There is no specific blood test for lymphoma.
Leukemia & Lymphoma Awareness month goes beyond wearing a colored ribbon or taping a flyer in a clinic window. Doctors should be attuned to differentials and patients should voice concerns over unexplained symptoms—perhaps insisting on accurate testing rather than empirical evaluations.
Lymphoma is a cancer of the lymphocytes (white blood cells) that typically play a key role in fighting infection. The lymphatic system is part of the circulatory system, comprising a network of conduits called lymphatic vessels that carry a clear fluid called lymph towards the heart. Collections of lymph nodes are found in the neck, underarms, chest, abdomen, and groin. Lymphatic tissue is also located in other parts of the body, including the stomach, skin, and small intestine. A multidisciplinary approach is useful to optimally manage patients with rare or complex neoplasms.
There are two broad types of lymphoma—Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) and many subclassifications. The main difference between HL and NHL is in the specific lymphocyte each involves. Because of so many variations, it is not uncommon for medical practitioners to offer differing diagnosis for the same symptoms or even lab results. In fact, a second opinion of pathologist biopsy interpretation (whether negative or positive) may be equally, if not more, important than a second opinion for an oncologist’s treatment plan. Differences between malignant and benign cells can be subtle and interpretations can be subjective.
People with Sjogren’s syndrome are 44 times more likely to develop non-Hodgkin lymphoma.
Dry eyes and aching joints can be precursors to lymphoma since people with Sjogren’s syndrome are 44 times more likely to develop NHL. If you have Sjogren’s syndrome, report any of the main early NHL symptoms to your general practitioner—a painless swelling in a lymph node (gland), usually in the neck, armpit or groin. Mucosa-Associated Lymphoid Tissue (MALT) lymphoma affects lymphatic tissue in parts of the body such as the stomach, gut, lungs and eyes. This B-cell lymphoma can, therefore, manifest dry eyes as secondary symptom.
In the United States, B-cell lymphomas (lymphocytes originating from bone marrow) account for about 85% of non-hodgkin lymphomas. The most common type is diffuse large B‑cell lymphoma (DLBCL) with average onset of 63-66 years of age. It is distinguished as a quickly growing mass within a lymph node.
Therapeutic targets for diffuse large B‑cell lymphoma include RelA NF-κB and IRAK4 Kinase.
Primary mediastinal B-cell lymphoma (PMBCL) accounts for only 2% of all lymphomas. It is more prevalent among women in their 30s. PMBCL is similar to DLBCL but with fibrosis and generally localized in the middle of the chest. Both types respond well to treatment. Intravascular large B‑cell lymphoma is a rare subtype of DLBCL affecting blood vessels.
Though most lymphomas manifest within internal organs, cutaneous T‑cell lymphomas (skin lymphoma or mycosis fungoides) can be observed externally. The problem with diagnosis is that there is great variation in appearance. Cutaneous pseudolymphoma is not a disease but rather an inflam­matory response to known or unknown stimuli that results in a lymphomatous-appearing but benign accumulation of inflam­matory cells. Pseudolymphomas often show broad patches and plaques. They often mimic cutaneous T-cell lymphoma. Examples include actinic reticuloid, lymphoma­toid contact dermatitis, and lymphoma­toid drug eruptions.
Mycosis fungoides (MF) makes up 72% of CTCL. Sezary syndrome is an advanced, variant form of MF, which is characterized by the presence of lymphoma cells in the blood. Extensive thin, red, itchy rashes usually cover over 80% of the body in MF.
Classic MF primarily arises in the double-clothed areas of the body: axillae, breasts, groin, and buttock primarily presented with thin, red, scaly, poorly demarcated plaques of at least 5cm in diameter. Over time the morphology tends toward thickening of the plaques to more erythematous prominence, and, of course, tumors that may ulcerate. Early MF can be subtle and usually lacks classic histopathologic signs, therein causing so much trouble for making the early definitive diagnosis. This is why I do not rely solely on pathology to confirm early-stage disease.
Slow growing lymphomas have the best early cure rate. The dichotomy is that they are generally discovered after disease has progressed to an advanced stage. High-grade aggressive lymphomas are often symptomatic early on and are potentially curable with aggressive treatments.
Pain is not a primary symptom. Skin lesions that do not heal, deep or surface lumps in the neck, armpits, chest, breasts, abdomen or groin should be brought to the attention of appro­priate medical professionals. Diagnosis may involve a physical exam, blood tests, imaging tests, and/or surgical biopsy of a swollen lymph node or bone marrow collection to determine A or B category of four progressive stages.  It is estimated that 9,290 men and women (5,070 men and 4,220 women) were diag­nosed with Hodgkin’s lymphoma in 2013.  Acording to the American Cancer Society, about 74,680 people, including children, (41,730 males and 32,950 females) will be diag­nosed with NHL this year.