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About Lymphoma  >  Lymphoma Overview

Last update: 08/08/2013

A lymphoma can be a serious disease,
but treatment can range from curative to highly effective
at managing it as needed- depending on the type and its aggressiveness.

The cells in most organs have a short lifespan.  Therefore, to continue functioning the body needs to replace these lost cells by the process of cell division. 

Under normal conditions there is a balance in which new cells replace old, and each cell carries out tasks specific to its kind.

Lymphoma is a blood cell cancer caused when lymphocytes -- a type of white blood cell that help to fight infection -- are damaged in ways that affect how the cells grow and survive.

Blood cell development; drawing shows the steps a blood stem cell goes through to become a red blood cell, platelet, or white blood cell. A myeloid stem cell becomes a red blood cell, a platelet, or a myeloblast, which then becomes a granulocyte (the types of granulocytes are eosinophils, basophils, and neutrophils). A lymphoid stem cell becomes a lymphoblast and then becomes a B-lymphocyte, T-lymphocyte, or natural killer cell.... The damaged cells reproduce and do not die off as do normal lymphocytes. The abnormal cells accumulate and eventually form tumors, most typically in the lymphatic system (lymph nodes, bone marrow, spleen) but also in other parts of the body such as the skin.

Risk factors for developing a lymphoma include chronic infection, immune deficiencies, environmental toxins, and older age.  Lymphomas probably arise most often from multiple causes (including random cell copy errors) over many years. 

The symptoms of lymphoma include unexplained: enlarged lymph glands, fatigue, persistent fever, drenching night sweats, and weight loss.   The symptoms of lymphoma are similar to common medical conditions, such as infection where normal lymphocytes accumulate to fight off infection.  Low levels of lymphoma may not cause symptoms, but symptoms can range from mild to severe.

The diagnosis of a lymphoma requires a tissue biopsy to examine the cells to see if they are abnormal (clonal: all derived from each other) or normal lymphocytes (diverse, polyclonal, polytypic) -- "reactive" to an infection. 

The diagnostic tests will also determine the type of lymphoma based on the maturation stage of the lymphocyte - sometimes referred to as the histology, which is based on the unique features of the cells in different stages of maturation (differentiation). 

The features of the cells are identified by staining tests to see what sticks to the receptors on the cell surface.

The most common histologies are Diffuse Large B-cell Lymphoma and Follicular Lymphoma.

Lymphomas are broadly classified:

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as Hodgkins or non-Hodgkin's lymphoma *

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as aggressive or indolent grade

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as B- or T-cell lymphoma  **

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by the normal counterparts of the cells -
the cell of origin, stage of maturation, or histology

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and sometimes by the genetic features *** 

* In Hodgkin's disease, the abnormal lymphocyte is the Reed-Sternberg cell (a B lymphocyte. This particular lymphocyte isn't found in other types of lymphomas. 

All other types of lymphomas are called non-Hodgkin's (NHL).  Important clinical differences are the very high cure rate of Hodgkin's; that it tends to affect younger people* ; and that the incidence rate of Hodgkin's is lower than NHL.

** B- and T-cells are the two distinct types of lymphocytes.  B-cells are antibody-producing cells.  T-cell lymphomas are much less common than the B-cell types.

*** Genetic mutations and expression (which genes are damaged, or turned on or off) can vary within the same diagnostic types of lymphoma, affecting how they behave and respond to treatment.

The treatment of lymphoma depends on type of lymphoma,* the grade, the stage (how widespread it is), one's age and general health, and whether the lymphoma has been treated before.

* An accurate diagnosis is important, and a second evaluation of the biopsy sample is often recommended because different types of lymphoma can look similar under the microscope and may be treated differently.

Importantly, unlike "solid" cancers, lymphomas are treatment-sensitive and can be effectively treated and/or cured even at an advanced stage. 

Indolent lymphoma might be observed, or treated conservatively as needed, or treated with intent to achieve a durable remission and possible cure. 

Aggressive lymphomas are generally treated soon after diagnosis with the intent to cure.

Because there are so many types of lymphoma and because best practice is evolving rapidly, we recommend that patients consult a lymphoma specialist for a second opinion.  For the less common types of lymphoma and the higher-risk types, consulting an expert is very important in order to take advantage of the latest advances in treatment, including clinical trials*.

* Contrary to widespread public perception, clinical trials rarely if ever use placebo controls (sugar pills).  Investigational protocols, carefully evaluating the safety and efficacy of new protocols that are thought to work by mechanisms that may overcome resistance to standard treatments - or improve on the safety and efficacy of standard treatments, can compare well to standard approaches as described here:

7 Clinical Circumstances to Consider Clinical Trials - patient centered criteria

See also for Best Practice guidelines: Cancer.gov and NCCN.org

Recommended article: Dr. Sharman's CLL & Lymphoma Blog:
Making sense of all the different lymphomas


And our Getting Started resources:

Guidelines at DiagnosisGetting Started  | Focus on Clinical Trials
and Lymphoma Simplified

Comments or Questions?
 

 
Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
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