Lymphoma: Treatment, Prevention, Staging and Risk Factor

Treatment for lymphoma depends on the type and stage. Factors such as age, overall health, and whether one has already been treated for lymphoma before are included in the treatment decision-making process.

Updated: November 4, 2019


Usually an oncologists, hematologists, pathologists, and radiation oncologists are involved in making treatment plans and caring for the patient of Lymphoma.
Depending upon what organs may be at risk in an individual, occasionally, other specialists may need to be involved.The patient should speak with more than one oncologist to find the one with whom he or she feels most comfortable. Once one settles in with an oncologist, he/she can discuss the treatment plan.The doctor will discuss the pros and cons of each type of treatment. The treatment plan recommendations will be based on published treatment guidelines and his or her own experience.

Treatment for Lymphoma:

Treatment for lymphoma depends on the type and stage. Factors such as age, overall health, and whether one has already been treated for lymphoma before are included in the treatment decision-making process.
While discussing the choice of treatment,understand exactly what will be done in each procedure and why and what can be expected from these choices. Lymphoma is most likely to be cured if it is diagnosed in an early stage and begin the treatment as early as possible. A combinations of chemotherapy and radiation therapy are most widely used therapies in treating lymphoma. Alternatively, Biological therapy, which targets key features of the lymphoma cells, is used in many cases nowadays.
The goal of treatment in lymphoma is complete remission which means disappearance of all signs of the disease after treatment. Remission is not the same as cure as one may still have lymphoma cells in the body during remission, but they are undetectable and cause no symptoms.
The lymphoma may come back when in remission which is called recurrence. The duration of remission depends on the type, stage, and grade of the lymphoma. A remission may last a few months, a few years, or may continue throughout lifetime.
Durable remission is the goal of therapy which will lasts a long time. A longer remission generally indicates a better prognosis. Remission can also be partial which means that the tumor shrinks to less than half its size after treatment.
Lymphoma's response to treatment can be described as:

  • Improvement: The lymphoma shrinks but is still greater than half its original size.
  • Stable disease: The lymphoma stays the same.
  • Progression: The lymphoma worsens during treatment.
  • Refractory disease: The lymphoma is resistant to treatment.

Different therapy used for the treatment are:

  • Induction therapy: It is designed to induce a remission.
  • Salvage therapy: If induce therapy does not induce a complete remission, new or different therapy will be initiated.
  • Maintenance therapy: Once in remission, one may be given yet another treatment to prevent recurrence.

Radiation and Chemotherapy:

Primary therapy for lymphoma includes radiation therapy for most early-stage lymphomas. A combination of chemotherapy and radiation is used in some cases. Chemotherapy is primarily used for or later-stage lymphomas, with radiation therapy added for control of bulky disease. Biological therapy, or immunotherapy, is routinely used alongside chemotherapy.

Radiation therapy:

Radiation therapy uses high-energy rays to kill cancer cells. A radiation oncologist will plan and supervise therapy in which it should be used to target areas of the body involved by tumor masses. The radiation is targeted at the affected lymph node region or organ. Sometimes nearby areas are also targeted to kill any cells that might have spread,but are not detected. The radiation is usually administered in low doses on five days a week over the course of several weeks. The low dose of each treatment helps prevent or lessen side effects. The common side effects include as fatigue, loss of appetite, nausea, diarrhea, and skin problems. Radiation of lymph node areas may result in suppression of the immune system and the degree of suppression depends on the amount of exposed radiation. Suppression of the blood counts may result if there is irradiation of the underlying bone and the marrow within the bone.

