Lymphoma is a cancer of the lymphatic system, a key part of the body’s immune system. The lymphatic system produces, stores and carries a set of immune system cells, called lymphocytes, to different parts of the body.
Lymphoma occurs when a lymphocyte mutates at some point in its development. This cell starts multiplying rapidly, crowding out healthy immune system cells.
The two types of lymphocytes that can turn into lymphoma are:
- T cells, which help the immune system respond to disease and directly kill abnormal cells.
- B cells, which produce antibodies that recognize and attack foreign substances like bacteria and viruses.
Parts of the lymphatic system
There are several parts to the lymphatic system. They include:
Lymph: Fluid that carries lymphocytes, a type of white blood cell, through the body in a network of lymph vessels, which are like tiny veins. Lymph helps fight against infection and cancer.
Lymph nodes: Tiny, bean-shaped masses found in several parts of the body, including in the underarm, pelvis, neck, abdomen and groin. They filter lymph and store white blood cells to help the body fight disease.
Spleen: An organ on the left side of the abdomen that helps lymphocytes develop, stores blood cells and gets rid of old blood cells.
Thymus: Located in the chest, this tiny organ helps make and develop lymphocytes.
Tonsils: Nodes in the back of the throat that store white blood cells.
Bone marrow: Material in bones that produces blood cells, including white blood cells like lymphocyte cells.
Lymphoma types
Lymphoma is classified by how the cells appear under a microscope. There are two main categories: Hodgkin lymphoma and non-Hodgkin lymphoma.
Hodgkin lymphoma
Almost all cases of Hodgkin lymphoma have Reed-Sternberg cells. These are large cells that can have more than one nucleus. These cells grow and divide more quickly and live longer than normal cells.
Reed-Sternberg cells also produce substances that encourage more healthy cells to gather in the lymph nodes. These healthy cells then produce substances that encourage the growth of Reed-Sternberg cells.
There are several subtypes of Hodgkin lymphoma, but the vast majority are classical Hodgkin lymphoma. The five-year overall survival rate for Hodgkin lymphoma patients under age 20 is about 98%.
Non-Hodgkin lymphoma
Non-Hodgkin lymphoma (NHL) does not have Reed-Sternberg cells. There are several subtypes of NHL, including:
- Burkitt's lymphoma (BL). This disease affects B cell lymphocytes. It is one of the fastest-growing cancers.
- Lymphoblastic lymphoma (LBL). LBL mostly affects T cell lymphocytes and is similar to acute lymphoblastic leukemia (ALL). It makes up about one-third of all childhood NHL, and is more common in boys.
- Large cell lymphoma (LCL), which includes two subtypes: diffuse large B-cell lymphoma (DLBCL) mostly affects pre-adolescent and teens; and anaplastic large cell lymphoma (ALCL) is more common in adolescents.
Doctors also classify NHL by how fast it spreads. Nearly all cases of pediatric NHL are an aggressive form of the disease. Despite this, the five-year survival rate for children and adolescents with NHL is about 90%.
Childhood lymphoma risk factors
A risk factor is anything that increases the chances of a person developing a disease.
There are many different types of lymphoma, so not every risk factor applies to every type. Most pediatric lymphoma patients don't have any of the risk factors listed here (other than race and sex). Nonetheless, the disease's risk factors include:
- Sex: Hodgkin lymphoma is more predominant in males than females.
- Race: White people are more likely to contract the disease than other groups.
- Infections, including Epstein-Barr virus (which causes mononucleosis) and HIV
- Immune system diseases, including lupus and rheumatoid arthritis
- Immune deficiency syndromes, including:
- Ataxia-telangiectasia
- Bloom syndrome
- Common variable immunodeficiency
- Severe combined immunodeficiency syndrome (SCID)
- Wiskott-Aldrich syndrome
- Taking immunosuppressants due to organ transplant
- Having a parent or sibling with the disease
Some cases of lymphoma can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Learn more about childhood lymphoma:
Learn more about pediatric clinical trials for childhood lymphoma.
‘How I knew I had lymphoma’: 6 survivors describe their symptoms
Night sweats, persistent fevers and unexplained weight loss are three of the most common symptoms of lymphoma, whether they stem from Hodgkin lymphoma or non-Hodgkin lymphoma. But each one has to meet certain criteria to be considered a possible sign of blood cancer.
In adults, that means:
- Night sweats must happen repeatedly, not be due to menopause-related hot flashes, and you should be drenched in sweat to the point that you have to get up and change your nightclothes and/or sheets at least once before morning.
- Weight loss must reflect 10% or more of your body weight, though you’re not actively trying to lose it.
- Fever must be persistent, higher than 100.4 degrees Fahrenheit and not due to an underlying infection.
