What is lymphoma?

Lymphoma is a type of cancer that affects the lymphatic system. Although lymphoma is a serious disease, good treatment options are available.

The lymphatic system is made up of a network of tubes (lymph vessels) and glands (lymph nodes) throughout your body. It collects and filters waste products from the body in a clear fluid called lymph. The lymph also contains white blood cells called lymphocytes, which fight infection.

Lymphoma occurs when the lymphocytes are damaged. This damage can make them cancerous, which is where they grow and multiply abnormally. When this happens, the abnormal lymphocytes lose their ability to fight off infections.

There are 2 main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma. The symptoms of Hodgkin and non-Hodgkin lymphoma are similar, but they spread and are treated differently.

What are the symptoms of lymphoma?

The first symptom of lymphoma is often a painless swelling in one or more lymph node, usually in the neck, armpit or groin. The swelling is caused by a build-up of abnormal lymphocytes (white blood cells) in the lymph node.

Many people develop swollen nodes due to an infection. If you have swollen nodes, don’t panic — just get them checked by a doctor.

Other symptoms of lymphoma include:

• unexplained tiredness or fatigue
• night sweats or fever
• unexplained poor appetite or weight loss
• widespread itching
• bruising or bleeding easily
• trouble getting over infections
• pain in the chest or stomach area
• swollen tummy
• unexplained, persistent cough or shortness of breath
• headaches or vision changes
• red patches on the skin

What causes lymphoma?

The cause of lymphoma is unknown.

It is more common in people who:

• have a weakened immune system from conditions such as an inherited immune disorder, an autoimmune disease or HIV infection or AIDS
• take medicines that suppress the immune system after having an organ transplant
• are infected with the Epstein-Barr virus (which causes glandular fever, especially if the immune system is already weakened) or some other viruses or bacteria
• have a family history of lymphoma
• are exposed to some radiation or toxins including benzene and some agricultural chemicals
• smoke cigarettes

Even if you have one or more of these risk factors, it does not mean you will develop lymphoma.

When should I see my doctor?

Many other conditions, such as the flu or a virus, can have similar symptoms to lymphoma. If you or someone you know is experiencing these symptoms, and you do not know the cause, it is important to see a doctor as soon as possible.

How is lymphoma diagnosed?

If your doctor suspects you have lymphoma, they may perform a physical examination. This includes feeling the lymph nodes in your neck, underarm or groin for signs of swelling; and your stomach area to check for swollen organs.

They may also ask you about other symptoms and talk to you about your health generally.

If your doctor suspects you may have lymphoma, you will probably be asked to have a biopsy. A biopsy involves removing some or all of an affected lymph node and some lymphocytes (white blood cells) to get a tissue sample. Biopsies can be carried out under local or general anaesthetic.

A pathologist then views the sample under a microscope in a laboratory. If cancerous cells are found, the type of lymphoma (Hodgkin or non-Hodgkin) will also be confirmed.

You may be asked to have other tests, such as:

• blood tests
• urine tests
• bone marrow biopsy
• x-ray
• computed tomography (CT scan)
• gallium scan
• magnetic resonance imaging (MRI)
• positron emission tomography (PET) scan

Some of these tests aim to check your general health, while others aim to identify the stage of the lymphoma — that is, the extent to which it has spread in the body.

This information is important to help work out the best treatment.

How is lymphoma treated?

If you are having treatment for lymphoma, the choice of treatment depends on:

• the type of lymphoma (Hodgkin or non-Hodgkin)
• the stage of lymphoma — whether or not the disease has spread to other areas of the body
• how fast it is likely to grow
• your age and general health
• your symptoms
• whether or not you have had any treatments before
• what you want

The main treatment options for lymphoma are chemotherapy and radiotherapy, which can be used on their own or in combination.

Other treatment options include:

• a type of immunotherapy called monoclonal antibodies. Immunotherapy uses the body’s own immune system to fight cancer
• targeted therapy drugs, which attack specific particles (molecules) in cancer cells to stop the cancer growing or to reduce its size
• steroids, to increase the effect of the chemotherapy

In some cases, a stem cell transplant is needed if the lymphoma has recurred (come back) or is likely to recur in the future.

Depending on where you live, the treatment of lymphoma may be managed by a group of health professionals called a multidisciplinary team. This team may include an oncologist (cancer specialist), a radiotherapist, a surgeon, a nurse, a social worker and other health professionals.

In some people with slow-growing tumours, doctors may recommend a watch and wait approach. This means they get regular check-ups, and are only treated when the lymphoma starts to grow faster.

If you are in complete remission from lymphoma, it’s best not to have a lot of CT scans as these can expose you to unnecessary radiation. For more information, visit the Choosing Wisely Australia website.

What are the side effects of lymphoma treatments?

Like all cancer treatments, lymphoma treatments can cause a wide range of side effects and complications. But not everybody experiences the same side effects of treatment, and often they are mild and can be dealt with easily.

If you are being treated for lymphoma, some of the medicines or radiation used may cause you to:

• lose some or all of your hair temporarily
• feel nauseous
• vomit
• feel very tired and washed out
• have a sore mouth
• have headaches
• have sore skin from radiation
• have an increased risk of infections

These side effects are temporary, and you can talk to your healthcare team about things you can do to prevent them or reduce them.

Infections

Lymphoma treatments can weaken your immune system, increasing your risk of infection. As a precaution, you may be given antibiotics.

If you are being treated for lymphoma and think you have an infection, tell your doctor immediately. Untreated infections can be very serious for people having cancer treatment. The symptoms of infection include:

• fever
• headache
• aching muscles
• diarrhoea
• tiredness
• a painful blistering rash

Infertility

Some lymphoma treatments can cause infertility. Infertility is often temporary, but in some cases it can be permanent.

Ask your treatment team if you are at high risk of infertility. In some cases, men may be able to store samples of their sperm, and women may be able to freeze eggs to use after treatment is over.

Doctors strongly recommend that people having chemotherapy use contraception during treatment and for 3 months after, as chemotherapy can damage embryos.

Second cancer

People who’ve had one cancer are at higher risk of having another one. A second cancer can be the same type or different to the first cancer. Chemotherapy and radiotherapy also further increase this risk.

Having a healthy lifestyle can reduce the risk of getting a second cancer. That means not smoking, maintaining a healthy weight, eating nutritious food and exercising regularly.

It is important to see you doctor about any suspicious symptoms.

Other problems

Lymphoma treatments can also increase your risk of getting heart and lung disease. A diagnosis of cancer can also increase your risk of suffering from depression.

Resources and support

Cancer Council Australia has detailed information about lymphoma. Support is also available by calling the Cancer Council helpline on 13 11 20.