Diagnosing and treating non-Hodgkin and Hodgkin lymphomas

Lymphomas are cancers of the lymphatic system and they are the most common blood cancer in the UK. This article discusses the signs and symptoms of lymphomas as well as treatments and post-treatment care.


What are lymphomas?

Lymphomas are cancers of the lymphatic system. When a person has lymphoma, some of their lymphocytes are no longer subject to the normal regulations within the body and are growing ‘out of control’. These abnormal lymphocytes can collect in the lymph nodes, which then enlarge to form tumours. Lymphoma can affect lymph nodes in all parts of the body as well as other organs, such as the spleen or the bone marrow. Although lymphoma is a disease of the lymphatic system, it can also happen in other areas of the body. For example, lymphoma can affect the stomach, the skin, or the liver and can affect the function of the involved organ.

There are more than 50 related cancers of the lymphatic system, although they are broadly categorised as either a Hodgkin lymphoma or a non-Hodgkin lymphoma.

It is estimated that more than 75,000 people in the UK are living with lymphoma and over approximately 12,000 new cases of lymphoma are diagnosed in the UK each year. It is the most common blood cancer and the fifth most frequently diagnosed cancer overall. Lymphomas vary greatly in how they present and are treated and require expect diagnosis and management. Some of the most common types of lymphoma such as Diffuse large B cell lymphoma and Hodgkin lymphoma are highly curable and most lymphoma are amenable to treatment that improves survival.

What are the symptoms of lymphoma?

Lymphoma can cause a wide range of symptoms or very few symptoms and some people have no symptoms at all. The most common symptom of lymphoma is a painless lump or swelling, most commonly in the neck, armpit or groin. Other common symptoms include:

  • excessive sweating, especially at night
  • fevers
  • unexplained loss of weight
  • unusual tiredness
  • a cough or breathlessness
  • a persistent itch
  • abdominal pain or diarrhoea

How is lymphoma diagnosed?

Lymphoma can only be diagnosed after a biopsy and this is a very important test.

A biopsy means removing a piece of tissue containing the abnormal cells to look at them under a microscope. In most cases, the whole lymph node or a substantial part of it is removed. This usually involves either a local or general anaesthetic and a brief stay in hospital. Experts prefer not to have a needle biopsy unless a biopsy from an accessible lymph node is not possible as getting bigger pieces of tissue makes the correct diagnosis easier. The results of the biopsy confirm the diagnosis of lymphoma and most importantly what type of lymphoma it is.

What does the staging system for lymphoma mean?

After making the diagnosis the next step is to find out what parts of your body are affected by lymphoma and this process is known as staging, which is a necessary part of planning treatment. Staging involves a number of other tests which usually include blood test, CT scans and bone marrow biopsies.

Blood tests will be taken to check the number of red cells, white cells and platelets in your blood, how well the liver and kidneys are working and some other blood tests that help in guiding prognosis and treatment.

A CT scan and / or PET CT scan will be performed. CT scans give a picture of the whole body in cross section from top to bottom and enable a more complete picture of which areas of the body are involved with the lymphoma. PET scans give more detailed information about the cancer cell activity. They measure the rate at which cells take up and process a radioactive form of sugar. This can help doctors to distinguish between cancerous and non-cancerous cells. You may hear this referred to as PET/CT scan which refers to new machines that combine a PET scan with a CT scan.
A bone marrow biopsy is commonly carried out to see if there is involvement of the bone marrow with lymphoma cells. You may hear your doctors refer to it as a bone marrow ‘aspirate’ or bone marrow ‘trephine’. This procedure involves taking a sample of bone marrow through a large needle. The needle is usually inserted through your skin into your hip bone – or the pelvis – using a local anaesthetic.

A summary of treatment approaches for lymphoma

Lymphomas are among the most sensitive cancers to treatment which usually includes chemotherapy, immunotherapy with antibodies and radiotherapy. Chemotherapy literally means treatment with chemicals or drugs. Drugs used in cancer treatment are called ‘cytotoxic’ drugs because they are toxic to cells. Cytotoxic drugs work by interrupting the life cycle of the lymphoma cell. There are many different cytotoxic drugs in use, and they work in different ways. Chemotherapy for lymphoma will usually be a combination of several different drugs and more recently is combined with antibodies, which are special proteins that specifically target the cancer cells. Each of the drugs works in a different way to kill the lymphoma cell. In combination they are more effective than on their own. They are given intravenously and as tablets. Sometimes you will hear the combinations of drugs referred to in abbreviations, for example R-CHOP, R-CVP or ABVD. Chemotherapy is generally given over a period of several months. It is usually given as an outpatient over a few hours however sometimes it may be necessary to stay in hospital. Some chemotherapy can be given in tablet form. Anti-sickness tablets are also given to prevent sickness and nausea at home and these have improved the quality of care significantly over the last few years. For some patients with localised disease or bulky lymphomas, radiotherapy is used.

What post-treatment follow-up takes place for lymphoma?

A post-treatment scan is arranged to assess response to therapy. This is usually the same sort of scan as at the initial diagnosis, i.e. a CT scan or PET / CT scan. Further scans are not routinely performed in those patients that achieve a complete remission but may be performed in those who have some residual disease present at the end of treatment to monitor subsequent progress.

For further information please see the Lymphoma Association.

For further information on the author of this article, Consultant Clinical Oncologist, Prof Tim Illidge, please click here.
Relating to the abdomen, which is the region of the body between the chest and the pelvis. Full medical glossary
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