Lymphoma

What is lymphoma?

Lymphoma is a kind of blood-related cancer that occurs in the lymphocytes, which are a type of white blood cell. Healthy lymphocytes help you fight infection, and are transported throughout the body by the lymphatic system, which includes the spleen, thymus gland, bone marrow and hundreds of bean-sized structures called lymph nodes, which help trap toxins in the blood.

There are two main types of lymphoma:

• Hodgkin's lymphoma: A type of lymphoma where the cancerous cells are called Reed-Sternberg cells, which are mutated immune cells characterized by their large size and multiple nuclei. Hodgkin’s lymphoma occur as a central chest mass or can present as swollen lymph nodes throughout the body. There are about 8500-9000 new patient cases per year. There are 5 subtypes of Hodgkin Lymphoma.

• Non-Hodgkin's lymphoma: A type of lymphoma that doesn’t include the presence of Reed-Sternberg cells, and results from mutated lymphocytes growing into a tumor. They usually grow tumors within the lymph nodes, but can also occur in other organs like the colon, brain, bone marrow, etc. It is the more common type of lymphoma, with about 80,000 new patient cases diagnosed each year. There are more than 55 subtypes of non-Hodgkin lymphoma.

What are the symptoms of lymphoma?

The symptoms of lymphoma can be different for every patient, but common symptoms can include:

• Swollen lymph nodes (known as lymphadenopathy), often in the neck, armpits, and groin. They can be felt under the skin but are usually not painful. Lymph nodes deeper in the body can also become swollen and cause symptoms. For example, swollen lymph nodes around the stomach can cause patients to have less appetite and early satiety, or swollen lymph nodes involving the lungs can cause a cough or shortness of breath.

• Unintentional weight loss of 10 percent or more of your body weight over a 6 month period, drenching night sweats (requiring changing of bedsheets or pajamas), or unexplained and recurring fevers which happen during the day or night. These three symptoms (weight loss, drenching night sweats, and fevers) are termed B symptoms.

• Crushing fatigue, keeping a person in bed most of or all day

• Flu-like body pain

• Loss of appetite

• Persistent, unrelenting coughing

• Itching throughout the body unrelieved with lotions/creams and without the visible occurrence of a rash

  Frequent infections (because of weakened immune system)

How is lymphoma diagnosed?

There are several tests and exams which our oncologists at Hoag may order, including:

• Lymph node biopsy: A physician, either a surgeon or interventional radiologist, will remove 1 or more lymph nodes. Another type of doctor, called a pathologist, will look at the removed lymph node under a microscope to see if it contains lymphoma cells.

• Bone marrow biopsy: A small sample of bone marrow (which is the spongy tissue in the center of some bones), along with a small sample of blood, will be taken using a needle by a doctor, usually by an interventional radiologist. Then, another type of doctor, called a pathologist, will look at the bone marrow sample under a microscope to see if it contains lymphoma cells and how they are affecting the normal cells in the marrow.

• Imaging scans: The imaging tests can be either a CT scan (computerized tomography) or a PET (positron emission tomography) scan, which generates pictures of the body to accurately show where the lymphoma tumors are located within the body. Sometimes, we will get an ultrasound of the heart (called echocardiogram) to assess the heart’s ability to properly pump blood forward as work-up prior to treatment.

• Blood work: Blood is usually drawn to see if the levels of certain cells (red blood cells, platelets, white blood cells), electrolytes (sodium, potassium, chloride, calcium, etc.), liver and kidney activity are within normal range and functioning properly.

• Genetic and Molecular Testing: Depending on the type of lymphoma, sometimes genetic and FISH (fluorescence in situ hybridization) testing to identify chromosomal abnormalities in the lymphoma cells will be done to better predict the growth and behavior of the lymphoma tumor.

Call 949-722-6237 to schedule an appointment or request a second opinion consultation with our lymphoma specialists.

What are the treatment options for lymphoma?

