Symptoms of Lymphoma Can Go Unnoticed

Published by Contra Costa Times

Posted on Wed, May 3, 2006

By Dr. Sharon Hiner

"I THOUGHT IT couldn't be cancer because it didn't hurt." My 45-year old patient, we'll call him John, seemed stunned when I told him the bad news.

John put off seeing a doctor because his swollen neck gland didn't hurt, and he felt fine: no fatigue, no weight loss, no pain.

A biopsy of one of John's quarter-sized lumps showed non-Hodgkin's lymphoma, a cancer of the white blood cells of the immune system. In cancer, pain often comes late, only after it has spread to the bones.

Non-Hodgkin's lymphoma is a type of lymphoma, which is a general name for cancers that often start in the lymph system.

The lymph system is made up of a series of tiny tubes and filters throughout our body. The filters, called nodes or glands, grow swollen and painful when fighting an infection, but in lymphoma the swollen node often doesn't hurt.

Non-Hodgkin's lymphoma usually affects people older than 40, with a peak incidence around 80 years old. By contrast, Hodgkin's lymphoma (disease) typically affects young people.

For unknown reasons, the incidence of lymphoma has nearly doubled in the past 35 years. Research has uncovered some factors that increase a person's risk of getting lymphoma. These include genetic and immune disorders such as Down syndrome, rheumatoid arthritis and HIV infection.

Other risk factors include lupus, h. pylori infection of the stomach, radiation exposure and regular exposure to some chemicals including pesticides, herbicides, asbestos, chemotherapy, immunosuppressant drugs and the anti-seizure medicine Dilantin.

Many people with lymphoma don't have obvious symptoms at first. They think they have a cold or the flu. Important warning signs include:

A sudden, painless swelling in the neck, groin or underarm area that doesn't resolve
Night sweats, fevers or weight loss lasting for several weeks, possibly associated with fatigue or itchy skin.

Consult your doctor if you have any of these symptoms.

The good news is that lymphoma is often curable, and, because of advances in treatment, most people with lymphoma survive. Fortunately, John survived his lymphoma.

The only way to diagnose lymphoma is to biopsy (take a sample of) the lump. In addition, the doctor will probably order blood tests, a bone marrow biopsy, chest X-ray, CT scan, and perhaps an MRI, spinal tap and PET scan. These tests will help your doctor "stage" the disease, from one (limited) to four (extensive).

Because the cancer is in the lymph system, throughout the body, it cannot be cut out by surgery. Instead, treatment usually consists of chemotherapy, radiation or both, depending on the type of lymphoma and how much it has spread.

Since chemotherapy and radiation suppress the bone marrow that makes blood, a transplant of your own bone marrow or stem cells may be helpful. In this procedure, your own cells, saved before treatment, are later transplanted back into your body.

Immunotherapy is a relatively new type of treatment, and has the potential to treat lymphoma with far fewer side effects.

All current cancer treatments take a toll on patients, but improvements in supportive care, especially for the symptoms of fatigue, nausea, depression, pain and other side effects, make treatment more tolerable.

For more information, visit the Leukemia and Lymphoma Society at www.leukemia-lymphoma.org or call 800-955-4572.

Hiner is the Cancer Program Medical Director at Contra Costa Regional Medical Center in Martinez and has been practicing medical oncology for 20 years.