Lymphoma

Lymphoma is a type of cancer that develops in the lymphatic system (the tissues and organs that produce, store, and carry white blood cells which fight infections and other diseases).

Lymphoma develops when cells of the immune system, particularly white blood cells called lymphocytes, grow and multiply abnormally.

Types of lymphoma:

Lymphoma is categorized into two broad categories: Hodgkin lymphoma and non-Hodgkin lymphoma. Non-Hodgkin lymphoma is more common than Hodgkin lymphoma.

The two types differ from each other in several important ways. Regardless of the lymphoma type, The King Hussein Cancer Center and Foundation (KHCC/KHCF) is dedicated to providing all of our patients with personalized, world-class medicine. We achieve this by retaining expert, caring staff, and tailoring care to our patients’ unique situations and needs.

Hodgkin lymphoma

Hodgkin lymphoma is generally characterized by the presence of a type of cell called Reed-Sternberg. There are two main types:

Classical Hodgkin lymphoma: This accounts for about 95% of Hodgkin lymphoma cases. This includes the following histological subtypes: Nodular sclerosis, mixed cellularity, lymphocyte rich and lymphocyte depleted.
Nodular lymphocyte predominant- Hodgkin lymphoma: This rare disease accounts for the remaining 5% of Hodgkin lymphoma. It doesn’t produce Reed Sternberg cells, and is usually diagnosed at an early stage and has an excellent prognosis.

Causes of Hodgkin lymphoma

Hodgkin lymphoma often develops in people between the ages of 16-35 years. The exact cause of Hodgkin lymphoma is unknown but several risk factors have been associated with an increase in the risk of developing it:

Infections: Epstein-Barr virus (EBV), a common viral infection that causes a disease called mononucleosis and human immunodeficiency virus (HIV), which causes AIDS.
Autoimmune diseases and treatment with immunosuppressive drugs.
Family history (1% of patients have family members with this disease).

However, having these risk factors does not mean that a person will definitely get Hodgkin lymphoma.

Symptoms of Hodgkin lymphoma

Painless lump in the neck
Fever
Unexplained weight loss
Night sweats
Persistent cough
Shortness of breath
Itchy skin
Back pain

Diagnosis and staging of Hodgkin lymphoma

Lymph node biopsy, where part or of all of the lymph node is removed and examined under the microscope
Imaging studies that include CT scan neck, chest abdomen, and pelvis and PET scan, which combines images of CT and PET scans for more accuracy
Bone marrow biopsy
Blood tests, including ESR, complete blood count (CBC), kidney and liver function tests and lactate dehydrogenase (LDH)
Echocardiogram to evaluate the function of the heart
Pulmonary function testing

Treatment of Hodgkin lymphoma at KHCC

In almost all cases, we treat Hodgkin lymphoma with the aim of curing it.
Before starting treatment, we discuss issues related to fertility preservation when appropriate.
On a weekly basis, our lymphoma team including medical and radiation oncology doctors, pathologists, radiologists, nurses, pharmacists and specialists meet weekly to discuss each patient’s plan and progress, and make joint decisions regarding their treatment.
One or more of the following therapies can be used according to the stage of disease and prior treatment given:
1. Chemotherapy
2. Radiotherapy
3. Immunotherapy
4. Hematopoietic stem cell transplantation

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma starts when white blood cells (B-cells or T-cells) start to grow abnormally. These cells grow and start to divide creating more abnormal cells, which in turn start to prevent the immune system from doing its job of protecting the body, as these cells don’t fight infections like normal cells do.

Causes of non-Hodgkin lymphoma

There is no known exact cause for non-Hodgkin lymphoma. However, there are factors that can increase the chance of developing non-Hodgkin lymphoma, including:

Infections such as Epstein-Barr virus (EBV), a common viral infection that causes a disease called mononucleosis, human immunodeficiency virus (HIV), which causes AIDS, Hepatitis C virus and bacteria called Helicobacter pylori
Autoimmune diseases and treatment with immunosuppressive drugs

Having one or more of these factors does not necessarily mean that a person will get non-Hodgkin lymphoma. On the other hand, people with none of these factors can develop the disease.

Types of non-Hodgkin lymphoma:

More than 60 specific subtypes of non-Hodgkin lymphoma have been identified and assigned names by the World Health Organization.

They are broadly categorized into:

B cell lymphomas: common, accounting for 85% of all non-Hodgkin lymphoma cases
T cell lymphomas: rare, comprising about 15% of non-Hodgkin lymphoma cases

Non-Hodgkin lymphoma can also be categorized into low, intermediate and high grade according to how fast or slow-growing they are.

Symptoms of non-Hodgkin lymphoma:

Painless swelling in the lymph nodes (the most common symptom)
Swelling of the head, neck, upper body or arms
Difficulty breathing
Fever
Night sweats
Persistent cough
Weight loss

Symptoms vary according to the type of the disease. For example, patients with low grade non-Hodgkin may present with a slowly growing swelling that may disappear for a while. On the other hand, patients with high grade non-Hodgkin lymphoma develop more symptoms and the swelling develops more quickly.

Diagnosis and staging of non-Hodgkin lymphoma

Lymph node biopsy where part or all of the lymph node is removed and examined under the microscope
Imaging studies that include a CT scan of the neck, chest abdomen, and pelvis and a PET scan, which combines images of CT and PET scans for more accuracy
Bone marrow biopsy
Blood tests such as a complete blood count (CBC), kidney and liver function tests and lactate dehydrogenase (LDH)
Echocardiogram to evaluate the function of the heart.

Treatment of non-Hodgkin lymphoma at KHCC

On a weekly basis, our lymphoma team including medical and radiation oncology doctors, pathologists, radiologists, nurses, pharmacists and specialists meet weekly to discuss each patient’s plan and progress, and make decisions regarding their treatment.
Before starting treatment, we discuss issues related to fertility preservation when appropriate.
Treatment decisions depend on multiple factors that include :
- Type of lymphoma
- Stage
- Age and general health of the patient
- If the lymphoma is causing symptoms

One or more of the following therapies can be used according to the stage of disease and prior treatment given:

Chemotherapy
Radiotherapy
Monoclonal antibodies including Rituximab for B cell lymphomas
Hematopoietic stem cell transplantation
Watchful waiting through close follow up without giving active treatment, especially in asymptomatic indolent lymphomas

Lymphoma survivorship program

Lymphoma patients having no evidence of disease three years after treatment are referred to our survivorship program to continue their follow up and to detect any long-term complications of treatment.