Brief overview:
- Prognosis: The chances of cure are good in many cases, provided treatment begins at an early stage. Prognosis for Hodgkin’s lymphoma somewhat better than for non-Hodgkin’s lymphoma.
- Causes and risk factors: Exact triggers not known. Risk factors include Epstein-Barr virus (EBV) infections, immune diseases (e.g., HIV infection), long-term smoking, chemical substances, age, genetic predisposition.
- Treatment: regular monitoring for low-grade tumors, chemotherapy and/or radiotherapy, stem cell transplantation, antibody or immunotherapy.
What is lymph node cancer?
Lymphoma is the colloquial name for a malignant lymphoma and was formerly also called lymphosarcoma. This tumor disease originates from degenerated cells of the lymphatic system (lymphatic system).
Lymphatic system (lymphatic system)
In addition, the lymphatic system serves the formation, maturation and differentiation of a specific type of white blood cells, the lymphocytes (= lymph cells). They are extremely important for the immune defense because they specifically recognize and eliminate pathogens. Most lymphocytes remain where they originated; only a small proportion pass into the blood and lymph.
You can learn more about lymphocytes and their two subgroups (T and B lymphocytes) here.
The spleen also plays an important role in immune defense as well as blood purification. You can read more about this here.
How lymphatic cancer develops
As the disease progresses, lymph node cancer often spreads beyond the lymphatic system and affects other organs.
Frequency and forms of lymph node cancer
Lymph node cancer is a rare form of cancer. Every year, two to ten out of every 100,000 people are newly diagnosed with malignant lymphoma. Men are affected more frequently than women.
Based on subtle differences in tissue structure, physicians distinguish between two major groups of lymph node cancers:
- Non-Hodgkin’s lymphoma (NHL): This includes all forms of lymphoma that are not considered Hodgkin’s lymphoma – that is, about 30 different ones (e.g., plasmocytoma). In 2020, 55,601 women and 67,378 men were newly diagnosed with NHL in Europe. The average age of patients is 72 years (women) and 70 years (men).
Hodgkin’s disease (Hodgkin’s lymphoma)
Read more about symptoms, causes, diagnosis, treatment and prognosis for this form of lymphoma in the article Hodgkin’s disease.
Non-Hodgkin’s lymphoma
You can learn everything you need to know about this much more common group of lymph node cancers in the article Non-Hodgkin’s Lymphomas.
What is the life expectancy of people with lymphoma?
In general, however, the prognosis for Hodgkin’s lymphoma is quite favorable. In many patients, a cure is possible. 84 percent of women and 86 percent of men with Hodgkin’s lymphoma live for at least five years after diagnosis (relative 5-year survival rate).
- Some types of NHL grow very aggressively (e.g., Burkitt’s lymphoma) and are called high-malignant lymphomas.
- Other types of NHL – called low-malignant lymphomas – develop slowly over years to decades (e.g., MALT lymphoma, hairy cell leukemia). They are considered chronic diseases.
Low-grade lymphomas, on the other hand, can usually only be reduced, but not permanently cured. Those affected are therefore under lifelong medical care. If necessary, repeated treatment is required.
Risk of second tumors
What can be the causes of lymph node cancer?
The exact causes of lymphoma are not yet known, but a combination of factors appears to be involved.
Risk factors for Hodgkin’s lymphoma
Other risk factors for Hodgkin’s disease include congenital diseases of the immune system and acquired immunodeficiencies, for example as a result of HIV infection.
Long-term smoking may also increase the risk of disease.
Risk factors for non-Hodgkin lymphomas
No generally applicable risk factors can be named for the heterogeneous group of non-Hodgkin’s lymphomas (NHL).
Various chemical substances also increase the risk of some non-Hodgkin’s lymphomas, such as benzene and other organic solvents that are widely used in industry.
Radioactive radiation and older age are also considered risk factors.
Other possible risk factors are being researched, such as genetic factors (in the case of multiple cases of the disease in a family) or a certain lifestyle.
Lymph node cancer: symptoms
You can read everything important about the typical signs of lymph node cancer in the article Lymph node cancer symptoms.
How is lymph node cancer diagnosed?
However, if the painless swelling of the lymph nodes persists for weeks, possibly accompanied by symptoms such as fever, night sweats and unwanted weight loss, you should urgently consult a doctor. The right person to contact if you suspect lymph node cancer is your family doctor or a specialist in internal medicine and oncology.
Medical history
The doctor will first take your medical history (anamnesis) in a detailed discussion with you. Possible questions include:
- Have you woken up at night lately because you were “drenched in sweat”?
- Have you had frequent fevers in the past (without signs of infection) and felt weak?
- Have you noticed painlessly enlarged lymph nodes (for example, on the neck, under the armpits, or in the groin)?
- Do you have any known medical conditions?
- Are there/were there any cases of cancer in your family? If so, what type of cancer?
