Many types of lymphoma are treatable and curable. Depending on the type and stage, and other factors, such as age and health, people can stay in remission for years.
Early symptoms include painless swelling of one or more lymph nodes (glands) in your neck, armpits, groin or belly. It’s normal for lymph nodes to swell during infections, but they shouldn’t linger.
The most common sign of lymphoma is a lump or swelling in your neck, armpit or groin. These are called swollen lymph nodes and they’re usually painless. Fatigue is a common symptom too. It’s different to normal tiredness, and you may feel exhausted for no obvious reason or feel washed out after doing little. Swollen lymph nodes can block the lymphatic vessels (the tubes that run throughout your body and carry lymph fluid). This stops the lymph fluid draining properly from the area, causing it to build up and causing symptoms. The lymphoma type and where the lymph nodes are swollen will determine what symptoms you get.
Lymphoma can cause cancer-related fatigue. It can also affect your thinking processes – you might forget things or take longer than usual to respond. This is sometimes known as chemo brain but can happen to anyone with cancer, not just those receiving chemotherapy. It can be made worse by stress, sleep problems and some medications.
If the lymphoma is in your chest, you might have a cough, breathlessness and a sore throat. This is because swollen lymph nodes can squeeze the superior vena cava, which feeds blood into your heart. You might also have a fever and night sweats.
When lymphoma develops in the tummy, it might make your spleen and liver swell up. You might feel bloated or full after eating only a small amount. It’s important to see your GP if you have a swollen tummy or your skin or the whites of your eyes turn yellow (jaundice).
If you have non-Hodgkin lymphoma, a biopsy will be needed to confirm the diagnosis and to find out more about it. You’ll have a CT scan and possibly a PET scan, which work in different ways and give doctors detailed pictures of the inside of your body.
If the doctor thinks your lymphoma isn’t spreading, they might suggest active monitoring (watch and wait) instead of treatment. This means you’ll have regular appointments with your GP and nurse to check for any changes. You might have tests and scans as part of this, such as a blood test to measure your red blood cell count and a urine sample.
To diagnose lymphoma, your doctor will do a physical exam and ask about your past health. Then he or she will order blood tests to look for cancer cells. These may include a complete blood cell (CBC) test, a platelet count and other tests to measure your calcium and electrolytes. You might also have a bone marrow test, which involves having a needle removed from your hipbone to examine the marrow under a microscope. Your doctor may also order a chest X-ray or MRI. These scans use a combination of low doses of radiation and magnetic waves to make detailed pictures of organs and structures inside your body.
Based on these results, your doctor can decide what type of lymphoma you have and how far it has spread. This is known as staging. Your doctor will also describe your prognosis, which is your chance of recovery based on the type and stage of your lymphoma.
Some types of lymphoma are very slow-growing and don’t cause symptoms. Your doctor may choose not to treat them right away, a process called active surveillance. He or she might repeat the blood and imaging tests on a regular basis to watch for signs of cancer growth. If you do need treatment, your doctors might give you chemotherapy or radiation therapy to destroy the cancer cells and improve your chances of a full recovery.
You may be given chemotherapy drugs through a vein (intravenously, or IV) or taken as pills. These drugs kill fast-growing cancer cells and reduce the number of cancer cells in your body. They can be used alone or in combination with other treatments, including surgery and radiation therapy.
Whether you have Hodgkin or non-Hodgkin lymphoma, you might receive a drug called Rituximab (Rituxan) to help keep the cancer cells from multiplying. These drugs can be used alone or with other chemotherapy medications.
Your doctor might recommend a stem cell transplant to treat your lymphoma if it is in an advanced stage. You will have a bone marrow transplant team that includes a hematologist or oncologist, a transplant surgeon and nurses.
A person’s treatment options will depend on the type and stage of lymphoma. The goal of treatment is to destroy cancer cells and restore normal tissue. Treatment usually includes medication that targets cancer cells, radiation and surgery. In some cases, the doctor may suggest a combination of these treatments.
The first step in treating most types of lymphoma is chemotherapy. Chemotherapy drugs are put into your bloodstream and travel to all parts of the body to kill cancer cells. You might receive this medicine through a tube (catheter) in your vein (IV), or you might take it as pills. Your doctor will also recommend other forms of treatment based on the type of lymphoma and its stage.
