Understanding Lymphoma: Key Insights into Hematopoietic Cancer

According to a 2024 study by the Institute of Medical Sciences and SUM Hospital, India has the third highest number of reported cases of blood cancer after the United States and China. 

Imagine what happens when the body’s immune system is under attack - this is what happens when affected lymphoma, a major type of blood cancer. This blog covers the symptoms, diagnosis and treatment of lymphoma.

What is hematopoietic cancer?

Hematopoietic cancer, also known as blood cancer, is cancer that occurs from blood-forming tissue, primarily in bone marrow and lymph nodes.

It is caused by abnormal and uncontrollable production of blood cells. Our blood consists of 

• Red blood cells that carry oxygen to the body's tissues
• White blood cells help in fighting infection as the immune system
• Platelets that help in blood clotting factor
•  

It starts when the normal process of blood production is disturbed by the uncontrolled growth of abnormal cells. When these cancer cells outnumber normal cells, it may affect their ability to perform their normal functions.

Types of blood cancer

Learn about the different types of blood cancer 

• Leukaemia
• Myeloma
• lymphoma

Each type of blood cancer affects the body differently and requires specific diagnosis and treatment approaches. Let's take a detailed look at different types of cancer.

Leukaemia

The uncontrollable and rapid growth of blood cells in the bone marrow leads to leukaemia. The abnormal white blood cells impair the bone marrow's ability to produce red blood cells and platelets. It is classified by how fast it develops and which type of cell blood cell is involved.

What are the categories of leukaemia?

Based on how fast it's developed, it is categorised as 

1. Acute leukaemia occurs when the majority of abnormal blood cells are unable to mature and carry out normal tasks. It can quickly worsen.

2. Chronic leukaemia: This occurs when some cells are immature while others are healthy and able to function as they should. It worsens more gradually than acute leukaemia.

Based on which cell is involved, it is categorised as

1. Lymphocytic leukaemia, also known as lymphoblastic leukaemia, involves bone marrow cells that become lymphocytes (a kind of white blood cell).

2. Myelogenous leukaemia, also known as myeloid leukaemia, involves marrow cells creating platelets, red blood cells, and other kinds of white blood cells.

Myeloma

Myeloma is a major type of cancer caused by plasma cells in the bone marrow. Plasma cells produce antibodies that fight infections. The bone marrow produces a large number of abnormal (cancerous) plasma cells, resulting in myeloma, which is also known as the most common bone marrow cancer. Multiple places of the bone marrow can be affected, leading to multiple myeloma.

Lymphoma

Lymphoma affects the lymphatic system, which is part of the immune system. The lymphatic system comprises organs, including the spleen, thymus gland, lymph node, bone marrow, and other organs. It occurs when lymphocytes, a type of white blood cell, undergo cancerous transformation. These transformed lymphocytes can accumulate in the thymus gland, spleen, lymph nodes, bone marrow, and other organs, forming lymphoid tumours.

Types of lymphoma

 There are two major types of lymphoma. 

• Hodgkin's lymphoma (HL)

It is a type of cancer that affects the lymphatic system. The presence of Reed-Sternberg cells in lymph nodes distinguishes it.

• Non-Hodgkin’s lymphoma (NHL)

When cancer originates in the lymphocytes of white blood cells, it is known as non-Hodgkin's lymphoma. Usually, the lymph nodes are affected. Lymphocytes contain T cells and B cells. An increase in B-cells or T-cell origins characterises non-Hodgkin's lymphoma. The increased formation of these cells around normal cells forms tumours.

Symptoms

The symptoms of lymphoma include

• Swollen glands (lymph nodes), usually in the neck, armpit or groin that are painless
• Shortness of breath
• Itching, rashes or lumps in the skin
• Weight loss
• Tiredness
• Loss of appetite
• Severe cough
• Fever and chills
• Breathlessness
   

What are the risk factors for lymphoma?

The risk factors that can cause lymphoma are 

• If you have been around chemicals that are used for agriculture or benzene, it may increase your risk. It's a silent threat to the immune system by the environment.
• If you've been infected with a virus such as HIV, Epstein-Barr, hepatitis or Kaposi sarcoma, you may develop risk factors.
• Having a weak immune system by other conditions or medications such as immunosuppressants.
• If you have an autoimmune disease, it happens when the immune system accidentally attacks the healthy cells of the body.

How is lymphoma diagnosed?

The diagnosis options for lymphoma may include

1. Physical examination

Before the diagnostic test is performed, a physical examination is done to check for swollen lymph nodes. These symptoms don't mean you have lymphoma, as most of the time, they can be normal infections of the lymph nodes that are unrelated to cancer. Your doctor can also ask about your family history and symptoms. 

2. Blood test

Blood tests are usually performed to check any abnormalities and overall health. These tests can measure

• Complete blood count: The number and different types of blood cells in our body.
• ESR: It is done to detect any inflammation that can be a sign of lymphoma.
   

3. Imaging studies

• PET (positron emission tomography) scan: This scan produces three three-dimensional colour images to show whether the cancer has spread to the bone marrow.

• CT (computerised tomography) scan: CT is done to look for signs of lymphoma, such as enlarged lymph nodes, spleen, or other organs.