“Lymphomas can be divided into two basic categories: aggressive and indolent,” explains lymphoma specialist Saira Ahmed, M.D. “Aggressive lymphomas grow and spread quickly, and can cause significant damage to tissue and organs. Because they are fast-growing, they are most commonly associated with what’s known as ‘B’ symptoms. Indolent lymphomas, on the other hand, are slow-growing. They may not cause any symptoms at all, or cause symptoms that come and go over long periods of time.”
Here's how six of our patients knew they had lymphoma, in their own words.
Swollen lymph nodes
“I went to the doctor about a lump in my throat,” says Rob Moss, who was 49 when he was diagnosed with non-Hodgkin lymphoma. “It grew and shrank several times. My doctor said it was probably a ‘thyroglossal duct cyst,’ or a growth on my thyroid. It turned out to be a swollen lymph node.”
Weight loss
“I lost 20 pounds in a few weeks, was extremely short of breath and was so tired I could barely cross a room without needing to sit down,” says Shelby Wade, who was 23 when she was diagnosed with B-cell lymphoma. “I was also very hoarse and coughing a lot.”
Night sweats
“I experienced severe headaches, a consistent dry cough, weight loss and night sweats for about a month,” says Omar Dirani, who was 30 when he was diagnosed with non-Hodgkin lymphoma. “I thought I was sweating a lot because of all the exercise I was doing.”
Cough
“I thought I had a cold or the flu,” says Jeff Johnson, who was 38 when he was diagnosed with Hodgkin lymphoma. “But the cough that came with it never went away. I kept visiting our family physician and trying different medications, but nothing helped.”
Pain
“I was having back pains on the left side of my kidney area,” recalls Ann Sorhouse, who was 49 when she was diagnosed with non-Hodgkin lymphoma. “But I was doing a lot of physical labor, so I attributed it to muscle strain.”
Itching
“I started having intense itching just a few months after I felt a lump on my collar bone,” recalls Mallory Parrish, who was 32 when she was diagnosed with Hodgkin lymphoma. “At first, I thought it might be a yeast infection, but an over-the-counter anti-fungal treatment didn’t help.”
When to see a doctor about your lymphoma symptoms
Ahmed recommends contacting a physician if your symptoms last more than two weeks without improvement.
“The more symptoms you have, the more concerned you should be,” she explains. “If you have multiple B symptoms that last more than two weeks, see your doctor right away. If you only have one symptom, but it’s inconsistent, just make your doctor aware of it.”
Lymphoma symptoms that you shouldn’t ignore
Some lymphoma symptoms are considered so serious that they warrant an immediate trip to the emergency room. These include:
Spinal cord compression
This can manifest as back pain, leg weakness, bowel or bladder incontinence, vision problems, changes in mental status, or altered sensation in the areas of the leg and buttocks that would typically be in contact with a saddle.
Superior vena cava obstruction
This can appear as difficulty breathing, chest pain, face or neck swelling, or difficulty swallowing. It’s usually due to a mass of clogged lymph nodes in the middle of the chest.
Tumorlysis
Caused by rapidly dying lymphoma cells, this condition can lead to heart arrhythmia, kidney problems and an overall sensation of just not feeling well. If you get blood work done, it may also show you have elevated potassium levels or white blood cell counts.
“Roughly 40% to 50% of patients with aggressive lymphomas show symptoms before their diagnosis,” notes Ahmed. “But only about 10% or less of patients with indolent lymphoma do.”
Lymphoma symptoms can occur with any type or stage of disease, but they’re more commonly seen in fast-growing lymphomas and when the disease is more advanced. That’s why it’s important to get symptoms checked out quickly.
Request an appointment at UT MD Anderson online or call 1-877-632-6789.
Why come to UT MD Anderson for childhood lymphoma care?
Selecting a hospital is the first big choice a family makes after a cancer diagnosis. UT MD Anderson’s Children’s Cancer Hospital offers childhood lymphoma patients the most advanced treatments from an expert team, along with support services designed to help the entire family through their cancer journey.
This journey starts with a highly detailed diagnosis of each patient’s lymphoma. Through the skills of our leading pathologists, UT MD Anderson is able to quickly pinpoint alterations in the cancer cells. This information can be used to develop treatment plans tailored to each individual patient.
These treatment plans are created by our multidisciplinary team of physicians working together to benefit each patient. Among these physicians are leading medical oncologists who focus exclusively on treating childhood lymphoma and related conditions, and specialists from one of the largest stem cell transplantation services in the country.
While here, pediatric lymphoma patients have access to clinical trials for children, teens and even adults. In addition, the Children’s Cancer Hospital offers supportive care services designed to improve your child’s quality of life, such as counseling and symptom management. Patients also have access to support programs like our arts in medicine activities, summer camps and support groups. We even have an accredited, in-hospital school that helps patients meet their academic goals while in treatment.
It was not the end of the world. There's so much hope out there, especially at UT MD Anderson.
UT MD Anderson's Children's Cancer Hospital
