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The lymphatic system is part of the body's immune system. It is an infection fighting network,
made up of lymph nodes, lymph ducts, and lymph vessels. Lymphoma is cancer of the lymphatic
system and it has 2 main categories: Hodgkin lymphoma, and non-Hodgkin lymphoma. The difference
between the 2 is the type of lymphocyte—a type of white blood cell—that is affected.
A diagnosis is described further by other factors, including its subtype. There are
a few subtypes of Hodgkin lymphoma and there are dozens of subtypes of non-Hodgkin lymphoma.
The most important piece of information for any 1 person is exactly what kind it is,
and then how much of it they have. When we think about non-Hodgkin lymphomas, we typically break
them up into 1of several categories. There are some that are very slow-growing, and these tend
to be treated more like chronic diseases. These are cancers that tend to take a very
long time to grow, often do not need treatment, and patients can live with them for decades at
a time. There's another group of lymphomas that we call aggressive lymphomas, and again there are
many different subtypes but in general, aggressive lymphomas are ones that grow much more quickly,
and if you don't treat them people can feel quite ill. On the other hand, if you do treat them,
some patients can be cured. We then have highly aggressive lymphomas, which are cancers that grow
extremely quickly, and it's an emergency to try to get patients under treatment as soon as possible.
Because of the different categories of lymphoma, when a patient is diagnosed it is very important
that there is a clear understanding of the specifics of their lymphoma diagnosis.
When people go to websites to try to get information, it can be very confusing,
again because there are so many different subtypes. My best guidance would be to make sure
that the diagnosis is confirmed. And in fact, 1 of the unsung heroes in this particular diagnosis is
the hematopathologist. And a hematopathologist is a pathologist who specializes in blood disorders.
Once the diagnosis is confirmed the lymphoma will be staged, which helps to describe the
location of the lymphoma in the body and how extensive it is. The oncology team will then
recommend a cancer treatment plan that is best for that particular type and stage of lymphoma.
A treatment plan typically includes systemic treatment which is the use
of medication given through the bloodstream to reach cancer cells throughout the body.
Most of the treatment we use are agents that travel in the blood.
Surgery is usually used to make a diagnosis, but not typically to treat the cancer.
Radiation can be very useful in certain types of lymphoma.
Options for Hodgkin lymphoma treatment include the systemic treatments of chemotherapy
or immunotherapy—also known as biologic therapy—and sometimes radiation therapy or
bone marrow and stem cell transplantation. Treatment of non-Hodgkin lymphoma can also
use these same approaches to treatment, as well as different targeted therapies.
When it comes to treatment that travels in the blood, we're usually talking about
several different categories. One big one historically has been chemotherapy,
and chemotherapy remains very useful in the treatment of patients with lymphoma. There is
certainly a move towards reducing the amount of chemotherapy that we use, and more towards other
types of therapy. The other types of therapy include agents such as monoclonal antibodies,
and monoclonal antibodies can be thought of as targeted agents. These are drugs that are smart
drugs. These monoclonal antibodies only attack their target, and their target is usually a
protein that lives on the surface of the lymphoma cells. Some of these monoclonal antibodies
can have a small payload associated with them. In other words, they go in by blood, they find their
target, and then they deliver a small amount of either chemotherapy or another biologic agent,
or sometimes even a small amount of radiation. The third category are what we call biologic agents
and these are often pills that are then absorbed and travel wherever the blood goes,
and these are medications that block particular pathways that the cancer cells use to survive.
And by sort of choking off these survival pathways, they help get rid of the cancer.
Doctors are also testing new treatments through clinical trials, which are research studies. There
is optimism about new targeted therapies and new types of immunotherapies that are in development,
offering additional treatment options and hope to people with lymphoma.
I think this is a really exciting time for treatment of lymphoma, and for patients with
lymphoma. We have many exciting new therapies that are in development. Some of them have to do with
the monoclonal antibodies, and trying to make them smarter and better and safer. Others have to do
with finding new targets that we can use pills to try to treat, or perhaps even get rid of the blood
vessels that supply lymphomas, or to get rid of some of the supporting cells that allow lymphomas
to survive. Another area that has been extremely exciting for lymphoma, particularly aggressive
lymphomas, which can be sometimes harder to treat when they return after the initial therapy,
would be immunotherapy one of the newest areas of immunotherapy is something called CAR-T,
C-A-R-dash-T, which stands for Chimeric Antigen Receptor T cells. And this is a way of taking
cells from the patient's own immune system, T cells, engineering them to now recognize
the lymphoma in a different or a stronger way, to give those T cells back to patients,
and then allow the T cells to divide, multiply, and attack the lymphoma. This is now FDA-approved
for certain types of lymphoma and I think is a very exciting area moving forward.
When you have a diagnosis of lymphoma it's important to remember that you're not alone.
Not only do you have your physician, nurse, and nursing team that's there at your institution,
but there are a number of fantastic support groups
that are available. An outstanding resource for people wanting to learn more about lymphoma is
Cancer.Net, which is the patient-dedicated website for the American Society of Clinical Oncology.
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