Lymphoma is a major cancer disease that is gripping India. Today we see not just adults but children also suffering from the deadly cancer disease. The delay in diagnosis and the unavailability of specialised hospitals to treat the same complicate the situation further causing numerous deaths.In a conversation with Dr Avinash Kumar Singh, Consultant Hemato-Onology, Paras Cancer Centre Patna the first hematologist in Bihar, we highlight the types of lymphoma and the grades of lymphoma. This information is essential for families that have a cancer patient who has been diagnosed with lymphoma.
Q1. What are the types of Lymphoma?
There are two main types of lymphoma – Hodgkin’s Lymphoma (HL) and Non Hodgkin’s Lymphoma (NHL). These two types of lymphomas are different and behave, spread and respond to treatment differently. Doctors can differentiate between the type of lymphoma by seeing the cells under a microscope. In some cases sensitive lab tests can also help in identifying the type of lymphoma.
- Hodgkin’s Lymphoma (HL):
It is also known as Hodgkin’s Disease. People with Hodgkin’s Lymphoma have abnormal cells called the Reed- Sternberg (R-S cells). Hodgkin’s Lymphoma is less prevalent than Non Hodgkin’s Lymphoma (NHL). Around 12% of cancer patients suffering from lymphoma have Hodgkin’s Lymphoma (HL). This type of lymphoma is found in both adults and children. Hodgkin’s Lymphoma (HL) is also classified in two types – Classic Hodgkin’s Disease (95% prevalence) and Nodular Lymphocyte Predominant Hodgkins Disease (5% prevalence).
- Non Hodgkin’s Lymphoma (NHL):
About 90% of the lymphoma’s are Non Hodgkin’s Lymphoma (NHL). They are of two types – B Cell Lymphoma and T- Cell Lymphoma. NHL has high prevalence and has grown by 80% since 1970. It is also estimated that more than 200,000 people die each year from the disease. NHL occurs mainly in adults with the peak occurrence between 45- 60 yrs of age. The likelihood of diagnosis of NHL increases as the age of the person increases.
What is the staging in Lymphoma?
Doctors describe lymphoma’s location and spread and correlate it to describe the stage of the lymphoma. Based on the same the best treatment plan is advised to the patient. Following are the stages.
- Stage I Lymphoma:
Lymphoma is early stage and the cancer cells have only invaded one lymph node region.
- Stage II Lymphoma:
In this stage the cancer cells have invaded two or more lymph nodes on the same side of the diaphragm. This is called a locally advanced disease.
- Stage III Lymphoma:
Here the cancer cells are in the lymph node area on both sides of the diaphragm. This is called an advanced disease
- Stage IV Lymphoma:
The cancer cells have spread to all parts of the body, beyond the lymph nodes. They have even spread to one or more organs – bone, bone marrow, etc. This is called a widespread disease. Stage III – IV Lymphoma are quite common and are still treatable.
- Progressive Lymphoma:
This is when the cancer becomes larger or spreads while the patient is being treated for the original lymphoma. This is called refractory NHL.
- Recurrent Lymphoma:
This is the type of cancer that can come back after the treatment in the same area has been done. Recurrence can occur shortly after the first treatment or years later. This is called relapsed NHL.
To understand the staging of the lymphoma various tests like ultrasounds, CT Scans, blood tests and bone marrow tests are done. PET Scans are also the standard scans that highlight the stage of the cancer, the organs that it has affected and the extent of the tumors. The PET Scans also show the metabolic activity of the cancer cells. These tests are necessary for the doctor to understand the response of the treatment in certain situations.
Paras Cancer Centre, Patna is the only centre in Bihar to provide comprehensive cancer care facilities for the diagnosis, treatment and management of Lymphoma including PET CT & Bone Marrow Transplant or stem cell transplantation.