What is a Lymphatic System? A lymphatic system is a complex network of tubes (lymphatic vessels), glands (or lymph nodes) and other organs including the spleen. The vessels and glands hold a fluid called lymph. The lymphatic system has a number of functions. It drains waste products and excess fluid from different parts of the body and moves them to the blood stream to be processed. It also conveys nutrients and cells. The lymphatic system is also part of the immune system, or the body’s natural defence against infection. The lymph carries white blood cells called lymphocytes, which help us to fight infection. We have lymph nodes and lymphatic vessels throughout our body. Often the lymph nodes are found in groups, particularly under the arms, in the neck and in the groin.
What is Lymphoma?
Lymphoma is a cancer of the lymphatic system, the body's disease-fighting network. The lymph system is made up of many cells and organs, including the lymph nodes, thymus gland, spleen, and liver. This system produces B-Cells and T-Cells lymphocytes, which make up your body’s immune system. These are spread throughout your body, much like your blood vessels. In lymphoma, lymphocytes start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes. Since these cells travel between the lymphatic and circulatory system while fighting infections and viruses, lymphomas are blood-related cancers. The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection.
What are the Causes of Lymphoma?
Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, cancer results.
What are the Risk Factors?
Scientists do not know exactly what causes lymphoma, but they have identified several potential risk factors.
Genetics - Lymphoma can be the result of a genetic predisposition that is inherited from family members. It is possible to be born with certain genetic mutations or a fault in a gene that makes one statistically more likely to develop cancer later in life.
Carcinogens- Carcinogens are a class of substances that are directly responsible for damaging DNA, promoting or aiding cancer. Exposure to certain pesticides, herbicides, and solvents such as benzene has been associated with lymphoma. Similarly, black hair dye has been linked to higher rates of NHL. When our bodies are exposed to carcinogens, free radicals are formed that try to steal electrons from other molecules in the body. These free radicals damage cells, affecting their ability to function normally, and the result can be cancerous growths.
Other Medical Factors - As we age, there is an increase in the number of possible cancer-causing mutations in our DNA. The risk of NHL increases as we age, and HL is most common between ages 16-34 and 55 years and older. Additional medical conditions that have been associated with higher lymphoma rates include infection with HIV, human T-lymphocytic virus type 1 (HTLV-1), Epstein-Barr virus, Helicobacter pylori, or hepatitis B or C; autoimmune disease (such as lupus); diseases that require therapies that suppress the immune system; and any other immunodeficiency diseases.
What are the Symptoms of Lymphoma?
Following are some of the symptoms of lymphoma;
Swollen, painless lymph nodes in the neck, armpits, or groin
unexplained weight loss
soaking night sweats
breathing or chest pain
feeling of fullness in the abdomen
What are the Diagnosis and Tests for Lymphoma?
Physical examination: Swollen lymph nodes in your neck, underarms, and groin, and swollen spleen or liver are usually examined doctors. Chest x-ray test is done to check the swollen lymph nodes.
Biopsy: Biopsy is the only sure way to diagnose Lymphoma
Excisional Biopsy:Entire lymph node is removed to diagnose lymphoma.
Incisional Biopsy: Only a part of Lymph node is removed to diagnose lymphoma.
CT scan/CAT scan
MRI (magnetic resonance imaging)
PET (positron emission tomography) scan
Laboratory tests: Blood tests and urine tests
What are the Types of Lymphoma?
There are two types of lymphoma: Hodgkin lymphoma (HL, also called Hodgkin's disease) and non-Hodgkin lymphoma (NHL). Both HL and NHL can occur in the same places and have similar symptoms. Their differences are visible at a microscopic level. Hodgkin lymphoma develops from a specific abnormal lineage of B cells. There are five subtypes of HL. NHL may derive from either abnormal B or T cells, and its 30 subtypes are distinguished by unique genetic markers.
Hodgkin Lymphoma (HL) -
Hodgkin lymphoma can arise anywhere in the body where lymphocytes are found. HL has characteristics that differentiate it from all of the other types of lymphoma, most notably the presence of a cell called the Reed-Sternberg cell. A Reed-Sternberg cell is a large, abnormal cell that does not protect the body from infection. When it abnormally multiplies, it often forms a tumor within a lymph node and attracts inflammatory cells around it. While the cause is unknown, certain factors have been shown to increase the risk of developing Hodgkin lymphoma. Treatment for Hodgkin lymphoma may include chemotherapy and/or radiation therapy. In certain cases, bone marrow or stem cell transplant may be recommended, especially if the disease does not respond to initial treatment or if it returns despite an initial response to treatment.
Non - Hodgkin Lymphomas(NHL) -
Non - Hodgkin's lymphoma is a general term for a large group of lymphatic cancers that comprise approximately 90% of all diagnosed lymphomas. Hodgkin's disease contain specific cells called Reed-Sternberg cells that are not found in patients with non-Hodgkin's lymphoma. Approximately 85% of all non-Hodgkin's lymphomas originate in B-lymphocytes and are sometimes referred to as B-cell lymphomas. Non-Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. The abnormal cells don't die when they should. They don't protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor. In general, the risk factors for non-Hodgkin lymphoma include the following: Weakened immune systemCertain infections like Human immunodeficiency virus, Epstein-Barr virus (EBV), Helicobacter pylori, Human T-cell leukemia/lymphoma virus type 1 (HTLV-1) and Hepatitis C.
What are the Stages of Lymphoma?
