Lymphoma

Lymphoma is the name of a group of approximately 40 cancers that affects cells known as lymphocytes, which are cells of the immune system. Lymphocytes constitute approximately 25% of white blood cells and include B cells, which help produce antibodies, and T cells, which function in cellular immunity. Lymphoma occurs when malignant lymphocytes multiply, eventually crowding out healthy cells and creating tumors that enlarge the lymph nodes or other parts of the immune system.

Lymphomas fall into one of two main categories: Hodgkin lymphoma (also known as Hodgkin's disease) and all other lymphomas (collectively known as non-Hodgkin lymphomas). Hodgkin lymphoma develops from a specific abnormal B lymphocyte lineage. Non-Hodgkin can develop from either abnormal B or T cells. Non-Hodgkin lymphomas are much more common than Hodgkin lymphoma.

Our patients with lymphoma are treated at the Moores Leukemia and Lymphoma Unit. See the Leukemia and Lymphoma Unit for more information.

You can also review the tabs at top of this page for information on Hodgkin and Non-Hodgkin lymphoma symptoms and risks, diagnosis, and treatment.

Hodgkin lymphoma is a cancer that develops in the lymphatic system, part of the body’s immune system. Abnormal changes in a lymphocyte, a type of white blood cell, cause it to become a lymphoma cell. Cancers involving lymphoid tissue are called lymphomas.

Because lymph tissue exists in many parts of the body (including the neck, armpits, chest, abdomen, and groin), Hodgkin lymphoma can start in almost any part of the body and spread to almost any organ or tissue, including the liver, bone marrow, and spleen. These abnormal cells form the masses, or tumors, that gather in lymph nodes or other parts of the lymphatic system.

About 11.5% of people with lymphoma have Hodgkin lymphoma, which is one of the most curable forms of cancer. Also known as Hodgkin disease, it is most likely to be diagnosed in people in their 20s or 30s and is less common in middle age. However, it again becomes more common after age 60.

Risk factors and symptoms

Possible risk factors are:

  • Epstein-Barr virus
  • The Human T-cell Lymphocytotropic Virus (HTLV) or human immunodeficiency virus (HIV)
  • Familial clustering, when several members of a family have the disease

Symptoms may include:

  • Fever
  • Tiredness
  • Weight loss
  • Night sweats
  • Itchy skin

Since these symptoms are common to a wide variety of illnesses, you'll need a thorough medical exam for diagnosis.

Treatment options

Hodgkin lymphoma is cured in about 75% of all patients, with the cure rate in younger patients about 90%. At UCSD Medical Center, our team of specialists is highly experienced in the treatment and care of Hodgkin lymphoma patients. Depending on your individual case, treatment can include the following:

Chemotherapy and radiation therapy

The most common treatment is chemotherapy, cancer-fighting drugs administered by mouth or injected in a vein. Generally a combination of several drugs is administered in cycles several weeks apart. Depending on the stage of your cancer, your doctor may also decide to target tumor masses with radiation therapy, which uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.

Blood and Marrow Transplant (BMT)

The two primary types of BMT are autologous (using your own previously harvested cells) and allogeneic (using donor cells). Both are preceded by high-dose chemotherapy and/or radiation, which destroy not only the cancerous cells in your body, but healthy cells as well. You will be in the hospital during this time, to ensure that you are not exposed to possible infection. Then, during the transplant procedure, you’ll receive healthy cells which make their way to your bone marrow and start producing new blood cells.

Biologic therapy

Biologic therapies, also known as immunotherapies, work by directing the body’s natural defenses to fight cancer. These therapies may be based on substances naturally produced by the body, or created in a lab. One type of biologic therapy, known as monoclonal antibody therapy, uses antibodies created in the lab from a type of immune cell, which are then infused into the body to specifically target and destroy lymphoma cells.

The majority of all lymphomas - about 88.5% - are non-Hodgkin lymphomas. There are about 30 different varieties of non-Hodgkin lymphoma, which starts in the lymphoid tissue (also called lymph or lymphatic tissue). The major sites of lymphoid tissue are lymph nodes, the spleen, the thymus gland, adenoids and tonsils, the digestive tract, and bone marrow.

Two of the most common types of non-Hodgkin lymphoma are:

  • Diffuse large B-cell lymphoma, which makes up about one of every three cases and can affect any age group, but occurs mostly in older people. About half of these patients are cured with treatment if the cancer is found in only one part of the body.
  • Follicular lymphoma, which makes up about one of every four cases and tends to grow in a circular pattern in the lymph nodes. A slow-growing cancer, it is found most often in older people.

Symptoms

  • Enlarged lymph nodes
  • Itching
  • Fever (can come and go in periods of several days or weeks)
  • Night sweats
  • Anemia
  • Weight loss
  • If the cancer involves lymph nodes close to the body surface, you or your doctor will most likely notice the unusual swelling.
  • If an area inside the abdomen is involved, the stomach can become painful or swollen; you may experience pain, nausea or reduced appetite.
  • If the cancer starts in the thymus or lymph nodes of the chest, pressure on the windpipe can cause coughing or shortness of breath. If the tumor presses on a large vein, areas of the body such as the head and arms may swell.
  • Lymphomas of the brain may cause headache, confusion, personality changes and sometimes seizures.
    If cancer occurs on the skin, this can be seen as red-to-purple lumps and can be very itchy.

Risk factors

  • Age (with most cases found in people in their 60s or older)
  • Exposure to certain herbicides or chemicals, such as benzene
  • Treatment with chemotherapy drugs
  • Radiation exposure
  • A weakened immune system
  • Autoimmune disease
  • Certain infections, such as Epstein-Barr virus or human immunodeficiency virus (HIV)
  • A type of bacteria that causes stomach ulcers
  • Obesity
  • Persons with organ transplants

Treatment options

UCSD's team of specialists are experienced in treating all types of non-Hodgkin lymphoma. Depending on your particular form of the disease and its stage, your treatment can include:

Radiation therapy

This uses high energy rays to kill or shrink cancer cells. Radiation is sometimes used as the primary treatment for early lymphomas, but more often is used in combination with chemotherapy.

Chemotherapy

This treatment consists of cancer-fighting medications taken orally or by injection. Often, multiple drugs are combined, with treatment given in cycles three or four weeks apart.

Biologic therapy, also known as immunotherapy, works by directing the body’s natural defenses to fight cancer. These therapies may be based on substances naturally produced by the body, or created in a lab.

Monoclonal antibodies

These are administered as an infusion over a period of weeks, use laboratory-designed antibodies to attack lymphoma cells.
Interferon, a protein made by white blood cells to fight infections, can cause some types of non-Hodgkin lymphoma to shrink.

Blood and Marrow Transplant (BMT)

The two primary types of BMT are autologous (in which your own previously harvested blood or marrow cells are used) and allogeneic (in which donor cells are used). Both are preceded by high-dose chemotherapy and/or radiation, which destroy not only the cancerous cells in your body, but healthy cells as well. During the transplant procedure, you’ll receive healthy donor cells which make their way to your bone marrow and start producing new blood cells.