Lymphoma

Lymphoma is cancer in your lymphatic system — the network of tissues, vessels and organs that help your body fight infection. Lymphoma is considered a blood cancer because the condition starts in white blood cells (lymphocytes), usually found in your lymphatic system.

There are two main types — Hodgkin lymphoma and non-Hodgkin lymphoma — and more than 70 subtypes. Non-Hodgkin lymphoma is much more common than Hodgkin lymphoma.

Like any form of cancer, lymphoma is a serious condition. If you’re diagnosed, your prognosis depends on factors like the type, the cancer stage and whether it’s aggressive (fast-growing) or indolent (slow-growing).

But in general, healthcare providers consider lymphoma to be one of the most treatable cancers. Often, treatment can put lymphoma into remission or even cure it.

Symptoms of lymphoma

Symptoms common to Hodgkin lymphoma and non-Hodgkin lymphoma include:

• Painless swelling of the lymph nodes in your neck, armpits or groin 
• Persistent fatigue
• Shortness of breath
• Chest pain
• Belly pain or swelling
• Unexplained weight loss
• Fever (that stays above 103 degrees Fahrenheit or 39.5 degrees Celsius for more than two days)
• Drenching night sweats

Your healthcare provider may refer to weight loss, fever and night sweats as “B symptoms.” Providers often look for them when diagnosing and staging lymphoma. It’s important to remember, though, that not everyone with these symptoms has lymphoma. See a provider so you know for sure.

What are the first signs of lymphoma?

The first sign is usually swelling in your lymph nodes. This may feel like painless lumps in your neck, underarm or groin. But you can have lymphoma for years without having symptoms. Sometimes, people learn they have it because routine imaging (like an X-ray or CT scan done for other reasons) identified signs of it.

Lymphoma causes

Lymphoma happens when the white blood cells in your lymphatic system change (mutate) into cancer cells that don’t die. Like most cancers, most of the genetic mutations that cause lymphoma happen spontaneously, without a clear cause.

Lymphoma usually starts in your lymph nodes. But it can also develop in lymph system organs, like your thymus or spleen. “Extranodal” lymphoma can start outside of lymph nodes in your lymphatic system, like your skin or any other organ.

Risk factors

Medical experts have found several factors that may increase your risk of developing lymphoma, including:

• A history of lymphoma in your biological family, especially involving a first-degree relative (parent, sibling or child)
• Infections, including HIV, Epstein-Barr virus, Hepatitis C and H. pylori
• Immune system deficiencies, like taking immunosuppressant medicines after an organ transplant
• Autoimmune diseases, including inflammatory bowel disease, rheumatoid arthritis, and other conditions that cause long-term inflammation and require immunosuppressant medicines as treatment

How doctors diagnose this condition

Your healthcare provider will ask about your symptoms and examine you. They’ll check for signs of lymphoma, like swollen lymph nodes.

Tests providers use to diagnose lymphoma include:

• Blood tests: These tests check for signs of disease, like abnormal blood cells or infections. They’ll check for high levels of lactate dehydrogenase (LDH), which can happen in lymphoma.
• Imaging tests: These tests can show signs of cancer cells throughout your body. You may need a CT scan, MRI, PET scan or combination PET-CT scan.
• Biopsy: Your provider may remove lymph node tissue to check for lymphoma cells. You may need a bone marrow biopsy and/or aspiration to see if lymphoma cells are in your blood.

How is lymphoma treated?

Treatments vary based on type. For example, if you have a slow-growing lymphoma, your healthcare provider may recommend active surveillance (watchful waiting) before starting treatment.

In active surveillance, providers monitor your overall health and check for signs of lymphoma. They’ll recommend treatment only when the benefits outweigh the risks of treatment side effects. It’s safe to do this because delaying treatment does not lower the chances that the treatment will be effective. But waiting can postpone the side effects of treatment.

Common lymphoma treatments include:

• Chemotherapy
• Radiation therapy
• Targeted therapies
• Immunotherapies, including CAR T-cell therapy and a newer class of medications called bispecific antibodies
• Stem cell (bone marrow) transplant
• Clinical trials (to test the safety and effectiveness of new treatments)

Your provider may also recommend palliative care. This treatment focuses on helping you manage symptoms and treatment side effects. Palliative care treatment may include medication, activities to help manage stress, and emotional and spiritual support.

When should I see my healthcare provider?

Schedule a visit with your provider if you have lymphoma symptoms that last for more than a couple of weeks. Reach out if your symptoms are getting worse fast.

Many symptoms of this condition are like those of other, less serious diseases. Having these symptoms doesn’t mean that you have lymphoma. But you should consider talking to a provider whenever you have changes in your body that don’t improve within a few weeks.

​What can I expect if I have lymphoma?

What you can expect after treatment, or your prognosis, depends on your unique situation. For example, it depends on the type of lymphoma, the cancer stage, your age and your overall health. That said, treatment often puts lymphoma into remission or cures it. Remission means you don’t have lymphoma symptoms and tests don’t detect lymphoma.

Lymphoma in remission can come back (recur). If you have lymphoma in remission, you’ll have regular follow-up appointments with your healthcare provider. They may do tests to check for signs of recurrence. You may need more treatment if it comes back.

Sometimes, lymphoma is a long-term condition that your provider will help you manage. This is especially the case with indolent (slow-growing) lymphomas. You may need continuous or occasional treatment throughout your life.

What are the survival rates for lymphoma?

The five-year relative survival rate for Hodgkin lymphoma is 89%. This means that just under 9 out of 10 people with this disease are alive five years after their diagnosis. The rate is 74% for people with non-Hodgkin lymphoma. 

It’s important to remember, though, that survival rates are estimates based on the experiences of groups of people with the same disease. They can’t predict how long a person may live with lymphoma.

If you have questions about how your diagnosis might impact your survival, ask your healthcare provider to explain what you can expect.

​Is there anything I can do to feel better?

A lymphoma diagnosis often means living with this condition over the long term. This is generally good news. But living with a chronic disease isn’t easy. This is why it’s important to prepare for life with lymphoma.

For example, you might benefit from creating a plan to see you through initial treatment and any follow-ups. Here are some things to consider as you develop your plan:

• What support will you need from loved ones?
• What foods will maintain your strength during treatment?
• What activities will help keep you feeling healthy?
• How will you manage stress?
• Are there services, programs or support groups that you can participate in?

Your healthcare provider can help guide you as you plan.