Lymphoma

Screening and prevention

Can you prevent Non-Hodgkin Lymphoma?

You cannot prevent this blood disorder. However, the following lifestyle habits may lower your risk of developing various cancers:

• Avoid activities that may increase your risk of getting HIV/Aids or hepatitis C infections

• Eat a well-balanced diet

• Maintain a healthy weight

• Quit smoking

• Exercise regularly

• Avoid unnecessary exposure to certain chemicals, such as benzene, glyphosate, herbicides, and others

Diagnosis

Successful treatment depends on a complete and accurate diagnosis.

Because there are so many types, an accurate diagnosis is critical to your treatment. Each of our patients receives a thorough evaluation by several doctors who specialize in diagnosing lymphomas. This typically involves:

• History and Physical Examination: We complete a thorough examination and take a full personal and family medical history.

• Blood and Urine Work: We may take blood and urine samples to test your complete blood count (CBC), blood chemistry, and other factors.

• Lymph Node Biopsy: We use a needle or an incision to remove all or part of a lymph node. A pathologist with specialty training and experience in lymphoma will then examine the sample with a microscope.

We may use additional tools to determine if the cancer has spread:

• CT (CAT) Scan: Computed tomography takes a series of X-rays from different angles, then stitches them together into 3D images.

• MRI: Magnetic resonance imaging uses a powerful magnetic field and radio waves to create detailed 3D images at higher contrast than CT scans. This can be useful for clarifying other test results.

• PET Scan and CT: After a substance called radionuclide glucose is injected into one of your veins, a positron emission tomography (PET) scanner rotates around your body. It creates a map of cancer cells, which take in more glucose and show up brighter. The test is combined with a CT scan.

• Bone Marrow Biopsy: We use a hollow needle to remove a small sample of bone marrow, blood, and bone from the hip bone or breastbone. The samples are studied under a microscope and may get other testing, including analysis for genetic changes.

• Laparotomy/Laparoscopy: The organs inside the abdomen may be checked for disease, using either one larger incision (laparotomy) or smaller incisions and special tools (laparoscopy). Diseased tissue or organs may get removed, or samples taken for examination with a microscope.

• Mediastinoscopy: An incision is made at the top of the breastbone, and a thin, lighted instrument (mediastinoscope) is inserted to check for abnormal tissue in the organs, tissues, and lymph nodes between the lungs. We may remove tissue or lymph node samples.

• Ultrasound: Sound waves create a picture of the suspicious area.

Types of cancer

What are the types of lymphoma?

They are commonly categorized as non-Hodgkin lymphomas (NHL) or Hodgkin lymphomas. However, there are many different types of these cancers within each of these broad groups, and the classification of these is complex. Their distinctions are important because treatment options vary based on the specific tumor characteristics of each type.

Non-Hodgkin lymphoma

Non-Hodgkin lymphomas are the most common type and can begin in either B lymphocytes (B cells) or T lymphocytes (T cells). There are dozens of different types within this general category. The following are the most common types of NHL:

• Diffuse Large B-Cell Lymphoma (DLBCL)

• Follicular Lymphoma

• Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)

Hodgkin lymphoma

Also known as Hodgkin's disease, Hodgkin lymphomas are a much rarer cancer type. While it can affect people of any age, it typically affects those between 15 and 38 and adults over 55.

Treatments

We offer the latest promising therapies using a team approach.

Your treatment will be based on several factors, including:

• Whether it's non-Hodgkin or Hodgkin lymphoma

• The subtype and genetic makeup of your cancer

• How quickly the cancer is growing

• Your overall health and goals

Some lymphomas grow quickly (aggressive) and require prompt treatment. In contrast, indolent lymphomas (slow-growing) may benefit from a "watch and wait" approach for several years before warranting treatment.

Because we work as a team, we offer all available treatment options guided by the expertise of doctors in different fields, including hematology, medical oncology, pathology, and radiation oncology. These experts meet weekly to determine the best possible treatment plan for each new patient, ensuring our patients have access to the right treatment at the right time.

Thanks to advances in medicine, many effective treatments are available, from conventional chemotherapy to new therapies that target certain tumor cells. These innovative treatments often lead to excellent results for patients with these blood disorders.

Chemotherapy

Chemotherapy is a traditional treatment option for patients with aggressive or fast-growing lymphomas. It uses a combination of several drugs given as injections or intravenously (through a needle or tube placed in a vein). It may also be given orally in pill form, in some instances.

Immunotherapy and targeted therapy

Targeted therapy represents a new front in attacking cancer drugs and other substances aimed at specific molecules that help a disease grow, progress, and spread. The idea is to target a cancer’s unique characteristics, including genes, proteins, supporting blood vessels, or host tissue, while limiting damage to healthy cells.

As we learn more about how these types develop and grow, we continue investigating new biological treatments that can target specific molecular pathways. Many of these novel therapies are now FDA-approved, and others in clinical trials show promising outcomes for patients with certain types of NHL. Among others, these include:

• Pathway inhibitors

• Bispecific antibodies

• CAR T-cell therapy

CAR T-cell therapy

Chimeric antigen receptor (CAR) T-cell therapy is an exciting new therapy used to treat certain types of blood disorders. It involves collecting immune cells from your blood, separating and modifying the T-cells, and then re-infusing them back into your body. Throughout this process, the T-cells are genetically modified to have new receptors on their surface. These act like missiles that can recognize and target cancerous cells when returned to the body. MedStar Georgetown University Hospital is the only authorized treatment center in the Washington, D.C., area to offer CAR T-cell therapy for adults.

Radiation therapy

Radiation therapy for blood cancers uses high-energy X-rays or other particles from an external machine to kill cancerous cells. While radiation is not used as frequently as other treatments like chemotherapy and targeted therapy, there are useful applications:

• Hodgkin lymphoma: While radiation is usually very effective for killing diseased cells in Hodgkin lymphoma, we try to limit its use because of side effects. Thanks to advanced imaging, we can target the disease more precisely and further avoid damage to healthy tissues.

• Non-Hodgkin lymphoma: We might recommend radiation alone for early-stage tumors or with chemotherapy for more aggressive disease. We might also pair it with high-dose chemotherapy before a stem cell transplant.

Whatever the application, we are careful to minimize radiation side effects, particularly for patients who are younger, pregnant, or older.

Stem cell transplants

Also called a bone marrow transplant, stem cell transplants use a patient's own cells (autologous) or donor cells (allogeneic) to replace stem cells in the bloodstream. While this is most commonly used to treat multiple myeloma and some other blood disorders, we may also recommend it for lymphoma patients when appropriate. We're proud to be the only academic stem cell transplant center in the Washington, D.C. region, giving patients in the area access to this life-saving treatment. MedStar Health is also the largest collection site for the National Marrow Donor program, which gives us exceptional expertise in cell collection.