Chemotherapy:

The use of powerful drugs to kill cancer cells is known as chemotherapy. Chemotherapy is a systemic therapy, as it circulates through the bloodstream and affects all parts of the body.
Chemotherapy also affects healthy cells which is the most common side effect of it. The side effects of chemotherapy depend partly on the drugs used and the doses.
Some people tolerate chemotherapy better than other people because of variability in metabolism of chemotherapy drugs. The most common side effects of chemotherapy include suppression of blood counts, which could result in increased susceptibility to infection, anemia, or blood-clotting problems. Other side effects may include nausea and vomiting, loss of appetite, hair loss, sores in the mouth and digestive tract, fatigue, muscle aches, and changes in fingernails and toenails.
Medications and other treatments are available to help people tolerate these side effects. Therefore it is very important to discuss and review the potential side effects of each chemotherapy drug in the treatment with the oncologist, pharmacist, or oncology nurse. Medications to lessen the side effects should also be reviewed before making a choice of treatment.
Chemotherapy may be given in pill form, but it is typically intravenously in which a liquid infused directly into the bloodstream through a vein. Most people who receive intravenous chemotherapy will have a semi-permanent device placed in a large vein, usually in the chest or arm. The device may be a catheter, port or central line. This device allows the medical team quick and easy access to the blood vessels, both for administering medications and for collecting blood samples.
A combinations of drugs are more efficient than use of a single medication. Combinations of different drugs both increase the chance that the drugs will work and lower the dose of each individual drug, reducing the chance of intolerable side effects.
The type of combinations used in an individual depends on the type of lymphoma and the experiences of the oncologist and the medical center where a person is receiving treatment. Usually the combinations of drugs are schedule that must be followed very strictly. Chemotherapy can be given in the oncologist's office. But in some cases the patient may require hospitalization.
Chemotherapy is given in cycles. Standard treatment typically includes a set of four to six cycles. One cycle includes the period of actual treatment. Usually it consist of several days, followed by a period of rest for several weeks. The period of rest is given to allow recovery from side effects caused by the chemotherapy, particularly anemia and low white blood cells. Spreading the chemotherapy this way allows a higher cumulative dose to be given, while improving the ability of the patient to tolerate the side effects.

Biological Therapy:

Biological therapies are sometimes referred to as immunotherapy because they take advantage of the natural immunity of the body against pathogens. These therapies are often preferred as they have anticancer effects without many of the undesirable side effects of standard therapies. There are many different types of biological therapies. These include:

Monoclonal antibodies: 

The substances produced by our body to fight pathogens are called antibodies. Every cell, organism, or pathogen within our body carries markers on its surface that antibodies may recognize. These surface markers are called antigens. . A monoclonal antibody is an antibody that is made in a laboratory to find and attach itself to a specific antigen. Monoclonal antibodies can be used to help own immune systems of an individual to kill tumor cells and other pathogens directly. They can also deliver cancer-killing therapies such as radiation or chemotherapy directly to a specific antigen found on cancer cells.

Cytokines:

These chemicals are produced naturally by the body to stimulate the cells in the immune system and other organs. They can also be produced artificially and administered in large doses to patients for greater effect. Interferons and interleukins are examples of cytokines, which stimulate the immune system. Colony-stimulating factors can stimulate the growth of blood cells.

Vaccines:

Cancer vaccines do not prevent the disease. However they can stimulate the immune system to mount a specific response against the cancer. They also create a memory of the cancer so that the immune system activates very early in cases of recurrence, thus preventing the development of a new tumor.

Other Therapies:

Sometimes for indolent recurrent tumors, watchful waiting is done in which the cancer will be observed and monitored rather than treating it right away. Treatment is given only if the cancer starts to grow more rapidly or to cause symptoms or other problems.

Stem cell transplantation:

It is usually not used as a primary therapy in lymphoma and is reserved for lymphoma that has been previously treated into remission but has recurred. Stem cell therapy is also considered when standard primary treatment is unable to control the lymphoma and achieve remission.
For aggressive T-cell NHL in first remission, it is used as primary therapy, usually as part of a clinical trial. This is very intensive therapy with a lengthy recovery period, which requires hospitalization. It involves very high doses of chemotherapy to kill the aggressive cancer cells. The chemotherapy doses are so high that it also stops the patient's bone marrow from producing healthy new blood cells. In such cases, a transfusion of healthy bone marrow or blood stem cells will be received by the patient.
This could be either from previously collected stem cells from the patient himself or herself called autologous transplantation or autotransplantation or from a donor called allogeneic transplantation, to kick start the bone marrow into producing healthy blood cells.

