Factors That Influence Lymphoma Treatment

Lymphoma is a cancer that starts in the lymphatic system. Treatments differ depending on the type of lymphoma a patient has (Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL)). Then it depends on the subtype, stage, etc.

What is lymphoma?

• Lymphoma is a cancer of the lymphatic system.
• All cancers are caused by abnormal cell behavior. In lymphoma, cancer begins when lymphocytes grow out of control.
• Malignant cells do not recognize control signals; they multiply rapidly and invade the spaces of other normal cells, disrupting and destroying their functions.

What are lymphocytes?

• Lymphocytes are a type of white blood cell.
• There are many types of lymphocytes, but the two main types are B lymphocytes and T lymphocytes.
• Both types of lymphocytes play an active role in the body's defense mechanisms.
• In addition, T cells are also part of the immune system's control mechanism, helping to enhance or suppress immune responses as needed.

What are the symptoms of lymphoma?

Both HL and NHL have similar symptoms, including:

• A lump caused by swollen lymph nodes in areas such as the neck, groin, and armpits.
• Fatigue
• Weight loss
• Night sweats
• Fever
• Difficulty breathing

However, experiencing any of these symptoms does not mean you have lymphoma; swollen glands can also be caused by an infection. For example, if a lump persists and is painless, you should see a doctor.

What factors influence treatment decisions for lymphoma?

• The process begins with a diagnosis of the lymphoma type, subtype, stage of the disease, and more.
• The two main types of lymphoma are Hodgkin and non-Hodgkin, and treatment depends on these types.

What is the difference between Hodgkin and non-Hodgkin lymphomas?

• Hodgkin lymphoma affects B lymphocytes.
• Non-Hodgkin lymphoma can occur in B cells or T cells.
• Non-Hodgkin lymphoma is the more common type of lymphoma.
• About 70,000 Americans are diagnosed with non-Hodgkin lymphoma each year, while there are only about 8,000 cases of Hodgkin lymphoma.
• There are only a few subtypes of Hodgkin lymphoma, but there are about 30 to 60 subtypes of non-Hodgkin lymphoma (doctors do not agree on the number of subtypes).

How do doctors determine if a patient has HL or NHL?

• When cancer cells in a biopsy are examined under a microscope, major distinguishing features can be identified.
• If the examination shows the presence of Reed-Sternberg cells, it is Hodgkin lymphoma.
• These are giant, malignant B cells that can be up to 5 times the size of normal cells.
• They are named after two scientists, Dorothy Reed and Carl Mendenhall, who first discovered and described these microscopic mutations.

Which of these forms is easier to treat?

• Hodgkin lymphoma is generally easier to treat.
• It progresses more slowly than NHL and is also diagnosed at an earlier stage.
• While the symptoms of HL and NHL are similar, NHL is often not diagnosed until it is in its later stages.
• There are multiple subtypes of non-Hodgkin lymphoma, making treatment more complicated.

What are the stages?

• The staging of the disease is important in the treatment of both Hodgkin and non-Hodgkin lymphoma.
• Both forms of lymphoma progress from stage I to stage IV.
• In stage I, the cancer is confined to one organ or area of lymph nodes.
• Thereafter, in each subsequent stage, the cancer progresses from its site of origin to other lymph nodes and even other parts of the lymphatic system.
• When treating non-Hodgkin lymphoma, doctors also assess whether it is indolent or aggressive.

How do doctors treat lymphoma?

• That depends on the type of lymphoma, subtype, stage, and more.
• While chemotherapy, radiation therapy, immunotherapy, and palliative care are usually part of the plan, the type of drugs used, dosages, and more may vary depending on the subtype and stage of the disease.
• The classic treatment for Hodgkin lymphoma varies by subtype. For example, whether the subtype is tuberous sclerosis, mixed cellular, lymphocyte-poor, or lymphocyte-rich.
• In NHL, some subtypes grow slowly. When the disease is in the slow-growing phase, it is called an indolent lymphoma.
• In this case, the doctor constantly monitors the patient's condition and only starts treatment if the condition changes, i.e.: If the non-Hodgkin lymphoma becomes aggressive.
• In aggressive lymphomas, the disease spreads and grows rapidly. In these cases, treatment for non-Hodgkin lymphoma is started immediately.

What is the prognosis?

• Hodgkin lymphoma is rare, and advances in the treatment of Hodgkin lymphoma have improved survival rates.
• Currently, the percentage of patients who survive 5 years or more after diagnosis is about 86%.
• While the survival rate for non-Hodgkin lymphoma is generally low, new treatments have improved the prognosis for NHL.

What is B-cell lymphoma?

• This term is usually used for NHL subtypes that begin in B cells rather than T cells.
• B-cell lymphomas account for the largest proportion of NHL in the country.
• The most common type of NHL is diffuse large B-cell lymphoma (DLBCL).
• Survival rates for large B-cell lymphoma depend on many factors, such as the stage of disease, age, general health, etc. If caught early, survival rates for B-cell lymphoma are high.

Treatment and prognosis for lymphoma depend on many of the factors listed above. In addition to traditional chemotherapy and radiation therapy, newer approaches such as immunotherapy and targeted therapy are improving the outlook for both Hodgkin lymphoma and non-Hodgkin lymphoma.