We continue to make strides against treating lymphoma.
Lymphoma: Hodgkin Vs. Non-Hodgkin
The two forms of lymphoma behave, spread and respond to treatment differently, and affect different white blood cells. Doctors examining the cancerous cells under a microscope look for an abnormal cell called a Reed-Sternberg, then make their classification:
- Hodgkin Lymphoma (HL): Hodgkin lymphoma has the Reed-Sternberg cell and is named after discover of the disease. Thanks to advances, more than 75 percent of newly diagnosed cases are curable. The disease is more common among teenagers and young adults (10 to 15 percent of cases), as well as those over 55. It’s further broken down into types (classical is the most common) and subtypes.
- Non-Hodgkin Lymphoma (NHL): Non-Hodgkin lymphoma does not have the Reed-Sternberg cell. The disease is further broken down based on the kind of white blood cell involved (85 percent of cases in B cells, 15 percent in T cells) and other characteristics. The types affecting children and adults are often very different. Also, some types grow slowly and don’t need immediate treatment, while others do. The three main types in children and teens grow quickly:
- Lymphoblastic lymphoma
- Burkitt lymphoma (small non-cleaved cell lymphoma)
- Large cell lymphoma
We create individualized treatment plans, with our specialists working with patients and their families to come up with the best and most comprehensive plans. At times, that could mean watchful waiting — careful monitoring until symptoms worsen — such as when someone has slow-growing non-Hodgkin lymphoma or is pregnant and wants to deliver before treatment.
Lymphoma Treatment Considerations
Treatments for adults may vary from those for children and teens. Our recommendations for the best treatment approach typically depend on:
- Patient’s age, gender and overall health
- The cancer’s type, subtype and stage
- Blood test results
- Patient’s symptoms
- Whether the cancer is newly diagnosed or has returned (recurred).
- Size of the tumor, if any
- Whether the cancer has spread, and to where
- How well the cancer responds to initial treatment, and to what type
- Genetic changes in the cancer and other features
Pregnancy and Lymphoma Treatment
If you are pregnant, we take additional precautions to protect the health of both you and your fetus. We account for the age of the fetus and your wishes, with our recommendations adjusting for any changes with the cancer or the pregnancy. Options may include:
- Watchful Waiting: We closely monitor your condition, with the goal of postponing treatment until the fetus is at least 32 weeks old and we can induce labor. Steroids may help the fetus’ lungs develop faster than normal.
- Careful Treatment: Unfortunately, some types of lymphoma are aggressive and require prompt treatment. If that’s the case, we choose the type of chemotherapy drug and the schedule that is least likely to harm the fetus. For radiation, we shield the fetus as much as possible.
Children, Teens and Lymphoma Treatment
While we always tailor treatments to minimize side effects from chemotherapy and radiation, we take special precautions for our youngest patients. Unfortunately, some effects might not show up for months or years later, including problems with:
- Development of sex and reproductive organs
- Bone and muscle growth and development
- Thyroid, heart, or lungs
- Teeth, gums, and salivary gland
- Other cancers, including breast
- Mood, feelings, thinking, learning or memory
A number of these effects are treatable — or minimized with proper planning. Learn more about our pediatric cancer care and our Late Effects Program.
Lymphoma Risk Factors
While we don’t know what causes most cases of lymphoma, there are risk factors that can increase your chances of developing the disease.
Risk Factors for Hodgkin Lymphoma
Risk factors for Hodgkin lymphoma include:
- Age: The disease is more common from 15 to 40 (especially in the 20s), and again after 55.
- Virus Infection: The risk is higher if you are infected with human immunodeficiency virus (HIV) or mononucleosis (mono), caused by the Epstein-Barr virus (EBV).
- Family History: While most patients do not have a family history of the disease, having a close relative (parent or sibling) with it can increase your risk.
- Inherited Diseases: Certain inherited immune system diseases can raise your risk.
Risk Factors for Non-Hodgkin Lymphoma
Risk factors for non-Hodgkin lymphoma include:
- Age: While some types of the disease are more common in younger people, most cases occur in people over 60.
- Gender: The risk is higher among men overall, but certain types are more common in women.
- Race: Whites are more likely than African-Americans and Asian-Americans to develop the disease.
- Chemical Exposure: Exposure to certain chemicals increases risk.
- Suppressed Immune System: Taking immunosuppressant drugs after an organ transplant raises risk.
- Certain Medical Conditions: Medical conditions that can increase risk include:
- An inherited immune disorder like hypogammaglobulinemia or Wiskott-Aldrich syndrome
- An autoimmune disease like rheumatoid arthritis, psoriasis or Sjögren syndrome
- Human T-lymphotrophic virus type I (HTLV-1) or Epstein-Barr virus (EBV)
- Infections that chronically stimulate the immune system
Lymphoma symptoms include:
- Unexplained fever
- Painless lymph node swelling in the neck, underarm, groin, chest or stomach
- Unexplained weight loss
- Night sweats
- Itchy skin
- Unexplained pain in the chest, abdomen or bones (adult NHL)
- Trouble breathing (pediatric NHL)
- Coughing (pediatric NHL)
- Trouble swallowing (pediatric NHL)
- Painless testicle lump or swelling (pediatric NHL)
Other symptoms can cause these problems, too, so it’s important to see a doctor.
Successful lymphoma treatment depends on a complete and accurate diagnosis. Each of our patients receives a thorough evaluation so we can create an individualized plan. We diagnose lymphoma with:
- History and Physical Examination: We complete a thorough examination and take a full personal and family medical history.
- Blood and Urine Work: We may take blood and urine samples to test your complete blood count (CBC), blood chemistry and other factors.
- Lymph Node Biopsy: We use a needle or an incision to remove all or part of a lymph node, then examine the sample with a microscope.
We may use additional tools to determine if the cancer has spread:
- CT (CAT) Scan: Computed tomography takes a series of X-rays from different angles, then stitches them together into 3D images.
- MRI: Magnetic resonance imaging uses a powerful magnetic field and radio waves to create detailed 3D images at higher contrast than CT scans — useful for clarifying other test results.
- PET Scan and CT: After a substance called radionuclide glucose is injected into one of your veins, a positron emission tomography scanner rotates around your body and creates a map of cancer cells, which take in more glucose and show up brighter. The test is combined with a CT scan.
- Bone Marrow Biopsy: We use a hollow needle to remove a small sample of bone marrow, blood and bone from the hipbone or breastbone. The samples are studied under a microscope and may get other testing, including analysis for genetic changes.
- Laparotomy/Laparoscopy: The organs inside the abdomen are checked for disease, using either one larger incision (laparotomy) or smaller incisions and special tools (laparoscopy). Diseased tissue or organs may get removed, or samples taken for examination with a microscope.
- Mediastinoscopy: An incision is made at the top of the breastbone, and a thin, lighted instrument (mediastinoscope) is inserted to check for abnormal tissue in the organs, tissues, and lymph nodes between the lungs. We may remove tissue or lymph node samples.
- Ultrasound: Sound waves create a picture of the suspicious area.