Lymphoma - Non-Hodgkin's Lymphoma & Hodgkin's Lymphoma

written by Dr Goh Kim Yen on 3 June 2013
Lymphoma - Non-Hodgkin's Lymphoma & Hodgkin's Lymphoma
Lymphoma is a form of cancer that originates 
from a type of white blood cell called lymphocytes. 
Normal lymphocytes are an important part of the immune system that help our body to fight infection. They are present in the blood stream and lymphatic system.
The lymphatic system is a network of vessels that transports fluid and nutrients around the body and is a part of the immune system.
When some of these cells in the lymphatic system multiply uncontrollably and abnormally, they become cancerous. This is called Lymphoma.
Symptoms of Lymphoma
The most common symptom of Lymphoma is painless swelling in the neck, armpit or groin area. Lymphoma may also affect other parts of the body such as the lungs and the bowels. 
Apart from swellings, the common symptoms of lymphoma are recurrent or persistent fever, night sweats, weight loss, loss of appetite,tiredness, persistent itching of the body, breathlessness or cough.
Painless swelling in the Armpit
Painless swelling in the Armpit

Types of Lymphoma

1. Hodgkin’s Lymphoma (HL)

    (Hodgkin’s Disease)

2. Non-Hodgkin’s Lymphoma (NHL)

Within each of these types or categories, they are further divided into different subtypes.

Indolent versus Aggressive Lymphoma
'Indolent’ NHLs grow slowly. 
They typically cause no symptoms initially,
and so remained undetected for some time. 
The most common symptom of indolent NHL
is an enlarged lymph node, noticed as a lump.
‘Aggressive’ NHLs grow quickly.
Patients are likely to notice symptoms and go to their doctor earlier. 
Treatment is usually required shortly after diagnosis. 
Although the name ‘aggressive’ sounds frightening,
these lymphomas often respond very well to treatment.
The decision to treat patients with Lymphoma depends on various factors:
Patient-related Factors:
• Age and general health of the individual
• Presence of any concurrent medical illness
• Patient’s need and wishes
Disease-related Factors:
• Type of Lymphoma,
   whether the disease is indolent or aggressive and its stage
• Whether the disease is newly diagnosed or has relapsed
Diagnosis & Tests for Lymphoma
A diagnosis of lymphoma must be obtained with biopsy.  A representative sample of the swelling is removed,
sent to  a pathologist for analysis. 
The pathologist can then determine if 
this is lymphoma, its type (Hodgkin’s or Non-Hodgkin’s Lymphoma), its subtype and its behaviour (aggressive or indolent).             
Follicular Lymphoma
Diffuse Large Cell Lymphoma
Staging for Lymphoma
Once a diagnosis of lymphoma is confirmed,  your doctor will carry out tests to stage the tumour  and to determine the spread and extent of the tumour.
These follow-on tests include :
• Blood tests
• Radiological Imaging
   X-Ray / C T Scan / PET-CT Scan / MRI
• Bone marrow examination
Staging for Lymphoma
Treatment Options for Lymphoma
1. Watch & Wait
‘Watch & wait’ approach is sometimes adopted for lymphomas which are slow-growing, still in early stage and those that do not cause too much discomfort or side effect to the patient.
It is not the same as doing nothing; 
Close monitoring with your doctor is needed. You will require periodic blood 
tests and scans.
2. Radiation Therapy
This involves the use of high energy X-ray to kill cancer cells directly.  This is useful in certain types of Lymphoma and 
when the disease if confined to one or two areas of the body.
3. Chemotherapy
Chemotherapy drugs are drugs that are used to kill cancer cells.  Different combinations of chemotherapy drugs are used to treat different types of Lymphoma. 
The common combinations or regimens are ‘CHOP’ for Non-Hodgkin’s Lymphoma and ‘ABVD’ for Hodgkin’s Lymphoma.
Chemotherapy is also often given in combination with other types of treatment e.g. monoclonal antibodies
4. Monoclonal Antibody
This is a type of targeted therapy or ‘smart bullet’’.  Once administered into the body, it will bind to the cancerous lymphoma cells and destroy them.  Its effect is enhanced if it is used in combination with chemotherapy.
One combination is Rituximab (a type of monoclonal antibody) with CHOP chemotherapy, commonly used for the treatment of Non-Hodgkin’s Lymphoma.
Medications used for the treatment of Lymphoma
Rituximab (Mabthera)
Brentuximab (Adcetris)
Pralatrexate (Folotyn)
Bortezomib (Velcade)