Limfoma (lymphoma, also called kanser limfoma) is a type of blood cancer that affects lymphocytes, the white blood cells that help you fight infection. The most common sign is a painless lump in the neck, armpit or groin. Other symptoms include fever, night sweats, itchy skin, shortness of breath and weight loss you cannot explain. There are two main types, Hodgkin and non-Hodgkin lymphoma, and both are diagnosed with a biopsy and staged from 1 to 4. Many people are cured, and slow-growing types can often be controlled for years. This guide explains the signs, types and stages of lymphoma, how it is treated, and what it means for women in Malaysia, including during pregnancy.
Apa itu limfoma?
Lymphoma is a cancer of the lymphatic system and is also called lymphatic cancer (Blood Cancer UK). It affects lymphocytes, a type of white blood cell that is an important part of the immune system. In lymphoma, the lymphocytes do not develop properly, do not work as they should and can multiply out of control (Blood Cancer UK).
Lymphocytes travel around the body through thin tubes (lymph vessels) and glands (lymph nodes, or kelenjar limfa) (NHS). The lymph system also includes the spleen, thymus, tonsils and bone marrow (National Cancer Institute). Groups of lymph nodes are found in the neck, armpits, chest, tummy, pelvis and groin (National Cancer Institute), which is why lymphoma often causes lumps in these places.
Lymphoma and leukemia are both blood cancers, but they are not the same. Leukaemia affects blood cells in the bone marrow, usually white blood cells (Blood Cancer UK), while lymphoma usually shows up as swollen lymph glands (NHS). In the UK, lymphoma is the most common blood cancer, with over 14,000 people diagnosed each year (Blood Cancer UK).
Jenis limfoma: Hodgkin dan bukan Hodgkin
There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma (Blood Cancer UK). Doctors tell them apart by looking at the cancer cells under a microscope. Hodgkin lymphoma cells called Reed-Sternberg cells are often seen in classic Hodgkin lymphoma (National Cancer Institute).
| Limfoma Hodgkin (Hodgkin lymphoma) | Limfoma bukan Hodgkin (non-Hodgkin lymphoma) | |
|---|---|---|
| How common | Less common (NHS) | More common (NHS) |
| Who it mainly affects | Young people and people aged 75 and over (NHS) | Mostly older people, but it can affect any age, including children (NHS) |
| Types | 2 types: classical Hodgkin lymphoma and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) (NHS) | Over 60 different types (NHS) |
| How fast it grows | Classical type; NLPHL is rare and tends to grow more slowly (National Cancer Institute) | Slow growing (low grade) or fast growing (high grade) (NHS) |
| Outlook | If caught early, treatment can often get rid of it completely (NHS) | Depends on the type; some can be got rid of completely, others need long-term treatment (NHS) |
Common types of non-Hodgkin lymphoma
- Diffuse large B cell lymphoma (DLBCL). A fast-growing (high grade) type, and the most common high grade lymphoma. Treatment starts soon after diagnosis (Cancer Research UK).
- Follicular lymphoma. Usually slow growing (low grade) (Cancer Research UK).
- Other types include Burkitt lymphoma, mantle cell lymphoma, marginal zone and MALT lymphoma, T cell lymphomas and lymphoma of the skin or brain (Cancer Research UK).
Most types of non-Hodgkin lymphoma begin in B lymphocytes, the cells that make antibodies to fight infection (National Cancer Institute).
Limfoma di Malaysia
Lymphoma is one of the most common cancers in Malaysia. According to the Malaysia National Cancer Registry Report 2017-2021 from the Ministry of Health:
- 8,793 lymphoma cases were registered in 2017 to 2021, up from 5,830 in 2012 to 2016. Lymphoma was the fourth most common cancer in Malaysia, after breast, colorectal and lung cancer.
- It was the most common cancer among young people aged 15 to 24, making up 20.1% of cancers in young women in this age group.
- Lymphoma was more common among Malays than other ethnic groups, in both men and women.
| Lymphoma in Malaysian women, 2017 to 2021 | Figure |
|---|---|
| Total cases in women | 3,677 |
| Hodgkin lymphoma | 646 |
| Non-Hodgkin lymphoma | 3,031 |
| Rank among cancers in women | 7th most common |
| Lifetime risk for women | 1 in 200 (1 in 200 for Malay and Other Bumiputera women; 1 in 250 for Chinese and Indian women) |
| Diagnosed at a late stage (stage 3 or 4) | 57.4% of women whose stage was recorded |
Source: Malaysia National Cancer Registry Report 2017-2021, National Cancer Institute, Ministry of Health Malaysia. More than half of women whose stage was recorded were diagnosed at a late stage, which is one reason it helps to know the signs and see a doctor early.
