Lymphoma

What is Lymphoma?

Lymphoma is a type of blood cancer that begins in lymphocytes, a type of white blood cell that helps the body fight infections. It develops when certain immune cells acquire genetic mutations that cause them to grow and divide faster than normal.

When abnormal lymphocytes build up, they can form tumours in lymph nodes (small, bean-shaped organs that act as the body's natural filtration system) and other organs.

What are the Types of Lymphoma?

Lymphoma is broadly divided into two main categories based on the type of abnormal lymphocyte involved:

How Common is Lymphoma in India?

Lymphoma is among the most common cancers in India. Reports suggest that more than 39,000 people were affected by non-Hodgkin lymphoma, and nearly 10,000 people were affected by Hodgkin lymphoma in the country. Together, these numbers highlight the burden of lymphoma in India, with people getting affected by non-Hodgkin lymphoma more than Hodgkin lymphoma, making it the 10th most common cancer overall in the country.

What are the Symptoms of Lymphoma?

Some individuals may initially experience only mild symptoms of lymphoma, while others may have symptoms that worsen as the disease spreads.

Common lymphoma symptoms in early and advanced stages are:

What Causes Lymphoma?

As of now, the exact cause of lymphoma is still unknown. However, several factors may increase the risk. Some of the causes that can lead to lymphoma include:

• Genetic Mutations: Changes in the DNA of lymphocytes can trigger uncontrolled growth.

• Weakened Immune System: Conditions that impair immunity may increase lymphoma risk.

• Viral Infections: Certain viruses have been associated with specific lymphoma types.

• Family History: Having a close relative with lymphoma may slightly increase risk.

• Ageing: Some forms of lymphoma occur more frequently in older adults.

• Chemical Exposure: Long-term exposure to certain industrial chemicals may contribute to risk.

• Autoimmune Conditions: Chronic immune system disorders may increase susceptibility.

Note: Having one or more risk factors does not necessarily mean a person will develop lymphoma.

Stages of Lymphoma

The table below shows the different stages of lymphoma along with their critical features for understanding:

Diseases Similar to Lymphoma

Lymphoma may often be confused with other types of cancer, like leukaemia and multiple myeloma, as they are all blood-related conditions. However, they are distinct conditions with distinct features.

A comparative overview of these conditions is given below for better understanding:

Lymphoma Vs. Leukaemia Vs. Multiple Myeloma

What are the Complications of Lymphoma?

Untreated or advanced lymphoma can affect several organs and body systems and cause complications like:

• Lower Immunity: Higher susceptibility to infections.

• Anaemia: Low red blood cell levels leading to weakness, anaemia, and fatigue.

• Bone Marrow Involvement: Lower production of normal blood cells.

• Enlarged Spleen: May lead to abdominal discomfort and a feeling of fullness.

• Liver Involvement: May affect liver function in advanced cases.

• Breathing Difficulties: Enlarged chest lymph nodes can put pressure on the airways.

• Nutritional Problems: Appetite loss may lead to weight loss and weakness.

• Treatment Complications: Certain treatments can affect immunity temporarily.

• Secondary Cancers: Some survivors can get other cancers such as lung cancer, breast cancer and other, later.

• Emotional Effects: Anxiety and stress are common after the diagnosis.

When Should I See My Healthcare Provider?

Certain lymphoma symptoms should not be ignored, especially if they persist. You should consider consulting the best healthcare provider if:

• A swollen lymph node persists for more than two weeks.

• Sudden weight loss occurs without any clear reason.

• Night sweats happen repeatedly without any clear cause.

• Persistent fever develops without any signs of infection.

• Fatigue disrupts normal daily activities.

• Shortness of breath or chest discomfort occurs.

• Abdominal swelling or persistent fullness develops.

• Frequent infections occur despite treatment.

How is Lymphoma Diagnosed?

Several tests may be needed to confirm lymphoma and determine its stage, which include:

Diagnostic Assessment Table

How is Lymphoma Managed or Treated?

Treatment depends on the lymphoma type, stage, age and overall health. Some ways to manage lymphoma include:

• Active Monitoring: Some slow-growing lymphomas may not require immediate treatment. Doctors may monitor lymphoma through regular check-ups and scans.

