Hollywood star Sam Neill who acted as Dr Alan Grant in Steven Spielberg’s 90s dinosaur blockbuster Jurassic Park has announced in his memoir Did I Ever Tell You This that he is diagnosed with non-Hodgkin’s lymphoma (NHL). According to news reports, he had noticed some swollen lumps on his neck while promoting Jurassic World Dominion, the fourth installment in the series in 2022 and was later diagnosed to be in the advanced third stage of this lymphoma variant.
What is non-Hodgkin’s lymphoma?
According to Prof Dr Vishwanath S, senior consultant, medical oncology, Apollo Cancers Centres, Bengaluru, lymphoma is the cancer of the lymph nodes and lymph vessels of the immune system. They carry lymph fluid which releases white blood cells or lymphocytes to fight infections. NHL is caused when lymphocytes multiply in a chaotic manner.
“There are hundreds of lymph nodes in our body. We could say in simple terms that lymphoma is a cancer of immune cells. The lymphoma is broadly classified into Hodgkin’s and non-Hodgkin’s lymphoma. The latter is more common in elderly people but no age is exempt while Hodgkin’s lymphoma affects both children and the elderly,” he adds.
B Cell lymphoma and T Cell lymphoma
“NHL is commonly classified into two B Cell and T Cell lymphoma depending on the affected lymphocytes. The B cell variant is the most common form,” Prof Dr Vishwanath adds.
Prof Dr Karthik Udupa, head, department of medical oncology, Kasturba Medical College, Manipal, Karnataka, adds that NHL is not a single entity but a collection of cancer variants in the lymph tissues and nodes.
“It could also spread and affect multiple parts including your bone marrow. Some of these variants are less aggressive or indolent while others could be more aggressive,” he says.
Dr Amit Kumar Jain, associate consultant, medical oncology, Fortis Hospital, Bengaluru, points out that NHL could also affect the lymphatic tissues of the brain (there are no lymph nodes in the brain.) This rare form variant is also called Central Nervous System lymphoma.
Common symptoms and diagnosis of non-Hodgkin’s lymphoma
Prof Dr Vishwanath points out that apart from swelling of the lymph node, some of the common symptoms include fever, night sweats, fatigue and weight loss. Swollen lumps, especially near the neck or upper body are also seen. He also adds that lymphoma is more common in patients with preexisting autoimmune disease.
“Usually a lymph node biopsy is done to confirm the diagnosis. If detected and treated at an early stage there are less chances of it spreading to other parts,” he adds.
Prof Dr Vishwanath also adds that there are different stages of NHL depending on the extent of its spread, and it could be accurately assessed by a PET/CT scan. According to the American Cancer Society, the stages are:
- Stage one: Lymphoma is detected in one lymph node or one nearby organ outside the lymph system
- Stage two: Lymphoma in two or more lymph nodes either above or below the diaphragm muscles between the chest and abdomen. It could also be in a group of lymph nodes near any organ on either side of the diaphragm.
- Stage three: Lymph nodes on both sides (above and below) of the diaphragm are affected
- Stage four: Extensive spread of lymphoma to at least one organ near the lymph system often the liver, lung or bone marrow.
Prof Dr Udupa, says that most of the time, the exact cause of lymphomas is idiopathic in nature where the exact cause remains not fully explained.
“Some of the factors like genetic ones are still being widely examined and studied,” he adds. Nothing is conclusive.
He also points out that people who have undergone transplant surgery are also at risk of lymphoma. Immunity suppressant therapy is often administered in these cases to avoid the rejection of transplanted organs. This reduces the body’s ability to fight cancer. Already existing cancer treatments like chemo and radiation therapy if not done properly could also lead to lymphoma.
Confusion between initial symptoms of lymphoma and tuberculosis
Dr Jain points out that NHL shares its initial symptoms with that of tuberculosis which often delays initial diagnosis. People affected with both these conditions will initially have symptoms like fatigue, weight loss, night sweats and fever. NHL could also exist alongside tuberculosis.
“Initial diagnosis could get tricky in such cases. TB will also cause these common symptoms and enlargement of lymph nodes. Often these patients are put on TB drugs and in some non-specialised treatment centres, especially in tier two and three cities. Further tests are performed only when there is no noticeable improvement and when there are no persisting or recurring bouts of fever, often after a month,” says Dr Jain. A biopsy often reveals the presence of NHL in most of these cases, he adds.
Treatment of non-Hodgkin’s lymphoma and relapse possibility
Prof Dr Vishwanath says 70-80% cases of lymphoma could be cured with chemoimmunotherapy if detected early.
“People with slow progressing lymphoma variants respond well to proper care and treatment but there is always a chance of relapse,” says Prof Dr Udupa.
According to the American Cancer Society, there are no lifestyle risk factors associated with NHL. So some of the preventive suggestions would be to opt for a lifestyle that promotes better immunity like adopting a healthy diet and an active lifestyle.
Takeaways
Non-Hodgkin lymphoma is the most common variant of lymph node cancer. It is not a single condition but an umbrella term for multiple variants of lymphoma. There are both slow-progressing and aggressive variants of this cancer. Early detection and proper treatment ensure better management. However, there is a risk of relapse in some of the slow-progressing variants.
