What Is Malignant Lymphoma?

"Malignant lymphoma," or lymphoma, is a general term for cancer that starts from cells in the lymph system called lymphocytes. These cells are part of the immune system.

Lymphoma occurs when lymphocytes become abnormal and multiply. It can be diagnosed in children and adults. Most lymphomas start from white cells called either B lymphocytes (B cells) or T lymphocytes (T cells).

This article will review the types of lymphoma, their causes, treatment, prognosis, and coping.

Types

There are more than 70 different types of lymphoma.

They can be slow growing or very fast growing, and anywhere in between. The two main groups of lymphoma are:

• Hodgkin's lymphoma
• Non-Hodgkin's lymphoma (NHL)
  

Hodgkin's Lymphoma

Hodgkin's lymphoma (HL), also called Hodgkin’s disease, is the rarest type of lymphoma, making up to approximately 1 in 10 diagnoses of lymphoma in developed countries.

It’s characterized by large, abnormal cancer cells called Hodgkin and Reed-Sternberg cells.

This type of cancer can occur at any age, but is typically diagnosed most often between the ages of 15 and 39, and again at 75 years or older.

Non-Hodgkin's Lymphoma

Treatment and prognosis for non-Hodgkin's lymphoma (NHL) depend on the subtype, so it’s important to get an accurate diagnosis. The World Health Organization (WHO) groups lymphomas based on:

• The type of lymphocyte the lymphoma starts in
• How the lymphoma looks under a microscope
• The features of the chromosomes in the lymphoma cells
• The presence of certain proteins on the surface of the cancer cells

B-cell lymphomas make up about 85% of NHLs in the United States.

Types of B-cell lymphoma include:

• Diffuse large B-cell lymphoma (DLBCL)
• Follicular lymphoma
• Chronic lymphocytic leukemia
• Small lymphocytic lymphoma
• Mantle cell lymphoma (MCL)
• Marginal zone lymphomas
• Burkitt lymphoma
• Primary central nervous system lymphoma
• Primary intraocular lymphoma

T-cell lymphomas can include:

• Peripheral T-cell lymphomas
• T-lymphoblastic lymphoma/leukemia
  

Symptoms

Many signs and symptoms are similar for both HL and NHL, although there are some differences. The most common symptom for both is one or more swollen or enlarged lymph nodes.

Hodgkin's Lymphoma Symptoms

Symptoms of HL can include:

• Fatigue that doesn’t go away
• Cough and shortness of breath
• Itchy skin
• Loss of appetite
• Feeling of fullness or abdominal pain/swelling
• Pain in lymph nodes after drinking alcohol

There are also symptoms called B symptoms, which can help with prognosis and staging. These symptoms include:

• Drenching night sweats
• Unexpected weight loss of 10% or more of your body weight
• Unexplained fever
  

Non-Hodgkin's Lymphoma Symptoms

Symptoms of NHL can include:

• Painless swelling in one or more lymph nodes
• Fever
• Drenching night sweats
• Fatigue
• Loss of appetite
• Cough or chest pain
• Weight loss
• Abdominal pain
• Itchy skin
• Spleen or liver enlargement
• Rashes or bumps on the skin
  

Causes

The causes of lymphoma are not definitively known, but there are known links to potential risk factors. These can include:

• Those who are infected with human immunodeficiency virus (HIV) have a higher risk of developing lymphoma
• Certain viruses have been linked with certain types of lymphoma, like human T-cell lympotrophic virus and Epstein-Barr virus
• Exposure to high amounts of ionizing radiation has been associated with increased risk of non-Hodgkin's lymphoma
• Family history has been associated with Hodgkin's lymphoma
• There is speculation about ingredients in herbicides and pesticides and their link to lymphoma, but more research is necessary

The cancerous cells multiply abnormally and rapidly, and crowd out healthy cells. Eventually these cancer cells form tumors or masses, usually in the lymph nodes.

Diagnosis

Since there are so many different types of lymphoma, it’s important to get an accurate diagnosis, as this helps guide treatment and provides information about prognosis.

