Lymphoma

The causes of lymphoma are not fully known, in part because there are so many types. Lymphoma is linked to changes in the genes and in the immune system. 

Some factors seem to increase the risk of developing Hodgkin’s and non-Hodgkin’s lymphomas. However, the increased risk is often small, and many people with lymphoma have no known risk factors. 

Risk factors for Hodgkin’s lymphoma

• Age 18 to 34 or older than 55
• Viruses, including Epstein-Barr virus (EBV), infectious mononucleosis (mono), human immunodeficiency virus (HIV) or human T-cell lymphocytotropic virus (HTLV) 
• A weakened immune system
• Having a sibling with Hodgkin’s lymphoma, especially an identical twin

Risk factors for non-Hodgkin’s lymphoma

• Age 60 and older 
• Viruses, including Epstein-Barr virus (EBV), human immunodeficiency virus (HIV) or human T-cell lymphocytotropic virus (HTLV) 
• A weakened immune system
• Autoimmune diseases 
• Exposure to radiation or certain chemicals, including benzene and pesticides
• Infections that affect the DNA of lymphocytes or cause chronic immune system stimulation
• Having a parent, child or sibling with non-Hodgkin’s lymphoma 

Having any of these risk factors does not mean you will develop lymphoma. If you are concerned about your risk, talk to your doctor.  

Family history of lymphoma

Children, parents and siblings of people who have had lymphoma may have a slightly higher risk. But researchers don’t know for sure if this is due to genetics or other factors. Currently, there are no genetic tests for lymphoma, but if you have a lymphoma family history, your doctor may recommend genetic counseling. 

There are no standard screening tests for lymphoma in people who have no symptoms. Most people are not diagnosed with the disease until they develop symptoms. 

Lymphoma cannot be completely prevented, but if you have risk factors that affect your immune system, talk to your physician. Also, be aware of the symptoms of lymphoma and let your doctor know if you develop any of them.

Lymphoma diagnostic testing enables Scripps Cancer Center specialists to determine the type and stage of lymphatic cancer and develop a personalized treatment plan. 

Scripps lymphoma specialists use a combination of tests, including imaging tests and a biopsy, to confirm a lymphoma diagnosis and determine if it is Hodgkin’s or non-Hodgkin’s lymphoma. One or more of the following lymphoma tests may be done.

Lymph node biopsy

Tissue is removed from a lymph node and examined under a microscope.

Bone biopsy

Tissue is removed from bones or soft tissue around bones to look for tumors.

Bone marrow aspiration and biopsy

A thin needle is inserted into a bone to collect cells from inside the bone and examine them with a microscope.

Blood tests 

Blood tests analyze the amount and appearance of blood cells, blood chemistry, and liver and kidney function.

Computed tomography (CT) scan

A CT scan is an imaging test that captures images of the body from different angles. The images are combined to create detailed cross-sectional views of organs, bones and blood vessels.

Magnetic resonance imaging (MRI)

MRI relies on a powerful magnet, radio waves and advanced digital technology to provide detailed images of organs, bone and soft tissue.

Positron emission tomography (PET) scan

A PET scan involves a type of radioactive sugar that existing cancer cells will quickly absorb so they can be identified under a special camera. It’s combined with a CT scan to give physicians the ability to view a picture of potentially cancerous areas through the PET while also seeing more detailed images from a CT scan.

Immunophenotyping

Lymph node, blood or bone marrow cells are analyzed to determine the type of lymphoma.

Pulmonary function test

This test evaluates how well the lungs are working.

Lymphoma cancer staging describes how far cancer may have spread. Scripps oncologists use stages to develop a treatment plan and cancer prognosis. 

Hodgkin’s lymphoma stages

Stage I (early stage)

• Stage I: Cancer is found in one lymph node region.
• Stage IE: Cancer is found outside the lymph system in one organ or area.

Stage II (locally advanced disease)

• Stage II: Cancer is found in two or more lymph regions on one side of the diaphragm
• Stage IIE: Cancer is found in one lymph node region plus a nearby area or organ. This is called "extension," or "E" disease.

Stage III (advanced disease)

• Stage III: Cancer is found in lymph nodes above and below the diaphragm.
• Stage IIIE: Cancer is found in lymph node groups above and below the diaphragm and in a nearby area or organ.
• Stage IIIS: Cancer is found in lymph node groups above and below the diaphragm and in the spleen.
• Stage IIIE, S: Cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ and in the spleen.

