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Treatment of Lymphoma

In comparison to even 20 years ago, you will have a large menu of options for treating your Lymphoma. The treatment plan that your radiologist will formulate for you will be primarily determined by the stage of Lymphoma that you have and by your input. The following treatments are available for Lymphoma, and they have different degrees and levels of success:

  • Chemotherapy
  • Radiation therapy
  • Immunotherapy
  • Targeted therapy
Chemotherapy

When you have chemotherapy treatment for Lymphoma, you’ll be given a cocktail of medicines that are powerful and are designed to kill your cancerous and precancerous cells. These medicines need to work directly on the problem cells and are given through an IV drip for this reason. They diffuse throughout your body quickly upon injection.  

Radiologists prefer to use chemotherapy for people with non-Hodgkin’s Lymphoma. If their Lymphoma is in the early stages, all they will likely need for treatment is chemotherapy. The same is not valid if they have advanced-stage Lymphoma. They will need a plan that combines chemotherapy with other types of treatment. Chemotherapy is commonly used in conjunction with radiation therapy or immunotherapy in people with advanced-stage Lymphoma.

The medicines used in chemotherapy are numerous and can be categorized accordingly:

  • Alkylation agents
  • Corticosteroids
  • Platinum medicines
  • Purine analogs
  • Anti-metabolites
  • Anthracylines
  • Vincristine
  • Mitoxantrone
  • Etoposide
  • Bleomycin

Chemotherapy medicines may be powerful on their own, but Lymphoma is sophisticated, aggressive, and powerful. This is the reason why radiologists prefer to give their patients medication in a combination of categories. One of the most common chemotherapy combinations is CHOP. You will be taking cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone. This medicine combination has been very effective at killing cancerous and precancerous cells and keeping lymphoma patients in remission for a long time. Radiologists love the chemotherapy-immunotherapy cocktail because this is a robust treatment plan that works in terms of destroying cancer cells and keeping people in remission. A popularly used immunotherapy medicine in this instance is Rituxan.

How radiologists give chemotherapy?

Because NHL is very sophisticated and aggressive, radiologists prefer to give their patients chemotherapy in a series of cycles. Chemotherapy patients will receive a few weeks of intensive injections of medicines. This will be followed by a few weeks of inaction. The process is repeated until the cancerous and precancerous cells have been killed, and the patient is in remission. Because chemo is given through an IV drip, it can be done in an outpatient setting.

It is common for patients to use one cocktail of chemotherapy medicines at the beginning of their cycle and a completely different cocktail at the end. This is because the medications used in the cocktail are robust and have different effects, results, and reactions in their (patients’) bodies.  

Intrathecal chemotherapy

This is a popular treatment method for patients whose Lymphoma is in the advanced stages and has metastasized to their brains and spinal cords. Radiologists prefer these medicines because they are instrumental in terms of penetrating the cerebrospinal fluid that surrounds the brain. This fluid is very thick, and this is what causes other types of chemotherapy medicines to diffuse upon contact with the liquid. This makes the medication useless.  

Side effects

Though modern medicine has formulated many treatment options which work wonders in terms of killing the cancerous and precancerous cells in people with NHL and keeping them in remission, they are no miracle treatments. All of them have side effects, some of which are mildly annoying and some of which are life-threatening. Chemotherapy is no exception. Some of the more common side effects of chemotherapy are:

  • Hair loss
  • Mouth sores
  • Appetite loss
  • Nausea and vomiting
  • Diarrhea and constipation
  • More frequent infections (chemotherapy has been known to attack and kill white blood cells. Hence people who undergo chemotherapy tend to have weaker and compromised immune systems.)
  • More frequent and unexplained bruising or bleeding (chemotherapy tends to lower its patients’ blood clotting platelet count.)
  • Fatigue and shortness of breath. This is caused by the lower red and white blood cell count that chemotherapy patients have
  • Life-threatening strokes

Most of these side effects are either minor or not severe. The other good news is that they tend to disappear after a few weeks. However, a patient’s chemotherapy plan may be stopped or modified if he or she is showing severe and life-threatening side effects and the side effects are long-lasting. If the chemotherapy is beneficial, and the patient is suffering from mild yet annoying side effects like nausea or diarrhea, his or her radiologist may prescribe specific medicines which suppress these side effects.