A biopsy will be preformed. This involves removing a small piece of tissue. There are two ways of doing this:

• Surgery: Part or all of a lymph node or piece of tissue is removed
• Core needle biopsy: A hollow needle is placed into a lymph node or tumor to extract a piece of tissue or fluid

Once the tissue or fluid is removed, it is examined under a microscope to look at the cells to identify types and subtypes.

Other tests that may be ordered include imaging tests like positron-emission tomography (PET), computed tomography (CT), or magnetic resonance imagery (MRI) scans, and a bone marrow biopsy or blood work. This is to see how much and where the lymphoma is in your body, which helps with staging.

Treatment

The treatment you have depends on the type and subtype of lymphoma that you have. This can vary widely.

Other things taken into consideration include:

• Overall health, age
• Fitness status
• Goals of treatment
• Personal preferences

If you have very slow-growing lymphomas, called indolent lymphoma, and aren’t having symptoms, you may be simply monitored.

Hodgkin's Lymphoma Treatment

The majority of people with Hodgkin's lymphoma can be cured.

If you are newly diagnosed, your treatment may consist of radiation and chemotherapy, or chemotherapy alone. One of the most commonly used chemotherapy regimens for HL is called ABVD, which stands for:

• Adriamycin (doxorubicin)
  
• Blenoxane (bleomycin)
  
• Velban or Alkaban-AQ (vinblastine)
  
• DTIC-Dome (dacarbazine)

If you have relapsed HL or HL that does not respond to treatment, your treatment may include chemotherapy, radiation, new drugs, and stem cell transplantation. Immunotherapy may also be an option, as well as participation in clinical trials.

Non-Hodgkin's Lymphoma Treatment

For those with aggressive B-cell NHL, chemotherapy is often recommended, in a regimen called R-CHOP, which includes:

• Rituxan (rituximab)
  
• Neosar (cyclophosphamide)
  
• Adriamycin or Rubex (doxorubicin)
  
• Oncovin or Vincasar Pfs (vincristine sulfate)
• Deltasone, Liquid Pred, Meticorten, and Orasone (prednisone)

You might also have other treatments like radiation or surgery.

Targeted therapies, immunotherapy, CAR T-cell therapy, stem cell transplantation, and radiation are also potential treatment options.

Prognosis

The prognosis for lymphoma depends on the type of lymphoma you have, as well as its stage and different prognostic factors. Other factors like your age and overall health can also impact the prognosis.

For HL, overall, the five-year survival rate is 87%. This means that at initial diagnosis, overall those diagnosed with HL are about 87% likely as those without the diagnosis to live five years after diagnosis.

If you break the five-year survival rate for HL down by stage, it looks like this:

• Localized (one lymph node/one organ outside lymph system/one lymphoid organ): 92%
• Regional (spread to one organ near a lymph node area/two or more lymph node areas on the same side of diaphragm/bulk disease): 94%
• Distant (in bone marrow/spread to distant parts of the body/spread to above and below the diaphragm): 82%

For NHL, there are so many different types of NHL that the five-year survival rate can vary. For NHL overall, the five-year relative survival rate is 73%.

Because prognosis depends on so many individual factors and disease characteristics, talk with your treatment team about what your prognosis is, and why.

Coping

Living with cancer and surviving cancer can be challenging, both physically and mentally. There are measures you can take to aid in your coping. This can include:

• Make sure you understand your diagnosis, as this may help with anxiety about unknowns and can help you be an active part of your treatment.
• Ask your treatment team about an oncology social worker. These are often on staff in hospitals and cancer centers and can help you with referrals for various things you might need, emotionally and practically.
• Seek out counseling or support groups, if needed.
• Don’t isolate: Reach out to family and friends, and let them care for you.
• Go easy on yourself. You’re dealing with a lot right now.

Summary

Lymphoma is a cancer of the lymph system cells, with two main groups: Hodgkin's lymphoma and non-Hodgkin's lymphoma. Within those two categories are many subtypes, and their treatment and prognosis can vary widely. Talk with your healthcare team about your specific diagnosis, as each type and subtype can be very different from one another.

A Word From Verywell

Lymphoma and its treatment can be overwhelming. Don’t be afraid to ask your healthcare team questions—that’s what they’re there for. If you get nervous or emotional at appointments, write down your questions ahead of time and bring them with you. Your team is there to help you, every step of the way.