4 . Biopsy

A small part of the affected lymph node tissue can be taken for biopsy to diagnose lymphoma. A bone marrow biopsy is done to check if the cancerous cells have spread to the bone marrow.

Treatment options for lymphoma

Lymphoma treatment depends on a variety of factors, including the type and stage of lymphoma, general health, and personal preferences. Treatment may not start right away after diagnosis as some types of lymphoma can grow very slowly. 

You and your healthcare team can wait and start the treatment when it causes symptoms. Let's have a look at the therapies available.

1. Chemotherapy

It works by targeting cancer cells, which divide more rapidly than most normal cells in the body, making them a main target. Chemotherapy drugs affect the DNA replication process, preventing cancer cells from multiplying and killing them.

However, Chemotherapy may affect the healthy cells in the body, leading to side effects such as hair loss, fatigue, and nausea. Supportive treatment can help in managing these side effects.
 

2. Immunotherapy

Immunotherapy enhances the body’s immune system to fight cancer. It involves therapy that includes immune checkpoint inhibitors and CAR T cell therapy. CAR T cell therapy uses the body’s own T cells to fight against cancer cells. It can be given as a short course after chemotherapy. The common side effects may include immune-related adverse effects, such as inflammation in organs.

3. Targeted Therapy 

Targeted therapy, also known as biological medicine, works by targeting cancer cells or helping the immune system attack cancer cells. Biological medicines used to treat lymphoma are rituximab (used together with chemotherapy), brentuximab vedotin, and pembrolizumab. The side effects may include low blood cell counts, and in rare cases, it may also cause liver problems.

4. Radiation therapy

Radiation therapy is commonly used in localised lymphoma either as a standalone treatment or as a combination therapy with chemotherapy. It uses high-energy rays or protons to target and kill cancer cells. This may shrink tha tumour size. The most common side effects may include skin irritation, fatigue and localised hair loss.

5. Stem cell transplant

It is also known as a bone marrow transplant, which involves replacing the damaged bone marrow with healthy stem cells. This is usually done in patients who have aggressive and recurrent lymphoma.

6. Surgery

It is often not considered a primary treatment for lymphoma. It might be necessary when a large tumour or biopsy is required, or it can also be done when a tumour is pressing on other organs.

 7. Palliative care

Your physician may consider palliative care, which aims to give relief from symptoms, manage stress, provide emotional support and improve overall quality of life.

What is the prognosis of lymphoma cancer?

The prognosis for lymphoid cancer varies depending on the cancer's type, stage, and response to treatment. Many patients' survival rates have increased due to advances in therapy and supportive care. Regular follow-up is necessary to evaluate disease progression, manage therapy adverse effects, and handle any relapses.

What is the survival rate of lymphoma cancer?

The five-year survival rate for non-Hodgkin lymphoma is 74%. It is important to know that the survival rate changes depending on the stages and how far the cancer has spread. The five-year survival rate for Hodgkin lymphoma is 93% for localised, 95% for regional, 83% for distant, and all stages combined account for 89%. 

Personal journeys from notable figures

Popular actress Kirron Kher was diagnosed with multiple myeloma, a type of blood cancer, in 2021. She also said that she continued to work while receiving treatment at the hospital. She says, "It's not the ideal situation to be in. Par yeh zindagi hai (but this is life). One learns to deal with it and carries on. There's no way out except to treat it. Nobody likes going through the treatment or its side effects." Now, she has totally recovered and is being a guiding light for cancer patients.

 Ace film-maker Anurag Basu was diagnosed with blood cancer in 2004. Even though his doctor told him that he had only two weeks to live, he believed and won the fight with cancer. He even said he shot a film while undergoing treatment.

Frequently Asked Questions (FAQs)

1. Can lymphoma be 100% cured?

Yes, intensive treatment for lymphoma may result in a cure or remission. High-grade NHL and HL are commonly curable. This may include intensive treatments like high-dose chemotherapy. However, proper follow-up would be needed after treatment.

2. Is lymphoma painful?

No, the cancer in lymph nodes grows slowly, which can take months or years. In some cases, it may develop quickly. Usually, the lump does not cause any pain.

3. Is lymphoma genetic?

No, lymphoma is not genetic, but having a family history of the condition may increase the risk of developing lymphoma.

What’s in store?
 

Lymphoid cancer is a significant type of haematological cancer with several forms and complicated pathogenesis. Understanding the categorisation, diagnosis, and treatment choices is critical for efficient management and better patient outcomes. As science advances, new medicines and techniques emerge, bringing promise for more effective and tailored therapies. Through continual breakthroughs and professional insights, we may better address the issues posed by lymphoma and improve the quality of life for those affected.
 

References
 

1. Blood Cancer: Types, Symptoms, Treatment & Survival Rate (cancercenter.com)
2. Lymphoma - StatPearls - NCBI Bookshelf (nih.gov)
3. Bone marrow niches in haematological malignancies - PMC (nih.gov)
4. Lymphoma: Diagnosis and Treatment - PubMed (nih.gov)
5. Hodgkin lymphoma: A review and update on recent progress - PubMed (nih.gov)
6. Non-Hodgkin Lymphoma - PubMed (nih.gov)
   
    

Note: The information provided in this blog is intended for general knowledge. It is important to remember that it should not replace professional medical advice. If you have any concerns about your health or cancer symptoms, please consult a healthcare provider.