Lymphomas - Specialists and Information

Benign lymphomas are usually caused by an infectious disease. These include both harmless colds and more serious viral or bacterial illnesses such as:

• mononucleosis
• HIV infections
• Tuberculosis or
• Lyme disease

Parasitic diseases such as toxoplasmosis can also cause enlarged lymph nodes.

Malignant tumors develop as a result of uncontrolled growth of lymphatic cells. Depending on which type of cells is affected by the malignant transformation, different types of lymphomas develop.

The incidence rate is 10 to 15 new cases per 100,000 people per year. Although malignant lymphomas can develop at any age, the likelihood increases significantly after age 60. Thus, advanced age is a risk factor for the malignant proliferation of lymphatic cells.

It is believed that genetic mutations occur more frequently with age. These changes result in the loss of genes that inhibit cell growth (tumor suppressor genes).

Increased activation of genes that stimulate cell growth is also discussed as a possible cause.

Another risk factor for the development of malignant lymphomas is a weakened immune system. Consequently, more people develop the disease following immunosuppressive therapy. The risk of lymphoma is also elevated in patients with autoimmune diseases. 

Other risk factors include increased exposure to herbicides and insecticides and exposure to UV radiation. In rare cases, lymphoma is caused by a genetic predisposition. 

It has not yet been conclusively proven whether one’s lifestyle increases the risk. However, being severely overweight appears to play a role, particularly in aggressive lymphomas.

Benign lymphomas usually manifest exclusively as enlarged lymph nodes. The affected lymph nodes are tender to the touch and can be easily moved when palpated. 

For malignant lymphomas, experts distinguish between:

• Hodgkin lymphoma and
• Non-Hodgkin lymphomas

Hodgkin’s disease is characterized by the presence of Sternberg-Reed cells or mononuclear Hodgkin cells. About 25 percent of all lymphomas are classified as Hodgkin’s disease.

Hodgkin lymphoma begins with painless swelling of the lymph nodes. Because the lymph nodes become fused together, they cannot be moved when palpated. 

Typically, the swelling is localized in the neck, under the armpits, or in the groin area. In addition, patients experience general symptoms such as fever, unintentional weight loss, and fatigue. 

Itching and night sweats are also among these so-called B symptoms. In some patients, the swollen lymph nodes become painful after drinking alcohol. Although this symptom is rare, it is sufficient for a diagnosis, as it does not occur in any other disease. 

Lymphoma usually causes swollen lymph nodes, which can appear anywhere in the body @ Dan Race /AdobeStock

In later stages of the disease, organs become affected. This can involve the nervous system, the urogenital tract, and hormonal balance. 

Due to a weakened immune system, patients are more prone to infections. Severe fungal or viral infections, as well as tuberculosis, are also possible. 

The term “non-Hodgkin lymphoma” encompasses all lymphomas that do not meet the diagnostic criteria for Hodgkin’s disease.

These include:

• Chronic lymphocytic leukemia
• Plasmacytoma, and
• Natural killer (NK) cell leukemia

Non-Hodgkin lymphomas initially cause symptoms such as:

• Swollen lymph nodes
• Loss of appetite
• Weight loss
• Paleness
• Fatigue and exhaustion
• Depressive moods
• Increased susceptibility to infections
• Headaches and/or back pain

Depending on the severity of the disease, symptoms may develop gradually or rapidly. As with Hodgkin’s disease, the swollen lymph nodes do not cause pain. They are also immovable. 

If lymph nodes in the chest or abdomen are affected, organ compression may occur depending on the severity of the swelling.

Symptoms include:

• Shortness of breath
• Cough or 
• Digestive problems

If the central nervous system is affected, patients may experience visual disturbances, dizziness, or vomiting.

Benign lymphomas generally do not require treatment. They usually resolve on their own once the underlying condition has been cured.

For Hodgkin’s disease, treatment consists of chemotherapy and radiation therapy. Doctors typically administer chemotherapy first, followed by radiation therapy.

Chemotherapy involves the use of various cell-damaging and growth-inhibiting drugs (cytostatics). To prevent further progression of the lymphoma, treatment should begin immediately after diagnosis. 

For non-Hodgkin lymphomas, chemotherapy can be administered alone or in combination with radiation therapy @ Seventyfour /AdobeStock

It is not uncommon for the disease to recur during or in the months following treatment. In such cases, high-dose chemotherapy followed by an autologous stem cell transplant is recommended. 

In this type of stem cell transplant, the patient’s own blood stem cells are harvested and transplanted after chemotherapy. If the patient does not respond to treatment, an allogeneic stem cell transplant may be necessary. In this case, the patient receives bone marrow or blood stem cells from a donor.

The treatment of non-Hodgkin lymphoma depends on the type of disease. If the disease progresses slowly and causes few or no symptoms, doctors often choose not to initiate treatment.

However, regular checkups should be conducted to ensure that treatment can be initiated in a timely manner if necessary. Treatment typically involves a combination of several therapeutic approaches.

Here, too, the combinations vary depending on the type of lymphoma. To kill the abnormal cells and reduce the size of the tumors, doctors administer chemotherapy drugs in tablet form or as an infusion. 

High-dose X-rays are often used as an adjunct to shrink the tumor. Doctors often treat so-called indolent—that is, painless—lymphomas in the early stages with radiation therapy alone.

Another treatment option is antibody therapy. Antibodies are often used in combination with chemotherapy drugs.