Does Mono Cause Lymphoma?

Mononucleosis Has Been Mistaken for Lymphoma

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Six degrees of separation is the idea that you can connect one person to another through six steps, going through different acquaintances and connections.

In medicine, viruses and cancers can be similarly linked, more readily than one might expect. But it’s important to remember that very few viruses are known to be necessary and sufficient to cause cancer on their own. Connection is not always cause, but there are some notable exceptions.

Does Mononucleosis Cause Lymphoma?

Most people recognize mononucleosis, or mono, as the kissing disease that a teen, adolescent or college student might contract. Epstein-Barr virus (EBV) is the virus responsible for mononucleosis. EBV can also (in addition to kissing) be transmitted through coughing, sneezing, or by sharing drinking or eating utensils. Most people in the United States are infected with EBV by the end of their teen years, although not everyone develops the symptoms of mono.

EBV is a risk factor for certain kinds of lymphoma, but it would be incorrect to say that EBV is the cause of lymphoma. According to the American Cancer Society, EBV infection doesn’t cause serious problems in most people:

  • EBV infection increases risk of nasopharyngeal cancer and certain types of fast-growing lymphomas such as Burkitt lymphoma
  • EBV may also be linked to Hodgkin lymphoma and some stomach cancers
  • EBV-related cancers are more common in Africa and parts of Southeast Asia; and overall, very few people who have been infected with EBV will ever develop these cancers.

When EBV does lead to cancer, it’s believed other risk factors are also involved. For more on this, and the interplay between diseases, see the article on EBV and lymphoma by Dr. Mallick.

Can Mono be Confused for Lymphoma?

This is not usually the case, but it is possible. An atypical clinical presentation of mono occasionally results in a lymph node or tonsillar biopsy. What the pathologist sees on the slide looks a lot like lymphoma. If it is truly lymphoma, however, other tests will bring this to light. For an example of this, see A Profile of Hope: Matt’s Story.

Which Viruses Cause Cancer, Then?

The American Cancer Society has a page devoted exclusively to this question. HPV and hepatitis B and C viruses are known to cause cancer, but there are important caveats.

More than 40 types of HPV can be passed on through sexual contact. About a dozen of these types are known to cause cancer. A few types of HPV are the main causes of cervical cancer, the second most common cancer among women worldwide.

With hepatitis viruses, chronic infections increase the risk of liver disease and cancer, however, if detected, some of these risks can be reduced with medical management of the infections.

Sources

Lymphoma - Non-Hodgkin: Risk Factors. http://www.cancer.net/cancer-types/lymphoma-non-hodgkin/risk-factors. Accessed December 2014.

Viruses that can lead to cancer. http://www.cancer.org/cancer/cancercauses/othercarcinogens/infectiousagents/infectiousagentsandcancer/infectious-agents-and-cancer-viruses Accessed December 2014.

Louissaint A, Jr., Ferry JA, Soupir CP, Hasserjian RP, Harris NL, Zukerberg LR. Infectious mononucleosis mimicking lymphoma: distinguishing morphological and immunophenotypic features. Modern pathology. 2012;25(8):1149-1159.

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