Lymphomas are cancers that develop in the lymphatic system -- the tissues and organs that produce, store, and carry white blood cells. The lymphatic system includes:

• Bone marrow
• Spleen
• Thymus
• Lymph nodes
• A network of thin tubes that carry lymph and white blood cells to all the tissues of the body

Types of lymphoma include:

• Non-Hodgkin lymphoma. The most common form of the disease. Cells in the lymphatic system become abnormal. They divide and grow without any order or control. Or old cells that should die don't. Non-Hodgkin lymphoma can begin or spread to almost any part of the body.
• Hodgkin lymphoma. The cells in the lymphatic system become abnormal. But the cancer tends to spread in an orderly way from one group of lymph nodes to the next. Eventually, it can spread almost anywhere.
• Cutaneous T-cell lymphoma. T-lymphocytes, which are infection-fighting white blood cells, become cancerous, causing skin problems.

Lymphoma is accompanied by the following signs and symptoms:

Non-Hodgkin and Hodgkin lymphomas

• Painless swelling in lymph nodes in neck, underarm, or groin
• Unexplained fever
• Drenching night sweats
• Fatigue
• Unexplained weight loss
• Itchy skin
• Persistent, nonproductive cough

Cutaneous T-Cell lymphoma

• Itchiness
• Dark patches on skin
• Tumors on skin (mycosis fungoides)
• Skin infections

People with the following conditions or characteristics are at risk of developing lymphoma:

Non-Hodgkin lymphoma

• Congenital immunodeficiency.
• Infections. Epstein-Barr virus (EBV), Helicobacter pylori, Kaposi's sarcoma herpes virus (HIV-related lymphoma), human T-cell leukemia virus type 1.
• Immunosuppressive therapy following organ transplant.
• Autoimmune diseases.
• Prior chemotherapy or radiation exposure or therapy.
• Exposure to certain chemicals or solvents.

Hodgkin lymphoma

• Viruses. EBV, mononucleosis, and HIV.
• Tonsillectomy.
• Genetic predisposition.
• Caucasians more likely than African-Americans.
• Men more likely than women.
• Same sex siblings. 10 times greater risk.

Cutaneous T-Cell lymphoma

• Human T-cell leukemia virus type 1.
• Exposure to certain chemicals or solvents.

If you are having symptoms of lymphoma, your doctor will carefully check for swelling or lumps in the neck, underarms, and groin. If the lymph nodes don't feel normal, your doctor will perform a biopsy. The doctor will remove a small piece of the lymph node -- or in the case of cutaneous T-cell lymphoma, a growth from the skin -- and a pathologist will examine the tissue under a microscope to check for cancer cells.

If you have cancer, your doctor will do more tests to find out if the cancer has spread to other parts of the body (staging). This may involve blood and bone marrow tests, computed tomography (CT) scans, positron emission tomography scans (PET), combination PET/CT scans, and, possibly a laparotomy, during which the doctor cuts into the abdomen and checks the organs for cancer.

Treatment Plan

Your doctor will develop a treatment plan based on the diagnosis, the stage of the disease, the size of the tumor, and your general health and age.

Drug Therapies

Your doctor may prescribe the following drug therapies:

For Hodgkin and Non-Hodgkin lymphomas:

• Radiation therapy
• Chemotherapy, possibly with alpha interferon

For cutaneous T-Cell lymphoma:

• Emollients, moisturizers, topical steroids
• Chemotherapy
• Electron beam therapy
• Retinoids and interferon

Surgical and Other Procedures

Patients sometimes receive bone marrow transplantation and peripheral blood stem cell transplantation. Researchers are testing the effectiveness of radioimmunotherapy, a treatment with a radioactive substance linked to an antibody that will attach to the tumor when injected into the body. They are also investigating immunotherapy, a form of treatment that bolsters the immune system to fight the cancer rather than targeting the cancer directly. A surgeon may also remove the tumor.

Complementary and Alternative Therapies

Lymphoma requires conventional medical management. A comprehensive treatment plan for lymphoma may include a range of complementary and alternative (CAM) therapies. Be sure to ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Some CAM therapies may interact negatively with conventional medical lymphoma interventions. Always tell your doctors about any supplements you are taking, and only work with qualified CAM physicians.

