Lymphoma Treatment

Blood Cancer: Types & Stages

The two main forms of lymphoma are Hodgkin lymphoma (HL) and non-­Hodgkin lymphoma (NHL). Lymphoma occurs when lymphocytes, a type of white blood cell, grow abnormally. The body has two main types of lymphocytes that can develop into lymphomas: B ­lymphocytes (B ­cells) and T ­lymphocytes (T­ cells).

Staging helps to describe where the Hodgkin lymphoma is located, if or where it has spread, and whether it is affecting other parts of the body. Radiation oncologists use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all tests are finished. Knowing the stage helps the radiation oncologist to decide what kind of treatment is best and can help predict a patient’s prognosis. There are different stage descriptions for different types of cancer.

When staging Hodgkin lymphoma, radiation oncologists evaluate the following:

• The number of cancerous lymph node areas
• Whether the cancerous lymph nodes are localized or generalized. Localized means they are located only in one area of the body. Generalized means they are located in many areas of the body
• Whether the cancerous lymph nodes are on one or both sides of the diaphragm, the thin muscle under the lungs and heart that separates the chest from the abdomen
• Whether the disease has spread to the bone marrow, spleen, or extralymphatic organs (organs outside the lymphatic system; noted using an “E” below), such as the liver, lungs, or bone

Lymphoma Stage Groupings

The stage of lymphoma describes the extent of the spread of the tumor, using the terms stage I through IV (1 through 4). Each stage may also be subdivided into “A” and “B” categories, based on the presence or absence of specific symptoms.

Stage I. The cancer is found in 1 region of a lymph node.

Stage II. Either one of these conditions:

• The cancer is in 2 or more lymph node regions on the same side of the diaphragm (stage II).
• The cancer involves a single organ and its regional lymph nodes (lymph nodes located near the site of the lymphoma), with or without cancer in other lymph node regions on the same side of the diaphragm (stage IIE).

Stage III. There is cancer in lymph node areas on both sides of the diaphragm, meaning above and below it (stage III). In addition, there may be involvement of an extralymphatic organ (stage IIIE), involvement of the spleen (using the letter “S,” stage IIIS), or both (stage IIIES).

Stage IV. The lymphoma has spread throughout more than one area of the body. Common places Hodgkin lymphoma usually spreads include the liver, bone marrow, or lungs.

Recurrent. Recurrent lymphoma is lymphoma that has come back after treatment. Lymphoma may return in the area where it first started or in another part of the body. Recurrence may occur shortly after the first treatment or years later. If the lymphoma does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Lymphoma Cancer Screening & Treatment

Your radiation oncologist will perform a complete physical examination, especially the areas where there are lymph nodes. Your radiation oncologist will also discuss your medical history and ask about symptoms.

Tissue Biopsy

If you have swollen lymph nodes that your radiation oncologist thinks may be cancerous, they will take some tissue from a swollen lymph node. This is called a tissue biopsy. The whole node may be removed or only a part of the node. This tissue will be sent to a pathology laboratory to be examined in detail to see if it has cancer cells in it.

You could have either a general or a local anesthetic when you have your biopsy. This will depend on where the lymph node is that the radiation oncologist wishes to biopsy. If the biopsy shows that you have lymphoma, other tests will be done to find out whether the cancer has spread, and if so, to where. This is called ‘staging’ the cancer.

Blood Tests

Your radiation oncologist may take some blood from your arm using a needle and syringe. This will be sent to a pathology laboratory to be examined. These tests will also tell the radiation oncologists how well your other organs such as liver and kidneys are working.

Bone Marrow Biopsy

Lymphoma cells can spread to bone marrow. In a bone marrow biopsy, a sample from your bone marrow is taken with a needle. The bone marrow is usually taken from the back of your hipbone. You will have a local anesthetic and possibly some sedative so you do not feel pain during the biopsy. The sample will be looked at under a microscope to see if the lymphoma has spread to the bone marrow.

Computerized tomography (CT) scan

A CT scan is a special type of x-ray that gives a three dimensional (3­D) picture of the organs and other structures in your body. It usually takes about 30 to 40 minutes to complete this painless test. You will be asked to lie on a table while the CT scanner, which is large and round like a doughnut, moves around you. Before the scan, you may have an injection of a dye that shows up body tissues more clearly. You will be asked not to eat or drink for a while before you have your scan. Most people are able to go home as soon as their scan is over. A child with non-Hodgkin’s lymphoma will also have an ultrasound scan of their abdomen.

Positron emission tomography (PET) scan

A PET scan builds up clear and detailed pictures of the body. You will have an injection of a glucose solution containing a very small amount of a radioactive substance. The scanner can ‘see’ this substance, which shows where the glucose is being used in the body. Cancer cells show up as areas where glucose is being used by actively growing cells.

Biologic Therapy

This treatment increases your body’s natural ability to fight cancer. It does this by giving a boost to your immune system. There are several kinds of biologic therapy:

• Monoclonal Antibodies: These are drugs like Rituxan®, which directly target lymphoma cells and do not harm normal cells. These drugs are sometimes called “smart drugs” or “guided missiles” because they know exactly where to go in your body.
• Radioimmunotherapy: These are therapies like Rituxan®, which have a radioisotope attached to them. These “guided missiles” are able to destroy cancer cells because they attach to the lymphoma and deliver small doses of medicine to the cells.
• Interleukin 2: This is a medicine that activates the immune system so that it can kill cancer cells.
• Vaccines: These are treatments that help the body protect itself against the lymphoma.

Chemotherapy

This treatment uses drugs to kill cancer cells and reduce the size of cancer tumors. Chemotherapy drugs may also affect healthy cells and cause side effects like hair loss or mouth sores. There are many types of chemotherapy drugs. Many drugs are often used together for chemotherapy.

Radiation Therapy

This treatment uses radiation (high energy X-­rays) to kill cancer cells. The treatment often only takes place in the part of your body where the lymphoma is located.

Bone Marrow Transplant

Sometimes high doses of chemotherapy destroy the lymphoma cells and your bone marrow, which is the “factory” for blood cells. To help your bone marrow make new healthy blood cells, some stem cells (immature cells that will grow up into red blood cells, white blood cells, and platelets) may be taken with a special machine before chemotherapy is given.

These cells are then transplanted (put back) into the body. These transplanted cells will then find their way to the bone marrow and restore it so that it can build healthy new blood cells.

There are two types of transplants:

1. Autologous transplants­ this uses your own bone marrow or stem cells
2. Allogeneic transplants­ this uses bone marrow or stem cells from a donor (someone else, often a brother or sister)