Symptoms and Risk Factors for Lymphoma

Because lymphoma impacts the immune system, the symptoms can mimic the body’s normal response to infection: swollen lymph nodes and fever, for example. It can be difficult to tell whether a patient is suffering from a minor illness or something more serious.

If you’ve found a swollen lymph node, there’s a good chance it was caused by a recent bout of sickness, not by lymphoma. But, if you’re ever concerned about your health, it’s always wise to visit your primary care provider for a check-up.

What are the symptoms of lymphoma?

The most common symptoms of lymphoma include:

• Swollen yet painless lymph nodes that appear in the neck, chest, groin, or underarms
• Fatigue
• Night sweats
• Fever, especially if you can’t identify a cause
• Unintended weight loss or lack of appetite

It’s important to keep in mind that many other conditions, including the common cold or flu, can also produce some of these symptoms.

Less common symptoms include:

• Pain, tingling or numbness, especially in the hands or feet.
• Vision changes, such as blurred vision or blind spots.
• Easy bruising or bleeding, such as nosebleeds or bleeding from the gums.
• Pain or a sensation of fullness below the ribs.
• Itchy skin, red rash, plaques or nodules on the skin.

Risk Factors

Lymphoma can occur in anyone, regardless of their family history. Non-Hodgkin lymphoma develops more frequently in older patients, although some forms of lymphoma (such as Hodgkin lymphoma) occur more frequently in younger individuals.

Certain life experiences or personal characteristics can increase the odds of developing the disease. These include:

• Having a weakened immune system from AIDS or other immune disorders or having taken immunosuppressant drugs following an organ transplant.
• Infection with the Epstein-Barr virus.
• Having an autoimmune disease.
• Recurrent infections with helicobacter pylori bacteria.
• Being exposed to pesticides.

Diagnosis

Determining the exact condition, and what specific type, often takes more than one approach:

The following tests and procedures may be used:

1. Physical exam and history to examine the patient’s past illnesses and treatments, and any signs of disease, such as a swollen spleen, lumps or anything else that seems unusual.
2. Complete blood count (CBC): A sample of blood is drawn to check for the number of red blood cells, white blood cells, and platelets, as well as the amount of hemoglobin (the protein that carries oxygen) and the portion of the sample made up of red blood cells.
3. Peripheral blood smear: This procedure checks a sample of blood for cells that look “hairy,” the number and kinds of white blood cells, and changes in the shape of blood cells.
4. Blood chemistry studies: These test a blood sample for the amounts of certain substances released into the blood by organs and tissues in the body to look for signs of disease.
5. Bone marrow biopsy to aspirate bone marrow, blood and a small piece of bone from the hipbone or breastbone to look for microscopic signs of cancer.
6. Immunophenotyping: A laboratory test in which the antigens or markers on the surface of a blood or bone marrow cell are checked to see what type of cell it is. This test helps diagnose the specific type of leukemia by comparing the cancer cells to normal cells of the immune system.
7. Flow cytometry: This laboratory test measures the number of cells in a sample, the percentage of live cells and certain characteristics of cells, such as size, shape and the presence of tumor markers on the cell surface. Measurements are based on how the light-sensitive dye reacts to the light.
8. Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.
9. PET scan (positron emission tomography scan): This procedure finds malignant tumor cells in the body by using a small amount of radioactive glucose (sugar) injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. This helps with staging the lymphoma.
10. CT scan: A procedure that makes a series of detailed pictures of areas inside the body, which are taken from different angles and use contrast dye to look for things like swollen lymph nodes or a swollen spleen.

Siteman has an active lymphoma banking program. Patients volunteer to participate in the bank by donating extra lymphoma tissue taken during the diagnosis procedure so it can be studied to improve treatment of future lymphoma patients. The lymphoma practice at Siteman sees hundreds of cases and is engaged in active research to bring even more effective treatments to practice.

Staging of Lymphoma

After lymphoma has been diagnosed, tests are done to find out the status of the disease. Staging defines how the cancer has spread within the lymph system and varies with the type of lymphoma. In addition to staging, the lymphoma may be designated primary or recurrent, meaning it has come back after treatment.

Staging is basically the same for non-Hodgkin and Hodgkin lymphomas. Stages are ranked 1 – 4 for extent of the disease and A, E, S. In A stages, the patient has no symptoms and it was discovered on imaging. E stage means the cancer is found in an area or organ other than the lymph nodes. S stage has the cancer in the spleen. Cutaneous lymphoma, because it involves the skin, uses a slightly different staging system.

Stages can then be grouped for treatment into the categories based on the number of risk factors of: early favorable or unfavorable (stage 1 or 2), and late favorable or unfavorable (stages 3 or 4).

Prognosis

The prognosis (chance of recovery) and treatment options depend mainly on the following:

• The type and sub-type of lymphoma.
• Whether it is indolent, in which case, 20 percent of patients never require treatment.
• Whether it is highly aggressive, in which case, chemotherapy can produce a cure.

Other factors taken into account include:

• The age of the patient.
• The extent of the spread of the cancer within the lymph system or to other organs.
• Whether there are certain changes in the genes.
• Whether the cancer has been treated before or has come back.