Medical essentials

The Key to Diagnosing Lymphoma

The Key to Diagnosing Lymphoma

The Key to Diagnosing Lymphoma

Lymphatic system

When our body is invaded by bacteria or viruses, our immune system will be activated. The microorganisms then pass through a chain of circular shaped nodules called lymph nodes. These lymph nodes are found in our body. Some of them are more superficially located, others are deeply embedded.

When the immune system kill the bacteria, lymph nodes may become reddish and swollen. In some cases, it may be painful to feel. The most common swollen lymph nodes are found in the neck, armpits and the groin. Hence, it can be mistaken as a tumour.


What is Lymphoma?

Lymphoma is the cancer of the immune system. Lymphoma occurs when a type of immune cells called lymphocytes start dividing uncontrollably, causing the lymph nodes to swell. This is why lymphoma can mimic swollen lymph nodes caused by an infection.



What are the signs and symptoms?

Very often, people who have lymphoma don’t even realise it until it has progressed to late stage and accompanied by other symptoms. In the beginning, there might just be localized and painless swollen lymph nodes. Then, the lymph nodes may enlarge rapidly and spread to other parts of the body. Frequently, this is the time where concerns are raised. In some cases, the swollen lymph nodes can wax and wane, causing patients to ignore the warning sign.

When the cancer starts growing and spreading, patients will start having the “B-symptoms”. This is an medical term that describes having fever, night-sweats and unintended weight loss over short period of time. To be precise, fever usually exceeds 38’c and weight loss should be more than 10% of the total body weight.

Besides that, patients who have lymphoma will feel tired all the time no matter how well rested they are. So it is not uncommon for doctor to detect signs of anaemia in lymphoma patients.



Types of Lymphoma

It is important to find out the type of lymphoma because they are presented with different characteristics. So the treatment method may also change accordingly.

It can be broadly categorised as Hodgkin’s lymphoma(HL) and Non-Hodgkin’s lymphoma(NHL). The main difference between them is that when HL is viewed under the microscope, a type of cell called “Reed-Sternberg cell” can be seen.

In HL, the swollen lymph nodes are usually localised. Conversely, NHL may cause multiple lymph nodes to become swollen. In the former, the chances of survival is relatively good as compared to the latter. Ultimately, prognosis is largely dependent on the stage of cancer. A 5-year chances of survival decrease as the cancer progresses to late stage.

Also, it is said that Hodgkin’s lymphoma is associated with Epstein Bar virus (EBV) while Non-Hodgkin’s lymphoma is related to Human Immunodeficiency Virus (HIV) and autoimmune diseases. Therefore, past medical history can be help us to find out the type of lymphoma in the patients.

There are two peak age period in which Hodgkin’s lymphoma is more likely to occur. The first peak begins at the 20 to 30’s year of age. This is followed by the second peak at above 50 year of age. Unfortunately, there is no clear consensus on the age in which NHL is more likely to take place.



Characteristic checklist for swollen lymph nodes

Since the swollen lymph nodes can be mistaken as other diseases, there are factors we need to consider in making sure the diagnosis is right. So I have listed the following points that are worth paying attention to:

  • Size: The size varies depending on cancer growth rate
  • Consistency : rubbery and firm
  • Edge: smooth, well-circumscribed, matted
  • Painless
  • Mobility- mobile or fixed to skin or underlying struture
  • Non-pulsatile 



How to diagnose?

Besides the obvious signs your doctor can find out from physical examination. A blood test results will certainly reveal more informations that support the diagnosis. Since lymphocytes divide uncontrollably in lymphoma, we may see significant increase in the lymphocyte count. It is also common to see a general increase in white blood cell count. Other than that, the Erthrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) count may also increase.

The next helpful method of investigation is Computerized Tomographic scan (CT-scan). The CT-scan result will often show hypo-attenuating lesions in the affected region, suggesting lymph nodes enlargement. This will be helpful in the staging process once the diagnosis is confirmed.

Lastly, your doctor will carry out a biopsy to find out the type of lymphoma.



Treatment options

Similar to other types of cancer, chemotherapy and radiotherapy remain as the gold standard treatment for lymphoma. Up to Stage IIA, 3 or 4 rounds of chemotherapy involving the affected lymph nodes will suffice. For more severe cases, 6 to 8 rounds of chemotherapy followed by radiotherapy will be required to kill the remaining cancer cells. One exception to this rule is that in low grade NHL patients, the management is close observation and treating the symptoms with low dose chemotherapy when necessary.


Are you a survivor of lymphoma? Share with me your experience in fighting lymphoma and let me know how did you overcome it in the comment section below. If you have any questions, do ask me and I will try to answer your question. Thank you.



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