Unlike other common cancers, for example breast and colon, lymphoma is not one of the cancers that are routinely screened for in the healthy population, so people with lymphoma who are not exhibiting any signs or symptoms are not going to be picked up by screening. If a doctor suspects lymphoma from the symptoms reported by a patient, they may begin investigation for lymphoma by first asking some questions to help eliminate other likely explanations for the symptoms, including possible risk factors, the person’s family history, and other medical conditions. After obtaining the patient’s history, the doctor will perform a physical examination. He or she will palpate (press upon) areas of the body where swollen lymph nodes may be felt. During the physical examination, the doctor will be looking for signs of infection near lymph nodes, since the majority of swollen lymph nodes can be explained by infection. If the swelling has persisted even after infection has been ruled out, a biopsy will be ordered. Diagnosis of lymphoma can only definitively be confirmed by biopsy (laboratory examination of lymph tissue under a microscope). Depending on the location of the swollen lymph node, biopsy may involve using a local anesthetic, sedative, or general anesthetic. Occasionally, the biopsy may be able to be performed in a less invasive manner using needles, known as fine needle biopsy or core needle biopsy. Biopsy testing helps to confirm not only the presence or absence of lymphoma, but also the type of lymphoma. Analysis of the biopsy sample also provides a guide to prognosis (outcome or survival rates) and the type of treatment that will be required. Other tests that may be ordered are blood tests to check the number of white blood cells and chest x-ray to pick up swollen lymph nodes.
HOW ARE LYMPHOMAS STAGED?
If a diagnosis of lymphoma has already been confirmed by biopsy, further testing is performed to determine the stage of the cancer, i.e., to see whether it has spread to other parts of the body. Staging tests can include blood tests; x-rays and CT scans; MRI scans for detailed images of tumors; ultrasounds; PET scans in which radioactive tracers pick up cancer; bone marrow biopsy; and spinal tap to look for lymphoma cells in the spinal fluid. These tests enable the treating physicians to identify the type and stage of the lymphoma. Four stages are described corresponding to how far the cancer has spread:
Stage I – the tumor is localized.
Stage II – there is limited spread of the lymphoma.
Stage III – there is regional spread of the cancer.
Stage IV – the lymphoma has spread to distant parts of the body.
WHAT ARE THE TREATMENT OPTIONS FOR LYMPHOMA?
Many of the treatment options used against other types of cancer are also effective in the treatment of lymphoma. Everyone’s lymphoma is different and statistics cannot predict the success of an individual person’s treatment plan, but the figures do show good overall success rates in beating lymphoma. The following treatment options are available to patients with lymphoma:
- Immunological therapy
- Radiation therapy
- Stem cell transplantation
- Surgery (for a few cases)
Several chemotherapy drugs are available for treatment of lymphoma, administered by mouth or injection, usually in cycles of outpatient treatment with rest periods in between treatments. Chemotherapy is often combined with other treatment options such as radiation therapy and immunotherapy. Radiotherapy involves directing a carefully focused beam of high-energy x-rays onto the tumor cells, thereby destroying them. Immunotherapy provides artificial versions of the normal immune system by the use of biological drugs to boost the immune system. Again, the aim is to kill cancer cells or slow down their growth. A small number of lymphomas may be treated by stem cell transplantation. This is a process in which high-dose chemotherapy, and sometimes high-dose radiotherapy, is given to a patient who has not responded to standard treatment. The high-dose treatment damages the bone marrow, which is then restored by the stem cell transplant which follows.
Although prevention of lymphoma is not possible because the causes are largely unknown, treatment is available and has been shown to be successful. All cancer treatments produce serious side-effects, and any treatment plan for lymphoma should always weigh the risks and benefits of therapy against potential adverse events.