Some people who have lymphoma are at a higher risk of developing other cancers in the future. This is because they have certain risk factors. These might include exposure to radiation or chemicals such as benzene, or infection with the Epstein-Barr virus or HIV.
There are also genetic mutations that can increase the chance of getting a specific kind of lymphoma. Doctors might run tests to see if you have these mutations.
If the lymphoma is in its early stages and is not spreading, your doctor might decide to watch it without starting treatment right away (watchful waiting). The doctors at Penn will discuss the pros and cons of this option with you.
In more advanced stages of lymphoma, your doctor might recommend a treatment that includes radiation and chemotherapy. They will consider how many chemotherapy drugs you can tolerate and whether you are a candidate for bone marrow transplant.
Bone marrow transplant is a treatment that replaces your diseased bone marrow with healthy bone marrow stem cells from your own body or a donor. High doses of chemotherapy and/or radiation are used to suppress your existing bone marrow so the new cells can grow.
A minimally invasive procedure called a lumbar puncture is used to remove a sample of cerebrospinal fluid (CSF) from around the brain and spinal cord to check for lymphoma cells. This is usually done in conjunction with a CT scan or a MRI.
The lymphatic system contains tubes (lymphatic channels) which transport lymph – a fluid that carries infection-fighting white blood cells throughout the body. There are over 600 lymph nodes in the body and they can enlarge as cancerous cells grow. Lymph nodes are located in many areas of the body, including the armpits, groin, belly and neck. Swelling in these nodes is a common early symptom of lymphoma, but it can be difficult to recognise.
People with certain autoimmune diseases like rheumatoid arthritis, celiac disease and inflammatory bowel disease have a higher risk of developing some types of lymphoma. Age is also a significant factor for some types of lymphoma.
Lymphoma symptoms can be very similar to the signs and symptoms of other conditions, so it’s important to talk to your doctor if you have any unusual or persistent health problems. Some of these symptoms include a painless swelling of one or more lymph nodes in the neck, armpits or groin; fatigue that doesn’t go away even when you get enough sleep; fever that stays above 103 degrees Fahrenheit (39.9 degrees Celsius) for two days or more; and drenching night sweats (sweating that soaks your clothes and sheets).
A diagnosis of lymphoma can be very stressful. It’s normal to feel a range of emotions, from anger and fear to anxiety and depression.
There are a number of treatment options for both Hodgkin and non-Hodgkin lymphoma. These can be given alone or in combination and may include chemotherapy, radiation therapy, monoclonal antibodies, immunotherapies and stem cell transplant.
The prognosis for lymphoma depends on the type of tumour and how fast it grows. This is called the grade of the tumour. Low-grade tumours are usually easier to treat than high-grade ones.
Radiation therapy is a mainstay of treatment for both lymphoma and other cancers, but there are some late effects from this treatment that can take decades to develop. These can include the risk of second cancers in the chest area, heart problems and nerve damage. For this reason, it’s very important to have regular mammograms and MRI scans after radiation therapy is finished.
Lymphoma is a cancer that starts in infection-fighting cells called lymphocytes. It’s different from leukemia, which starts in blood-forming cells in bone marrow.
Symptoms depend on where the lymphoma is located. Swollen lymph nodes (lymphoedema) are the most common symptom.
Fatigue is feeling tired even after resting. Unexplained weight loss is another common symptom. Lymphoma that spreads to the brain and spinal cord may cause headache, trouble thinking or personality changes.
The first sign of lymphoma is usually painless swelling (enlargement) of one or more lymph nodes. These are small glands that filter fluid around cells in the lymphatic system, a part of the immune system. Lymph nodes are located throughout the body, including the neck, armpits, belly and groin. Some lymphomas, such as Hodgkin’s disease, are caused by a type of white blood cell called B cells. Other types of lymphoma are caused by T cells, another type of white blood cell.
If lymphoma affects a lot of lymph nodes, it may cause them to enlarge and become painful or tender. A lump or mass can also form and be felt as a hard, round or swollen area. Lymphoma can also cause a wide range of other symptoms, depending on where the cancer starts or spreads.
