What is lymphoma?
Lymphomas refers to types of cancer that begin in the lymphatic system (the various lymph glands around the body) when abnormal white blood cells grow. Lymphomas are the sixth most common form of cancer overall (excluding non-melanoma skin cancer).
There are two main types of lymphoma, which spread and are treated differently:
- Non-Hodgkin lymphoma (which accounts for about 90% of lymphomas)
- Hodgkin lymphoma (which has a characteristic appearance in biopsies).
The risk of being diagnosed with non-Hodgkin lymphoma by age 85 is 1 in 39. The risk of being diagnosed with Hodgkin lymphoma by age 85 is 1 in 414. There are around 40 subtypes of non-Hodgkin lymphoma and they vary in how fast they grow and spread, and how sick people feel. They are not all treated the same.
The incidence of lymphomas in Australia has risen over the past 20 years and is continuing to rise. Multiple studies have found no clear reason for the increase. Compared with a number of preventable cancers, there is only a weak association between lymphoma and known risk factors (see following). So, while a healthy lifestyle helps reduce your overall cancer risk, most individual cases of lymphoma cannot be attributed to any specific cause. Research continues.
In 2016, 6000 new cases of lymphoma were diagnosed in Australia. Non-Hodgkin lymphoma is over six times more common, with 5315 new cases diagnosed in 2016, compared with 685 cases of Hodgkin lymphoma.
In 2018, there were 1653 deaths caused by lymphomas in Australia.
Common symptoms include:
swelling of one or more lymph glands such as in the neck or armpits
abnormal sweating, especially at night
loss of appetite
bruising or bleeding easily
cough, chest pain or problems breathing
rash or itching.
Causes of lymphoma
Exposure to radiation and certain types of chemicals can put some people at higher risk. Benzene and some agricultural chemicals have been implicated; people exposed in the workplace, who can be at highest risk, should follow occupational health guidelines to minimise exposure. For people whose immune system is suppressed, exposure to viruses such as the Epstein-Barr virus or HIV can also be at increased risk of lymphoma.
Diagnosis of lymphoma
Tests usually used to diagnose lymphoma include:
PET (positron emission tomography) scan which produces a three-dimensional colour image to show whether the lymphoma has spread to the bone marrow.
CT (computerised tomography) scan using a computer and x-rays to create a detailed picture of an area inside your body.
MRI (magnetic resonance imaging) scan may be used to check the brain and spinal cord.
Blood tests are taken regularly if you are diagnosed with lymphoma, to check on how the cancer or its treatment is affecting blood cells in your body.
Biopsy of the lymph nodes to confirm a diagnosis of lymphoma.
Bone marrow biopsy
Bone marrow biopsy to check whether there are cancer cells have spread to the bone marrow.
After a diagnosis of lymphoma
After a diagnosis oif lymphoma you may feel a range of emotions such as anger, confusion, anxiety and distress. These are normal reactions and everyone is different. There are also practical considerations such as what treatment to have and how to organise work and finances and this can be stressful.
Talk with your doctor about different treatment options including likely outcomes, potential side effects and risks and benefits. It is up to you how involved you want to be in decisions about treatment so ask for as much treatment as you need.
Treatment for lymphoma
Treatment depends on the type of lymphoma, the stage of the disease (i.e. how far it has spread around the body) and how fast it is likely to grow.
The extent of the cancer is determined by a CT scan of the abdomen and bone marrow biopsy. A PET scan, where available, provides extra information about distant spread, including to bones. CT scans show enlarged lymph glands; whereas a PET scan shows lymph glands that are metabolically abnormally active (but may not yet be swollen) and may be the more accurate test for staging.
Types of treatment
Treatment options include chemotherapy, radiation therapy (radiotherapy) and monoclonal antibodies. Surgery which can be successful to remove early breast, bowel and a number of other cancers, doesn't work in lymphoma. In some cases, a stem cell transplant with strong chemotherapy just beforehand is required if the lymphoma has recurred or where there is a high likelihood of recurrence in the future.
Early Hodgkin disease is treated with combination chemotherapy plus radiation therapy. Radiation therapy may be required for bulky or non-responding sites.
For patients with non-Hodgkin lymphoma, some can be managed with localised radiotherapy alone, or radiation therapy plus combination chemotherapy.
If the non-Hodgkin lymphoma is fast-growing, or "aggressive", successful treatment usually requires starting chemotherapy immediately. For early-stage disease and advanced stages with bulky sites, "involved field radiotherapy", which only targets the affected site, is usually required.
In some cases of lymphoma, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer, without aiming to cure it.
As well as slowing the spread of lymphoma, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiation therapy, chemotherapy or other drug therapies.
Treatment TeamDepending on your treatment, your treatment team may consist of a number of different health professionals, such as:
- GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
- Haematologist- specialises in diagnosing and treating diseases of the blood and lymphatic system.
- Radiation oncologist- prescribes and coordinates radiation therapy treatment.
- Medical oncologist- prescribes and coordinates the course of chemotherapy.
- Surgeon- surgically removes tumours and performs some biopsies.
- Cancer nurses- assist with treatment and provide information and support throughout your treatment.
- Other allied health professionals- such as social workers, pharmacists and counsellors.
Screening for lymphoma
There are no routine screening tests, and no direct blood tests, for lymphoma.
Having a parent, brother or sister who has had Hodgkin lymphoma or non-Hodgkin lymphoma slightly increases a person's risk of developing it. However, this family link is uncommon and most people with either type of lymphoma do not have a family history.
There are no proven measures to prevent lymphoma, except potentially the avoidance of causes such as HIV infection.
Prognosis of lymphoma
An individual's prognosis usually depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis.
Understanding Non-Hodgkin Lymphoma, Cancer Council NSW ©2019. Last medical review of source booklet: November 2019.
Understanding Hodgkin Lymphoma, Cancer Council NSW © 2019. Last medical review of source booklet: May 2019.
Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW.
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