Lymphoma

There are two major categories of lymphoma – Hodgkin’s and non-Hodgkin’s - and more than 20 tumor types, necessitating precise diagnosis and individualized approaches to treatment. Types include:

• Hodgkin’s Lymphoma
• Non-Hodgkin’s Lymphoma (NHL)
• AIDS-Related
• Burkitt Non-Hodkgin Lymphoma
• Cutaneous T-cell
• Primary central nervous system

Factors that increase the risk of lymphoma include:

• Age 60s or older (NHL)
• Ages 15 – 35 (Hodgkin’s nodular sclerosis subtype)
• Older than 55 (Hodgkin’s mixed cellularity subtype)
• Exposure to certain chemicals
• Previous chemotherapy
• Radiation exposure
• Pesticide exposure
• An inherited immune disorder (for example, hypogammaglobulinemia or Wiskott-Aldrich syndrome).
• An autoimmune disease (for example, rheumatoid arthritis, psoriasis, or Sjögren syndrome).
• Human Immunodeficiency Virus (HIV)/AIDS virus
• Genetic (inherited) syndromes
• Autoimmune diseases
• Certain infections (Helicobacter pylori, human T-cell leukemia/lymphoma virus (HTLV-1), Epstein-Barr virus (EBV), Kaposi sarcoma-associated herpes virus (KSHV))
• Post transplant lymphoproliferative disease (PTLD)
• Taking immunosuppressant drugs after an organ transplant

Signs and symptoms of lymphoma may include:

• Painless, swollen lymph nodes in neck, armpits or groin
• Persistent tiredness or fatigue
• Fever for no known reason
• Night sweats
• Unexplained weight loss
• Coughing, trouble breathing or chest pain
• Pain in the chest, abdomen, or bones for no known reason
• Loss of appetite
• Itchy skin

Brigham and Women’s Hospital lymphoma specialists are experienced in the most modern, safe and minimally invasive biopsy techniques to identify lymphomas. They will provide the highest quality diagnostic material to establish a definitive diagnosis. These surgical procedures include mediastinoscopy, video-assisted thoracic Surgery (VATS), and robotic-assisted mediastinal lymph node biopsy.

Diagnostic tests and procedures may include:

• Physical exam and medical history
• Complete Blood Count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
• Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. One of the following types of biopsies may be done:
  • Excisional biopsy: The removal of an entire lymph node.
  • Incisional biopsy: The removal of part of a lymph node.
  • Core biopsy: The removal of part of a lymph node using a wide needle.
  • Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid using a thin needle.
• Mediastinoscopy, a small incision is made in the neck above the sternum or between the ribs under general anesthesia. A rigid, tubular lighted scope is inserted to see into the middle of the chest (mediastinum) and obtain tissue samples of mediastinal lymph nodes.
• Video-assisted thoracic surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (a tiny camera) and surgical instruments into small incisions in the chest. VATS uses small incisions without any spreading of the ribs. A camera is used to assist the dissection of sensitive blood vessels and mediastinum masses. It allows excisional biopsies of lymph nodes. Less pain and quicker recovery are the goals.

If cancer is found, the following tests may be done to study the cancer cells:

• Immunohistochemistry: A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer.
• Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.
• Immunophenotyping: A process used to identify cells, based on the types of antigens or markers on the surface of the cell. This process is used to diagnose specific types of leukemia and lymphoma by comparing the cancer cells to normal cells of the immune system.

Treatment for lymphoma depends on many factors including the type of lymphoma, stage of the cancer and where it is located. You will be treated by a multidisciplinary team including experts in radiation therapy and chemotherapy. Often a combination of therapies will be recommended.

Non-Surgical Cancer Treatments

• Radiation therapy uses high-energy rays to kill or shrink cancer cells. Radiation is often used in conjunction with chemotherapy to shrink the tumor. The Radiation Oncology service at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) uses the most advanced equipment and techniques to deliver radiation to cancerous areas, while minimizing exposure to normal tissues.
• Chemotherapy Chemotherapy at DF/BWCC uses anticancer drugs to kill cancer cells throughout the entire body. Chemotherapy is often used before or after surgery or alone in the most advanced cases. Chemotherapy is often used in conjunction with radiation.
• Plasmapheresis removes extra plasma and antibody proteins from the blood.
• Biologic therapy, also called biotherapy or immunotherapy, uses the patient's immune system to fight cancer with substances made by the body or in a laboratory.
• Vaccine therapy
• High-dose chemotherapy with stem cell transplant
• Careful monitoring without active treatment until the lymphoma causes symptoms (for some slow-growing lymphomas)
• Clinical trials and targeted therapy

When you become a patient of The Lung Center you will meet many members of the team who will carefully review your medical history and studies. In addition, you will receive a thorough diagnostic examination where you will receive a recommendation for a therapy tailored just for you based on your specific diagnosis.

Any surgery recommended will be performed by an experienced, board-certified surgeon, in collaboration with a treatment team including oncologists, radiation oncologists, anesthesiologists, radiologists and pathologists, as well as nurses and physician assistants, all of whom specialize in taking care of patients with lymphoma.

Lymphoma patients benefit from the wide range of specialists at The Lung Center, including thoracic surgeons, oncologists, pulmonologists, cardiovascular medicine physicians and imaging experts. This collaboration ensures comprehensive diagnosis and targeted treatment for patients.

Visit the Dana-Farber/Brigham and Women’s Cancer Center for more information about lymphoma.

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