T-Cell Lymphoma

T-cell lymphoma refers to rare blood cancers that begin in the T lymphocytes (T cells), a type of white blood cell. These cells support your immune system. They protect your body from cancer cells, bacteria, viruses and other intruders.

These blood cancers are rare forms of non-Hodgkin lymphoma. They often start in your lymph nodes and spleen. But it may also begin in places like your bone marrow, liver, gastrointestinal tract and skin. They may grow very quickly or more slowly.

Condition types

Aggressive T-cell lymphoma

These fast-growing forms of the condition may cause symptoms that worsen quickly. Types include:

• Adult T-cell lymphoma/leukemia (human T-cell lymphotropic virus type I positive): This form can affect your skin and bones.
• Anaplastic large cell lymphoma (ALCL): ALCL may affect your lymph nodes and other organs. Disease subtypes affect your skin or your breasts.
• Angioimmunoblastic T-cell lymphoma (AITL): AITL is a fast-growing disease that can spread to your bone marrow, liver or lungs.
• Enteropathy-associated T-cell lymphoma: This type can form in your colon, small intestine or stomach. This can be associated with celiac disease.
• Follicular helper T-cell lymphoma (FHTCL): This is an aggressive lymphoma that involves the lymph nodes and other organs.
• Monomorphic epitheliotropic T-cell lymphoma (MEITL): This involves your colon, small intestine or other parts of the gastrointestinal tract. This is more common in those of Asian and Caribbean descent and isn’t associated with celiac disease.
• Hepatosplenic gamma/delta T-cell lymphoma: This type starts in your liver and spleen.
• Nasal NK/T-cell lymphoma: NK cells (natural killer cells) destroy damaged cells. This lymphoma often begins in your nose, sinus or oropharyngeal areas, but can also affect skin and other organs.
• Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS): This category includes conditions that don’t fit into other subtypes.

Indolent T-cell lymphoma

This group includes less aggressive subtypes:

• Cutaneous T-cell lymphoma: This is a group of blood cancers that affect your skin. There are many types of CTCL. The most common types are mycosis fungoides and Sézary syndrome.
• Subcutaneous panniculitis-like T-cell lymphoma: This form affects tissues under your skin.

Symptoms of T-cell lymphoma

Symptoms vary depending on where the lymphoma starts. Some common symptoms include:

• Heavy night sweats
• Pain in your belly, bones or chest
• Persistent fatigue
• Rash
• Swollen lymph nodes in your neck, armpits or groin
• Unexplained fever
• Unexplained weight loss

Causes of T-cell lymphoma

The condition happens when genetic mutations (changes) turn normal T cells into abnormal cells that multiply uncontrollably. You don’t inherit these changes. Healthcare providers don’t know the exact cause of T-cell lymphoma, but several factors increase your risk.

Risk factors

Factors that increase your risk include:

• Your age: Most cases occur in people over 55.
• Your sex: Males are more likely to develop this condition.
• Your race: It’s more common in people who are Asian or white than in people who are Black or Native American.
• Your health: Having certain autoimmune diseases or viral infections.
• Your lifestyle: Long-term use of or exposure to cancer-causing substances, like workplace chemicals or ultraviolet light.

How doctors diagnose this condition

Your oncologist may use blood tests, imaging tests and biopsies to diagnose the disease:

• Blood tests: Common blood tests include complete blood count (CBC) with differential, complete metabolic panel (CMP) and lactate dehydrogenase test. They may do tests to check for viral infections that can increase your risk. These include HIV, human T lymphotropic virus (HTLV-1) and the Epstein-Barr virus.
• Imaging tests: These tests create images of the inside of your body. They may include a CT scan, MRI test or PET scan.
• Biopsies: Your oncologist gets a tissue sample from your lymph nodes, mass or bone marrow. You may have a bone marrow aspiration and biopsy, or a lymph node or mass biopsy. A medical pathologist will examine the tissue or bone marrow sample under a microscope. They may do other tests to identify the type of T-cell lymphoma you have.

Staging T-cell lymphoma

Oncologists use cancer staging systems to plan your treatment. T-cell lymphoma stages are:

• Stage I: Lymphoma is in one lymph node area or organ, like your thymus, spleen and bone marrow.
• Stage II: Lymphoma is in two or more groups of lymph nodes on the same side of your diaphragm.
• Stage III: Lymphoma is in lymph nodes on both sides of your diaphragm, above or below your diaphragm or in your spleen.
• Stage IV: Lymphoma is widely spread in at least one organ outside your lymphatic system, like your bone marrow, liver or lung.

Your oncologist may use a different staging system if you have cutaneous T-cell lymphoma. This disease’s growth pattern, or how it spreads, is different from other forms of lymphoma.

How is T-cell lymphoma treated?

Your treatment will depend on your situation. Treatment options include:

• Chemotherapy: Uses drugs to kill cancer cells. It’s the main treatment for non-Hodgkin lymphomas.
• Immunotherapy: Immunotherapy targets proteins on your cancer cells and kills them. Your oncologist may call it biologic therapy. Monoclonal antibodies are a common treatment.
• Radiation therapy: Uses external-beam radiation therapy to kill cancer cells.
• Stem cell transplant: This procedure creates a new immune system to fight cancer. You may have an autologous or allogeneic stem cell transplant. An autologous transplant uses your own healthy cells. An allogeneic one uses matched donor stem cells.

You may want to consider clinical trials. Medical researchers find out if proposed treatments are safe and effective.

When should I seek care?

Talk to a healthcare provider if you have symptoms like fatigue, fever or swollen lymph nodes that don’t go away. Contact your oncologist if you have T-cell lymphoma and your symptoms get worse.

Is T-cell lymphoma curable?

Treatment may put some types into remission. Remission means you don’t have symptoms, and tests don’t detect signs of disease. But T-cell lymphomas can come back.

T-cell lymphoma survival rates

T-cell lymphomas are a group of cancers with different survival rates. Cancer survival rates estimate the percentage of people with a specific cancer who are alive one to five years after their diagnoses. Ask your oncologist to explain how survival rate estimates factor into what you can expect.

Is there anything I can do to feel better?

There are several things you can do. Consider self-care activities that will help you manage stress, like spending time outdoors or practicing yoga. And take time to care for your basic needs:

• Eat well: Focus on foods that boost your energy levels and support your immune system.
• Rest: Treatments like chemotherapy can make you feel exhausted. Resist the urge to power through your day. Rest when you need to, not just when you can.
• Consider palliative care: This is specialized care that offers everything from ways to ease symptoms and treatment side effects to connecting you with support groups and other resources.

A cancer diagnosis may make you feel helpless and as if you’ve lost control of your health and your body. Making time for self-care may help you regain a sense of control.