Physical examination
Blood tests and immunohistochemistry
However, the latter can also be elevated (leukocytosis), as is often the case in Hodgkin’s disease. If the physician breaks down the various subgroups of leukocytes in a so-called differential blood count, it becomes apparent that the increase in total leukocytes is due to an increase in the subgroup of “eosinophilic granulocytes” (eosinophilia).
The blood of patients with lymph node cancer often also shows elevated levels of inflammation (especially increased blood sedimentation). However, such an increase is non-specific and may have other causes.
Tissue sample (biopsy)
For a confirmed diagnosis of lymph node cancer, it is necessary to take and analyze tissue samples. This also helps to determine what type of lymph node cancer is involved.
Samples (biopsies) can be taken not only from lymph nodes, but also from other tissues if necessary. If skin lymphoma (cutaneous lymphoma) is suspected, it is a sample from the skin; if MALT lymphoma is suspected, it is a sample from the gastric mucosa. Both lymphomas belong to the non-Hodgkin lymphomas.
Further examinations
In some patients, an additional examination of the bone marrow is necessary to detect a possible infestation. This usually involves puncturing the iliac crest (under local anesthesia) with a needle and aspirating some bone marrow. The physician then examines the bone marrow under a microscope.
In rare cases, it is also necessary to take a sample of the cerebrospinal fluid (CSF).
Lymphoma: staging (according to Ann-Arbor, modified after Cotswold (1989) and Lugano (2014)).
Doctors divide lymph node cancer (malignant lymphoma) into disease stages (staging) based on the results of the examination. This is done according to the so-called Ann Arbor classification with four stages. This classification was originally developed for Hodgkin’s lymphoma, but is now also used for non-Hodgkin’s lymphomas.
|
Stage |
Involvement of the lymph nodes |
|
I |
Involvement of only one lymph node region |
|
Involvement of two or more lymph node regions on the same side of the diaphragm (i.e., either in the chest or abdomen) |
|
|
III |
Involvement of lymph node regions on both sides of the diaphragm (i.e., both chest and abdomen) |
|
IV |
diffuse involvement of extra-lymphatic organ/district (e.g. bone marrow) with or without involvement of lymph node regions |
With the parameters A and B as an addition to the tumor stage, it can be indicated whether the patient shows B symptoms (weight loss, fever, night sweats). With parameter A, the B symptoms are absent, with parameter B, the B symptoms are present.
What is the therapy for lymph node cancer?
Chemotherapy and radiotherapy for lymph node cancer
In the early stages of lymphoma, radiation therapy is usually helpful because the cancer has not yet spread very far in the body. In non-Hodgkin’s lymphoma, local radiation is sufficient in some cases. However, it is usually combined with another therapeutic procedure – very often chemotherapy.
Chemotherapy and radiation therapy also play an important role in more advanced stages of lymphoma.
Stem cell transplantation for lymphoma
Another therapeutic option in certain cases of lymphoma is the transfer of hematopoietic stem cells (hematopoietic stem cell transplantation). In this procedure, the physician first obtains healthy hematopoietic stem cells, usually from the patient’s own body (autologous stem cell transplantation).
In the next step, the diseased person receives high-dose chemotherapy to destroy all their bone marrow and the cancer cells it contains. Immediately after that, doctors transfer the healthy stem cells taken earlier, which start a new hematopoiesis without cancer cells.
In certain cases, donated blood stem cells from another person are also considered for transplantation (allogeneic stem cell transplantation).
Immunotherapy for lymph node cancer
There are several types of immunotherapies available for the treatment of malignant lymphoma.
Antibody therapy
In this form of immunotherapy, the patient receives artificially produced antibodies that bind specifically to the cancer cells and cause their destruction in different ways. Two examples are the antibodies rituximab and brentuximab vedotin.
For certain individuals with Hodgkin’s lymphoma, the active ingredient brentuximab vedotin may be considered. This is an artificially produced antibody loaded with a cytostatic drug. This is a substance that inhibits cell division.
Immunotherapy with checkpoint inhibitors
For some people with Hodgkin’s lymphoma, treatment with checkpoint inhibitors is an option. These are also special antibodies. However, they do not act directly on the cancer cells, but influence certain checkpoints of the immune system. These “immune checkpoints” slow down the immune responses.
CAR-T cell therapy
CAR-T cell therapy is a fairly new form of immunotherapy. It is suitable for the treatment of certain forms of non-Hodgkin’s lymphoma and leukemia.
Mild chemotherapy is used to prepare for this treatment. It kills part of the cancer cells as well as the body’s own T cells. This “gap” in the stock of T cells is filled by laboratory-produced CAR T cells, which the patient receives via an infusion.
Therapy with signal pathway inhibitors
One example is the active ingredient idelalisib. Such therapy is considered for people with follicular lymphoma (an NHL) when chemotherapy and antibody therapy have not been effective.
For detailed information on the treatment of the different types of lymphoma, see the articles Hodgkin’s disease and non-Hodgkin’s lymphoma.