Treatment for lymphoma is highly individualized and depends on many factors, including how advanced the cancer is when detected and any other health issues a patient may have. Treatments for lymphoma vary from patient to patient, but may include:

• Chemotherapy: Conventional chemotherapy is still the primary mainstay and backbone of initial treatment for lymphomas. Usually, the patient will receive a combination of chemotherapy medications, known as a chemotherapy regimen, to treat their lymphoma on a set schedule. These chemotherapy agents are administered as an outpatient at one of Hoag’s infusion centers, which are very well-equipped and staffed by oncology nurses to deliver these drugs. Occasionally, patients have to be admitted into the hospital and stay for a few days to receive their chemotherapy.

• Radiation: Targeted radiation to certain tumor sites can help better control the tumor growth and kill cancer cells. This is usually done after completion of chemotherapy at the discretion of the oncology team.

• Cellular Immunotherapy: Cellular immunotherapies (e.g., CAR-T cell therapy) are relatively recent advancements in lymphoma care which are being utilized, especially if a patient has lymphoma that has returned after initial treatment (known as relapse) or did not respond adequately enough (refractory disease). They involve utilizing elements of a patient’s own immune system, activating or supercharging the immune cells to better attack and kill lymphoma cells.

• Stem Cell or Bone Marrow Transplant: A bone marrow or stem cell transplant (using bone marrow or stem cells) is sometimes offered for eligible lymphoma patients if they have relapsed or refractory disease. There are two types of stem cell transplant, autologous and allogeneic. An autologous stem cell transplant uses a patient’s own stem cells, while allogeneic transplants involve using a different person’s bone marrow or stem cells and infusing them into a patient. High-dose chemotherapy is first given and then followed with infusion of previously collected stem cells to restore healthy bone marrow function alongside the eradication of the cancer.

• Monitoring and surveillance: Active monitoring or surveillance is where your hematologist/oncologist sees you on a regular schedule to carefully measure if the cancer has relapsed or progressed. This tactic is sometimes employed in slow-growing lymphomas, or in those cases where the patient is in remission and being followed.

Survivorship Before, During and After Treatment

At Hoag Family Cancer Institute, we understand that a cancer diagnosis may cause you and your family to experience a variety of significant life changes. We are committed to providing you with support before, during and after treatment. Hoag’s survivorship begins when a patient is first diagnosed, not when the treatment ends. Our resources at Hoag are designed to help you navigate through the challenges of telling friends and family about your cancer, working while living with cancer, returning to “normal” after cancer and so much more. We strive to provide you with the resources needed to feel empowered in your everyday life. We’re committed to offering the best support services, resources and educational information to our patients and their families at every stage of their cancer journey. Hoag’s Integrated Cancer Support Services are open to everyone regardless of their prognosis, cancer stage or phase of recovery.

Resources include:

• Classes & Workshops

• Counseling Services

• Brighter Image Program

• Support Groups

• Hoag Rehabilitation Services

• Spiritual Care Services

• Oncology Massage

• Oncology Nutrition

• Pastoral Care Services

• Financial Navigators for cancer-related care

Areas of survivorship support include:

• Emotional & psychological support for patients and families

• Oncology nutrition and physical rehabilitation

• Financial navigation for treatment-related expenses

• Spiritual and pastoral care

• Support for returning to work while living with cancer

• Guidance for talking to friends and family about your diagnosis

• Ongoing monitoring and management of long-term side effects

Find more information about Integrated Cancer Support Services at Hoag at this link.

Are there any clinical trials for lymphoma?

Clinical trials are investigational research studies which evaluate newly discovered or breakthrough treatments or combination treatments, tests for detecting cancer, or assessing new methods for monitoring and preventing cancer. Hoag offers clinical trials for lymphoma and has a tradition of being a national leader in having access to clinical trials for cancer patients, with a robust early-phase trial program that offers cutting edge medical technologies traditionally available only at large academic hospital centers in the country.

View clinical trials for lymphoma here.

At Hoag, our clinical research team is committed to excellence in research and a continuing commitment to protect the interests and well-being of patients. Contact us at (949) 764-4577 to see if joining a clinical trial for lymphoma is right for you.