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Lymphoma: Diagnosis and Treatment

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We have talked about blood cancer in a separate article. Types of blood cancer include leukaemia, lymphoma and myeloma.

Lymphoma is a cancer afflicting your lymphatic system, which is responsible for fighting diseases and infections. Non-Hodgkin’s lymphoma is more common in adults, while Hodgkin’s lymphoma is the most commonly diagnosed in teenagers aged 15 to 19 years old. Lymphoma is a broad term covering many subtypes. Knowing the type of lymphoma you have is crucial in understanding your treatment options and prognosis. Continue reading to find out more about the different types of lymphoma, it’s diagnosis, and treatment options. 

What is lymphoma?

Lymphoma is a cancer that begins in the lymphocytes. These are white blood cells which fight diseases and infections.

The lymphatic system consists of your lymphatic organs, lymph nodes, and lymphatic vessels.  Key functions of the lymphatic system include maintaining body fluid levels, removing cellular waste, absorbing digestive tract fats, and protecting the body from foreign invaders. The system carries lymph, a colourless fluid which transports lymphocytes to different parts of the body to fight infections. When the lymph nodes are diseased, they are no longer able to filter out cancer cells and produce normal lymphocytes. 

When a lymphocyte develops a genetic mutation, it multiplies uncontrollably, causing the growth of diseased lymphocytes. The mutation also allows the diseased lymphocytes to survive while other normal cells get crowded out and die. Thus, the high rate of infected lymphocytes causes your lymph nodes, spleen, and liver to swell. 

What are the different types of lymphoma?

Generally, there are two main types: 

  1. Non-Hodgkin’s lymphoma
  2. Hodgkin’s lymphoma

Most lymphoma patients have non-Hodgkin’s lymphoma. Each type of lymphoma develops in different lymphocytes. Hodgkin’s lymphoma begins with the detection of an abnormal cell called a Reed-Sternberg cell. Non-Hodgkin’s lymphoma can begin in T-cells, B-cells, or natural killer (NK) cells. The most common type of non-Hodgkin’s lymphoma is B-cell lymphoma

B cells produce antibodies which fight bacteria and other infections. T cells kill viruses, fungi, bacteria, abnormal cells, and trigger the B cells to produce antibodies. Natural killer cells kill cancer cells and viruses. 

How to diagnose lymphoma?

Lymphoma may first begin with symptoms like swollen lymph nodes in your armpits, neck, or groin. Other symptoms include fever, fatigue, itchy skin, and weight loss. If you have non-Hodgkin’s lymphoma, you may also feel pain in the bones or skin rashes. 

Here are the tests involved to diagnose lymphoma: 

  1. A detailed physical exam where the doctor checks for swollen lymph nodes, spleen, or liver. 
  2. Lymph node biopsy – this involves removing part of a lymph node for lab testing to determine what types of cells are involved. 
  3. Bone marrow biopsy – A needle is inserted into your hipbone to remove a sample of your bone marrow, to look for lymphoma cells. 

Once the above tests have been done to confirm a diagnosis, other tests can establish the extent and severity of the cancer, to help doctors plan treatment. The tests include: 

  1. Blood test – This may include a complete blood cell count test, analysis of the different white blood cells, liver and kidney function tests. 
  2. Imaging tests – The doctor may recommend imaging tests such as CT scans, MRI, and PET (positron emission tomography), to detect cancer that has spread to other parts of the body. 

What are my treatment options for lymphoma?

Here are the different types of treatment options of lymphoma: 

CAR T-cell therapy

Chimeric antigen receptor (CAR) T cell therapy, is a type of immunotherapy approach which uses patients’ own immune cells to kill off cancer cells. T cells are removed from the patient and genetically modified to create CARs. These recognise and destroy antigens on the surface of lymphoma cells. The CAR-T cells are grown in the lab and then infused back into the patient. 

Immunotherapy

Some immunotherapy drugs are designed to identify unique proteins on the surface on cancer cells, enabling the immune system to detect and destroy them. Other immunotherapy drugs prevent cancer cells from suppressing the immune system. As a result, the immune system’s ability to destroy them is destroyed.

The ability to transplant stem cells allows physicians to use higher doses of chemotherapy to treat the cancer than the body would normally tolerate, increasing the probability of eradicating the cancer cells. If the chemotherapy is followed by an infusion of stem cells, these new stem cells can replace the cells in the bone marrow that were destroyed during the chemotherapy treatment.

A stem cell is an immature cell in the bone marrow that can develop into mature blood cells. These cells maintain a person’s blood cells, replacing older or damaged cells with newer ones. 

Stem cell transplantation

A stem cell transplant may be required if the patient requires higher doses of chemotherapy to treat cancer. A stem cell is a developing cell in the bone marrow that can mature into blood cells. Chemotherapy can cause significant damage to stem cells in the bone marrow, resulting in decreased ability to renew blood cells. High-dose chemotherapy treatment can cause significant damage to stem cells in the bone marrow. Thus, a stem cell transplant can be performed to replace any destroyed stem cells. 

Radiation

Radiation therapy uses high-energy rays to kill cancer cells and shrink tumours in the affected area. 

Oral therapy

There are some targeted anticancer and chemotherapy drugs that can be taken orally, to treat lymphoma. However, its effectiveness will depend on patients’ adherence to the prescribed dosage regimen. 

Participating in clinical trials

By participating in clinical trials, patients may be able to get access to the latest therapies in a carefully monitored and controlled environment. This is especially important for lymphoma patients as many types of lymphoma are rare diseases. It’s important to consult the doctor to find out about the risk and benefits of clinical trials. 

Chemotherapy

Chemotherapy drugs are used to treat cancer which has spread throughout the body. It halts cell growth and division to prevent cancer cells from multiplying. However, healthy cells that are also fast dividing in the body will also be affected, resulting in side effects like hair loss.

Hodgkin’s lymphoma patients will typically receive a combination of chemotherapy, radiation therapy, and immunotherapy. Bone marrow or stem cell transplant may also be conducted. 

Non-Hodgkin’s lymphoma patients may undergo chemotherapy, immunotherapy, radiation therapy, or CAR T-cell therapy. Similar to Hodgkin’s lymphoma, bone marrow or stem cell transplant may be conducted. In some slow growing forms of non-Hodgkin’s lymphoma, a wait and see approach may be necessary, as response to treatment can evolve over time. 

What’s next?

The prognosis for both types of lymphoma is not negative, with patients surviving for many years after treatment. Up to 50% of lymphoma patients survive at least 5 years after diagnosis. Diagnosing the type of lymphoma is essential for effective treatment. It is important to consult an oncologist and get a biopsy reviewed by a pathologist if you suspect that you may have this disease.

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