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Lymphoma Cancer Treatment in India

Lymphoma Cancer

Lymphoma is cancer that begins in infection-fighting cells of the immune system, called lymphocytes. These cells are in the lymph nodes, spleen, thymus, bone marrow, and other parts of the body. When you have lymphoma, lymphocytes change and grow out of control.

There are two main types of lymphoma:

  • Non-Hodgkin: Most people with lymphoma have this type.
  • Hodgkin

Non-Hodgkin and Hodgkin lymphoma each affect a different kind of lymphocyte. Every type of lymphoma grows at a different rate and responds differently to treatment.

Non-Hodgkin

Non-Hodgkin lymphoma (also known as non-Hodgkin’s lymphoma, NHL, or sometimes just lymphoma) is a cancer that starts in cells called lymphocytes, which are part of the body’s immune system. Lymphocytes are in the lymph nodes and other lymphoid tissues (such as the spleen and bone marrow).

Hodgkin

Hodgkin disease (Hodgkin lymphoma) is a type of lymphoma, a cancer that starts in white blood cells called lymphocytes. Lymphocytes are part of the immune system.

Symptoms of Hodgkin Lymphoma

Warning signs that you might have lymphoma include:

  • Swollen glands (lymph nodes), often in the neck, armpit, or groin
  • Cough
  • Shortness of breath
  • Fever
  • Night sweats
  • Stomach pain
  • Fatigue
  • Weight loss
  • Itching

Causes of Hodgkin Lymphoma

  • Are in your 60s or older
  • Are male
  • Have a weak immune system from HIV/AIDS, an organ transplant, or because you were born with an immune disease
  • Have an immune system disease such as rheumatoid arthritis, Sjögren’s syndrome, lupus, or celiac disease
  • Have been infected with a virus such as Epstein-Barr, hepatitis C, human T-cell leukemia/lymphoma (HTLV-1), or human herpesvirus 8 (HHV8)
  • Have a close relative who had lymphoma
  • Were exposed to benzene or chemicals that kill bugs and weeds
  • Were treated for Hodgkin or non-Hodgkin lymphoma in the past
  • Were treated for cancer with radiation
  • Are overweight

Types of Hodgkin Lymphoma

Classical types

There are 4 types of classical Hodgkin lymphoma. All these types contain abnormal cells called Reed-Sternberg cells that can be seen under the microscope. Reed-Sternberg cells are a type of white blood cell (B lymphocyte) that has become cancerous

The 4 types of classical Hodgkin lymphoma are

Nodular lymphocyte predominant type

Only about 1 in 20 cases (5%) of Hodgkin lymphoma are the nodular lymphocyte predominant type. It is more common in older people but can occur in young people. The main difference between this type and classical Hodgkin lymphoma is that in the nodular lymphocyte predominant type there are very few Reed-Sternberg cells. But there are other abnormal cells that doctors call popcorn cells. This type of Hodgkin lymphoma is often only in one group of lymph nodes when it is diagnosed (localised disease). It tends to be slower growing than classical Hodgkin lymphoma and the treatment is different.

Hodgkin Lymphoma Stages

  • Stage 1 means there is Hodgkin lymphoma in only 1 group of lymph nodes or lymphoma in 1 body organ only
  • Stage 2 means Hodgkin lymphoma in 2 or more groups of lymph nodes or an organ and 1 or more group of lymph nodes. In both cases, the 2 sites of lymphoma must be on the same side of the diaphragm
  • Stage 3 means Hodgkin lymphoma on both sides of the diaphragm
  • Stage 4 means that many groups of lymph nodes contain Hodgkin lymphoma and it has spread to body organs such as the liver, bones or lungs

Diagnosis of Hodgkin Lymphoma

  • Blood test. It checks the number of certain cells in your blood.
  • Bone marrow aspiration or biopsy. Your doctor uses a needle to remove fluid or tissue from your bone marrow — the spongy part inside bone where blood cells are made — to look for lymphoma cells.
  • Chest X-ray. It uses radiation in low doses to make images of the inside of your chest.
  • MRI. It uses powerful magnets and radio waves to make pictures of organs and structures inside your body.
  • PET scan. It uses a radioactive substance to look for cancer cells in your body.
  • Molecular test. It looks for changes to genes, proteins, and other substances in cancer cells to help your doctor figure out which type of lymphoma you have.

Treatment of Hodgkin Lymphoma

Several types of treatment can be used for Hodgkin disease

Chemotherapy

Chemotherapy (chemo) is the use of drugs to kill cancer cells. Chemotherapy for Hodgkin disease is usually injected into a vein under the skin or taken as a pill. Chemo drugs enter the bloodstream and travel throughout the body to reach and destroy cancer cells wherever they may be.

Radiation therapy

Radiation therapy uses high-energy rays (or particles) to destroy cancer cells. To treat Hodgkin disease, a carefully focused beam of radiation is delivered from a machine outside the body. This is known as external beam radiation. Radiation therapy is most useful when Hodgkin disease is only in one part of the body. For classic Hodgkin disease, radiation is often given after chemotherapy, especially when there is a large or bulky tumor mass (usually in the chest)

Monoclonal antibodies

Antibodies are proteins made by your immune system to help fight infections. Man-made versions, called monoclonal antibodies (mAbs), can be designed to attack a specific target, such as a substance on the surface of lymphocytes (the cells in which Hodgkin disease starts).