For example, lymphoma that starts in or near organs such as the liver and spleen may cause abdominal pain or a feeling of fullness after eating. If it starts in or grows near the thymus or lungs, it can cause coughing, shortness of breath or chest pain. If lymphoma spreads to the brain, it can cause confusion or numbness in the arms or legs.
Other symptoms of lymphoma include itching, which is a result of the immune system’s reaction to lymphoma cells. Itching is often worse at night and it can also be accompanied by a fever.
It is important to see your doctor if you have any of the above symptoms, especially if they don’t go away. It is possible that your symptoms are caused by something else, but it’s worth getting checked out just in case.
The risk of lymphoma is higher in people who have autoimmune diseases, such as rheumatoid arthritis or celiac disease. It is also more common in people over age 55. However, some types of lymphoma grow slowly and don’t produce any symptoms at all, so it is difficult to diagnose them early. Some people are diagnosed only after routine imaging tests show signs of the disease. Your doctor can use a physical exam, blood tests, a chest x-ray and a biopsy to diagnose lymphoma.
Fatigue is one of the most common symptoms of lymphoma. It can occur before diagnosis, during treatment or even after the cancer has gone into remission. The fatigue may be a result of the disease itself or its side effects such as chemotherapy, radiation or bone marrow transplantation. It may also be due to other health conditions like anemia or infections. The fatigue caused by cancer can be debilitating and affect a person’s quality of life, including their relationships with family and friends.
Fatigue can cause a person to have difficulty concentrating and doing daily activities such as cooking, cleaning or shopping. This can make it difficult to maintain a job or care for children. It may also be hard to socialize and can lead to feelings of depression. If the fatigue is caused by chemotherapy, it can be made worse by stress or loss of appetite.
Symptoms of lymphoma may vary depending on the type and location of the tumor, but it is important to talk with your doctor if you experience unexplained fatigue. Your doctor will discuss other possible causes of your unexplained fatigue and provide advice on how to manage it.
Unexplained fatigue that persists for two weeks or more could be a sign of lymphoma. Other symptoms of lymphoma include painless swelling of one or more lymph nodes in the neck, armpits or groin; fever that is not caused by an infection; night sweats so intense that you wake up with your pajamas and sheets soaking wet; loss of appetite; an enlarged spleen; and weight loss.
Many of these symptoms are similar to those caused by a number of other diseases and illnesses, so it is important to see your doctor if you have any of them. Your doctor will perform tests to diagnose the cause of your unexplained fatigue and may refer you to an oncologist, haematologist or GP. They may ask you to fill in a questionnaire that will ask about when your fatigue started, how long it has lasted and how much it interferes with your daily activities.
The lymphatic system is a network of glands and vessels that spread throughout the body. Clear fluid called lymph flows through it and carries infection-fighting white blood cells called lymphocytes. Lymph nodes (glands) and other tissues in the lymphatic system—including bone marrow, the spleen, thymus gland, tonsils, and the digestive tract—collect and store lymphocytes to protect against disease and remove bacteria and waste matter from the body. In lymphoma, the lymphocytes develop abnormally and grow out of control.
Most types of lymphoma start in B lymphocytes, while a minority start in T lymphocytes or natural killer (NK) cells. Different types of lymphoma cause different symptoms depending on where the cancer starts and where it grows.
Fatigue is a common lymphoma symptom. It can be caused by many things, including certain cancer treatments. If fatigue does not improve with rest, talk to your doctor.
Unexplained weight loss can occur in people with any type of lymphoma, but it is more common in Hodgkin lymphoma. Unexplained weight loss can also be a sign of other conditions, such as an underactive thyroid gland or menopause. Some people may also feel that their stomach is full, which can be a result of chemotherapy or other treatment.
Night sweats are a common symptom in people with lymphoma, especially in Hodgkin lymphoma. They are often drenching, and they can wake you up at night. They can be a normal part of a fever or they can indicate that the lymphoma has spread to other parts of the body.
If you have unexplained weight loss and other lymphoma symptoms, make an appointment with your doctor as soon as possible. This will help your doctor find the best treatment for you.