Many chemotherapy drugs have specific side effects. A good example lies with platinum medicines. Since most of these side effects are severe and life-threatening, they force radiologists to find alternative medication or treatment options if their patients experience any of them. Some of the common side effects include:

  • Nerve damage – this is especially true with cisplatin. Patients suffering from this can experience short and long-term numbness, tingling, or hand or foot pain.
  • Ifosfamide can cause severe bladder damage. Radiologists often prescribe mensa (another medicine) since it tends to minimize these side effects or even make them disappear.
  • Doxorubicin can send people into congestive heart failure. Radiologists are aware of this and order heart function and capacity tests before putting their patients on it.
  • Bleomycin can cause lung damage. This is why radiologists test patients for lung function and health before starting cycles with this medicine
  • Most of the chemotherapy drugs can cause infertility in both men and women. This is why women are often advised to freeze or put their eggs in special storage before starting chemotherapy.
  • People who are given these medicines are at a higher risk of getting leukemia.

Tumor lysis syndrome

This is a severe side effect because of the way it affects lymphoma patients’ kidney function. This is ideally the case with people suffering from aggressive Lymphoma. When chemotherapy drugs kill cancerous and precancerous cells, their harmful contents flood their (patients’) bloodstreams. Since the kidneys filter blood, they may not be able to keep up with the constant bombardment of compelling and harmful content that they must filter out. The kidneys do not work correctly and filter out all of the content effectively. Patients can end up with toxic mineral buildups in their bloodstream or even chronic kidney failure.

Radiologists try to minimize the effects of and even prevent patients from developing tumor lysis syndrome by giving them special fluids and medicines which are designed to isolate and flush the harmful content out of their (patients’) bloodstreams. Some more common and useful drugs are baking soda, allopurinol, and rasburicase.

Treatment for MALT lymphoma

MALT is an acronym for mucosa-associated lymphoid tissue. People with this type of Lymphoma are usually caused by the presence of healthy bacteria known as H.pylori. They are given antibiotics and protein pump inhibitor medicines to kill these bacteria. Most people with this type of Lymphoma are cured and remain in remission after undergoing treatment.

Radiation therapy

This therapy is somewhat targeted because it aims high energy radiation beams in the area with large concentrations of cancerous and precancerous cells and lymphoma tumors. This therapy is used as a stand-alone treatment in patients with Lymphoma in the early stages. Radiation therapy is often combined with other types of treatment if cancer has advanced or metastasized. The beams are very good at destroying cancerous and precancerous cells and tumors. It is also good at keeping lymphoma patients in remission.

When radiation therapy is used, it is given in the form of external beam therapy. This subtype of therapy saturates tumors and cancerous/precancerous areas with high-energy radiation beams. It is very good at targeting and destroying problem areas and tumors only.  

Immunotherapy

This is a new and relatively useful/unique type of treatment. A popular immunotherapy medicine known as Opdivo is useful in terms of treating patients for whom other treatment methods are mostly ineffective. It also works wonders when treating patients whose cancer has relapsed (come back.) it is a single cell antibody that works by stopping protein PD-1 on T cells from activating. The T-cells don’t stop working and are encouraged by the medicine to attack and destroy precancerous and cancerous cells and tumors. The best part is that it delivers quick results.

Targeted therapy

These are potent medicines that are designed to target specific proteins in cancerous and precancerous lymphoma cells to keep them from growing. In some instances, these medicines are capable of killing these cells.

Stages of Lymphoma

The two main types of Lymphoma: Hodgkin’s and non-Hodgkin’s grow in a series of four steps which are explained in further detail below:

  • Stage 1 – the Lymphoma is localized to a single organ or lymph node
  • Stage 2 – the Lymphoma has spread to another closely located lymph node. The lymph nodes are located on the same side of the body. Lymphoma can also be in this stage when it has spread from one organ to many surrounding lymph nodes.
  • Stage 3 – the cancer is present in many lymph nodes, which are located on either side of and all over the body.
  • Stage 4 – the Lymphoma metastasizes from one organ to many others. Some of the most famous organ lymphomas metastasize to is the liver, lungs, and bone marrow.

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