Treatment

Symptoms, Risk and Diagnosis

Lymphomas are cancers that affect the white blood cells of the lymph system, part of the body’s immune system. The main goal at the Siteman Cancer Center is to get a correct diagnosis of your lymphoma and decide if treatment is needed. Some forms are slow-growing and may initially be handled with active surveillance and may never need treatment. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.

Siteman Cancer Center also has an interdisciplinary tumor board. In some situations, your case may be reviewed by this group of radiologists, radiation oncologists, pathologists and medical oncologists who meet to discuss unusual cases that are challenging from a diagnostic or treatment perspective.

Symptoms of Lymphoma (and other conditions)

The early signs and symptoms of lymphoma may be similar to the flu or other common diseases.

Common symptoms include:

  • Painless swollen lymph nodes in the neck, chest, underarm or groin.
  • Weakness or feeling tired.
  • High fever or drenching night sweats.
  • Weight loss or loss of appetite.

Less common symptoms:

  • Peripheral neuropathy: Pain, tingling or numbness, especially in the hands or feet.
  • Vision changes, such as blurred vision or blind spots.
  • Easy bruising or bleeding such as nosebleeds or bleeding from the gums.
  • Pain or feeling of fullness below the ribs.
  • Itchy skin, red rash, plaques or nodules in the skin.

Risk Factors

  • Having a weakened immune system from AIDS or other immune disorders, or having taken immunosuppressant drugs after an organ transplant.
  • Infection with the Epstein-Barr virus.
  • Having a first-degree relative with lymphoma.
  • Having an autoimmune disease.
  • Recurrent infections with the helicobacter pylori that causes stomach ulcers.
  • Being exposed to pesticides.

Diagnosis

Determining the exact condition, and what specific type, often takes more than one approach:

The following tests and procedures may be used:

  1. Physical exam and history to examine the patient’s past illnesses and treatments, and any signs of disease, such as a swollen spleen, lumps or anything else that seems unusual.
  2. Complete blood count (CBC): A sample of blood is drawn to check for the number of red blood cells, white blood cells, and platelets, as well as the amount of hemoglobin (the protein that carries oxygen) and the portion of the sample made up of red blood cells.
  3. Peripheral blood smear: This procedure checks a sample of blood for cells that look “hairy,” the number and kinds of white blood cells, and changes in the shape of blood cells.
  4. Blood chemistry studies: These test a blood sample for the amounts of certain substances released into the blood by organs and tissues in the body to look for signs of disease.
  5. Bone marrow biopsy to aspirate bone marrow, blood and a small piece of bone from the hipbone or breastbone to look for microscopic signs of cancer.
  6. Immunophenotyping: A laboratory test in which the antigens or markers on the surface of a blood or bone marrow cell are checked to see what type of cell it is. This test helps diagnose the specific type of leukemia by comparing the cancer cells to normal cells of the immune system.
  7. Flow cytometry: This laboratory test measures the number of cells in a sample, the percentage of live cells and certain characteristics of cells, such as size, shape and the presence of tumor markers on the cell surface. Measurements are based on how the light-sensitive dye reacts to the light.
  8. 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.
  9. PET scan (positron emission tomography scan): This procedure finds malignant tumor cells in the body by using a small amount of radioactive glucose (sugar) injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. This helps with staging the lymphoma.
  10. CT scan: A procedure that makes a series of detailed pictures of areas inside the body, which are taken from different angles and use contrast dye to look for things like swollen lymph nodes or a swollen spleen.

Siteman has an active lymphoma banking program. Patients volunteer to participate in the bank by donating extra lymphoma tissue taken during the diagnosis procedure so it can be studied to improve treatment of future lymphoma patients. The lymphoma practice at Siteman sees hundreds of cases and is engaged in active research to bring even more effective treatments to practice.

Staging of Lymphoma

After lymphoma has been diagnosed, tests are done to find out the status of the disease. Staging defines how the cancer has spread within the lymph system and varies with the type of lymphoma. In addition to staging, the lymphoma may be designated primary or recurrent, meaning it has come back after treatment.

Staging is basically the same for non-Hodgkin and Hodgkin lymphomas. Stages are ranked 1 – 4 for extent of the disease and A, E, S. In A stages, the patient has no symptoms and it was discovered on imaging. E stage means the cancer is found in an area or organ other than the lymph nodes. S stage has the cancer in the spleen. Cutaneous lymphoma, because it involves the skin, uses a slightly different staging system.

Stages can then be grouped for treatment into the categories based on the number of risk factors of: early favorable or unfavorable (stage 1 or 2), and late favorable or unfavorable (stages 3 or 4).

Prognosis

The prognosis (chance of recovery) and treatment options depend mainly on the following:

  • The type and sub-type of lymphoma.
  • Whether it is indolent, in which case, 20 percent of patients never require treatment.
  • Whether it is highly aggressive, in which case, chemotherapy can produce a cure.

Other factors taken into account include:

  • The age of the patient.
  • The extent of the spread of the cancer within the lymph system or to other organs.
  • Whether there are certain changes in the genes.
  • Whether the cancer has been treated before or has come back.