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Disease & Conditions >>> Lymphoma Articles & News

What Is Lymphoma?

Lymphoma is a type of cancer that can occur when an error occurs in the way a lymphocyte is produced, resulting in an abnormal cell. These abnormal cells can accumulate by two mechanisms: (a) they can duplicate faster than normal cells, or (b) they can live longer than normal lymphocytes. Like normal lymphocytes, the cancerous lymphocytes can grow in many parts of the body, including the lymph nodes, spleen, bone marrow, blood, or other organs. There are two main types of cancer of the lymphatic system. One is called Hodgkin's disease, while the other is called non-Hodgkin's lymphoma.

What are the signs and symptoms of lymphoma?
A symptom is anything out of the ordinary that could be caused by a disease. Symptoms are not specific to lymphomas and are, in fact, similar to those of many other illnesses. People often first go to the doctor because they think they have a cold, the flu, or some other respiratory infection that does not go away.

The most common presentation of lymphoma is usually a painless swelling of lymph nodes that often occurs in the neck or under the arms. Some people may also experience swelling of lymph nodes in other parts of the body. For example, enlarged lymph nodes in the groin can cause a swelling in the legs or ankles, while enlarged lymph nodes in the abdomen can cause abdominal discomfort or a feeling of bloating. Less commonly, patients with lymphoma may present without swollen lymph nodes. Other patient complaints that may indicate the presence of lymphoma can include fever, unexplained weight loss, sweating (often at night), chills, a lack of energy, or itching. There is usually no pain involved, especially when the lymphoma is in the early stage of development.

Most people who have these non-specific complaints will not have lymphoma. However, it is important that anyone who has persistent symptoms be seen by a doctor to make sure that lymphoma is not present.

What will the doctor look for during a physical examination?
If you have symptoms suggesting lymphoma, a complete physical examination will be performed. During this examination, the doctor will look for swollen lymph nodes under the chin, in the neck and tonsil area, on the shoulders and elbows, under the arms, and in the groin. The doctor will also examine other parts of the body to see whether there is swelling or fluid in your chest or abdomen that could be caused by swollen lymph nodes. You will be asked about pain and examined for any weakness or paralysis that could by an enlarged lymph node against nerves or the spinal cord. Your abdomen will be examined to see whether any internal organs are enlarged, especially the spleen.

If the doctor suspects after reviewing your symptoms and performing a physical examination, he or she may order other tests help confirm the diagnosis. These tests should include a biopsy, and may include blood tests, x-rays and other imaging tests, scans, bone marrow evaluation, and perhaps an examination of the cerebrospinal fluid.

What is a biopsy and how is it performed?
A biopsy is a procedure in which a piece of tissue from an area of suspected cancer is removed from the body for examination under a microscope. The information provided by this tissue sample is crucial to diagnosing and treating lymphoma.

There are several types of biopsies. One is called a core biopsy, where a needle is inserted into a lymph node suspected of being cancerous and a small tissue sample is removed. This type of biopsy can be done under local anesthesia and stitches are usually not required.

Core biopsies sometimes do not provide enough tissue to establish a diagnosis. Consequently, if a lymph node is readily accessible, many physicians recommend an open biopsy (also called a surgical biopsy), in which an entire swollen lymph node is removed. This procedure usually can be done under local anesthesia, but a general (whole body) anesthetic is sometimes needed. A few stitches are often required. When the only signs of lymphoma are in the abdomen or the pelvis, laparoscopy (inserting a tube) or surgery may be necessary to obtain a sample of the tumor for examination.

After a tissue sample has been removed, it is examined by a pathologist (a doctor who studies tissues and cells to identify diseases). Pathologists look at the tissue under a microscope and then provide the oncologist with a detailed report. Information obtained from a biopsy indicates the type of lymphoma. If the pathologist's interpretation of the biopsy is uncertain, it should be reviewed by another pathologist who is an expert in lymphoma.

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What will the blood tests tell about the cancer?
Blood tests are performed to determine whether different types of blood cells are normal in number and appearance when viewed under the microscope. These include red blood cells, white blood cells, and platelets. Abnormalities in these blood cells may sometimes be the first sign of lymphoma. Certain blood tests can be used to determine whether a tumor is affecting the liver, kidneys, or other parts of the body. Blood cell abnormalities can also help doctors determine potential treatment choices and predict outcomes. For example, inpatients with NHL, the lactate dehydrogenase (LDH) level is commonly measured because higher levels suggest that the lymphoma may be more aggressive and that more intensive treatment may be needed.

What is a bone marrow examination?
Bone marrow, the spongy material found inside our bones, contains immature cells called stem cells, which develop into three types of cells found in the body: red blood cells that deliver oxygen to all parts of the body and take away the waste product carbon dioxide; white blood cells that protect the body from infection; and platelets that help blood clot. NHL can spread to the bone marrow or start in the bone marrow, therefore doctors may want to examine part of the marrow to see whether cancer is present. Bone marrow is obtained by numbing the skin, tissue, and surface of the bone with a local anesthetic, and then inserting a thin needle into the hip or another large bone and withdrawing a small sample. The procedure can be painful at the moment when the marrow is withdrawn. Patients should talk with their doctor and nurse if they would like a calming medication before the procedure.

What is a cerebrospinal fluid examination?
NHL can sometimes spread to the nervous system. When this occurs, the fluid present around the spinal cord and the brain (known as cerebrospinalfluid ) may be abnormal and contain cancer cells. To determine whether this has occurred, the physician may recommend a test called a spinal tap or a lumbar puncture in which a thin needle is inserted into the lower back under local anesthetic. A small sample of fluid is then removed. Cerebrospinal fluid is examined for chemical content and abnormal cells.

What other tests may be needed?
Doctors may also order other tests to evaluate the health of organs that could be affected by treatments. Examples include echocardiograms or radionucleotide tests to evaluate the heart, and pulmonary function tests to evaluate the lungs.

For more information:
Lymphoma Research Foundation

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