Tanda dan simptom limfoma
The most common symptom of lymphoma is a painless lump or swelling, usually in the neck, armpit or groin (NHS). Other symptoms include (NHS):
- a high temperature, or feeling hot, cold or shivery (see our guide to demam (fever));
- night sweats;
- shortness of breath (sesak nafas);
- itchy skin (gatal kulit);
- sudden weight loss that you cannot explain.
Some people with Hodgkin lymphoma also have pain in the glands in the neck, armpit or groin when they drink alcohol (NHS), itching that is worse after drinking alcohol, a cough that does not go away, or pain in the tummy (Cancer Research UK). Hodgkin lymphoma can also cause tiredness (National Cancer Institute).
B symptoms
Doctors call three symptoms "B symptoms" (Cancer Research UK):
- heavy sweating at night;
- high temperatures that come and go, often at night;
- unexplained weight loss of more than a tenth (10%) of your body weight in the last 6 months.
B symptoms affect the stage and outlook, and people with them may need more treatment (Cancer Research UK).
Symptoms from where the lymphoma is
Swollen lymph nodes can press on organs and cause chest pain, a cough, breathlessness or tummy pain (Blood Cancer UK). They can also press on nerves and cause pain, or cause swelling in the arms or legs (Cancer Research UK).
If lymphoma affects the bone marrow, it can cause tiredness and breathlessness from anaemia (kurang darah), more infections, and low platelets that can lead to nosebleeds, very heavy periods or a rash of tiny blood spots under the skin (Cancer Research UK).
These symptoms are common and can be caused by many other conditions. Having them does not mean you have lymphoma, but it is important to get them checked, because finding lymphoma early means treatment is more likely to be successful (NHS).
Benjolan limfoma atau kelenjar bengkak biasa?
Most swollen glands are not lymphoma. Lymph nodes commonly swell when you have an infection, and they usually go back to normal over a short time (Cancer Research UK). Our guide to benjolan di leher (lumps in the neck) explains the many common causes.
| Swollen gland from an infection | Possible lymphoma | |
|---|---|---|
| How it starts | Often with a common illness such as a cold, tonsillitis or an ear or throat infection (NHS) | Often no recent infection (Cancer Research UK) |
| How it changes | Usually gets better by itself within 1 to 2 weeks (NHS) | Often grows slowly and may be there for months or years before it is noticed; sometimes grows very quickly (Cancer Research UK) |
| Pain | Feels like a tender, painful lump (NHS) | Usually painless, although some people say the lumps ache, or hurt after drinking alcohol (Cancer Research UK) |
| Other symptoms | Symptoms of the infection | May come with night sweats, fevers, weight loss or itching (NHS) |
You cannot tell for sure what a lump is by feeling it. See a doctor if you have swollen glands and (NHS):
- they are getting bigger, or have not gone down within 1 week;
- they feel hard or do not move when you press them;
- you have night sweats or a very high temperature;
- you have no other signs of illness or infection;
- the swollen glands are just above or below your collarbone.
Get urgent help if you have swollen glands and find it very difficult to swallow or breathe (NHS). A blood test may show a high white cell count for many reasons; see our guide to sel darah putih tinggi (high white blood cell count).
Punca dan faktor risiko limfoma
It is not known what causes lymphoma, but some things may increase your chances of getting it (NHS). Anyone can get it.
| Hodgkin lymphoma: higher risk if you (NHS) | Non-Hodgkin lymphoma: higher risk if you (NHS) |
|---|---|
| are in your early 20s or late 70s | are over 50 |
| are a man | have had certain infections, including the Epstein-Barr virus (which causes glandular fever) and hepatitis C |
| have had the Epstein-Barr virus, which causes glandular fever | have a weakened immune system, from a condition such as HIV or from treatment that weakens it |
| have a weakened immune system, from a condition such as HIV or from treatment that weakens it | have an autoimmune condition, such as coeliac disease or psoriasis |
| have a parent, brother or sister who has had Hodgkin lymphoma | have a parent, brother or sister who has had non-Hodgkin lymphoma |
| smoke, or are overweight |
Having a risk factor does not mean you will get lymphoma, and it can develop in people who have no known risk factors (National Cancer Institute).
Ujian dan diagnosis
A doctor will ask about your symptoms and may feel for lumps in your neck, armpits and groin. You may also be asked to have a blood test (NHS). If lymphoma is possible, you will be referred to a specialist at a hospital (NHS). A doctor who specialises in blood conditions is called a haematologist (Cancer Research UK).
