Lymphoma includes a group of blood cancers that affect lymphocytes , a type of white blood cell . There are more than 70 different types and subtypes of lymphoma, which can be divided into two categories:
The distinction between HL and NHL is made by microscopic examination of a tissue biopsy . HL contains abnormal cells with two nuclei called Reed-Sternberg cells, which are not found in NHL. Despite cellular differences, HL and NHL share many of the same symptoms, especially in the early stages of the disease.
The lymphatic system consists of:
Many of the symptoms of lymphoma are nonspecific and can be confused with other less serious conditions. The warning signs of lymphoma are often subtle, and it may take months or years before you realize something is wrong. However, if you suspect you have lymphoma or have a family history of the disease, you can watch out for symptoms, including:
Of all the symptoms of lymphoma, lymphadenopathy is the central defining feature. Swollen nodes are usually hard, elastic, and mobile in the surrounding tissue. Lymphadenopathy caused by lymphoma is rarely painful, but painful lymph nodes associated with viral infections are usually painful.
Progress and types
The path of development and location of the disease differs depending on the lymphoma subtype.
- The HL moves sequentially through the lymphatic system. Lymphadenopathy almost always begins in the upper body, usually in the neck ( cervical lymph nodes ), chest ( mediastinal lymph nodes ), or armpits ( axillary lymph nodes ), before progressing to the lower body.
- In NHL, the disease develops randomly and can affect lymph nodes anywhere in the body, including the abdomen (peritoneal lymph nodes) and the groin (inguinal lymph nodes).
The mere fact that your lymph nodes are constantly swollen should prompt you to see your doctor.
For unknown reasons, lymphoma can cause lymph node pain immediately after drinking.
Symptoms per organ
Lymphoma symptoms are determined by the type and subtype of lymphoma , as well as its stage, severity (severity), and location in the body. Extranodal lymphoma, which occurs outside the lymph nodes, causes symptoms based on location.
The two main categories of extranodal lymphoma are:
- Primary extranodal lymphoma : Arises outside the lymphatic system. The vast majority of primary extranodal cases occur in NHL; this is unusual for HL.
- Secondary extranodal lymphoma : It arises in the lymphatic system and then spreads to other organs. This can happen with both the HL and the NHL.
The definition of extranodal may differ slightly depending on whether it is LH or NHL. In HL, the spleen, tonsils, and thymus are considered nodules. Rather, these same organs are considered extranodal in NHL.
The stomach and small intestine are the first and second most common sites for extranodal lymphoma.
Symptoms of gastrointestinal (GI) lymphoma can include:
- Pain, ache, and cramps in the abdomen.
- Indigestion, nausea, and vomiting.
- Malaise (malaise)
- Feeling full after a few bites of food.
- Rectal bleeding
- Black tarry stools
- Involuntary weight loss
Cutaneous (cutaneous) lymphoma occurs in both HL and NHL. Approximately 25% of nodular lymphomas will present with skin symptoms, and 65% of all cases of cutaneous NHL will be attributed to a subtype known as cutaneous T-cell lymphoma. One of the most common subtypes is fungal mycosis .
Symptoms of cutaneous lymphoma can include:
- Round patches of skin that may be raised, scaly, or itchy.
- Lightened skin areas
- Skin tumors that can open spontaneously
- Thickening of the palms of the hands or soles of the feet
- Itchy redness, similar to a rash, covering most of the body.
- Alopecia (hair loss)
Bone and bone marrow
The vast majority of bone lymphomas are associated with NHL and are caused by a type known as B-cell lymphoma. HL almost never affects the bones.
Primary bone involvement in NHL is classified as stage 1 lymphoma. Secondary involvement with generalized (disseminated) disease is considered stage 4.
When lymphoma affects the bone marrow, it can drastically disrupt the production of red and white blood cells, leading to anemia (low red blood cell count) and thrombocytopenia (low platelet count). It also inhibits the white blood cells (white blood cells) produced in the bone marrow, which leads to leukopenia.
Symptoms of lymphoma of the bone include:
- Swelling of the limbs
- Loss of range of motion of the limbs.
- Easy bruising and bleeding
If the spine is involved, the lymphoma can cause numbness, weakness, and loss of bladder or bowel control.
Central Nervous System
Central nervous system (CNS) lymphomas account for 7% to 15% of all brain cancers. They are generally classified as B-cell lymphomas and occur most often in people with weakened immune systems , such as those with advanced HIV infection.
Symptoms of primary or secondary CNS lymphoma include:
- Muscle weakness in a specific part of the body.
- Loss of sensation in a specific part of the body.
- Balance, memory, cognition and / or language problems.
- Vision changes or partial loss of vision.
- Nausea and vomiting
Pulmonary (pulmonary) lymphoma is a rare condition and is more common in HL than NHL. Secondary pulmonary involvement in lymphomas is more common than primary pulmonary lymphoma, both in NHL and HL. The mediastinal lymph nodes can be affected in both LH and NHL.
Symptoms of lung lymphoma are often nonspecific in the early stages of the disease and can include:
- Chest pain
- Difficulty breathing
- Crepitus (audible wheezing in the lungs)
- Hemoptysis (coughing up blood)
- Involuntary weight loss
Primary liver lymphoma is extremely rare and is almost exclusively associated with NHL. Secondary liver damage affects 15% of people with NHL and 10% of people with LH. In most cases, the malignancy spreads from the retroperitoneal lymph nodes (behind the abdominal cavity) to the liver.
Symptoms of liver lymphoma are often mild and nonspecific and can include:
- Pain or swelling in the upper right corner of the abdomen.
