Lymph node cancer: (non-)Hodgkin lymphoma

What is lymph node cancer?

Lymph node cancer is a cancer that originates in the lymphatic system. The lymphatic system is an extensive network of vessels that runs throughout our body. It transports waste products from the tissues to the bloodstream via lymphatic fluid. These are then excreted via the liver and kidneys.

Lymph nodes are located where several lymphatic vessels cross each other, for example in the neck, armpits and groin. Lymph nodes play an important role in purifying our body and our immune system: they contain filter tissue and a large number of lymphocytes, a specific type of white blood cells. These cells make germs, such as bacteria and viruses, harmless.

How does lymphoma develop?

When lymphocytes develop abnormally and proliferate, lymphoma develops. These malignant lymphocytes (malignant lymphomas) no longer function properly. This reduces your defenses against germs and makes you susceptible to infections.
Most commonly, lymphoma starts in the lymph nodes or in the bone marrow. Lymphomas can also spread through the lymphatic fluid and bloodstream to other sites in the lymphatic system and lodge in other organs, including the spleen, liver, brain, and/or lungs.

How often does it occur?

Every year, approximately 2850 Dutch people are diagnosed with lymphoma. Hodgkin lymphoma (HL) is involved in about 15 percent of cases. This is about 350 people. Usually they are between the ages of 18 and 35 or older than 50 years. HL is 1.5 times more common in men than in women.

Roughly 85 percent of malignant lymphomas are non-Hodgkin’s lymphomas (NHL). It affects about 2,500 people, mainly older people with an average age of 60-65 years. NHL is slightly more common in men than in women.

Hodgkin or non-Hodgkin?

An important difference between these two main forms of lymphoma is in which type of lymphocyte the disease arises. There are four types. In HL this happens in one specific cell. These are abnormally large. They are called ‘Reed-Sternberg’ cells.
No Reed-Sternberg cells are found in NHL. In addition, different types of lymphocytes can derail. There are more than 30 types of NHL. Each type of lymphoma has a different disease course and responds differently to treatment. The prognosis in HL is much better than in NHL.

Cause and risk factors

It is still unclear exactly how lymphoma develops. It is well known that there are several risk factors. For example, the risk of lymphoma is greater in people with a long-term reduced resistance, such as in AIDS patients or when using drugs that suppress the immune system, for example after a transplant. Furthermore, certain viral infections seem to be of influence, such as the Epstein-Barr virus, which also causes mononucleosis.

What are the symptoms?

The first symptom of lymph node cancer is usually a painless, permanent swelling of the lymph nodes in the groin, armpits and/or neck. In addition, the disease often gives vague, general complaints, such as unexplained fatigue and significant weight loss or fever attacks and night sweats.

Other possible symptoms depend on the location where a lymphoma originated, for example:

• Shortness of breath (with a large lymphoma between the lungs).
• Stomach or abdominal pain (in case of lymphoma in the stomach, spleen or intestines).
• Confusion (in lymphoma in the brain).

However, it is also possible that lymphoma does not cause any symptoms.

Diagnosis

See your doctor if you have symptoms related to lymphoma. At the practice you will first be physically examined. If the doctor shares your suspicion, a blood test will follow. This may indicate that further investigation is required.

A lymph node biopsy is required to diagnose lymphoma. In this examination, a piece of tissue from a suspected lymph node or the entire lymph node is removed and examined. Other possible investigations include:

• x-ray examination
• ENT research
• PET CT scan. This examination can determine where the lymphoma is and how far the disease has spread.

The treatment of lymph node cancer

The treatment of lymphoma can be aimed at a cure, but also at slowing down the disease and reducing the symptoms. Which of the treatment options below are possible, how long the treatment lasts and what the chance of a cure is, depends on the type of lymphoma, where it started, the stage of the disease and the condition of the patient.

• Chemotherapy. With this form of treatment you are given medicines that prevent the growth of cancer cells or destroy the cells.
• Radiation (radiation therapy). Ionizing rays destroy the cancer cells.
• immunotherapy. This relatively new treatment method uses drugs to ensure that the immune system is better able to destroy the cancer cells. There are roughly four types of immunotherapy. Whether immunotherapy can be used and, if so, which type, depends on various factors. The reports about this form of treatment are promising.
• Stem cell transplant. In stem cell transplantation, the patient receives stem cells from himself or from a donor through an IV. Stem cells are cells that can develop into cells that the body needs to repair damaged cells. This is necessary when healthy bone marrow has been destroyed by chemotherapy, so that there are no more healthy stem cells.
• Pain relief.

Prognosis

Chemotherapy today gives very good results in HL. The chance of a cure or long-term survival is more than 80 percent with a slow-growing lymphoma that is discovered at an early stage.

NHL is very often treated with immunochemotherapy, a combination of chemotherapy and immunotherapy. The chance of recovering from NHL is smaller than with HL. For example, with a slow-growing form of NHL in stage I and II, the chance of a cure is 50-60 percent. However, usually the condition is only discovered at a later stage. With treatment, the lymphomas can usually be reduced well, but as a rule the disease comes back after a while. More than half of all NH lymphomas are aggressive. The chance of surviving for a long time varies greatly. This is between 20 and more than 80 percent. In extensive aggressive lymphoma, life expectancy is poor.