Biopsy
The main test for lymphoma is a biopsy, where a sample of an affected lymph node is taken and checked for signs of cancer (NHS). You may have part or all of a lymph node removed (excision biopsy), or a sample taken with a thin needle (needle biopsy). You will usually have a local or general anaesthetic so you do not feel any pain (NHS).
Tests after diagnosis
If you are told you have lymphoma, you may need more tests, including (NHS; National Cancer Institute):
- blood tests, such as a full blood count, LDH, and tests for hepatitis B, hepatitis C and HIV, which help plan treatment;
- scans, such as a CT, PET-CT, MRI or ultrasound scan;
- a bone marrow biopsy, which takes a sample of the spongy tissue inside your bones.
These tests show how far the lymphoma has spread (the stage). For non-Hodgkin lymphoma, you will also be told what type you have and whether it is slow growing (low grade) or fast growing (high grade). The type, stage and grade help your specialist team decide what treatment you need (NHS).
Being told you have lymphoma can feel overwhelming. A team of specialists will help you through your diagnosis and treatment, usually including a specialist nurse you can ask questions (NHS). It can help to bring someone with you for support (NHS).
Tahap limfoma (tahap 1 hingga 4)
Doctors use the Lugano classification to stage both Hodgkin and non-Hodgkin lymphoma. There are 4 stages (Cancer Research UK). The stage depends on how many places are affected, whether they are on one or both sides of the diaphragm (the breathing muscle between the chest and tummy), and whether the lymphoma is inside or outside the lymphatic system (Cancer Research UK).
| Tahap (stage) | What it means (Cancer Research UK) |
|---|---|
| Tahap 1 | Lymphoma in one lymph node or one group of lymph nodes, or one organ of the lymphatic system such as the thymus; or in one organ outside the lymphatic system (stage 1E) |
| Tahap 2 | Lymphoma in two or more groups of lymph nodes, or in one organ outside the lymphatic system and one or more groups of lymph nodes (stage 2E), all on the same side of the diaphragm |
| Tahap 3 | Lymphoma on both sides of the diaphragm, for example in lymph nodes in the chest and in the spleen |
| Tahap 4 | Lymphoma in the lymph nodes and an organ outside the lymphatic system, or in more than one organ outside it, such as the liver, bones or lungs |
Stages 1 and 2 are called early or limited stage, and stages 3 and 4 are called advanced stage (Cancer Research UK). Your doctor may also add letters to the stage (Cancer Research UK):
- A or B: B means you have B symptoms (night sweats, fevers or weight loss); A means you do not.
- E: the lymphoma is in an organ outside the lymphatic system, such as the lungs, liver, bone marrow or kidneys.
- Bulky: an area of lymphoma is above a certain size, such as 10 cm or more in Hodgkin lymphoma.
Limfoma tahap 4: what it means
Stage 4 means the lymphoma has spread outside the lymphatic system. It is still treatable. Treatment for stage 3 and 4 Hodgkin lymphoma is usually 4 to 6 cycles of chemotherapy, sometimes with steroids, radiotherapy or targeted medicine (Cancer Research UK). In England, almost 85% of people with stage 4 Hodgkin lymphoma survive for 5 years or more after diagnosis (Cancer Research UK). For non-Hodgkin lymphoma, the outlook depends a lot on the type as well as the stage (Cancer Research UK).
Rawatan limfoma
Treatment depends on the type of lymphoma, where it is, whether it has spread, whether it is fast or slow growing, your symptoms and your general health (NHS). You may be offered a combination of treatments, and your specialist team will explain the benefits and side effects of each (NHS).
| Treatment | What it is | When it may be used |
|---|---|---|
| Chemotherapy | Medicines that kill cancer cells, sometimes given with steroid medicine (NHS) | The main first treatment for most types; also before a stem cell transplant (NHS) |
| Radiotherapy | High-energy radiation to kill cancer cells in the lymph nodes (NHS) | With or after chemotherapy, for large areas of lymphoma, or on its own for some low grade lymphomas (NHS) |
| Targeted medicines and immunotherapy | Medicines that kill cancer cells or help the immune system attack the cancer (NHS) | With chemotherapy, to keep lymphoma under control, or if it comes back (NHS) |
| Stem cell transplant | Damaged blood cells are replaced with healthy ones (NHS) | If lymphoma comes back after treatment or other treatments are not working (NHS) |
| Watch and wait | Regular tests instead of treatment straight away (NHS) | Some slow-growing lymphomas that are not causing symptoms (NHS) |
CAR T-cell therapy is another treatment used for some lymphomas (Blood Cancer UK).