Improved relaxation and decreased stress are helpful in promoting a better sense of well being. Try activities such as guided imagery, tai chi, yoga, and meditation. Intimacy and support from others helps promote a positive and empowering attitude, as well.

Nutrition and Supplements

Some nutritional guidelines may help reduce symptoms. Many herbs and supplements can interact negatively with conventional cancer medications. New research about such interactions is ongoing. While supplements may be helpful, it's important to work with a knowledgeable provider and inform your doctors about any supplements you're using or considering using.

• Try to eliminate potential food allergens. Your doctor may want to test you for food sensitivities.
• Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as kale, spinach, and peppers).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat cruciferous vegetables (such as broccoli, cabbage, and cauliflower). Studies show that a higher intake of green leafy vegetables and cruciferous vegetables is associated with a lower risk of non-Hodgkin lymphoma. Speak with your doctor about any dramatic changes you've made in your diet to make sure it's compatible with your treatment goals.
• Use healthy oils in foods, such as olive oil or coconut oil.
• Reduce or eliminate trans fatty acids, found in such commercially-baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants.
• Avoid alcohol and tobacco.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise lightly, if possible. Speak to your doctor about what regimen is right for you.

You may address nutritional deficiencies with the following supplements:

• Probiotic supplement (containing Lactobacillus acidophilus). For maintenance of gastrointestinal and immune health. Some probiotic supplements need refrigeration. Check the label carefully. Probiotics may not be appropriate for severely immunocompromised patients, or people on certain immunosuppressive drugs. Speak with your doctor.
• Omega-3 fatty acids. Such as fish oil, to help reduce inflammation. Fish oils may increase bleeding in sensitive individuals, such as those taking blood-thinning mediations (including aspirin).
• Melatonin. When needed for sleep. Some alternative providers recommend high doses. Melatonin may interact with a variety of medications, including sedatives, antidepressants, hormonal medications, and others.

Herbs

Herbs can be an important part of an integrated cancer plan, however, they should only be prescribed by a knowledgeable provider who is in communication with all of your other doctors.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (such as nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you individually. You should only take homeopathic remedies under the direction of experienced homeopathic, and keep all of your doctors informed about any remedies you may be considering.

Homeopathy may help improve symptoms and strengthen overall constitution. It may also help reduce the side effects of chemotherapy.

• Radium bromatum. Is specific for radiation poisoning, especially followed by arthritic complaints.

Physical Medicine

Contrast hydrotherapy may help enhance immune function and facilitate the transport of nutrients and waste products. End hot showers with 1 to 2 minutes of cold water spray. Since hydrotherapy stimulates lymphatic flow, talk to your doctor first before beginning a hydrotherapy regimen.

Acupuncture

Acupuncture may help strengthen immunity and detoxification. It may also reduce the side effects of chemotherapy. For many patients and doctors, acupuncture has become one of the most widely used alternative interventions in cancer treatment. Unlike botanicals and nutrients, acupuncture works without ingesting substances, so possible interactions with cancer treatments is less likely.

Prognosis varies, depending on the type and stage of lymphoma. Survival rates for Stage I and II non-Hodgkin lymphoma and Hodgkin lymphoma are very high. Cure rates as high as 75% to 80% are now possible with appropriate initial therapy.

Potential complications include:

• Hodgkin sometimes develops into non-Hodgkin's lymphoma.
• Radiation and chemotherapy can cause secondary cancers.
• Infections and pulmonary fibrosis (thickening and scarring of the air sacs of the lungs) may occur.
• Neuropathy and cardiomyopathy.
• Endocrine dysfunction.

Once you are in remission, it is essential that you be checked for signs of relapse on a regular basis.

Basu S, Li G, Bural G, Alavi A. Fluorodeoxyglucose positron emission tomography (FDG-PET) and PET/computed tomography imaging characteristics of thyroid lymphoma and their potential utility. Acta Radiol. 2009;50(2):201-204.

Bellizzi S, Cocco P, Zucca M, et al. Household contact with pets and birds and risk of lymphoma. Cancer Causes Control. 2011;22(2):159-165.

Bierman PJ, Armitage JO. Non-hodgkin lymphoma. In: Goldman L, Schafer AI, eds. Goldman' Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 185.