People with lymphoma usually have other symptoms, too. These include a painless swelling in one or more lymph nodes in the neck, armpit, or groin; persistent fatigue that does not improve with rest; a fever that stays above 100.5 degrees Fahrenheit (39.5 degrees Celsius) for two days or more; and drenching night sweats.
The most common early symptom of lymphoma is painless swelling of one or more lymph nodes, usually in the neck, armpits and groin. Lymph nodes are part of the immune system and contain infection-fighting cells called lymphocytes. Cancer occurs when these cells grow out of control and develop genetic changes. Non-Hodgkin lymphoma (NHL) is the 6th most common cancer in the UK and it affects people of all ages. It can affect the lymph nodes, thymus, bone marrow and stomach.
It is normal for lymph nodes to become swollen as the body fights off infections such as colds and flu. However, if lymph nodes stay swollen for long periods or a lump appears, it is important to see your doctor.
Unexplained fatigue – feeling tired day after day, even after getting enough sleep – can be caused by many illnesses, including chronic fatigue syndrome (CFS or ‘ME’) and anaemia (low levels of red blood cells). Fatigue can also be a side effect of certain treatments for lymphoma, such as chemotherapy.
Some types of lymphoma may cause a rash that resembles psoriasis or eczema, and it is also common for people with lymphoma to experience itching in the torso area. Lymphoma that develops in the reproductive organs of women may cause pelvic pain or pressure, as well as vaginal discharge and bleeding.
Depending on the type of lymphoma, it is possible that you may suffer from an uncontrollable fever or severe headaches. It is also important to seek medical advice if you have chest pain, especially if it combines with breathlessness or a sudden weakness or faintness.
You are more likely to develop lymphoma if you have a weakened immune system, which can be caused by having an infection such as glandular fever, or taking drugs that suppress the immune system, such as immunosuppressive steroids. Being male, being over 55 and having a family history of lymphoma are other risk factors.
Most types of lymphoma grow and spread slowly. This is called indolent lymphoma. People who have indolent lymphoma with no symptoms may not need treatment at all.
If lymphoma shrinks after treatment or recurs, doctors recommend close follow-up and possibly further treatment with rituximab or the monoclonal antibody ibritumomab tiuxetan (Zevalin). These drugs can lower the chance that lymphoma will come back later.
Chemotherapy is the main treatment for most types of lymphoma. The drugs in chemotherapy kill fast-growing cells, including cancer cells. It can be given into a vein (IV) or taken as pills. If the cancer has spread beyond the lymph nodes, it may also be given into the cerebrospinal fluid or directly into the eye.
For B-cell non-Hodgkin lymphoma, chemo is usually given on its own or in combination with radiation therapy and/or rituximab. In some cases, doctors may decide not to treat B-cell lymphoma if it is slow growing and not causing symptoms. This is called active surveillance. Your doctor will monitor your condition with periodic blood tests and imaging studies.
If the lymphoma recurs, doctors will use every weapon at their disposal, from traditional chemo to the newest advances in immunotherapy. A bone marrow transplant, also known as a stem cell transplant, can help for younger patients with high-risk lymphoma. Our specialists first suppress your own bone marrow with high doses of chemotherapy and/or radiation, then infuse healthy bone marrow stem cells from your body or a donor. Your new bone marrow produces healthy blood cells that can fight the lymphoma.
We have the experience and resources to give you the best chance of a cure. We work with your other healthcare providers to manage the side effects of your treatment. If your lymphoma has a genetic mutation, we can offer clinical trials that test new treatment strategies.
When your chemo is finished, we may recommend radiation therapy to any areas where the cancer has not disappeared. We might also suggest a second chemo regimen or a combination of chemo, radiation and rituximab.
For Waldenstrom macroglobulinemia, our doctors usually treat this rare form of lymphoma with a combination of rituximab and a more intensive chemo regimen than what is used for CLL. This regimen may include the monoclonal antibody ibrutinib (Imbruvica) or acalabrutinib (Calquence), as well as the chemo drugs chlorambucil, fludarabine, and cyclophosphamide. We may also add a targeted drug, such as obinutuzumab (Gazyva). The combination is sometimes given intrathecaly or directly into the eye.