Hodgkin lymphoma
Treatment for stage 1 and 2 Hodgkin lymphoma is usually 2 to 4 cycles of chemotherapy, sometimes with radiotherapy (Cancer Research UK). For most people, treatment gets rid of Hodgkin lymphoma completely. It can come back, but treatment may still be able to get rid of it again (NHS).
Fast-growing non-Hodgkin lymphoma
Fast-growing (high grade) non-Hodgkin lymphoma needs to be treated straight away. Treatment can often get rid of it completely, although sometimes more treatment is needed (NHS).
Slow-growing non-Hodgkin lymphoma
Treatment for slow-growing (low grade) non-Hodgkin lymphoma does not get rid of it, but it can keep it under control for many years. If you have no symptoms, treatment can sometimes be delayed (watch and wait) (NHS). Some people with slow-growing lymphoma never need treatment (Blood Cancer UK). Being told you have cancer but will not be treated straight away can feel strange, so ask your team to explain the plan and what to watch out for.
If advanced lymphoma cannot be cured, treatment aims to slow it down, help with symptoms and help you live longer, and a palliative care team can help you feel more comfortable (NHS).
Boleh sembuh? Peluang hidup
Many people with lymphoma are cured or live for many years. Survival depends on the type, stage, B symptoms, your age and your general health, and no one can tell you exactly what will happen to you (Cancer Research UK). The figures below are from the UK and are averages from large groups of people.
| Type of lymphoma | Survive 5 years or more after diagnosis |
|---|---|
| Hodgkin lymphoma, all adults (UK) | Almost 90% (Cancer Research UK) |
| Hodgkin lymphoma stage 1 (England) | Around 95% (Cancer Research UK) |
| Hodgkin lymphoma stage 4 (England) | Almost 85% (Cancer Research UK) |
| Non-Hodgkin lymphoma, all types (England) | Around 65% (Cancer Research UK) |
| Follicular lymphoma, slow growing (one area of England) | Around 85% (Cancer Research UK) |
| Diffuse large B cell lymphoma, fast growing (one area of England) | Around 60% (Cancer Research UK) |
"5-year survival" does not mean you will only live for 5 years. Many people live much longer than this (Cancer Research UK). Your specialist can tell you more about your own outlook.
Limfoma, kesuburan dan kehamilan
Kesuburan (fertility)
Some treatments for lymphoma can affect your ability to have children. If you want to have children in the future, speak to your specialist team before treatment starts (NHS). If you are planning a pregnancy after treatment, see our guide to trying to get pregnant and ask your team when it is safe to try.
Limfoma semasa mengandung
Lymphoma can be diagnosed during pregnancy. Treatment is chosen carefully to protect the baby, and decisions are based on the mother's wishes, the stage of the lymphoma and how far along the pregnancy is (National Cancer Institute).
- Scans: tests that protect the baby from radiation are used, such as MRI without contrast dye and ultrasound (National Cancer Institute).
- Hodgkin lymphoma: a diagnosis in the first trimester does not necessarily mean you will be advised to end the pregnancy. When Hodgkin lymphoma is diagnosed in the second half of pregnancy, most women can delay treatment until after the baby is born (National Cancer Institute).
- Non-Hodgkin lymphoma: most non-Hodgkin lymphomas found during pregnancy are fast growing, and treatment straight away is often recommended, even during pregnancy, because delaying it may lower the mother's chance of survival. Slow-growing types may be watched until after the birth (National Cancer Institute).
- Radiotherapy is put off until after delivery if possible. If it is needed sooner, a lead shield covers the tummy to protect the baby as much as possible (National Cancer Institute).
Some chemotherapy can cause birth defects if given in the first trimester, which is why the timing and choice of treatment are planned with you by your specialist team (National Cancer Institute).
Bila perlu jumpa doktor
See a doctor if you have any symptoms of lymphoma (NHS), especially:
- a painless lump in your neck, armpit or groin, particularly if you have not had a recent infection (Cancer Research UK);
- night sweats, fevers that come and go, or weight loss you cannot explain (NHS);
- itching, a cough or shortness of breath that does not go away (NHS; Cancer Research UK).
Your symptoms are unlikely to be cancer, but it is important to get them checked (Cancer Research UK). Being referred to a specialist for more tests does not definitely mean you have cancer (NHS).
Frequently asked questions (FAQ)
Apa itu limfoma (what is lymphoma)?
Limfoma (lymphoma, sometimes called kanser limfoma) is a type of blood cancer that affects white blood cells called lymphocytes, which are part of the immune system (Blood Cancer UK). It usually causes painless lumps in the lymph glands, most often in the neck, armpit or groin (NHS). There are two main types: Hodgkin lymphoma and non-Hodgkin lymphoma. In Malaysia, lymphoma was the fourth most common cancer in 2017 to 2021, with 8,793 cases registered (Malaysia National Cancer Registry).
