Lymphoma is a general term that is used to describe cancers of the lymph system. Lymphoma may arise from a lymph node or any other part of the lymphoid tissue. There are two major types of lymphomas, i.e. Hodgkin's lymphoma and non-Hodgkin's lymphoma.
Hodgkin's lymphoma
Hodgkin's lymphoma is the most common lymphoma. It is characterised by the presence of Reed-Sternberg cells, which are malignant giant cells having multiple nuclei. If the Reed-Sternberg cells are not seen, the diagnosis of Hodgkin's lymphoma is rarely made. Hodgkin's lymphoma has a bimodal age distribution with one peak during 20 to 35 years of age and the other during 55 to 70 years of age. Epstein Barr Virus seems to play an important role in the genesis of the Hodgkin's lymphoma. The incidence of Hodgkin's lymphoma is found to be higher in woodworkers, chemists, first-degree relatives of a known case of Hodgkin's lymphoma and in the persons with suppressed immunity. The Hodgkin's lymphoma can be pathologically divided into four types, i.e. lymphocyte predominance type, nodular sclerosis type, mixed cellularity type, and lymphocyte depletion type.
Hodgkin's lymphoma presents as a painless swelling usually in the axilla, neck and the groin. There may be a pain in the affected lymph nodes after consumption of alcohol. Symptoms of Hodgkin's lymphoma include weight loss, fever, fatigue, pruritus, night sweats, anaemia, and pancytopaenia. There may be persistent cough and repeated episodes of infections. The enlarged mediastinal lymph nodes may lead to pressure symptoms such as difficulty in breathing and difficulty in swallowing. There may be venous engorgement and cyanosis in the head & neck region. Pressure on the spinal cord may lead to paraplegia. Hodgkin's lymphoma usually metastasises to the bones, spleen, stomach and the skin.
Staging of the Hodgkin's lymphoma is done as follows:
- In stage I, the Hodgkin's lymphoma affects one group of lymph nodes or one organ of the body.
- In stage II, the lymphoma involves more than one group of lymph nodes on the same side of the diaphragm; or involves one organ of the body along with the regional lymph nodes.
- In stage III, the Hodgkin's lymphoma involves different groups of lymph nodes both above and below the diaphragm; or involves the spleen.
- In stage IV, the lymphoma spreads to other organs of the body such as the liver, lungs, bones and the bone marrow.
- In the relapsed stage, the Hodgkin's lymphoma recurs after an apparent recovery (remission) in response to the initial treatment.
Procedures used to diagnose the Hodgkin's lymphoma include blood tests, X-rays, CT scan and biopsy.
Non-Hodgkin's lymphoma
Non-Hodgkin's lymphoma (NHL) is a group of cancers originating in the lymph system. It is more common in men as compared to women. The non-Hodgkin's lymphoma can be classified into the low-grade NHL, intermediate-grade NHL, and the high-grade NHL. About 80 percent cases of the low-grade non-Hodgkin's lymphoma and about 20 percent cases of the high-grade non-Hodgkin's lymphoma show chromosomal abnormalities, particularly translocation between the chromosome 14 and the chromosome 18. The non-Hodgkin's lymphoma is found to be associated with bc12 oncogene. Causative factors of the non-Hodgkin's lymphoma include Epstein Barr virus, exposure to radiation and suppression of the immune system of the body. Burkitt’s lymphoma, first described by David Burkitt in 1958, is a fast-growing type of non-Hodgkin's lymphoma, which is very common in the children of Africa.
Low-grade non-Hodgkin's lymphoma presents with painless lymphadenopathy, usually involving the retroperitoneal, mesenteric and the pelvic lymph nodes along with anaemia, thrombocytopaenia and frequent episodes of infection. There may be other symptoms such as weight loss, lethargy and night sweats. The abdominal distension or discomfort may occur due to an enlarged spleen and the liver.
Intermediate-grade and high-grade non-Hodgkin's lymphoma has a rapid onset. These lymphomas usually originate in a lymph node and spread throughout the lymphoreticular system. About 70 percent of cases of intermediate and high-grade non-Hodgkin's lymphoma are diagnosed in the disseminated stage of the disease. The symptoms include night sweats, weight loss, lethargy, and pallor. There may be involvement of extranodal sites such as the skin, gastrointestinal tract, liver, lungs, and the bone marrow. Involvement of the lungs may lead to respiratory symptoms. Abdominal lymphadenopathy may lead to abdominal symptoms and low backache. There may be impaired bone marrow functions and the renal failure in advanced stages of the non-Hodgkin's lymphoma.
Staging of the non-Hodgkin's lymphoma is done as follows:
- In stage I, the non-Hodgkin's lymphoma affects one group of lymph nodes or one extranodal organ.
- In stage II, the tumour involves more than one group of lymph nodes on the same side of the diaphragm; or involves one extranodal organ along with the regional lymph nodes.
- In stage III, the non-Hodgkin's lymphoma involves lymph nodes on both sides of the diaphragm along with or without involving the spleen.
- In stage IV, there is widespread involvement of the extranodal organs along with or without the involvement of the lymph nodes.
- In the relapsed stage, the non-Hodgkin's lymphoma recurs after an initial remission in response to the treatment.
Procedures used in the diagnosis and evaluation of the non-Hodgkin's lymphoma include physical examination, blood tests, lymphangiography, X-rays, ultrasound, CT scan, bone marrow cytology, and biopsy.
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Lymphoma