Lymphoma is a cancer of lymphocytes, a type of white blood cell. Lymphocytes are part of body’s immune system and are found in the blood stream, lymphatic system, spleen, lymph nodes and bone marrow. When lymphocytes become malignant, they multiply and form tumorous growth also known as lymphoma.
Overview of structural distribution of normal Immune system
What are the types of lymphoma
Lymphomas encompass two types of neoplasm
Hodgkin lymphoma
Non Hodgkin lymphoma
Hodgkin lymphoma: These type of lymphomas are characterized by slow growth and contiguous lymph node involvement
Non Hodgkin Lymphoma: There are more than 30 different types of NHL’S which can be broadly classified into 3 types
Low grade or indolent lymphoma: These are characterized by painless swelling of lymph nodes usually in neck in an otherwise healthy individual
Aggressive NHL: These types of lymphoma grow more rapidly than low grade lymphoma. Apart fro pain and swelling in neck, axilla, groin or abdomen these patients may also have fever or weight loss
High grade NHL: These lymphomas grow very rapidly and thus have aggressive symptoms depending upon the organ of involvement.
What are the common tests used for diagnosis and staging of lymphoma
a) Lymph node biopsy: It is the most important diagnostic test which tells about the type of lymphoma
b) Computerized axial tomography (CT scan): CT scan of chest and abdomen can be used for staging of disease
c) Positron Emission Tomography (PET scan): PET scan is the preferred imaging modality for initial staging as well as response to therapy
d) Bone marrow biopsy: A thin needle is inserted into hip bone and small sample of blood and tissue is collected to confirm involvement of bone marrow by lymphoma
e) Blood tests: Blood tests are performed to determine if various blood cells and bio chemistries are within normal limits
Treatment Of Lymphoma:
CHEMOTHERAPY: Chemotherapy is the main modality of treatment of lymphoma. Chemotherapy means treatment of cancers with drugs that kill cancer cells. Chemotherapy drugs work by stopping division of cancer cells or by triggering death of cancer cells. Many different combinations of cytotoxic drugs are given in form of cycles for treatment of lymphomas. Most chemotherapy treatments are given on outpatient basis but some protocols may require hospital stay.
BIOLOGICAL THERAPIES: Biological therapies are treatments which act on cell processes and stop cells from growing and dividing. These are useful to treat lymphomas. Monoclonal antibodies are the most common biological therapies used in lymphoma treatment. These are proteins made from single copy of humanized antibody that target particular protein found on cancer cell surface.
RADIOTHERAPY: Depending on which type and stage of lymphoma you have, your treatment might involve radiotherapy alone, or in combination of chemotherapy.
Some types of lymphoma that are low grade or ‘indolent’ (slow-growing) can be cured with radiotherapy alone if they are at an early stage.
High-grade lymphomas that are early stage are often treated with chemotherapy followed by radiotherapy.
STEM CELL TRANSPLANT: Some people need high doses of chemotherapy to treat their lymphoma. High doses of chemotherapy can be very effective at killing lymphoma cells but they can cause permanent damage to your bone marrow. Patients can be given healthy blood stem cells after high-dose chemotherapy to avoid the harmful effects of high dose chemotherapy, this is called a stem cell transplant.
Stem cell transplants are used in lymphoma treatment in different situations but mainly when:
Lymphoma has relapsed (come back) after treatment
Lymphoma is refractory (doesn’t respond) to treatment
As part of first treatment if lymphoma is likely to relapse (high risk).