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Cancer
What is lymphoma?

Lymphoma is cancer of the lymphatic system.
The lymphatic system is a complex network of tubes (lymphatic vessels), glands (or lymph nodes) and other organs including the spleen. The lymphatic system is part of the immune system, or the body's natural defence against infection. It carries white blood cells called lymphocytes, which help us to fight infection. When a person has lymphoma, some of their lymphocytes become cancerous.

These cancerous lymphocytes divide in an abnormal way, or do not die off when they should. They can collect in the lymph nodes, which then grow to form tumours. Lymphoma usually starts in the lymph nodes but it can affect other parts of the body. It is quite common for lymphoma to affect the bone marrow. It can also affect the gut, the skin, or the liver. The cause of lymphoma is not known, but some forms of lymphoma are more common in people with reduced immunity for example, people who have taken drugs to prevent rejection of a transplanted organ or people with HIV or AIDS.

What are the symptoms of lymphoma ?

The most common symptom of lymphoma is a painless lump or swelling, often in the neck, armpit or groin.
Other common symptoms include:

  • Excessive sweating, especially at night
  • Fevers
  • Unexplained loss of weight
  • Unusual tiredness
  • A cough that won't go away, or shortness of breath
  • A persistent itch
  • Abdominal pain or diarrhoea

Most people who have these symptoms will not have lymphoma. But if you have any of these symptoms, and particularly if you have a combination of these symptoms, you should see your doctor.

How is lymphoma diagnosed ?

Lymphoma is usually diagnosed following a test called a biopsy. A biopsy means removing some of the abnormal cells to look at them under a microscope. A pathologist will look at the cells and carry out some tests on them. The results of these tests will reveal what type of lymphoma you have. This is called 'classification'.
The main types of lymphoma are:

  • Hodgkin lymphoma
  • High grade (or fast growing) non-Hodgkin lymphoma (NHL)
  • Low grade (or slow growing) non-Hodgkin lymphoma(NHL)

NHL is more common and is usually seen in people aged over 55. However, NHL is actually a diverse group of conditions, which are often sub-divided into low grade and high grade, depending on how quickly the cells are dividing. The treatments for low and high grade are different. Follicular lymphoma is the most common type of NHL, representing 30% of low grade lymphomas diagnosed. Other forms of low grade NHL include: small lymphocytic lymphoma/chronic lymphocytic leukaemia; Lymphoplasmocytoid lymphoma and MALT lymphoma. The most common high grade NHL is diffuse large B-cell lymphoma. Other high grade NHLs include: Burkitt's lymphoma; lymphoblastic lymphoma and peripheral T-cell lymphoma.

How is lymphoma treated?

The treatment for lymphoma will be planned according to each individual situation. The most important factors in planning treatment are:

  • What type of lymphoma you have
  • The stage of your disease

Treatment for Hodgkin lymphoma

Stage 1 and sometimes Stage 2 Hodgkin lymphoma (known as early stage) can be treated with a short course of chemotherapy and/or radiotherapy to the enlarged lymph nodes. Stage 2,3 or 4 Hodgkin lymphoma is treated with chemotherapy typically given over a period of 6-8 months. Some people may have radiotherapy too. Chemotherapy involves giving several drugs in combination. These combinations are named after the initials of the drugs used. The most commonly used chemotherapy combination for Hodgkin lymphoma is called ABVD.

Treatment for high grade non-Hodgkin lymphoma

High grade non-Hodgkin lymphoma is usually treated with combination chemotherapy, the most common of which is chemotherapy combined with a monoclonal antibody, that helps the immune system kill the lymphoma cells but it is not suitable for all lymphomas. In addition, some people with high grade non-Hodgkin lymphoma may have radiotherapy while others might have treatment with a stem cell transplant.

Treatment for low grade non-Hodgkin lymphoma

Most people with low grade non-Hodgkin lymphoma have advanced disease by the time they are diagnosed. It is unlikely to be completely cured. It tends to behave as a 'relapsing and remitting' disease. This means that it comes and goes, sometimes it needs treatment and sometimes not but it is less likely to go away altogether.
Some people with advanced low grade lymphoma, who feel well and have no symptoms, will need no treatment to begin with. This is known as 'watch and wait'. Treatment will be recommended when symptoms get worse.

Most people with low grade non-Hodgkin lymphoma will be treated with combination chemotherapy. The combinations in common use include CVP and CHOP. Most people with low grade lymphoma will have monoclonal antibody therapy added to chemotherapy. Some people will have tablet chemotherapy alone. The drug most often used is called chlorambucil. Sometimes people have treatment with a monoclonal antibody on its own to prolong remission after chemotherapy. This is called maintenance therapy.

This article is an edited extract from our booklet 'Lymphomas'. For more information, or for a copy of the booklet, visit our website at www.lymphomas.org.uk or telephone the Lymphoma Association's Freephone Helpline on 0808 808 5555.



The production costs associated with this piece have been sponsored by Roche for the advancement and support of medical, scientific and patient initiatives.
RXUKMABO00173 December 2010


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