Lymphoma is a type of blood cancer that occurs when B or T lymphocytes, the white blood cells that form a part of the immune system and help protect the body from infection and disease, divide faster than normal cells or live longer than they are supposed to.

Lymphoma may develop in the lymph nodes, spleen, bone marrow, blood or other organs and eventually they form a tumor.

Typically, lymphoma presents as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases, radiotherapy and/or bone marrow transplantation, and lymphomas can be curable depending on the histology, type, and stage of the disease.

These malignant cells often originate in lymph nodes, presenting as an enlargement of the node (a tumor). It can also affect other organs in which case it is referred to as extranodal lymphoma. Extranodal sites include the tonsils, skin, brain, bowels, and bone.

Lymphomas are closely related to lymphoid leukemias, which also originate in lymphocytes but typically involve only circulating blood and the bone marrow (where blood cells are generated in a process termed hematopoiesis) and do not usually form static tumors.

There are many types of lymphomas, and in turn, lymphomas are a part of the broad group of diseases called hematological neoplasms.

Lymphoma presents with certain non-specific symptoms. If symptoms are persistent, lymphoma needs to be excluded medically.

Lymphadenopathy or swelling of lymph nodes – It is the primary presentation in lymphoma.

B symptoms (systemic symptoms) – Can be associated with both Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.

They consist of:

Fever
Night sweats
Weight loss

Other Symptoms :

Loss of appetite or anorexia
Fatigue
Respiratory distress or dyspnea
Itching

Lymphoma is definitively diagnosed by a lymph node biopsy, meaning a partial or total excision of a lymph node that is then examined under the microscope. This examination reveals histopathological features that may indicate lymphoma.

After lymphoma is diagnosed, a variety of tests may be carried out to look for specific features characteristic of different types of lymphoma.

There are many forms of lymphoma. Some forms of lymphoma are categorized as indolent (e.g. small lymphocytic lymphoma), compatible with a long life even without treatment, whereas other forms are aggressive (e.g. Burkitt’s lymphoma), causing rapid deterioration and death. However, most of the aggressive lymphomas respond well to treatment and are curable.

The prognosis, therefore, depends on the correct diagnosis and classification of the disease, which is established after examination of a biopsy by a pathologist (usually a hematopathologist).

After a diagnosis and before treatment, cancer is staged.

This refers to deducing how far cancer has spread, in local tissue and to other sites.

Staging is reported as a grade between I (confined) and IV (spread). Staging is carried out because the stage of cancer impacts its prognosis and treatment.

The Ann Arbor staging system is routinely used for the staging of both HL and NHL.

In this staging system, stage I represents a localized disease contained within a lymph node.

Stage II the presence of lymphoma in two or more lymph nodes.

Stage III spread of the lymphoma to both sides of the diaphragm.

Stage IV to tissue outside a lymph node.

A CT scan or PET scan are imaging modalities used to stage cancer.

Treatment

Prognosis and treatment are different for HL and between all the different forms of NHL, and also depends on the grade of the tumour, referring to how quickly cancer replicates.

Paradoxically, high-grade lymphomas are more readily treated and have better prognoses.

A well-known example of a high-grade tumor is that of Burkitt’s lymphoma, which is a high-grade tumor that has been known to double within days but is readily treated.

Low-grade lymphomas

Many low-grade lymphomas remain indolent for many years. In these lymphomas, metastases are very likely. For this reason, the treatment of the non-symptomatic patient is often avoided. This is carried out because the harms and risks of treatment outweigh the benefits.

If a low-grade lymphoma is becoming symptomatic, radiotherapy or chemotherapy are the treatments of choice; although they do not cure the lymphoma, they can alleviate the symptoms, particularly painful lymphadenopathy.

Patients with these types of lymphoma can live near-normal lifespans, but the disease is incurable.

High-grade lymphomas

Treatment of some other, more aggressive, forms of lymphoma can result in a cure in the majority of cases, but the prognosis for patients with a poor response to therapy is worse.

Treatment for these types of lymphoma typically consists of aggressive chemotherapy, including the CHOP or R-CHOP regimen.

Hodgkin lymphoma typically is treated with radiotherapy alone, as long as it is localized. Advanced Hodgkin disease requires systemic chemotherapy, sometimes combined with radiotherapy.

Lymphoma is the most common form of hematological malignancy, or “blood cancer”, in the developed world.

Taken together, lymphomas represent 5.3% of all cancers (excluding simple basal cell and squamous cell skin cancers) in the United States and 55.6% of all blood cancers.



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