Lymphoma


Not every lymph node swelling means lymphoma. Lymph nodes collect waste molecules and cells in the body. They also houses immune cells. Painful lymph nodes are usually not associated with lymphoma. Soft and mobile lymph node swelling in the groin area, under the jaw, behind the ears are usually not malignant.



What is Lymphoma? Why does it happen?

Lymphoma is a tumor of the lymph nodes. It is a disease in which the blood cell called lymphocyte produced in the bone marrow accumulates in a wide variety of organs or tissues, primarily in the lymph nodes. The cause of lymphoma in most cases is unknown. DNA changes, called “mutations" in the cell nucleus make the cell proliferation uncontrollable. Very rarely, lymphoma can be observed in members of some families. Lymphomas are divided into two categories: Hodgkin lymphomas and non-Hodgkin lymphomas. There are approximately 50 types of lymphomas. Even if it is the same type, lymphoma may develop in different organs between patients. Therefore, the approach that is still valid in our country, which is to exemplify and identify with the experiences of patients or their relatives suffering from the same disease, is not correct.

 

At what age does lymphoma occur the most?

The probability of developing lymphoma increases with age. It is rare in children. Hodgkin's lymphoma usually occurs in early adulthood (15-40 years) or late adulthood (over 55 years).  Non-Hodgkin's lymphoma frequently develops in the elderly, and it is rare under the age of 15.

 

Who is at risk for lymphoma?

Non-Hodgkin's lymphoma is usually seen in developed countries such as America, Australia, New Zealand and Europe. Lymphoma can develop in everyone. But some people are a little more at risk.

People at high risk for lymphoma;
  • Obesity
  • Patients with autoimmune disease: Connective tissue diseases such as rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome are the most typical examples.
  • Patients using immunosuppressive drugs: for example, transplant patients are at risk of developing lymphoma.
  • Some infections increase the risk of lymphoma.

What are the symptoms of lymphoma?

  • Since lymphoma can develop in almost every tissue and organ, it can show symptoms associated with organ damage. But most often patients with lymph node enlargement consult a physician.
  • Lymph node enlargement: It is usually noticed as a swelling in the neck, armpit or groin areas. Painless swellings suggest lymphoma.
  • Abdominal distension, pain: This is associated with spleen growth. If the pain is spreading to the back and waist, it may be related to the compression of the abdominal lymph nodes.
  • Unexplained fever
  • Unexpectedly rapid weight loss
  • Significant excessive sweating at night
  • Unexplained rash-free itch
  • Severe dry cough, shortness of breath: It can develop due to compression by lymph nodes that grow on the trachea.
  • Unexplained, usually puffy rashes on the skin
  • Fatigue, exhaustion, headache, nerve damage-associated limb movement impairments (paralysis)
 

How is Lymphoma diagnosed?

The diagnosis of lymphoma comes to the mind of the physician who examines the patient. Definitive diagnosis is made by microscopic examination of a sample from the tissue where the tumor cells accumulate by a pathologist, in conjunction with the information and opinion provided by the physician who examines the patient in the clinic. Since there are many types of lymphomas, determining the type of lymphoma requires significant knowledge, experience and laboratory work. Sometimes the name of the lymphoma might not be specified; in this case, a biopsy may be necessary. The physician and the pathologist evaluate the patient's complaints and findings together in the clinic. This is a condition that patients do not like and often misunderstand as a lack of skill in diagnosis. After a lymphoma diagnosis is made by the pathology laboratory, a staging procedure is performed in the clinic in order to determine the spread of the disease to determine the tumor burden or biological behavior. Staging is performed either by radiological evaluation of the whole body, called PET-CT, or by imaging the neck, abdomen, groin and rib cage by computerized tomography or magnetic resonance imaging. Some blood tests are performed to investigate the presence of organ damage and infectious disease screening. Generally, bone marrow samples are also taken.
 

Should every lymph node swelling suggest lymphoma?

Of course, not every lymph node swelling is associated with lymphoma. Lymph nodes collect waste molecules and cells in the body. They also houses immune cells. Hence, the most plausible explanations are especially viral or bacterial infections. Painful lymph nodes are usually not associated with lymphoma. Soft and mobile lymph node swelling in the groin area, under the jaw, behind the ears are usually not malignant.

Other conditions that enlarge the lymph node;
  •  Infection (eg. swelling of the lymph nodes in the throat area in case of tonsil infections): Tuberculosis, brucellosis, fungal infections, HIV)
  •  Rheumatic diseases
  •  Allergic reactions
  •  Substance accumulation
  •  Leukemia
  •  Cancer spread (metastasis)
 

What is the treatment process for lymphoma?

The type of treatment varies according to the type of lymphoma. Some types of non-Hodgkin's lymphoma have a quiet course. It can be monitored for years without treatment. If it is observed to become aggressive, then treatment will begin.
 

Treatment types

  • Chemotherapy: It is the administration of multiple tumor cell killer drugs together at predetermined times and numbers.
  • Radiotherapy: It is generally preferred if the tumor cell mass is very large (10 cm at the time of diagnosis). Following chemotherapy, radioactive irradiation is performed.
  • Bone marrow transplantation
 

Drugs used in clinical trials

In general, treatment is administered in accordance with widely accepted treatment guidelines in the world. In other words, when Hodgkin's lymphoma is diagnosed, the same treatment is applied in almost every country in the world. Following the new diagnosis, imaging is usually repeated in the 3rd-4th month to control the response to the first-line treatment. If the tumor mass has shrunk by less than 50%, it is considered not to have achieved a good response. In this case, treatment modalities in which multiple drugs are used together in higher doses are used. If response to this treatment, which is called second-line treatment, is reduced tumor burden, even if partial, high-dose chemotherapy is administered. High-dose chemotherapy is supported by intravenous administration of previously stored blood stem cells to the patient to regenerate bone marrow. This form of treatment is called autologous stem cell transplant or bone marrow transplant with its former name. Sometimes patients are given medications based on clinical trials that have not yet proven efficacy.

 

Is lymphoma a type of tumor that should be feared?

In general, lymphoma is not a type of tumor that should be feared. In the last 10–15 years, there have been positive advances in the treatment of lymphomas. Drugs used in chemotherapy are drugs that kill cells without differentiating diseased cells from healthy ones. Therefore, rapidly proliferating cells such as gastrointestinal tract epithelium cells and hair follicle cells are also adversely affected, in addition to tumor cells. In recent years, drugs acting against a molecule on the tumor cells have been developed. In lymphoma types carrying the target molecule, they are usually used in combination with chemotherapy, rather than on their own. Again, a large number of drugs with demonstrably improved efficacy that were developed based on disease development mechanisms are increasingly being licensed.
 

What awaits the patient after lymphoma treatment is completed?

There is a response ratio to treatment depending on the type of lymphoma. Of course, the patient's physical ability to handle the treatment is also important for giving full doses. Many types of lymphoma with a complete response are closely monitored, especially during the first two years. Blood tests and disease recurrence controls are carried out once in 3 to 6 months.  In case the disease recurs, the type and dose of chemotherapy is selected by taking into account the period of recurrence (first year or later), stage, new biopsy sample, comorbidities (hypertension, heart disease, diabetes) and age. Some patients may even be recommended a bone marrow transplant plan from other people.
 

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