Lymph Node Cancer, Lymphoma – Types, Causes, Diagnosis

The incidence of lymph node cancer is increasing globally and is more common in developed nations. However the rise in lymph node cancer in South Africa may often be attributed to the high incidence of HIV/AIDS although this is not the only cause. Due to the nature of the area, there is always a risk of rapid spread as the lymph nodes are connected to each other through the vast network of vessels that make up the lymphatic system.

The Lymphatic System

The lymphatic system is made up of lymphatic vessels and nodes that are situated throughout the body. The vessels carry fluid from the tissue spaces back into the circulating blood. This fluid is filtered by the lymph nodes so that any bacteria, viruses, dead cells and any waste material is not deposited into the blood. Lymphocytes (white blood cells) within the lymph nodes are the main filters and the entire lymphatic system is an important part of the immune system.

Types of Lymph Node Cancer

There are two types of lymph node cancer :

1. Primary lymph node cancer, or lymphoma, occurs when the cancer develops within the lymph node or spreads from another lymph node.
2. Secondary lymph node cancer is also known as metastatic lymph node cancer. Here the cancer cells have spread from a malignant tumor that is located elsewhere in the body.

Primary lymph node cancer is further divided into Hodgkin’s and non-Hodgkin’s lymphoma and the latter is categorised into various subtypes. Any lymphoma that is not a Hodgkin’s lymphoma is classified as a non-Hodgkin’s lymphoma.

Causes of Lymph Node Cancer

While the exact cause is not known, certain risk factors have been identified. These include :

• Gender – it is more common in men.
• Age – some are common in younger age groups while others may affect the elderly.
• Family history of lymph node cancers.
• Certain infections like Epstein-Barr virus that causes infectious mononucleosis or HIV which causes AIDS. Other infections like hepatitis B  or C may also be a risk factor for developing lymph node cancer.
• Cigarette smoking.
• Exposure to toxins like pesticides, herbicides and other chemicals.
• Radiation.

These are not the only risk factors associated with lymph node cancer.

Signs and Symptoms of Lymph Node Cancer

Cancer is not always obvious and the signs and symptoms may be mistaken for other diseases. One of the main symptoms is a swollen lymph node but this may also arise for many other reasons including infections, blockages and due to other chronic diseases. If the lymph node swelling is persistent, recurs frequently or is increasing in size, then it is important to consult with your doctor.

Other symptoms associated with lymph node cancer may be non-specific and is at times mistaken for various conditions. These signs and symptoms include :

• Loss of weight.
• Loss of appetite.
• Night sweats.
• Fever of unknown origin.
• Fatigue.
• Persistent coughing and difficulty with breathing.
• Aches and pains, especially abdominal and/or chest pain.
• Headaches.
• Changes in bowel movements – diarrhea or constipation.

In the event of a secondary lymph node cancer, there may be signs and symptoms related to initial site of cancer although at times, the lymph node swelling may be the first sign.

Diagnosis of Lymph Node Cancer

Lymph nodes that are increasing in size, are hard, fixed (immobile) and/or matted together are often a warning sign for further investigation. Your doctor may request an x-ray to identify the extent of lymph node swelling throughout the body and may also conduct an MRI or CT scan. Other investigative techniques may involve an ultrasound scan or PET (positron-emission tomographic) scan.

Lymph nodes may be surgically removed for microscopic examination or a sample from the lymph node may be taken. This is known as a biopsy. In a lymphoma, the presence of a specific type of cell known as Reed-Sternburg cells is conclusive of Hodgkin’s lymphoma. In secondary metastatic lymph node cancer, the cancer cells will often resemble the cells of the organ or tissue containing the initial tumor.

Treatment of Lymph Node Cancer

As is the case for any cancer, treatment may involve one of the following options :

1. Radiation therapy.
2. Chemotherapy.
3. Surgical excision of the tumor.

Other treatment options may involve the use of immunotherapy (biological therapy) which triggers the immune system to attack the cancer cells. Your oncologist (cancer specialist) will discuss your treatment options with you and a combination therapy utilising two or more options simultaneously may be necessary.