Let’s learn about lymphoma

What is lymphoma? Lymphoma is a tumor of lymphatic system of the body. Lymphatic system is a part of the immune system consisting of lymphatic organs including spleen, bone marrow, tonsil gland, and thymus gland. These organs are filled with lymph that carries nutrients and lymphocytes to all over the body. Abnormalities of these lymphocytes can cause lymphoma.

Lymphoma is classified into 2 main groups, i.e. Hodgkin Lymphoma and Non-Hodgkin Lymphoma. In Thailand, Non-Hodgkin Lymphoma is commonly found.

Non-Hodgkin Lymphoma can be categorized into 30 sub-groups. However, it can be divided into 2 types based on the cancer growth rate.

  1. Indolent type: This type of lymphoma has quite slow proliferation rate, but it is usually not cured by available treatments.
  2. Aggressive type: This type of lymphoma has rapid proliferation rate. If not treated, patients may die within 6 months to 2 years. It is different from indolent type in terms of curability, this type can be cured if treated.
     

Risk factors for lymphoma

Risk factor is a condition that possibility of disease is higher, but it does not mean that having one of the risk factors enables such disease to occur. Nowadays, we cannot clearly identify the causes of lymphoma in all patients, but it is associated with multiple conditions including

  • Age: Incidence of lymphoma increased in older age. The incidence is highest between 60-70 years.
  • Gender: Lymphoma is found in males more than females.
  • Infections: Certain types of lymphoma are associated with infection, such as Helicobacter pylori infection and MALT lymphoma, EBV infection and Burkitt lymphoma.
  • Immunodeficiency: Incidence of lymphoma is increased in HIV patients
  • Autoimmune disease: Incidence of lymphoma is increased in SLE patients
  • Chemical exposure: e.g. pesticide increases risk of lymphoma.
     

Lymphoma symptoms

Since lymphoma symptoms are varied, such as infection, then there are some patients who have not been diagnosed and treated properly. However, lymphoma symptoms usually take a long time and cannot be explained by other reasons.

Initial lymphoma symptoms

  • Mass Found in different areas of the body, e.g. throat, armpits, groin. Lymphoma mass does not cause pain, which is different from mass caused by infection that is usually painful.
  • Fever, Chill
  • Excessive sweat at night
  • Loss of appetite and weight loss
  • Fatigue with unknown cause
  • Chronic cough and difficulty breathing
  • Enlarged tonsil gland
  • Generalized itching
  • Headache (found in lymphoma that occurs in neurological system)
     

Diagnosis of lymphoma

The diagnosis begins with collecting medical history and physical examination, and further determine the following:

  1. Biopsy
  2. Bone marrow examination to determine if there are any bone metastases.
  3. CT scan
  4. MRI
  5. Bone scan
  6. PET scan. All results will be used to determine the stage of disease and for further prognosis and treatment.





Stage of disease assessment

Treating doctor will collect all data obtained from additional investigations, and determine which stage of disease patients are in. These data will be compiled for treatment plans. Lymphoma are divided into 4 stages.

Stage 1: Only one lesion at or outside lymphoma gland

Stage 2: 2 or more lesions at or outside lymphoma gland and within the same side of the diaphragm

Stage 3: Lesions at or outside lymphoma at the different side of the diaphragm and/or along with lesions at spleen

Stage 4: Lesion has spread outside where it is found originally. The locations which are commonly found including liver, bone marrow, or lung.

In addition to the assessment of stage, treating doctor will also calculate prognosis index, which can be categorized patients further into high-risk and low-risk group, based on other patient information.
 

Lymphoma treatment guidelines

Treatment of lymphoma is a combination of various methods depending on type and stage of lymphoma. The following treatments can be used as monotherapy or combination therapy.

  1. Watch & Wait for disease
    This method is often used in indolent type of lymphoma or in patients with moderate symptoms. Blood test or radiographic examination will be done periodically while monitoring.
  2. Chemotherapy
    Chemotherapy will destroy cancer cells by interfering their proliferation process. Selection of chemotherapy is based on the type of lymphoma. In general, either the combination of chemotherapy drugs or the co-administration with monoclonal antibodies is often used in treatment of lymphoma.
  3. Treatment with monoclonal antibodies
    Monoclonal antibody is a synthetic substance that will bind to surface protein of cancer cells, and body immune system is then activated resulting in elimination of cancer cells.
  4. Radiation therapy
    It is a treatment with high dose of radiation to destroy cancer cells.
  5. Stem cells transplantation
    The principles of stem cells transplantation are to completely destroy all cancer cells and replace with normal cells. It can be categorized into 2 types as follows:
    5.1  Allogeneic transplantation
    5.2  Autologous transplantation
7

Self-care

  1. Eating habits
    ● Always eat clean and freshly cooked food.
    ● Avoid taking food stored for a while without reheating or dried food if unsure that they are freshly cooked, e.g. bakery shops.
    ● Select fruits with thick peels, e.g. orange, banana, which must be washed every time before eating.
    ● Avoid fruits with thin peels, e.g. guava, grape, or fruits that cannot clean thoroughly, e.g. pineapple.
    ● Wash hands every time before eating
    ● Avoid drinking alcohol
  2. Exercise
    ● Exercise as much as you can tolerate, but not too much. You may not be able to work out as much as before, but your body will recover afterwards especially for patients who have never worked out. They should not stay in bedroom, but walk around occasionally to help lung fully expand. Exercising will help patients to recover faster.
  3. Body cleaning
    Take a bath at least 2 times daily with gentle soap, especially at damp area, e.g. armpits, groin
    ● Apply lotion with fragrance free onto the skin to prevent from dryness
    ● Brush teeth gently with soft toothbrush at least 2 times daily
    ● Wash the anus area every time after defecation and wipe dry with napkins
  4. Always stay cheerful. Strictly follow doctor’s instructions and visit doctor regularly 
  5. Get enough sleep helps strengthen body immunity.




NPM-TH-0540-05-2020