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Nasty Nodes: A Primer on Lymphoma

By: Ivan Olegario, MDNasty Nodes: A Primer on Lymphoma

Lymphoma: sounds familiar?

If your answer to the above question is “no”, we don’t blame you. An international survey found that a majority of people worldwide have very little knowledge about this increasingly common disease.

Lymphomas are cancers that originate from cells of the lymph nodes. Specifically, lymphomas come from lymphocytes (a specialized type of white blood cell) that make up a large proportion of cells of the lymph nodes. Recall that white blood cells are the cells of the blood that help defend our body from illness.

However, the worldwide survey found that:

  • Less than half (49 percent) of people said they know what lymph nodes do.
  • Fifty-two (52) percent know very little or nothing about lymphoma.
  • Sixty-seven (67) percent did not know lymphoma is a type of cancer.

There are two general types of lymphomas, depending on how the cancer cells behave, spread, and respond to treatment. These types are Non-Hodgkin lymphoma (NHL), which comprises the majority of lymphomas, and Hodgkin lymphoma (HL). NHL and HL can be further subdivided to almost 50 different subtypes. The differences between the different subtypes are complex and need not be discussed in depth here.

For most types of lymphomas, whether NHL or HL, the most common symptoms are as follows:

  • Enlarged lymph nodes, usually non-painful
  • Symptoms of anemia, such as fatigue
  • Bruising
  • Frequent infections
  • Loss of appetite
  • Weight loss
  • Prolonged or recurrent fever
  • Sweating, usually at night
  • Itching

However, in the early stages of the disease, patients may have no symptoms or experience just one or a few of them. Hence, it is important for people who experience one or more of these for at least two weeks to see their doctor immediately.

Causes and prevention

The cause of many cases of lymphoma is unknown. However, a number of risk factors that may predispose to lymphoma have been identified. These include:

  • For HL: infection with the Epstein–Barr virus or the human immunodeficiency virus (HIV), and history of HL in the family.
  • For NHL: obesity, frequent consumption of red meats, smoking, history of rheumatoid arthritis, systemic lupus erythematosus (SLE or lupus) and other diseases of the immune system, HIV infection, infection with human T-lymphotropic virus, infection of the stomach by the bacteria Helicobacter pylori (a very common bacteria that may cause gastric ulcers), medications that suppress the immune system, and some insecticides or pesticides used in farming.

As you may notice, not all of these risk factors can be avoided in the hopes of preventing lymphoma. In fact, so far, there is really no sure way to prevent lymphoma. However, there are a few ways one can minimize its risk. These include:

  • Avoiding smoking cigarettes and other tobacco products.
  • Avoiding HIV infection by avoiding sex with multiple partners, condom use during sex, and regular HIV testing.
  • Avoiding excessive weight through exercise and a healthy diet.
  • Seeing a doctor for possible Helicobacter pylori treatment if you have symptoms of gastric ulcer (e.g., burning or gnawing abdominal pain).

I have symptoms: now what?

Don’t freak out! Take a step back and relax. Our objective here is to educate and not scare you. Note that the symptoms of lymphoma are similar to other non-cancerous diseases, so a correct diagnosis is crucial. Early diagnosis is also important because lymphoma can be treated effectively – at least two-thirds of patients survive beyond 5 years with the proper diagnosis and treatment.

Importantly, you can also see that the chances of living a long and happy life improve the earlier the disease is diagnosed (the earlier the stage, the better). With treatment, over 80% of patients diagnosed in the early stages of lymphoma live beyond 5 years after the discovery of the illness. In fact, some lymphomas may be curable if treated early enough.

The first important step then is to see your doctor, be it your family physician or internal medicine practitioner (adult medicine), or a pediatrician if the patient is a child. They will take your history, ask important questions, and examine you physically. This will help them narrow down the possible causes of your symptoms, which may or may not include lymphoma. They may also request a number of tests to help in the decision.

Should lymphoma be suspected, your doctor will request for a biopsy. This involves getting a small sample tissue of the lymph node, which is examined under the microscope. Getting the tissue sample is simple if the lymph node involved is near the surface of the skin, such as the lymph nodes. Deeper lymph nodes may need to be examined first by the CT scan, which is also important in understanding if other organs are involved.

In case lymphoma is diagnosed, treatment may involve one or more of the following, depending on the type of lymphoma and stage of the disease:

  • Chemotherapy and other medications (called targeted therapy)
  • Radiation therapy
  • Surgery

In some cases where the lymphoma is extremely slow-growing, treatment may be delayed. However, if this is the case, the disease should be monitored, which requires regular visits to your doctor.

Conclusion

This primer provides you a basic understanding of this complex disease. We hope that this knowledge will help you become more aware of your body and prompt you to seek additional information from your doctor. Thousands of lives have been saved by this simple act.

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