplained weight loss, or drenching night sweats, sometimes chills, persistent fatigue. Shortness of breath can often be found. And patients with Hodgkin lymphoma may develop an itchy skin. Just because you're experiencing these types of things doesn't mean you have lymphoma, but it is important to see your doctor if you're experiencing recurring symptoms.

Firstly, they're likely to give you a physical exam to check for swollen lymph nodes and see whether your spleen or liver feel swollen. A lymph node may in fact be removed for a biopsy. This can show not only if lymphoma cells are present but will actually help to identify the type of lymphoma. The bone marrow is where the cells are made, and so a sample of the bone marrow may also be taken. This is usually performed both on the liquid of the bone marrow, the so-called aspirate, and then a biopsy is taken from the solid portion of the bone marrow. This is done using a needle, and the sample is usually extracted from the hipbone and sent for analysis. Additionally, your doctor may recommend other kinds of tests including imaging studies. This could include a PET scan, a CT scan, or an MRI scan. All of them are being done to look for signs of lymphoma in other areas of your body.

A specialized team of doctors can work with you to develop a strategy for treating your lymphoma. And the strategy is based on the type of lymphoma, the stage of the lymphoma, the aggressiveness of the cancer, as well as your overall health. Some lymphomas grow very slowly, and it may not be necessary to start treatment right away. Active surveillance is often your best option. You and your doctor may decide not to treat the lymphoma until it interferes with your lifestyle. We call this watchful waiting. However, until then, you would need to have periodic tests to monitor your disease. Now, you may be given chemotherapy. These are usually powerful drugs that will kill lymphoma. Additional treatments are coming out that allow for targeted therapy. Targeted drug treatment focuses just on specific abnormalities in cancer cells and is highly effective. A further strategy is immunotherapy. And immunotherapy drugs use your own immune system to fight your cancer.

Finding out you have lymphoma and going through treatment can be overwhelming, but there are things you can do to help you cope. Learn about your lymphoma. Don't be afraid to ask your doctor questions and have them recommend resources for more information. Knowing more about your particular case and the options you have will help you feel confident and empower you to make decisions regarding treatment. Keep your friends and family close, rely on them for practical and emotional support. It may also be important to find a support group to talk with people who are going through the same thing. Although cancer and going through treatment is never easy, with lymphoma, there is plenty of hope and long-term success. A lot of progress has been made in fighting lymphoma, getting patients into remission, getting them back to a normal life. And as the research continues, ever-improving and more effective ways to combat lymphoma are being developed. If you want to learn more about your lymphoma, please go ahead and watch the related videos or visit mayoclinic.org. We wish you well.

1. Chronic lymphocytic leukemia
2. Cutaneous B-cell lymphoma
3. Cutaneous T-cell lymphoma
4. Hodgkin's lymphoma (Hodgkin's disease)
5. Non-Hodgkin's lymphoma
6. Waldenstrom macroglobulinemia