• Medical Treatment: Cancer specialists may use chemotherapy, immunotherapy, targeted therapy or a combination of treatments. These approaches aim to destroy abnormal lymphocytes while preserving healthy cells.

• Radiation Therapy: Radiation therapy uses high-energy beams to target specific areas affected by lymphoma. It is often used for localised disease.

• Stem Cell Transplant: In selected cases, stem cell transplantation may be considered after intensive treatment. This approach helps restore healthy blood-forming cells.

Common Medicines Used to Treat Lymphoma

Treatment for lymphoma can involve several medications and therapies, depending on the type, stage and the individual's health. These include:

• Cyclophosphamide: A chemotherapy drug commonly used in standard combination regimens and used for many types of lymphoma in India.

• Doxorubicin: A chemotherapy drug that is used to kill fast-growing cancer cells and is part of many first-line regimens used to treat lymphoma.

• Vincristine: A chemotherapy drug that works by stopping the ability of cancer cells to divide. It is often used in combination with other chemotherapy drugs.

• Prednisone: A steroid that helps kill some lymphoma cells and also reduces inflammation and helps chemotherapy regimens work better.

• Rituximab: A targeted therapy used for the treatment of CD20-positive B-cell lymphomas (usually given with chemotherapy in India).

• Bendamustine: A chemotherapy medicine often used for certain indolent (slow-growing) B-cell lymphomas and relapsed or refractory disease, sometimes in combination with rituximab.

• Brentuximab Vedotin: A targeted antibody-drug conjugate primarily for CD30-positive lymphomas, including some forms of Hodgkin lymphoma and anaplastic large cell lymphoma.

• Pembrolizumab: An immune therapy (immune checkpoint inhibitor) for some people with relapsed or refractory classical Hodgkin lymphoma who have not responded to other treatments.

Note: The treatment of lymphoma depends on the individual’s symptoms, overall health of the patient and stage of the condition. As treatment needs can vary, medicines should always be taken under the guidance and supervision of a qualified healthcare professional.

Living with Lymphoma: Challenges and Caregiving

Day-to-day life with lymphoma presents major difficulties for the patient and the family in terms of medical monitoring, caregiving and possible expenses. These often include:

What is the Prognosis of Lymphoma?

The outlook varies depending on the subtype, stage and response to treatment. Some forms of lymphoma can be treated successfully and may remain in remission for many years.

Remission means that signs and symptoms of lymphoma become undetectable after treatment. However, remission does not always mean the disease has been permanently cured.

Even when lymphoma cannot be completely cured, it can often be managed effectively with ongoing medical care and monitoring.

How Can I Prevent Lymphoma?

There is no guaranteed way to prevent lymphoma. However, certain steps may help reduce the risk of lymphoma, which are:

• Avoid tobacco products.

• Maintain a healthy weight.

• Eat a balanced diet.

• Exercise consistently.

• Limit exposure to harmful chemicals.

• Get medical treatment for chronic infections.

• Go for regular health check-ups.

• Boost immune health.

Treatment Cost of Lymphoma in India

An overview of the treatment cost of lymphoma is given below:

Does Health Insurance Cover Lymphoma?

Yes, most health insurance plans in India typically cover lymphoma treatment. Coverage often includes hospitalisation costs, diagnostic tests and other required medical procedures. Lymphoma is also covered under critical illness insurance, which provides a lump-sum payout that can be used for treatment or unemployment costs. However, for this, you need to complete a waiting period of up to 90 days and a survival period of up to 30 days.

If lymphoma is diagnosed after purchasing a policy, coverage may begin in accordance with the policy's terms and conditions. If it is treated as a pre-existing condition, waiting periods of up to 3 years may apply in many plans.

Coverage details vary between insurers. Therefore, it is important to review policy documents carefully before making decisions.

How Much Health Insurance Coverage is Needed for Lymphoma Treatment?

Lymphoma treatment usually includes chemotherapy, radiation therapy, diagnostic testing, hospitalisation and follow-up care. A higher cover may be considered when advanced treatments are required. Generally, health insurance coverage of ₹20- ₹40 lakh should cover most lymphoma treatment costs. If a stem cell transplant is required, the coverage should be around ₹50 lakh.

It is advisable to compare insurance plans, including applicable riders, to determine the most suitable coverage for your needs.