Stage IV (widespread disease)

Cancer is found:

• Outside the lymph nodes throughout one or more organs, and may be in lymph nodes near those organs; or
• Outside the lymph nodes in one organ and has spread to areas far away from that organ; or
• In the lung, liver, bone marrow or cerebrospinal fluid (CSF). The cancer has not spread to the lung, liver, bone marrow, or CSF from nearby areas.

Non-Hodgkin's lymphoma stages

Stage I (early stage)

Non-Hodgkin’s lymphoma stage I involves one lymph node region. If the cancer is in one organ outside the lymph node, such as the skin, lung or brain, this is called extension, or E non-Hodgkin’s lymphoma.

Stage II (locally advanced disease)

Non-Hodgkin’s lymphoma stage II involves two or more lymph regions on one side of the diaphragm. If the cancer is in one lymph node region plus a nearby area or organ, it is considered E disease.

Stage III (advanced disease)

Non-Hodgkin’s lymphoma stage III involves lymph nodes above and below the diaphragm or one node area and one organ on opposite sides of the diaphragm.

Stage IV (widespread disease)

Non-Hodgkin’s lymphoma stage IV is when cancer is found outside the lymph nodes and spleen and has spread to one or more organs, such as bone, bone marrow, skin and other organs.

In addition, each stage is classified as A or B. A means the patient does not have symptoms including fever, drenching sweats or unexplained weight loss. When patients have any of these symptoms, the non-Hodgkin’s lymphoma is classified as B.

No one wants to hear that they have lymphoma. You may feel frightened, overwhelmed, anxious or sad. All of these feelings are perfectly normal. The more you learn about your diagnosis and next steps, the sooner you can begin to make informed decisions about your treatment.

Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your lymphoma diagnosis:

• Should I get a second opinion?
• How do I find a specialist?
• What is my cancer treatment plan?
• Will I have to miss work/school?
• What are the side effects of lymphoma treatment?
• How successful is my treatment likely to be?
• What costs will be covered by insurance?
• Which costs will I be responsible for?

Your Scripps cancer care team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community resources that provide education, information and helpful resources — often at no cost.

Learn more about the many cancer patient resources available to you and your loved ones at Scripps.

Your Scripps cancer care team develops a personalized treatment plan based on 

several factors, including:

• The type and stage of your cancer
• Your symptoms
• If your cancer has returned after treatment 
• Your age and overall health

Your treatment may include one or more of the following therapies:

Chemotherapy

Treatment often includes a combination of chemotherapy drugs given in pill form or intravenously. Scripps Health offers chemotherapy in several locations throughout San Diego County, including Scripps hospitals, outpatient infusion centers and in Scripps affiliated physicians’ offices. All treatments are managed by physicians and nurses specially trained in oncology.

Radiation therapy

Radiation therapy may be used when lymphoma is found in its early stages. It is usually used with chemotherapy. Scripps radiation oncologists use advanced radiation therapy techniques that precisely target tumors while minimizing radiation exposure to nearby healthy tissues and organs.

Targeted therapy

As the name implies, this therapy targets specific proteins and receptors on cancer cells, or the blood vessels that support the cells, to stop them from growing. Targeted therapies also may help the body’s own immune system attack and fight the cancer.

Stem cell transplantation

If other treatments are not effective, or if lymphoma returns, a stem cell transplant may be recommended. Stem cell transplants can be either autologous (stem cells taken from the patient) or allogenic (stem cells from a donor).

Watchful waiting

Not all people with non-Hodgkin’s lymphoma need treatment right away, especially if the disease grows and spreads very slowly. Your team will closely monitor your lymphoma to determine if and when treatment should begin.

Some lymphoma treatment plans may involve clinical trials. Talk with your physician about whether a clinical trial is right for you. 

For a list of clinical trials that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your lymphoma treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need. 

Your team may include:

• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

Visit your cancer care team for more information on Scripps' multi-disciplinary approach to treatment.

We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps Cancer Center offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:

• Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
• Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life. 
• Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
• Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
• Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
• Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
• Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
• Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
• Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.

For the full spectrum of offerings, please visit our cancer patient support services section.