- Extreme fatigue and lethargy
- Involuntary weight loss
- Night sweats
- Nausea and vomiting
- In rare cases, jaundice (yellowing of the skin and / or eyes)
- Loss of appetite
- Dark urine
Kidneys and adrenal glands
Kidney lymphoma causes symptoms such as:
- Side pain
- A lump or swelling in the side or lower back.
- Hematuria (blood in the urine)
- Loss of appetite
- Persistent fatigue
- Involuntary weight loss
Adrenal lymphoma usually presents with adrenal insufficiency, also known as Addison's disease .
Testicular lymphoma accounts for approximately 5% of all testicular growth abnormalities. This usually results in painless swelling, usually in a single testicle. What makes testicular lymphoma especially dangerous is that it tends to involve aggressive B-cell lymphomas that travel rapidly to the central nervous system.
Women can develop lymphoma in the tissues around the genitals, known as the epididymis. Genital involvement in women is rare, although cervical and uterine involvement have been reported.
Lymphoma weakens the immune system and can lead to serious long-term complications.
Although current treatments provide a near-normal life expectancy for people with lymphoma, continued exposure to chemotherapy drugs can trigger the early onset of aging-related diseases such as cancer, heart disease, hormonal imbalance, and infertility. .
Secondary cancers, including leukemia and solid tumors, are one of the leading causes of death in people with lymphoma. Leukemia , a related blood cancer, can develop years or even decades after exposure to alkylating chemotherapy drugs, and between 70% and 80% of all secondary solid tumors occur in people who have previously received a combination of radiation and chemotherapy.
Breast cancer often occurs 10 to 15 years after chest radiation, especially if the radiation was given before age 35. The incidence of lung cancer is higher in HL smokers who have previously received radiation and / or chemotherapy.
Higher doses of radiation are associated with an increased risk of secondary breast or lung cancer, increasing the risk by 900% compared to low-dose chest radiation.
Heart disease is believed to be the leading cause of non-cancerous death in people with lymphoma. Among the main problems is coronary artery disease (CHD) , which occurs five times more often than in the general population. Most cases of coronary heart disease develop 10 to 25 years after exposure to radiation therapy for chest lymphoma.
Also, radiation to the neck is associated with a five-fold increased risk of stroke.
Hormonal disorders and infertility
As a disease that often affects the organs of the endocrine system , lymphoma can cause hormonal imbalances or deficiencies that can persist for many years after the disease is successfully treated.
The most common complication is hypothyroidism (low thyroid function), which affects up to 60% of people with HL. The risk of hypothyroidism is directly related to the amount of radiation used to treat the disease, especially in the advanced stages of lymphoma.
Infertility is a common consequence of lymphoma.
- Testicular lymphoma can affect male fertility.
- The alkylating chemotherapy drugs used to treat lymphoma are the most common cause of infertility in men and women. The people most affected were those who received the BEACOPP chemotherapy drugs (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone).
Up to 50% of women receiving BEACOPP chemotherapy will experience abnormal menstrual cycles, while 89% of men will develop azoospermia (no motile sperm).
Other chemotherapy regimens (such as AVBD ) are less likely to cause infertility. In general, men and women with chemotherapy-induced infertility will experience a return to fertility after treatment ends, although some may end up experiencing permanent infertility.
When to contact a healthcare provider
In many cases, lymphoma does not show early signs, and obvious symptoms develop only later in life. The most pressing symptom, persistent lymphadenopathy with no known cause, requires immediate medical attention.
However, in cases where the disease is confined to the chest or abdomen, you may have no visible signs of lymphadenopathy at all. Also, the so-called "B" symptoms (fever, night sweats, weight loss) are often mistaken for other conditions.
If you think you are at risk of developing lymphoma, it is worth taking the initiative and checking all the symptoms as soon as possible.
Your risk increases if:
- You have a first-degree relative (parent, brother, or sister) with lymphoma, which is known to increase your risk of developing NHL by 1.7 times and VL by 3.1 times.
- You have been exposed to industrial chemicals for a long time.
- You have a weakened immune system.
The risk of lymphoma also increases with age.
Radiation and chemotherapy
Previous exposure to radiation and chemotherapy increases the risk of lymphoma. Even people with LH who have previously received radiation and chemotherapy are at increased risk of developing NHL in later years.
Frequently asked questions
What Causes Lymphoma?
Researchers have not revealed the exact cause (s) of lymphoma, but they believe that genetics, environmental and lifestyle factors, and certain infections play a role. Other factors associated with an increased risk of developing certain types of lymphoma include age, gender, body weight, and geographic location.
How is lymphoma diagnosed?
If your healthcare provider suspects you may have lymphoma based on your symptoms, medical history, and physical exam, he or she will most likely order certain blood tests and imaging tests to look for signs of cancer. A lymph node biopsy is the gold standard for diagnosis and can confirm the presence of cancer cells.
What does a lymphoma rash look like?
A lymphoma rash can appear in many different ways, and it can have more than one type. It can be itchy and scaly, cover large areas of the body, and can range in color from red to purple.
You can have:
- Papules that look like small pimples.
- The patches are flat
- Plaques that are thick rise or sink into the skin.
You may also see bumps under the skin caused by nodules or swellings.
Get the word of drug information
Although risk factors can often indicate a lymphoma diagnosis, anyone can get the disease without even having risk factors. To do this, the most important thing you can do is never ignore symptoms that persist , no matter how mild.
For example, even if nonspecific GI symptoms temporarily improve with antacids and other medications, tell your doctor if they don't go away completely.