Alternative therapies:

The alternative therapies has not been found to work better than or as well as standard medical therapies. However these therapies have been found to be potentially helpful as complements to medical therapy. These include:

  • Acupuncture has been helpful in relieving musculoskeletal symptoms, as well as in controlling nausea and vomiting associated with chemotherapy.
  • The supplements coenzyme Q10 and polysaccharide K (PSK) drugs have immune enhancing properties. PSK has been used more extensively in Japan as part of an anticancer therapy.

You can use these therapies only after you discuss them with your doctor.

Prevention Lymphoma:

There is no known way to prevent lymphoma. However avoiding the known risk factors for the disease can help prevent the disease to some extent. Some risk factors for lymphoma are unknown, and therefore impossible to avoid. Infection with viruses such as HIV, EBV, and hepatitis are some of the known risk factors that can be avoided with frequent hand washing, practicing safe sex, and by not sharing needles, razors, toothbrushes, and similar personal items that might be contaminated with infected blood or secretions.

Lymphoma Staging:

Staging is the classification of a cancer type by its size and whether and how much it has spread around the body. Determining the stage of a cancer is very important as it is useful in deciding the treatment plan. Based on the staging the oncologist can decide which treatment is most likely to work and what are the chances of remission or a cure. Based on the results of imaging studies and related tests that reveal the extent of the cancer involvement in body, staging is done.
HL is often classified as as bulky or nonbulky. Nonbulky means the tumor is small and bulky means the tumor is large. Nonbulky disease has a better prognosis than bulky disease. 
NHL is a complicated set of diseases with a complex classification system. The classification is not only based on the microscopic appearance of the lymphoma but also its location in the body and genetic and molecular features. Grade is also an important component of the NHL classification.

Low grade:

Because they grow slowly, these are often called indolent lymphomas. Low-grade lymphomas are often widespread when discovered. But as they grow slowly, they usually do not require immediate treatment unless the organ function is effected. They are rarely cured and can transform over time to a combination of indolent and aggressive types.

Intermediate grade:

These are rapidly growing or aggressive lymphomas that usually require immediate treatment, but they are often curable.

High grade:

These are very rapidly growing and aggressive lymphomas that require immediate, intensive treatment and are much less often curable.
The staging for both HL and NHL, are similar. These include:

  • Stage I: This is an early stage where lymphoma is located in a single lymph node region or in one lymphatic area.
  • Stage IE: Cancer is found in one area or organ outside the lymph node.
  • Stage II: This is an early stage where lymphoma is located in two or more lymph node regions all located on the same side of the diaphragm.
  • Stage IIE: This is same as II, but cancer is also found outside the lymph nodes in one organ or area on the same side of the diaphragm as the involved lymph nodes.
  • Stage III: This is an advanced stage where lymphoma affects two or more lymph node regions, or one lymph node region and one organ, on opposite sides of the diaphragm.
  • Stage IV : Here the disease become widespread or disseminated where lymphoma is outside the lymph nodes and spleen and has spread to another area or organ such as the bone marrow, bone, or central nervous system.

If the cancer is also found in the spleen, an "S" is added to the classification.

Risk Factors:

For HL, the following seven risk factors to play a role in treatment outcome.

  • Male sex
  • Age 45 years or older
  • Stage IV disease
  • Hemoglobin (red blood cell level) less than 10.5 g/dL
  • Albumin (blood test) less than 4.0 g/dL
  • Low lymphocyte count less than 600/mL or less than 8% of total WBC
  • Elevated white blood cell (WBC) count of 15,000/mL

The absence of any of the above risk factors is associated with an increased rate of control of Hodgkin's disease where as whereas the presence of a risk factor decreases rate of disease control.
For NHL the following five risk factors are responsible to make an effect:

  • Age older than 60 years
  • Stage III or IV disease
  • High LDH
  • More than one extranodal site
  • Poor performance status as a measure of general health


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