Chiu BC, Kwon S, Evens AM, Surawicz T, Smith SM, Weisenburger DD. Dietary intake of fruit and vegetables and risk of non-Hodgkin's lymphoma. Cancer Causes Control. 2011;22(8):1183-1195.

Connors JM. Hodgkin lymphoma. In: Goldman L, Schafer AI, eds. Goldman' Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 186.

Drake MT, Maurer MJ, Link BK, et al. Vitamin D insufficiency and prognosis in non-Hodgkin's lymphoma. J Clin Oncol. 2010;28(27):4191-4198.

Ferri FF, ed. Ferri's Clinical Advisor 2017. 1st ed. Philadelphia, PA: Elsevier. 2017.

Guerard E, Bishop M. Overview of non-hodgkin's lymphoma. Dis Mon. 2012;58(4):208-218.

Hollender A, Bjoro T, Otto Karlsen K, et al. Vitamin D deficiency in patients operated on for gastric lymphoma. Scand J Gastroenterol. 2006;41(6):673-681.

Huebner J, Follmann M. Complementary medicine in guidelines of the German Guideline Program in Oncology: comparison of the evidence base between complementary and conventional therapy. J Cancer Res Clin Oncol. 2013;139(9):1481-1488.

Jiang J, Slivova V, Sliva D. Ganoderma lucidum inhibits proliferation of human breast cancer cells by down-regulation of estrogen receptor and NF-kappaB signaling. Int J Oncol. 2006;29(3):695-703.

Kelemen LE, Cerhan JR, Lim U, et al. Vegetables, fruit, and antioxidant-related nutrients and risk of non-Hodgkin lymphoma: a National Cancer Institute-Surveillance, Epidemiology, and End Results population-based case-control study. Am J Clin Nutr. 2006;83(6):1401-1410.

Kelly JL, Friedberg JW, Calvi LM, van Wijngaarden E, Fisher SG. A case-control study of ultraviolet radiation exposure, vitamin D, and lymphoma risk in adults. Cancer Causes Control. 2010;21(8):1265-1275.

Kormosh N, Laktionov K, Antoshechkina M. Effect of a combination of extract from several plants on cell-mediated and humoral immunity of patients with advanced ovarian cancer. Phytother Res. 2006;20(5):424-425.

Legendre L, Barnetche T, Mazereeuw-Hautier J, Meyer N, Murrell D, Paul C. Risk of lymphoma in patients with atopic dermatitis and the role of topical treatment: A systematic review and meta-analysis. J Am Acad Dermatol. 2015;72(6):992-1002.

McCarty MF, Block KI. Toward a core nutraceutical program for cancer management. Integr Cancer Ther. 2006;5(2):150-171.

MacLean CH, Newberry SJ, Mojica WA, et al. Effects of omega-3 fatty acids on cancer risk: a systematic review. JAMA. 2006;295(4):403-415.

Miller MF, Bellizzi KM, Sufian M, et al. Dietary supplement use in individuals living with cancer and other chronic conditions: a population-based study. J Am Diet Assoc. 2008;108(3):483-494.

Polesel J, Talamini R, Montella M, et al. Linoleic acid, vitamin D and other nutrient intakes in the risk of non-Hodgkin lymphoma: an Italian case-control study. Ann Oncol. 2006;17(4):713-718.

Reardon DA, Gilvert MR, Wick W, Liau L. Immunotherapy for neuro-oncology: the critical rationale for combinatorial therapy. Neuro Oncol. 2015;17 Suppl 7:vii32-vii40.

Tomita M, Koike H, Kawagashira Y, et al. Clinicopathological features of neuropathy associated with lymphoma. Brain. 2013;136 (8);2563-2578.

Wan XS, Ware JH, Zhou Z, Donahue JJ, Guan J, Kennedy AR.. Protection against radiation-induced oxidative stress in cultured human epithelial cells by treatment with antioxidant agents. Int J Radiat Oncol Biol Phys. 2006;64(5):1475-1481.

Velicer CM, Ulrich CM. Vitamin and mineral supplement use among US adults after cancer diagnosis: a systematic review. J Clin Oncol. 2008;26(4):665-673.