Once the diagnosis is confirmed, doctors "stage" the disease. Staging is how doctors determine the extent of the disease, which affects treatment options.
Stage I: The cancer is limited to one lymph node region or a single organ.
Stage II: In this stage, the cancer is in two different lymph nodes or the cancer is in a portion of tissue or an organ and nearby lymph nodes. But the cancer is still limited to a section of the body either above or below the diaphragm.
Stage III: When the cancer moves to lymph nodes both above and below the diaphragm, it's considered stage III. Cancer may also be in one portion of tissue or an organ near the lymph node groups or in the spleen.
Stage IV: This is the most advanced stage of lymphoma. Cancer cells are in several portions of one or more organs and tissues. It affects not only the lymph nodes but also other parts of your body, such as the liver, lungs or bones.
What are the various Types of Treatment available for Lymphoma?
There are several factors that you will need to take into account when deciding on your treatment. They include patient’s age, stage of lymphoma, likely progression of lymphoma, sub-type of lymphoma and possible side effects of the treatments.
Chemotherapy is a widely used treatment for lymphoma, often combined with radiotherapy. The type of chemotherapy you receive will depend on the type and stage of your lymphoma. If it is thought that your lymphoma is curable you will normally receive an aggressive treatment regime designed to kill all of the cancerous cells in your body. However, if a cure is unlikely, then a more moderate treatment regime may be used which can often provide long-term relief from symptoms. An aggressive chemotherapy regime will involve you receiving injections of chemotherapy (intravenous chemotherapy) while a more moderate regime will involve you taking chemotherapy tablets (oral chemotherapy).
Radiotherapy is often used to treat stage 1 and 2 lymphomas, when the cancerous cells are located in only one part of the body. Treatment is normally given daily, over the space of 2-6 weeks. The radiographer will need to first carefully plan your treatment. This may involve one or several appointments, where the radiographer uses a machine to 'map' out the lymphoma and decide what parts of your body the radiotherapy should be directed at. This may involve making small marks on your skin with a kind of marker pen. Radiotherapy itself is painless, but it does have a number of common side effects. These can vary, depending on which part of your body is being treated. For example, if the affected lymph nodes are in your throat radiotherapy can lead to a sore throat, while treatment to the head can lead to hair loss.
Monoclonal Antibody Therapy
Monoclonal antibodies are drugs that can ‘recognize’ and find specific cells in the body. These drugs can be designed to find a particular type of cancer cell in the body. The monoclonal antibodies attach themselves to the cancer cells and destroy them. There are different types of monoclonal antibody treatment. They can be used alone, with radiotherapy or with chemotherapy. A monoclonal antibody treatment is available for certain types of lymphoma. The treatment may be used as part of initial treatment or if the disease recurs. In lymphoma, monoclonal antibody treatment can be given in different ways.
Steroids are used to treat some cases of lymphoma, in combination with chemotherapy. It is believed steroids make the chemotherapy more effective. Steroids are given intravenously, usually at the same time as your chemotherapy. A short-term course of steroids, lasting no more than a few months, is usually recommended, as this limits the number of side effects you could experience. Some side-effects of steroids are increased appetite, sleeping problem, indigestion, increased energy levels, etc.
Sometimes high doses of chemotherapy destroy the lymphoma cells and your bone marrow. To help your bone marrow make new healthy blood cells, some stem cells may be taken with a special machine before chemotherapy is given. These cells are then transplanted into the body. These transplanted cells will then find their way to the bone marrow and restore it, so that it can build healthy new blood cells.
Benefits of Lymphoma Treatment:
Many people are frightened at the idea of having cancer treatments because of the side-effects that can occur. Although the treatments can cause side effects, these can usually be well-controlled with medicines. The potential benefits of treatment of Lymphoma vary depending upon the individual situation and stage of Lymphoma. Many people with Hodgkin lymphoma will be cured with treatment. However, sometimes if the lymphoma has come back after initial treatment, any further treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. The treatment increases your body's natural ability to fight cancer. It does this by giving a boost to your immune system.
Lymphoma Treatment in India:
The phenomenon of medical tourismis rapidly spreading around the world and for many people in the US, UK and other western countries. India has been their destination of choice for medical and health care.When you are being treated for cancer, you want a physician who is familiar with your particular disease. Yet because many forms of lymphoma are rare it can be difficult to find a doctor who has treated patients with the disease. In India most of the hospitals has a multidisciplinary team that includes heamotologists, radiation and medical oncologists, pathologists, radiologists, nuclear medicine physicians, nurses and other relevant health professionals. Indian hospitals offer the most advanced diagnostic technologies and treatments available today. Indian doctors and hospitals have immense experience of handling lymphoma cases. Indian hospitals are similarly ranked to those in the U.S. according to the world health organization. Physicians in India are often known for their level of personal care and interaction with their patients.
Cities in India providing Lymphoma Treatment are as follows;
Cost of Lymphoma Treatment in India: A combination of many factors has lead to the recent increase in popularity of medical tourism in India which include rising costs of healthcare in industrialized nations, ease and affordability of international travel, favorable currency exchange rates in the global economy, rapidly improving technology and proven, superior internationally accredited standards of care. International medical travelers are generally residents of the United States, Canada, Great Britain, Western Europe, Australia and the Middle East that are attracted towards Indian medical industry. Following table gives you an idea about the cost difference between India and other major countries;
Some of the common countries from which patients travel to India for surgery are: