About Lymphoma

What is Lymphoma?

Lymphoma is cancer of the lymphocytes (the white blood cells that help to fight infection).

Lymphocytes are found in a liquid called lymph which travels throughout our body in the lymphatic system (a series of tubes, nodes and organs such as the spleen and thymus that are part of our immune system).Because the lymphatic system exists throughout the body and involves many organs, there may be cancerous tumours in many parts of the body when someone has lymphoma. There are two main categories of lymphoma: Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL).

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What is cancer?

Cancer is a disease of the body’s cells. Cells make up every part of the human body including our skin, nails, hair, lymph nodes, blood and body organs. Normally cells grow and multiply in a controlled way, known as cell division and die in an orderly way. Cell division is a normal part of a cell’s life cycle and is regulated by our genes. Genes are segments (or parts) of DNA. DNA determines a person’s unique characteristics and how their body functions.

Under healthy conditions, the process of cell division is tightly controlled. There are many checks and balances in place. The definition of cancer is the abnormal, uncontrolled growth of cells.

Why does cancer occur?

This is a question that scientists have been trying to answer for a long time. Cancer occurs when normal cells become damaged. The abnormal cells then grow in an uncontrolled way. These abnormal cells can damage or invade the surrounding tissues. They can also spread to other parts of the body, causing further damage.

One main reason that cancer may develop is due to genetic errors. There are many different genes present in all cells. Each gene controls a different function in the body and controls the cell division. When errors occur in the genes, they are called genetic mutations. Genetic mutations result in an abnormal cell. The abnormal cell is then unable to do the function that it is made to do.

The role that the cells of the immune system are to constantly move around the body. The immune cells identify and destroy these abnormal cells. When there is a genetic abnormality of the cells in the immune system, these cells do not work properly. If the genetic mutation is too severe, these abnormal cells remain. These mutated cells continue to grow at an uncontrolled rate. As these abnormal cells divide, they create their own blood supply and form a solid mass called a tumour. A cancerous tumour will continue to grow at an uncontrolled rate. They will eventually cause harm to other areas of the body.

What is lymphoma?

Lymphoma is the 6th most common cancer in adult men and women in Australia. Lymphoma can affect people of all ages, however it does increase in incidence in older ages. Lymphoma is the most common cancer in young people aged 15-29 years. Lymphoma is the 3rd most common cancer in children aged 0-14 years. It affects around 6,500 Australians each year.

There are over 80 different types of lymphoma. They are all grouped under the one name. Some types of lymphoma are more common, and some types are very rare.

Lymphoma is a type of blood cancer that begins in cells called lymphocytes. Lymphocytes are our infection-fighting cells in our immune system. Lymphoma is the name given to a group of cancers of the lymphatic system. The lymphatic system is made up of vessels and organs throughout the body. These include lymph nodes, the spleen, the thymus, bone marrow and other parts of the body.

Lymphoma occurs when lymphocytes, which are a type of white blood cell, gain a DNA mutation. The role of lymphocytes is to fight infection, as part of the body’s immune system. There are B-lymphocytes (B-cells) and T-lymphocytes (T-cells) that play different roles. The lymphoma cells then divide and grow uncontrollably or do not die when they should.

Lymphoma has a build-up of abnormal lymphocytes. These cause lumps or swelling in your lymph nodes. The swelling can often be felt in your armpits, neck or groin, but can be located in most tissues of the body.

There are two main types of lymphoma. They are called Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Lymphomas are further divided into:

  • Indolent (slow growing) lymphoma develop over months to years
  • Aggressive (fast-growing) lymphoma develop over weeks to months
    B-cell lymphoma are abnormal B-cell lymphocytes & are the most common. B-cell lymphomas account for around 85% of all lymphomas
  • T-cell lymphoma are abnormal T-cell lymphocytes. T-cell lymphomas account for around 15% of all lymphomas. All NHL are T-cell lymphomas.

World Health Organization (WHO) lymphoid classification

The World Health Organisation (WHO) was formed in 1948. WHO works worldwide to promote health, to keep the world safe, and serve the vulnerable. WHO has brought together the world’s top health experts to produce international reference material and to make recommendations to bring better health to people all over the world.

In 2016 the WHO re-classified the lymphoid neoplasms (cancers). The classifications maintain the goals of helping identify homogeneous (of same kind) groups of well-defined entities and facilitating the recognition of uncommon diseases that need further classification. The next version will be launched later in 2020, where it is expected that there will be more subtypes recognised.

As researchers continue to understand how lymphomas are developed, more will be recognised. This helps researchers to find better treatments.

There are over 80 subtypes of lymphoma that all develop from abnormal B lymphocytes and T lymphocytes.

The WHO breaks them down into:

  • Mature B-cell neoplasms
  • Mature T and NK neoplasms
  • Hodgkin lymphoma
  • Posttransplant lymphoproliferative disorders
  • Histiocytic and dendritic cell neoplasms

Hodgkin Lymphoma

Hodgkin lymphoma (HL) was named after the doctor who first described the condition named Dr Thomas Hodgkin (in 1832). In Hodgkin lymphoma, a particular type of abnormal cell, that is unusually large, malignant (cancerous) mature B-cell called Reed-Sternberg cells (named after the scientists who discovered it), can be seen under the microscope in tissue samples.

All lymphomas that were discovered after Hodgkin lymphoma were called a ‘non-Hodgkin lymphoma’. NHL is a group of blood cancers that includes all types of lymphoma except Hodgkin lymphomas. NHLs do not contain the Reed-Sternberg cell. NHL account for 90% of lymphomas and over 70 different subtypes. All subtypes of lymphoma behave and are treated differently. It is important to know what you subtype is.

Non-Hodgkin lymphomas (NHL) are classified into either B-cell lymphomas or T-cell lymphomas. All T-cell lymphomas are non-Hodgkin lymphomas. These abnormal lymphocytes form collections of cancer cells called tumours, in lymph nodes and other parts of the body.

Non-Hodgkin lymphoma

There are over 70 different subtypes of non-Hodgkin lymphoma (NHL). There are some subtypes that are more common, others that are less common (rare) and some are very rare. All subtypes of NHL are treated and managed differently.

NHL can be divided into different groups, depending on how they have developed or how they behave. It is important for the doctor to determine the lymphoma subtype to work out how they may treat or manage the lymphoma.

NHL can be divided into the following categories:

  • B-cell lymphoma
  • T-cell lymphoma
  • Indolent (slow growing) lymphoma
  • Aggressive (fast growing) lymphoma

 

B-cell non-Hodgkin lymphomas develop from B-cell lymphocytes. These are the most common type, accounting for around 85% of all lymphomas (including Hodgkin lymphoma).

T-cell non-Hodgkin lymphomas develop from T-cell lymphocytes. These lymphomas account for around 15% of all lymphomas. All T-cell lymphomas are NHL.
Indolent non-Hodgkin lymphoma are slow-growing types of lymphomas. These mostly develop over months to years. Many people may live with these lymphomas for many before they are diagnosed. Indolent NHL are mostly incurable, where people may have long periods of time being monitored. These lymphomas are considered like a chronic medical condition.

Aggressive non-Hodgkin lymphomas are fast-growing types of lymphoma. These mostly develop over weeks to months. Most people have symptoms that develop quickly. Most people will need to start treatment soon after diagnosis. These lymphomas are potentially curable.

B-cell non-Hodgkin lymphoma (NHL)

T-cell non-Hodgkin lymphoma (NHL)

Aggressive and Indolent lymphoma

Indolent lymphoma

Indolent lymphoma is a slow-growing type of non-Hodgkin lymphoma (NHL) that is considered incurable most of the time. It is also called low-grade lymphoma. Indolent lymphomas tend to have fewer signs and symptoms when first diagnosed. Indolent lymphomas represent about 40 percent of all non-Hodgkin lymphomas

The average age of onset is usually about 60 years of age. It affects both men and women.

Most common types of indolent lymphoma include:

  • Follicular lymphoma (FL)
  • Cutaneous T-cell lymphoma (CTCL)
  • Waldenstrom’s Macroglobulinemia (WM)
  • Chronic lymphocytic leukaemia (CLL) and small cell lymphocytic lymphoma (SLL)
  • Marginal zone lymphoma (MZL)

Early stage indolent lymphoma may successfully be treated and stay in remission for a long time. Some people do not need treatment straight away. They are put on ‘watch and wait’. People with indolent lymphoma may have long periods when they are well and do not require active treatment.

Aggressive lymphoma

Aggressive lymphoma is a fast-growing lymphoma and tends to spread quickly. It is also called high-grade lymphoma. Approximately 60 percent of non-Hodgkin lymphoma have aggressive disease.

Most common types of aggressive lymphoma include:

  • Anaplastic large-cell lymphoma
  • Burkitt lymphoma
  • Primary Central nervous system lymphoma
  • Diffuse large B-cell lymphoma (DLBCL)
  • Mantle cell lymphoma (MCL)
  • Peripheral T-cell lymphoma (PTCL)

Most high-grade lymphomas respond very well to treatment and stay in remission for a long period of time.

What are the different types of blood cancer?

Blood cancers are also known as haematological cancers. There are three main types of blood cancers, called lymphoma, leukaemia, and myeloma. There are about 15000 Australians diagnosed each year with blood cancers.

Lymphoma

Lymphoma is a type of blood cancer. It develops when the white blood cells called lymphocytes grow out of control. These abnormal cells develop in the lymph nodes or in the organs of the lymphatic system. There are two main types of lymphoma. Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL).

Chronic lymphocytic leukaemia (CLL) and Hairy cell leukaemia were once known as leukaemia. They involve abnormal B-lymphocytes, they have been reclassified as a lymphoid (lymphoma) cancer.

Leukaemia

Leukaemia affects the white blood cells including the lymphocytes. The abnormal cells develop in the bone marrow or bloodstream. With leukaemia, blood cells are not produced the way they should be. There may be too many, too few, or blood cells that do not work as they should. Leukaemia can be classified by the type of white cell affected, either a myeloid cell or a lymphatic cell. The disease progresses (acute or chronic). Acute or chronic refer to how fast it progresses.

For further information please see the Leukemia Foundation Website.

Myeloma

Myeloma affects a white blood cell called a plasma cell. The abnormal cells develop in the bone marrow. Plasma cells form part of the immune system. Normal plasma cells produce antibodies, also called immunoglobulins, to help fight infection. In myeloma, the abnormal plasma cells make only one type of antibody known as paraprotein. This protein has no useful function. In myeloma too many abnormal plasma cells collect in your bone marrow. Your body may then find it hard to fight infection.

For further information please see the Myeloma Australia Website.

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