Lymphoma in India

Lymphoma is a type of blood cancer. If you have lymphoma, there will be an increase in the number of lymphocytes in your body. The abnormal lymphocytes or 'lymphoma cells' are present in the lymph nodes than in the blood. In leukemias, there is an increase in the number of lymphocytes in the blood. 

Apart from lymph nodes, lymphomas also affect your spleen, thymus, bone marrow, etc. It may also affect your lungs, liver, and other organs as well. 

There are about 70 types of lymphoma. The main ones are Hodgkin's and Non-Hodgkin's lymphomas. More than eighty-five percent are Non-Hodgkins lymphomas. 

The presence of Reed-Steinberg cells is the sign of Hodgkin's lymphoma. Even though treatment is the same for both, Hodgkin's lymphoma is the more easily treatable type. 

Chemotherapy, targeted therapy, and radiation are the usual treatment methods. Your doctor will choose the right plan as per the type and stage of your disease. 

Causes of lymphoma

The exact cause of lymphomas is not clear. Genetic changes in the stem cells that develop into lymphocytes may be a reason. These changes affect the way the cells survive and divide. As the lymphoma cells live longer than normal lymphocytes, they cluster together in lymph nodes and organs like the splee and the bone marrow.

Risk factors of lymphoma

Things that increase your risk of having a disease are called risk factors. You can also have the disease even when you do not have any of these. 

Some of the common risk factors are 

• A weak immune system
• Exposure to chemicals like benzene and those in pesticides and herbicides 

Hodgkins lymphoma risk factors

• Hodgkin's lymphoma is more common in those between the age of fifteen and forty and those above sixty.
• History of Epstein-Barr virus infections
• Having a family history of the disease

Non-Hodgkins lymphoma risk factors

• Most common in those above sixty years of age
• History of virus infections like HIV
• Having previous cancer treatments like chemotherapy and radiation

Symptoms of lymphoma

Few of the common symptoms for lymphomas are

• Swollen lymph nodes-You may have lumps in your neck, armpits, and groin areas. These lumps are usually painless and may feel rubbery.
• Fatigue-You may feel very tired without any reason. Taking rest or sleeping does not make you feel any better. 
• Losing weight without trying
• Night sweats- You may sweat a lot during the nights. Your sweating will be such that you may wake up due to the drenching of your sheets. Experts believe that abnormal lymphocytes produce certain chemicals that raise body temperature at night.
• Itchy skin- Your skin may feel very itchy without any reason. Again this is due to the effects of certain chemicals. The itching gets worse during hot weather. 
• Breathing problems- These occur when the lymph nodes press against your chest. You may feel breathless or have a severe cough or wheezing. 
• Abdominal problems- You may have severe bloating of your abdomen. You may feel less hungry due to this. It happens due to the liver and spleen's enlargement, which presses against the stomach and intestine. 

Diagnosis of lymphoma

If some of your symptoms make the doctor suspect lymphomas, you will have a few tests. Thes include

• Physical examination- Your doctor will check for swollen lymph nodes in the neck, underarm, groin, etc. The doctor will also look for an enlarged spleen or liver.
• Lymph node biopsy- A surgeon will remove a lymph node for checking it under a microscope for lymphoma cells. It helps to understand the type and stage of the disease.
• Bone marrow tests- It looks for the presence of lymphoma cells in a bone marrow sample.
• MRI, CT, and PET scans help identify the lymphomas in areas other than the lymph nodes  

Lymphoma treatment

Your treatment will depend on the type of lymphoma you have and how fast it is growing. 

Some types of lymphomas will not have any symptoms for a very long time. In such cases, the doctor will wait until the symptoms appear.

You will have treatments either to control your symptoms or to bring the disease to a phase of remission.

Chemotherapy for lymphoma

Chemotherapy uses medicines to destroy cancer cells. You will have the medication orally or as injections to your veins. These medicines destroy the cellular mechanism that helps the cancer cells to survive and multiply abnormally. You will have the treatment in cycles that last for a few days together. The number of cycles you will have will depend on the severity of the disease. The medicines cause some damage to healthy cells as well. To help you recover from these side effects, you will have periods of rest between the cycles.

Targeted therapy for lymphoma

This treatment, like chemotherapy, uses medicines to destroy cancer cells. It acts by blocking the signals that tell the cancer cells to grow and divide. These medicines target only the cancer cells and cause very little damage to healthy cells. So the side effects are less than that of chemotherapy.

Immunotherapy for lymphoma

In this treatment, you will have medicines to boost your body's immunity to fight cancer. Though abnormal, cancer cells have a mechanism to disguise as healthy cells in front of the natural antibodies in your body. It prevents these antibodies from identifying the cancer cells properly, allowing them to survive. Immunotherapy drugs help these antibodies to locate and destroy the cancer cells

Surgery for lymphoma

Surgery is rarely a frontline treatment for lymphomas. If you have lymphomas in a single site other than lymph nodes, surgery will help to remove it. Radiation therapy is a better option if you have lymphomas in multiple sites.

Radiation therapy for lymphoma

The treatment uses high energy x-rays to destroy the lymphoma cells. It is very useful for early-stage lymphomas. In those with advanced-stage lymphomas, radiation helps to ease the symptoms. Those having a bone marrow transplant will have radiation before it. It helps to destroy the faulty bone marrow and to destroy as much of the lymphoma cells as possible.

Bone marrow transplant for lymphomas 

Chemotherapy, while a good option, will also destroy several stem cells in the bone marrow along with lymphoma cells. It will thus lead to a decrease in the number of different blood cells. 

A stem cell/bone marrow transplant can overcome this problem. It helps you to have more intensive chemotherapy.

Remission

In this phase, the amount of lymphoma cells in your body is very small or almost zero. This type of remission is complete remission. You will not have any of the signs and symptoms of lymphoma. In short, you are free of the disease. But, there may be small amounts of lymphoma cells that remain undetected in your body. It is then possible for the disease to relapse. 

In partial remission, the amount of lymphoma cells in your body is low, and there are no obvious symptoms. In such cases, you will not need any treatment.

Wait and watch approach

Sometimes your lymphoma diagnosis happens by chance during a routine blood test. You will also not have any other symptoms in such situations. In that case, your doctor will ask you to wait and watch. You will not have any treatment during this time. All that you will have is periodic tests to see whether the cancer is growing. You will have treatment only if it grows beyond a particular stage, or if the signs are worrying