Apa tanda awal limfoma (what are the early signs of lymphoma)?
The most common sign is a painless lump or swelling, usually in the neck, armpit or groin (NHS). Other symptoms include a high temperature, night sweats, shortness of breath, itchy skin and sudden weight loss that you cannot explain (NHS). These symptoms are common and can be caused by many other conditions, so having them does not mean you have lymphoma, but you should get them checked by a doctor (NHS).
Apa beza limfoma dan leukemia (what is the difference between lymphoma and leukaemia)?
Both are types of blood cancer (Blood Cancer UK). Lymphoma affects lymphocytes, which travel through the lymph vessels and lymph glands, and it usually shows up as painless swollen glands (NHS). Leukaemia affects blood cells in the bone marrow, usually white blood cells (Blood Cancer UK). Lymphoma can sometimes spread to the bone marrow too (Cancer Research UK).
Apa maksud limfoma tahap 4 (what does stage 4 lymphoma mean)?
Stage 4 means the lymphoma is in the lymph nodes and in an organ outside the lymphatic system, or in more than one organ outside it, such as the liver, bones or lungs (Cancer Research UK). It is an advanced stage, but it can still be treated, and many people do well. In England, almost 85% of people with stage 4 Hodgkin lymphoma survive for 5 years or more after diagnosis (Cancer Research UK). Survival for non-Hodgkin lymphoma depends a lot on the type.
Boleh ke limfoma sembuh (can lymphoma be cured)?
Often, yes. For most people with Hodgkin lymphoma, treatment gets rid of the lymphoma completely, although it can come back (NHS). Fast-growing (high grade) non-Hodgkin lymphoma can often be got rid of completely with treatment, while slow-growing (low grade) types usually cannot be cured but can be kept under control for many years (NHS). Your specialist team can tell you what to expect for your type and stage.
Adakah setiap benjolan kelenjar bermakna limfoma (is every swollen gland lymphoma)?
No. Lymph glands commonly swell when you have an infection, and they usually go back to normal over a short time (Cancer Research UK). With lymphoma, the swollen glands are usually painless and often grow slowly over months (Cancer Research UK). See a doctor if you have a swollen gland, especially if you have not had a recent infection, or if it comes with night sweats, fever or weight loss (Cancer Research UK).
Boleh ke limfoma berlaku semasa mengandung (can lymphoma happen during pregnancy)?
Yes, lymphoma can be diagnosed during pregnancy. Doctors plan treatment carefully to protect the baby, based on the type and stage of lymphoma, how far along the pregnancy is and the mother's wishes (National Cancer Institute). Scans that do not use radiation, such as MRI without contrast dye and ultrasound, are used during pregnancy (National Cancer Institute). Most women diagnosed with Hodgkin lymphoma in the second half of pregnancy can delay treatment until after the baby is born, while fast-growing non-Hodgkin lymphoma often needs treatment straight away (National Cancer Institute).
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. See a doctor if you have a lump that does not go away or any symptoms that worry you.
References
- What is Hodgkin lymphoma? — NHS
- Symptoms of Hodgkin lymphoma — NHS
- Causes of Hodgkin lymphoma — NHS
- Tests and next steps for Hodgkin lymphoma — NHS
- Treatment for Hodgkin lymphoma — NHS
- What is non-Hodgkin lymphoma? — NHS
- Symptoms of non-Hodgkin lymphoma — NHS
- Causes of non-Hodgkin lymphoma — NHS
- Tests and next steps for non-Hodgkin lymphoma — NHS
- Swollen glands — NHS
- Treatment for non-Hodgkin lymphoma — NHS
- Symptoms of Hodgkin lymphoma — Cancer Research UK
- Stages of Hodgkin lymphoma — Cancer Research UK
- Stages of non-Hodgkin lymphoma — Cancer Research UK
- Types and grades of non-Hodgkin lymphoma — Cancer Research UK
- Survival for Hodgkin lymphoma — Cancer Research UK
- Survival for non-Hodgkin lymphoma — Cancer Research UK
- Lymphoma — Blood Cancer UK
- Leukaemia — Blood Cancer UK
- Hodgkin Lymphoma Treatment (PDQ), Patient Version — National Cancer Institute
- Non-Hodgkin Lymphoma Treatment (PDQ), Patient Version — National Cancer Institute
- Malaysia National Cancer Registry Report 2017-2021 — National Cancer Institute, Ministry of Health Malaysia
