July 14, 2021

Understanding Lymphoma

Cancer is an umbrella term for hundreds of diseases involving abnormal cell division. With so many different types of cancer, it can be hard to understand the significance of certain cancer diagnoses. The best place to start is by learning which area of the body a particular type of cancer affects.

Lymphoma is a rare form of cancer that affects bone marrow, lymph nodes, the thymus gland and spleen, collectively known as the lymphatic system. This network rids the body of toxins and waste and is an important part of our immune system.

To understand more about lymphoma, we spoke with the co-medical director of the Cancer Program at Mountainside Medical Center, Lori Leslie, M.D.

“Lymphoma is a type of cancer affecting the lymphocytes, which are a type of white blood cell that play a key role in your body’s immune response to help fight diseases. It is the seventh most common type of cancer in the United States,” Dr. Leslie said.

The two main types of lymphoma are non-Hodgkin lymphoma [NHL] and the less common Hodgkin lymphoma, which accounts for only 10% of cases. “Hodgkin lymphoma occurs most commonly in two age groups,” Dr. Leslie said. “It often occurs in early adulthood with a second peak in the sixth decade of life.”

“NHL is more common and there are between 75,000-80,0000 cases in the United States each year. Of these, 15 percent are cancer of the T-lymphocyte, while 85 percent are cancer of the B-lymphocyte. B-cell NHL is classified as indolent, slow-growing or aggressive, fast-growing. The median age of diagnosis for patients with non-Hodgkin lymphoma is around age 70, but the range is wide, affecting those in their 20s through 90s,” Dr. Leslie explained.

Although experts are not exactly sure what causes lymphoma, certain risk factors may make individuals more susceptible to the disease. “Risk factors include having a weakened immune system due to prior organ transplantation, HIV infection, inherited immunodeficiency syndromes or autoimmune conditions, particularly if you’re on immunosuppressive therapy. The vast majority of patients diagnosed with lymphoma do not have an identifiable risk factor,” Dr. Leslie said.

“A previous history of lymphoma may increase the odds of having it again. Certain chronic infections, such as hepatitis C, Lyme disease, and H.pylori, as well as certain exposures, including Agent Orange, can be associated with lymphoma.”

Because you may not notice any obvious changes in your body, even in and around the lymph nodes, it can be difficult to know if you have this type of cancer.  

Many patients diagnosed with lymphoma do not have symptoms but are diagnosed based on the incidental discovery of enlarged lymph nodes on imaging performed for unrelated reasons,” Dr. Leslie said. “Others present with a growing mass that can be seen or felt, or other symptoms collective referred to as ‘B-symptoms’ that include unintentional weight loss, drenching night sweats, fever without infection and unexplained fatigue.

Even though lymphoma is a disease of white blood cells, most patients have normal routine bloodwork. “Lymphoma is diagnosed based on a biopsy of a lymphoma node, mass or another site of involvement that may include a solid organ, bone marrow or even skin,” explained Dr. Leslie.  

While there’s no cure for lymphoma, doctors and scientists are working to better understand it and find new and effective treatment options for this type of cancer. The treatment landscape for lymphomas is expanding rapidly and depends on the subtype,” Dr. Leslie said. “Overall treatments include chemotherapy, immunotherapy, targeted agents, and even cellular therapies.” Chemotherapy nonspecifically interferes with the machinery of rapidly growing cells to trigger self-destruction, while immunotherapies retrain the immune system to recognize and eradicate cancer cells.  Small molecular inhibitor therapies target a specific pathway or protein/enzyme that the cancer cells are addicted to. Cellular therapies include chimeric antigen receptor T-cell (CAR-T) therapy and stem cell/bone marrow transplantation.

Dr. Leslie is encouraged by the number of clinical trials happening around lymphoma and believes understanding the potential of these studies is important. “There is a wide range of clinical trials for all types of lymphoma, in all treatment settings,” Dr. Leslie said. “Patients may think of trials as an ‘experiment,’ to be considered as a choice only when they’re out of options. This could not be further from the truth. Trials are available and designed to improve upon currently available standards of care and should be discussed with your provider as a potential option in all lines of therapy.”

Lori Leslie, M.D., is a hematologist-oncologist whose research and clinical practice focus on non-Hodgkin lymphoma, Hodgkin lymphoma and chronic lymphocytic leukemia. Join Dr. Leslie on Thursday, September 23 at 2 p.m. as she hosts the webinar Lymphoma and Your Immune System. For more information and to register please visit www.mountainsidehosp.com/events.

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