High-dose chemotherapy and stem cell transplant

Stem cell transplants (SCTs) are sometimes used for hard-to-treat Hodgkin disease, such as disease that doesn’t go away completely after chemotherapy (chemo) and/or radiation or that comes back after treatment.

The doses of chemo drugs given to patients normally are limited by the side effects these drugs cause. Higher doses can’t be used, even if they might kill more cancer cells, because they would severely damage the bone marrow, where new blood cells are made.

A stem cell transplant lets doctors give higher doses of chemo (sometimes along with radiation therapy). This is because after getting high-dose chemo treatment, the patient receives a transplant of blood-forming stem cells to restore the bone marrow.

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma (sometimes called NHL, or just lymphoma) is a cancer that starts in cells called lymphocytes, which are part of the body’s immune system. Here we will discuss NHL in adults.

Types of Non-Hodgkin Lymphoma

T-cell or B-cell lymphomas are categorized under lymphomas that depends on whether these lymphomas have began from T-cell lymphocytes or B-cell lymphocytes. B-cell lymphomas are considered as the most common that include –

  • Follicular lymphoma
  • Diffuse large B-cell lymphoma

Some of the not so common types are –

  • Lymphoplasmacytic lymphoma
  • Extranodal marginal zone lymphoma of mucosa-associated tissue
  • Small lymphocytic lymphoma (SLL)
  • Mediastinal large B-cell lymphoma
  • Mantle cell lymphoma
  • Nodal marginal zone lymphoma
  • Burkitt lymphoma

T-cell lymphoma types include –

  • Lymphoblastic lymphoma
  • Peripheral T-cell lymphoma
  • Anaplastic large cell lymphoma
  • Skin (cutaneous) lymphoma

Symptoms of Non-Hodgkin Lymphoma

Non-Hodgkin’s lymphoma symptoms may include:

  • Painless, swollen lymph nodes in your neck, armpits or groin.
  • Abdominal pain or swelling.
  • Chest pain, coughing or trouble breathing.
  • Fatigue.
  • Fever.
  • Night sweats.
  • Weight loss.

Stages of Non-Hodgkin Lymphoma

Stage 1 

This means you have lymphoma

  • In one group of lymph nodes or
  • In just one organ or area of the body outside the lymphatic system (extranodal lymphoma)

Stage 2

This means you have lymphoma

  •  In 2 or more groups of lymph nodes on the same side of your diaphragm, or
  •  In 1 or more groups of lymph nodes and also in one nearby organ or area of body, all on the same side of the diaphragm

Stage 3

This means you have lymphoma

  • In lymph nodes on both sides of the diaphragm, or
  • In lymph nodes on both sides of the diaphragm and a nearby organ or area of body is affected

Stage 4

This means you have lymphoma

  • Throughout one or more organs that are not part of the lymphatic system, or
  • In an organ that is not part of the lymphatic system, and it has also spread to organs or lymph nodes far away from the organ, or
  • In your liver, bone marrow, cerebrospinal fluid (CSF) or lung (unless it has spread to your lung from nearby lymph nodes)

Diagnosis of Non-Hodgkin Lymphoma

A tissue biopsy is done for diagnosing Non-Hodgkin lymphoma. When there is painless and enlarged lymph node that does not have any infection then a biopsy is required. Other tests include –

  • Spinal tap that depends on the location, stage and type of the Non-Hodgkin lymphoma
  • Blood tests
  • Chest x-ray
  • PET scan
  • MRI scans for epidural or spinal lymphoma
  • Bone marrow biopsy
  • Upper GI endoscopy
  • Computed tomography (CT) scans of the pelvis, chest, neck and abdomen
  • Testicular ultrasound is done for evaluating the opposite testicle for a testicular lymphoma primary site
  • Upper GI series and small bowel x-rays
  • Head and neck examination

Treatment of Non-Hodgkin Lymphoma

The treatment of Non-Hodgkin lymphoma depends on its stage, symptoms and the type. The aim of the treatment is to eliminate the lymphoma without causing any damage to the surrounding cells. The common treatment options for Non-Hodgkin lymphoma include –

Chemotherapy

Chemotherapy (chemo) is the use of drugs to kill cancer cells. Chemotherapy for Hodgkin disease is usually injected into a vein under the skin or taken as a pill. Chemo drugs enter the bloodstream and travel throughout the body to reach and destroy cancer cells wherever they may be.

Radiation therapy

Radiation therapy uses high-energy rays (or particles) to destroy cancer cells. To treat Hodgkin disease, a carefully focused beam of radiation is delivered from a machine outside the body. This is known as external beam radiation. Radiation therapy is most useful when Hodgkin disease is only in one part of the body. For classic Hodgkin disease, radiation is often given after chemotherapy, especially when there is a large or bulky tumor mass (usually in the chest)

Monoclonal antibodies

Antibodies are proteins made by your immune system to help fight infections. Man-made versions, called monoclonal antibodies (mAbs), can be designed to attack a specific target, such as a substance on the surface of lymphocytes

Radioimmunotherapy: This treatment uses a monoclonal antibody that also combines a radioactive particle to it. This helps in destroying the lymphoma cells and simultaneously it also destroys many more cells that are in the radiation path.