Advancement in medical science has transformed Lymphoma into a curable disease

Ahmedabad, Gujarat: World Lymphoma Awareness Day is observed every year on 15th September. The theme for 2023 is “We Can’t Wait to Focus on Our Feelings.”

The human body relies on the circulatory system to transport essential nutrient and maintain organ function. A portion of circulating blood is filtered out and enters a parallel circulatory domain called ”Lymphatic circulation”. This specialized network contains lymph, a filtrate, and immune cells called lymphocytes. Lymph circulates within lymphatic vessels and these vessels intersect at specific points called Lymph Nodes. This forms an intricate interconnected network within our body.

Dr Ankit Jitani, Consultant, Hematology, Hemato-Oncology and Bone Marrow Transplant, Marengo CIMS Hospital, Ahmedabad said, “Advancement in medical science has transformed Lymphomas into a curable disease. Treatment options for Lymphomas involve combination or sequential use of Chemotherapy, Immunotherapy, and Targeted therapies.”

The lymphatic system and lymph nodes contains certain cells of immune system that acts as a watchman and defends us from external threats like infections. In a normal health, these lymph nodes are small and are not visible or palpable. However, when our body encounters an infection, the lymph node gets activated, enlarges (becoming visible or palpable) in size to defend our body. However, not all swellings of these lymph glands are due to infections. Sometimes, the cells within the lymph node become autonomous and undergo uncontrolled multiplying to form a cancer called lymphoma.

What are the subtypes of lymphoma?

Lymphomas are classified into two types “Hodgkin’s Lymphomas” named after Dr. Thomas Hodgkin who first described the disease in 1832. All other subtypes of lymphoma are grouped under the term “Non-Hodgkin’s Lymphomas” (NHLs). NHLs are further subdivided based on the type of lymphocytes involved into T-cell or B-cell type. Additionally, based on rapidity of growth NHLs are classified as “Aggressive (fast growing)” ones or “Indolent (slow growing)” ones. All these subtypes are treated differently.

What symptoms may a patient with lymphoma have?

Lymphoma often manifests with swelling of lymph nodes which are commonly palpable at the neck, armpits and groin region. Lymph nodes inside the chest and abdomen may also enlarge which can be detected only by special radiology tests. Enlarged lymph nodes may compress vital organs inside our body like wind pipe, food pipe or major blood vessels leading to respiratory problem, gastrointestinal obstruction (vomiting, nausea, and abdominal pain) as well as swelling over face/extremities, and abdominal swelling.

Other accompanying symptoms like weight loss, fever, drenching sweats, fatigue, weakness, lethargy frequently coexist. However, these presenting symptoms are not specific for Lymphomas, warranting evaluation under the supervision of Hematologist.

How is lymphoma diagnosed?

A biopsy is done to remove one of the enlarged lymph node. In some cases, removing the entire lymph node is not feasible, small cores of tissue are taken out with a special core biopsy gun. The biopsy sample goes through multiple tests like microscopic examination and other special tests like immunohistochemistry and other molecular tests for precise subtyping. Once the diagnosis is confirmed, staging is done to understand the extent of the disease. Radiological tests like CT scan, PET-CT scans and bone marrow test are done for staging. Prior to treatment, patient is also subjected to fitness assessment.

How is lymphoma treated?

Advancement in medical science has transformed Lymphomas into a curable disease. Treatment options for Lymphomas involve combination or sequential use of Chemotherapy, Immunotherapy, and Targeted therapies. Usually the patient receives these therapies for a period of six months depending on the type of lymphoma and the stage. Each cycle of therapy requires one to two days of hospital visit and majority of the treatment is done in the day care. Radiation therapy is employed in certain cases. For some patient, Bone Marrow or Stem Cell Transplant is recommended to achieve a possible cure.

Where do we stand?

The burden of lymphoma in our country is alarmingly high, possibly attributable to our large population. The estimated number of new lymphoma cases in India each year is over fifty thousand. These estimates are based on 12 Lymphoma registries at various places in India and do not include many cases that goes unreported. The reported numbers are possible just a fraction of the actual burden.

Despite the promising modalities of treatment and the advances in medical science, India is lagging behind the developed countries in Lymphoma outcomes. Such poor outcomes are possibly due to delay in diagnosis and treatment attributable to delay in seeking medical care, incorrect diagnosis due to non-availability of advanced laboratories and trained hematopathologists, and financial limitations. Treatment gap due to financial disparity is rapidly getting bridged due to generic drugs, improvement in laboratory chain and governmental schemes. Now, it is imperative for us to stay aware and alert and do not ignore our symptoms.