Lymphoma, a cancer of the immune system, occurs in two forms: Hodgkin disease and non-Hodgkin lymphoma, each of which has many subtypes.
According to the Leukemia & Lymphoma Society’s 2014-2015 blood cancer fact sheet, an estimated 761,659 people in the United States either live with, or are in remission from, lymphoma. Of those, 177,526 are living with or are in remission from Hodgkin lymphoma, and 584,133 are living with or are in remission from non-Hodgkin lymphoma.
To get the facts, we spoke to two leading experts: Robert W. Chen, MD, a hematologist oncologist and assistant professor of hematology at the City of Hope cancer center, in Duarte, California; and Frederick Lansigan, MD, a hematologist oncologist and inpatient medical director of cancer services at Dartmouth-Hitchcock Medical Center’s Norris Cotton Cancer Center in Lebanon, New Hampshire. Both facilities are National Cancer Institute-Designated Comprehensive Cancer Centers. Here are 10 essential lymphoma facts that you should know:
1. Doctors don’t know exactly what causes lymphoma, says Dr. Lansigan. But some factors may increase a person’s risk, such as family history of lymphoma or having an autoimmune disease. Organ transplant recipients and people who have been infected with viruses, such as Epstein-Barr, HIV, HTLV-1, and hepatitis C, are also at risk. Exposure to pesticides, fertilizers, and organic solvents (like benzene) are environmental risk factors, says Lansigan.
2. Lymphoma starts in your body’s white cells (lymphocytes). Lymphocytes usually come in two types of cells: B lymphocytes (B cells), which make antibodies that fight infection, and T lymphocytes (T cells), which help kill microbes and tumor cells, and control the immune system. Lymphocytes are found in the various organs and tissues of your immune system, including the lymph nodes (tiny clusters of tissue scattered throughout your body), bone marrow, thymus, spleen, tonsils, and the lymphoid tissue in your digestive tract.
3. No screening tests exist yet for lymphoma. Plus, its symptoms overlap with those of many other conditions, says Dr. Chen. These include fever, chills, soaking night sweats, coughing, trouble breathing, chest pain, weight loss, generalized fatigue, and enlarged lymph nodes. Your doctor will likely perform a physical exam, followed by blood tests, a chest X-ray, and a biopsy to help diagnose lymphoma.
4. Hodgkin disease differs from non-Hodgkin lymphoma in several ways. In Hodgkin disease, people have large, malignant cells known as Reed-Sternberg cells; physicians will look for these cells to confirm a Hodgkin disease diagnosis. Plus, Hodgkin lymphoma has several variations: one is a “classic” type (with four different subtypes) that comprises about 95 percent of all cases; another 5 percent of cases are known as nodular lymphocyte predominant (NLPHD), which is typically a slow-growing form of the disease.
5. Hodgkin lymphoma is a highly curable form of cancer, says Lansigan. The survival rate during the years 2004 to 2010 was nearly 88 percent — more than double the survival rate of 40 percent during 1960 to 1963, according to statistics from the Leukemia & Lymphoma Society. “The latest research has been to tailor the right combination of treatments according to the patient and the stage of his or her cancer,” says Lansigan.
6. Modern oral medications are being used in place of chemo and radiation. “These make treatment easier for many people with lymphoma, especially for those people with chronic lymphomas, who can now more conveniently be treated and go on living their lives,” says Lansigan.
7. There are different forms of non-Hodgkin lymphoma. B-cell lymphoma is the most common form and accounts for about 85 percent of all cases. Most, but not all, non-Hodgkin lymphomas are slow growing; some forms are curable, and all can be treated.
8. New treatments for both non-Hodgkin and Hodgkin lymphoma are in use or are currently being tested. According to Chen, recently approved drugs and drugs currently in clinical trials look very promising, even for people whose cancers have relapsed. Among these is a new class of drugs, called PD-1 and PD-L1 inhibitors, which enhance the patient’s own immune system to fight Hodgkin lymphoma cells. A drug called Imbruvica (ibrutinib) has gotten approval from the Food and Drug Administration for treating certain types of lymphoma. “It is strongly effective and very well-tolerated,” says Chen.
9. If you’re diagnosed with lymphoma, don’t panic. “There are many different subtypes of these diseases, and the prognoses and treatments are different depending on which you have. The most important thing to do is seek a second opinion at a National Cancer Institute-Designated Cancer Center with a lymphoma expert who can identify the specific type of lymphoma you have and choose the best treatment,” says Chen. Some lymphomas do not need to be treated right away, while others require more urgent treatment, notes Lansigan.
10. Treatment is highly effective. “We understand the molecular biology between lymphoma and its subtypes much better today than we did 10 years ago,” says Chen. “Because we can identify specific markers linked to specific subtypes of lymphomas, and use these as targets to kill cancer cells, we are able to make new drugs that are truly targeted. In general, lymphoma treatment is very well-tolerated and highly effective,” he says.