There are different types of radiation treatments for lymphoma, depending on what type of cancer you have and where it is in your body. The doctor may recommend radiation therapy before or after surgery, or it might be given as part of your chemotherapy treatment. You might also have it if the lymphoma has spread to your brain or spinal cord (central nervous system lymphoma). The doctor will give you a treatment plan that includes how many doses of radiation you need and when you need them. The doctor may also order imaging tests to check for the spread of lymphoma in other areas of your body. These tests might include a CT scan, an MRI or a PET scan.
You might have radiation that is delivered directly to the site of the lymphoma, a procedure called brachytherapy. This is usually done with a catheter or with a needle that contains encapsulated radioactive material. The doctor puts the needle or catheter into a body cavity, such as the spleen or liver. The encapsulated material is then blasted with high-powered beams of radiation, which target the tumour or tumour-bearing tissue and limit damage to surrounding healthy cells.
Another type of radiation treatment is called proton beam therapy. It delivers high-energy protons rather than conventional X-rays, which help to destroy the tumour and reduce side effects from radiation. This treatment may be used in combination with other treatments, such as a stem cell transplant or an immunotherapy drug.
Your lymphoma treatment team will consist of specialists from several disciplines. This includes a medical oncologist (cancer doctor who specializes in treating cancer with medications) and a hematologist (doctors who specialize in blood disorders). Other members of your team might include a radiation oncologist, a nurse, a nutritionist, social workers or psychiatrists. It’s important to ask questions and participate actively in your own care. This will help you feel more confident and in control of your health. The team will also help you manage side effects during and after your treatment. These side effects might be temporary and improve as your treatment continues.
The discovery of monoclonal antibodies (mAbs) that specifically target B cells and destroy them led to the development of rituximab, which is currently the gold standard treatment for CD20+ lymphoid malignancies and other autoimmune disorders associated with abnormal B-cell function. Rituximab is a chimeric anti-CD20 mAb that is used to treat B cell malignancies and other hematological disorders by infusing the drug into the patient’s bloodstream. While initially met with skepticism because of its potential to deplete both tumor and normal B cells, the efficacy of rituximab as a monotherapy or in combination with chemotherapy was quickly established. Rituximab is well-tolerated with relatively few AEs, and has become a staple of the treatment for many hematological malignancies and autoimmune disorders involving B-cell or humoral mechanisms.
Rituximab has been approved as a single agent for low-grade non-progressive B cell non-Hodgkin Lymphoma after CVP chemotherapy, and as part of a combination regimen in advanced disease. It is also an orphan drug for immune thrombocytopenic purpura, and has been demonstrated to be effective in rheumatoid arthritis (RA) and other antineutrophil cytoplasmic antibody-associated vasculitides including granulomatous polyangiitis and microscopic polyangiitis.
A recent randomized trial demonstrated that extending the duration of rituximab therapy improves EFS and response rates in patients with follicular lymphoma. 206 patients with newly diagnosed or refractory/relapsed FL were randomized to receive either standard rituximab therapy (2 doses of 375 mg/m2 every 2 months for 4 times) or prolonged rituximab therapy (1 infusion per week for 12 weeks).
The results from the study showed that patients receiving prolonged rituximab significantly improved their outcomes when compared to those who received only the standard rituximab schedule. Moreover, the improvement in EFS and remission rate was obtained without an additional increase in toxicity. It is important for intensivists to be aware of this therapy and its AEs, particularly in cases where the use of rituximab is considered in patients with severe underlying illness. This will ensure that they are better able to identify and manage patients who develop a life-threatening complication requiring critical care management. In addition, it will enable them to identify and counsel patients who may benefit from the use of a biosimilar of rituximab that is now available.
Stem cell transplant (also called bone marrow transplant) is the replacement of a person’s blood-forming stem cells with healthy donor cells. Typically the goal is to cure lymphoma that has returned after treatment or to keep a patient in remission after chemotherapy and radiation have been used. At NYU Langone, our doctors offer both autologous and allogeneic stem cell transplants to patients who meet certain criteria.
Your blood-forming stem cells are specialized cells that produce all the other types of cells in your body, including white blood cells, red blood cells and platelets. The high doses of chemotherapy used to treat cancer often destroy these cells along with the cancer cells.
