Everything you need to know about Lymphoma 

by Dr. Naresh Somani, Director Oncology & Sr. Consultant Medical Oncology, HCG Cancer Centre Jaipur

Lymphoma is a type of cancer that affects the infection-fighting cells of the immune system, called lymphocytes. About half of the blood cancers that occur each year are lymphomas, or cancers of the lymphatic system. This system - composed of lymph nodes in our neck, armpits, groin, chest, and abdomen - removes excess fluids from our body and produces immune cells. Sometimes abnormal lymphocytes become lymphoma cells, which multiply and collect in lymph nodes and other tissues. 
About 10-15% of patients with lymphomas have Hodgkin lymphoma. Because of advances in treatments, Hodgkin lymphoma, once considered a fatal disease has been transformed into a highly curable condition to the tune of over 90%. There are more than 50 subtypes of non-hodgkin and can often be cured or controlled for long time. Most non-hodgkin lymphoma are B-cell lymphoma, some are slow growing (indolent), and some grow quickly (aggressive). The prognosis of depends on the specific sub type.
The two main types of lymphomas are: 
1.    Hodgkin lymphoma: It is also known as Hodgkin’s disease. Usually starts in a type of B cell that is found in the bone marrow. Hodgkin’s disease considered as the most curable forms of cancer, especially if diagnosed and treated at an early stage.  

2.    Non-Hodgkin lymphoma: It is the most common form of lymphoma and usually tend to develop among older people. 
What causes Lymphoma?
Lymphomas develop due to genetic changes in the cells (lymphocytes) leading to their uncontrolled growth, however in most cases the cause of these changes are unclear. Certain risk factors like an autoimmune disease, HIV/AIDS, age factor and exposure to certain pesticides can increase the risk of developing lymphomas. 
What are the common signs and symptoms of Lymphoma?
Signs and symptoms of lymphoma may include painless swelling of lymph nodes in the neck, armpits or groin region, persistent fatigue, fever, night sweats, shortness of breath, unexplained weight loss and itchy skin. 
How are lymphomas diagnosed & treated?
Lymphomas are typically managed by medical oncologists’ cancer specialist. A proper lymph node biopsy with markers tests is essential for diagnosis. Additional tests such as blood tests, cytogenetics, imaging tests (like CT or PET scan), bone marrow biopsies are often necessary to determine the extent (stage) of the disease.

Treatment decision is usually based on: 
1. Age & general health 
2. Specific type of the lymphoma 
3.  Stage of lymphoma etc.  

Treatment for Hodgkin’s lymphoma normally depends on the stage of the disease. The main treatment options are chemotherapy and radiation. Various other treatment modalities include, immunotherapy, radiotherapy, targeted therapy, and stem cell transplant. Recent advances in field of immunotherapy like CAR- T cell therapy has made it possible to attempt cure of even heavily pre-treated lymphoma. 
In general, the objective of treatment is to destroy as many lymphoma cells as possible and to induce a complete remission. Complete remission eliminates all evidence of the disease. Patients who get the remission done are sometimes cured of the disease. 
Prevention of lymphoma
The risk factors for lymphoma cannot be regulated but there are some precautions that can be taken. Its always advisable to avoid intravenous drugs and unprotected sex with multiple partners since HIV and hepatitis C weakens the immune system which in turn increases the risk of developing lymphoma. 
Also avoiding unnecessary exposure to radiation and following a healthy diet and maintaining weight helps in preventing from lymphoma.