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Lymphoma

Lymphoma is a cancer that starts in cells called lymphocytes, which are part of the body’s immune system. The two main types are Non-Hodgkin Lymphoma (NHL) and Hodgkin Lymphoma (HL). They behave, spread and respond to treatment differently, so it's important to identify which form of lymphoma you or a loved one has to get appropriate, effective care and treatment.

Types of NHL can also be grouped based on how fast they grow and spread:

  • Indolent lymphomas grow and spread slowly. Some indolent lymphomas might not need to be treated right away, but are closely monitored instead. The most common type of indolent lymphoma in the United States is follicular lymphoma.
  • Aggressive lymphomas grow and spread quickly, and usually need to be treated right away. The most common type of aggressive lymphoma in the United States is diffuse large B cell lymphoma (DLBCL).

Classic Hodgkin Lymphoma (cHL) is the most common of the four subtypes of Hodgkin Lymphoma. The cancer cells in cHL are called Reed-Sternberg cells. These cells are usually an abnormal type of B lymphocyte. 

Risk Factors 

Non-Hodgkin Lymphoma (NHL)

  • Age: Most occur in people in their 60s or older, some types are more common in younger people
  • Gender: Overall NHL is higher in men, but certain types are more common in women
  • Race: In the United States, whites are more likely than African Americans and Asian Americans to develop NHL
  • Family history: Having a first degree relative (parent, child, sibling) with NHL increases your risk
  • Infections: HIV, Epstein-Barr virus (EBV)
  • Exposure to certain chemicals or drugs: chemicals such as benzene and certain herbicides and insecticides (weed and insect-killing substances) may be linked to an increased risk of NHL
  • High-dose radiation exposure: being a survivor of an atomic bomb blast or nuclear reactor accident
  • Autoimmune diseases: Rheumatoid arthritis, systemic lupus erythematosus (SLE or lupus), Sjogren disease, celiac disease and others

Hodgkin Lymphoma (HL)

  • Age: Most common in early adulthood (especially in their 20s) and in late adulthood (after age 55)
  • Gender: Slightly higher in men
  • Family history: Brothers and sisters of young people with this disease have a higher risk. The risk is very high for an identical twin of a person with Hodgkin lymphoma
  • Infections: HIV, Epstein-Barr virus (EBV)

Diagnosis

Non-Hodgkin Lymphoma (NHL)

  • A lymph node biopsy of enlarged lymph node is needed if the lymph node does not shrink on its own as the infection goes away
  • A bone marrow biopsy to check the bone marrow after diagnosis to see if lymphoma is present
  • Immunohistochemistry lab test to look for certain proteins on the surface of the cancer cells to help identify the subtype of lymphoma
  • Chromosome tests. In some types of lymphoma, the cells have changes in their chromosomes, such as having too many, too few or abnormal chromosomes. These changes can often help identify the type of lymphoma
  • Lumbar puncture (spinal tap) to obtain sample of the fluid surrounding the brain and spinal cord to test for cancer cells
  • Computed tomography (CT) scans help tell if any lymph nodes or organs in your body are enlarged. CT scans are useful for looking for Hodgkin's Lymphoma (HL) in the neck, chest, abdomen (belly) and pelvis
  • Positron Emission Tomography (PET) scan can help find lymph nodes or small spots in the body that might be lymphoma, even if the area looks normal on a CT scan
  • Ultrasound can be used to look at lymph nodes near the surface of the body or to look inside your abdomen for enlarged lymph nodes or organs such as the liver and spleen

Hodgkin Lymphoma (HL)

  • A lymph node biopsy of enlarged lymph node is needed if the lymph node does not shrink on its own as the infection goes away
  • A bone marrow biopsy to check the bone marrow after diagnosis to see if lymphoma is present
  • Immunohistochemistry lab test to look for certain proteins on the surface of the cancer cells to help identify the subtype of lymphoma
  • Computed tomography (CT) scans help tell if any lymph nodes or organs in your body are enlarged. CT scans are useful for looking for Hodgkin's Lymphoma (HL) in the neck, chest, abdomen (belly) and pelvis
  • Positron Emission Tomography (PET) scan can help find lymph nodes or small spots in the body that might be lymphoma, even if the area looks normal on a CT scan

Treatments & Therapies

  • Chemotherapy
  • Immunotherapy
  • Targeted therapy (Non-Hodgkin Lymphoma only)
  • Radiation therapy
  • Stem cell transplants allow doctors to use higher doses of chemo (sometimes along with radiation) to kill the cancer cells. After these treatments are finished, the patient gets an infusion (transplant) of blood-forming stem cells to restore their bone marrow

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