During a stem cell transplant, your blood-forming cells are replaced with healthy donated cells that have the ability to grow and replace the diseased ones. This is done by transferring the donor’s cells through a tube in the vein into your bloodstream. At the same time, you receive a high dose of chemotherapy to kill any remaining cancer cells in your body.
To prepare for the procedure, you may need to receive daily injections of a medication called G-CSF (filgrastim, Granix®, Neupogen®, Zarxio®). This medicine increases the number of blood-forming stem cells in your bloodstream so they can be collected. In most cases, the stem cells are collected through a small tube in the arm (a peripheral blood stem cell collection). In rare instances, the doctor may need to collect your blood-forming stem cells from the hipbones using a procedure called a bone marrow harvest in a hospital operating room.
Before the stem cells are infused, you will receive several days of high-dose chemotherapy with or without radiation in the hospital. This pre-transplant treatment lowers your risk of complications such as infection and reduces the chance that the transplanted stem cells will reject or attack your body’s healthy cells.
If your lymphoma has relapsed or is refractory (did not respond to standard chemotherapy), stem cell transplant can provide the best chance for a lasting remission. Studies have shown that patients with lymphoma who have a complete response (CR) after frontline therapy, then receive an ASCT or allo-SCT, have a much higher 4-year survival rate than those that do not receive the procedure.
Many factors can affect your risk for lymphoma. These include autoimmune diseases, certain infections like hepatitis C or Epstein-Barr virus, and age.
Lymphoma is cancer that starts in white blood cells called lymphocytes. These cells normally help fight infection and disease as they travel through the lymphatic system (a network of vessels, nodes and ducts). There are two broad categories of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma.
Hodgkin Lymphoma is one of the most curable cancers, especially when it’s caught and treated early. People with Hodgkin lymphoma who achieve a remission—meaning there are no signs or symptoms of the cancer—can live long and healthy lives. Remissions can be temporary or permanent, and many people worry that their cancer will return. But learning about your risk for recurrence can help you cope with this fear.
To diagnose Hodgkin lymphoma, your health care provider will ask you about any symptoms you have and do a physical exam. He or she will check for swollen lymph nodes in your neck, underarm and groin, as well as a swollen spleen and liver. Your health care provider will also order lab tests and imaging exams.
Laboratory tests include a complete blood count, blood chemistry study, hepatitis B and C virus test and an erythrocyte sedimentation rate. Your health care provider will order a biopsy to find out whether or not you have Hodgkin lymphoma. In most cases, the biopsy is done by removing a small piece of tissue from the lymph node. In rare cases, your health care provider will remove a sample of tissue from another part of the body to make a diagnosis.
The morphology of the tissue helps doctors determine which subtype of Hodgkin lymphoma you have. Classical Hodgkin lymphoma (HL) shows a nodular growth pattern with sclerosis bands in an inflammatory background. Nodular sclerosis with mixed cellularity (NS-HL) typically affects young adults and mainly develops in the chest, while nodular sclerosis with ring-shaped cells (NS-HL+) often develops in the belly (abdomen).
Your health care team will use information from these tests to decide on treatment. Your provider may recommend a combination of chemotherapy, radiation therapy and immunotherapy (therapies that harness your immune system). Your doctor will also consider your overall health and the potential side effects from treatment when choosing a plan.
Research has made many treatment options available for Hodgkin lymphoma, including new chemotherapy combinations, biological therapies and bone marrow or stem cell transplantation. Research continues to improve these treatments and increase the number of people who go into remission.
After completing treatment, you will need regular follow-up with your health care team. These visits will help your provider look for any late effects of treatment and treat them as they occur. It’s important to track any side effects so that your health care team can prevent complications, such as infections or heart problems.
People who have been treated for Hodgkin lymphoma can have a long, healthy life with routine follow-up exams. You should also keep up with any recommended vaccinations. It is important to talk to your health care team about your fears and concerns. It’s also helpful to bring a loved one with you to appointments for support and to take notes or record the conversation. You may also find it useful to join a support group for people with Hodgkin lymphoma or other types of lymphoma. The Leukemia & Lymphoma Society has a list of local support groups.