Symptoms and Treatment Methods of Lymph (Lymphoma) Cancer

The lymphatic system, also known as the lymph or lymphoid system, is associated with both the circulatory and immune systems. This system, which consists of lymph nodes and a network of lymph vessels, circulates a fluid called lymph, made up of blood plasma and white blood cells. These white blood cells play a role in immunity by fighting disease-causing agents. Lymph nodes act as filters, cleaning out foreign disease agents and providing protection against infections and other diseases. Lymphoma, or lymph cancer, occurs due to the uncontrolled growth and proliferation of lymphocytes, the primary cells of the lymphatic system. This disease, which shows varying symptoms depending on the area of involvement, is most commonly found in the lymph nodes.

What is Lymph (Lymphoma) Cancer?

Lymphoma is the most common type of hematological cancer, with a wide variety of clinical findings and distinct histological and biological characteristics. These cancers often develop in lymph nodes, where lymph vessels converge, or in other tissues of the lymphatic system and are identified by concentrated formations in an organ. Lymphomas are resilient tumors of the immune system. Although lymphoma primarily emerges in the lymph nodes, cancer cells can also be found in the spleen, thymus gland, and Peyer’s patches, which are part of the lymphatic system.

Lymphoma cancer is more commonly observed in men than in women. It is also known that the incidence of the disease increases with age. Additionally, the frequency of lymphoma varies according to geographical regions and races.

Lymphomas are traditionally divided into two main types: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). These lymphomas are further classified within themselves. Hodgkin lymphoma has classic and non-classic forms, while non-Hodgkin lymphoma includes varieties originating from B cells, T cells, and natural killer cells. Non-Hodgkin lymphoma accounts for 90% of lymphoma cases, whereas Hodgkin lymphoma comprises 10%. Hodgkin lymphoma is a type of lymph cancer that originates from white blood cells, named after Thomas Hodgkin, who first identified the disease. The incidence of Hodgkin lymphoma increases steadily from the age of 10, peaking in the 20s, and has a second peak around the age of 45. Non-Hodgkin lymphoma, on the other hand, is a heterogeneous, progressive lymph cancer originating from B lymphocytes, T lymphocytes, or natural killer cells. Since the lymphatic system covers the body like a network via lymphatic vessels, non-Hodgkin lymphoma can manifest in any part of the body.

What Are the Symptoms of Lymph (Lymphoma) Cancer?

The symptoms of lymph cancer vary depending on the tissues and organs affected. However, there are some general symptoms commonly seen in lymph cancers. The first symptom of lymph cancer is usually an unexplained swelling in the lymph nodes, which may be accompanied by pain in some cases. Since lymph nodes and nodes are scattered throughout the body, this swelling can occur in the head, neck, arms and legs, under the arms, in the groin, and in many other areas. Additional symptoms that may be observed in lymph cancer include:

• Fever,
• Night sweats that increase at night,
• Unexplained weight and appetite loss,
• Abdominal pain, bloating, indigestion, vomiting if the gastrointestinal system is involved,
• Skin redness, nodule formation if the skin is involved,
• Headache, loss of consciousness, muscle weakness, vision impairment, cranial nerve palsy if the nervous system is involved,
• Persistent cough, difficulty breathing if the respiratory system is involved.

What Causes Lymph Cancer?

The exact causes of lymph cancer are not fully understood. However, the disease is known to result from malignant lymphocyte cells that grow uncontrollably and continuously due to changes in the DNA structure of lymphocytes. This change leads to irreversible functional and structural alterations within the cell. Additional factors thought to contribute to the development of lymph cancer include:

• Chronic infectious diseases,
• Immune system deficiencies that occur spontaneously or due to the use of immunosuppressive drugs,
• Genetic predisposition,
• Obesity,
• Side effects of certain medications,
• Low socioeconomic status,
• Diseases caused by certain viruses (such as EBV, HIV).

Stages of Lymph (Lymphoma) Cancer

The staging of lymph cancer is based on the size, location, number of affected areas, and severity of the disease. This staging, done according to the Ann Arbor classification system, is determined based on the results of imaging studies such as computed tomography (CT) or positron emission tomography (PET). Before treatment, patients receive a score reflecting the course of the disease according to this classification scale, which helps guide the treatment plan. This staging is important to understand whether the disease has systemic spread. The stages of lymph cancer are as follows:

• Stage 1: There is a single involvement in one lymph node, a single lymphoid structure such as the thymus, or any non-lymphatic region.
• Stage 2: In this stage, involvement is seen in multiple lymph regions on one side of the diaphragm. If a single organ outside of the lymph nodes or its surrounding lymph nodes are involved on the same side of the diaphragm, it is classified as stage 2 lymphoma.
• Stage 3: Lymphoma involving lymph nodes on both sides of the diaphragm is classified as stage 3. Along with this involvement, an additional organ outside the lymph nodes may also be affected.
• Stage 4: This stage is characterized by widespread and extensive involvement in tissues and organs.

How is Lymph Cancer Diagnosed?

Most hospital visits related to lymph cancer are due to swelling in the lymph nodes. However, since lymphoma symptoms often resemble those of other diseases, early diagnosis can be challenging. For diagnosing lymphoma, a detailed medical history is taken, followed by a physical examination. Laboratory tests are often inconclusive and do not significantly aid in diagnosis; even blood test results are often normal. If the disease has spread to the bone marrow, anemia and neutropenia may be observed. Although lactate dehydrogenase enzyme levels are often elevated in lymph cancer, this is not a specific measurement. The most definitive diagnostic method for lymphoma is biopsy, with the best results obtained from a lymph node biopsy. Other diagnostic methods that may be used for lymph cancer include:

• Chest X-ray,
• Contrast-enhanced CT scan,
• Positron emission tomography (PET),
• Screening for HBV, HCV, and HIV.

How is Lymph Cancer Treated?

The main goal of treating lymph cancer is to stop and eliminate the uncontrolled growth and proliferation of cancer cells. Multiple treatment methods are used to achieve this goal. The treatment methods used for lymph cancer include:

• Chemotherapy: One of the most commonly used treatments for lymphoma is chemotherapy. In chemotherapy, cytotoxic drugs are administered to prevent the uncontrolled growth of cells. In cases where a single chemotherapy drug is insufficient, multiple drugs can be combined.
• Radiotherapy: When chemotherapy alone is not enough, radiotherapy may be added to the treatment. Radiotherapy, which uses X-rays, aims to destroy uncontrollably growing cells, just like chemotherapy. These rays damage the DNA of cancer cells.
• Surgery: Surgery is not a suitable treatment option for lymph cancers with widespread involvement. However, for lymph cancer in a small tissue or organ, it may be possible to remove the tumor surgically.
• Immunotherapy: This method uses immune checkpoint inhibitors, T-cell transfer therapy, monoclonal antibodies, cancer treatment vaccines, and immune system modulators to destroy abnormal cell formations in the body. This treatment primarily aims to strengthen the immune system.
• Stem Cell Transplant: Stem cells are special cells with the potential to renew themselves and transform into different types of cells. In stem cell therapy, stem cells from the patient or a donor proven compatible through testing are transplanted into the patient. The goal is for these transplanted stem cells to regenerate damaged cells, tissues, or organs, restoring them to a healthy state. While initially limited to stem cells from bone marrow, a variety of stem cells are now used in treatment.

The lymphatic system is essential in maintaining the body's internal balance and is affected when damaged or when immunity decreases. Disorders in the lymphatic system can be indicators of lymphoma and other diseases. Therefore, for early diagnosis and to receive treatment before the disease impacts quality of life, consulting a specialist is recommended.