Lymphoma

There are tens of different types of lymphoma, i.e. lymphatic tissue cancer. They are diagnosed in patients of all ages, but are most common among people aged over 60. In Finland, approximately 1,300 new cases of lymphoma are diagnosed annually. Most often, the disease is diagnosed from a biopsy taken from an enlarged lymph node. At Tays, we treat lymphomas with diverse cancer pharmacotherapy and radiation therapy options.

Some of the lymphomas are fast growing and require quick examination and treatment measures. Some, however, are very slow in their disease progression and monitoring alone may be sufficient. Surgical treatment is needed only in rare cases, and the actual treatment involves cancer pharmacotherapy and radiation therapy.

The disease prognosis depends on the lymphoma type, its spread and other risk factors. In addition, the other diseases and overall condition of the patient have a significant impact on the treatment possibilities.

Treatment results are already good in many of the disease groups and they continue to improve. Usually, the goal of treatment is permanent recovery or at least a good treatment result that lasts for years.

Referral to Tays

Usually, a lymphoma is suspected when an enlarged lymph node is observed, most often a ‘lump in the neck’. Lymphatic tissue is everywhere in the body, so the disease may manifest itself in very different ways – sometimes there are no manifestations to be felt or seen from the outside.

Decline in overall condition, weight loss, abnormally heavy night sweating, reoccurring temperature or abnormal blood count may give cause to suspect a lymphoma.

If a doctor suspects a lymphoma, he/she prepare an urgent referral to Tays. Even in the case of slow-growing diseases forms, we prepare a treatment plan within 3–6 weeks from the arrival of the referral.

Examinations at Tays

In order to determine the nature of the disease and lymphoma type, a biopsy, i.e. a tissue sample, is always needed. The sample is taken by a surgeon or, sometimes, a radiologist under imaging guidance.

Sometimes, a lymphoma diagnosis is specified with the help of a bone marrow sample – especially in cases where the patient’s complete blood count has been abnormal, i.e. diagnosed anaemia or abnormal number of white blood cells or blood platelets.

In order to determine the extent of the lymphoma, a full-body CT scan is needed and sometimes also a PET-CT scan.

Blood panels are used to determine the changes in the body caused by the disease and usually also a bone marrow sample is needed. In the case of certain aggressive diseases the spinal fluid sample is also checked.

Treatment negotiation and start

After the examinations, we invite the patient to the cancer outpatient clinic for treatment planning. During the visit, a specialist and nurse specialising in lymphoma treatment discuss treatment-related issues with the patient and possibly also with close relatives if so desired by the patient.

It is important to determine the type, scope, severity level and prognosis of the lymphoma and other factors impacting the treatment selection. Especially in the case of young patients, it is necessary to assess the possible long-term side effects of the planned treatments, for example, their impact on fertility.

We make the treatment decision together with the patient. Often, we also schedule the start of treatment, most often at the ward, in connection with this visit.

If a lymphoma causes very severe, quickly escalating symptoms, the treatment can be planned at the ward. In such cases, the treatment is usually launched at the same time.

Cancer pharmacotherapy of lymphoma

The treatment of lymphomas has developed quickly and new pharmacotherapies are continuously being introduced. Lymphomas are very susceptible to cancer pharmacotherapy. Often, the most efficient course of treatment is a combination of several medications with different effects. The traditional chemotherapy is combined with the more recent so-called precision treatments, such as antibodies.

Cancer pharmacotherapy repeats in the form of courses of drug administered at the hospital every 1–3 weeks and usually requires different supportive treatments alongside. The patient usually spends the intervals between treatments at home.

We begin treatment at the ward, but it can often be continued at the outpatient clinic. Typical pharmacotherapy of lymphoma lasts for 4–6 months. Cancer pharmacotherapy impacts the whole body and reaches, among other things, lymphoma cells in the circulation.

A minority of patients require highly efficient cancer pharmacotherapy in large doses that must be supported by a stem cell transfer.

Radiation therapy of lymphoma

Sometimes, radiation therapy is used as the sole form of treatment, when a lymphoma is situated only in a small, local area, but usually it is provided to complement the treatment result gained by cancer pharmacotherapy.

Lymphomas are very susceptible to radiation therapy, so the treatment periods are not long – from a few treatment sessions to 3–4 weeks. One radiation therapy session lasts under 30 minutes, so usually the patient comes to receive treatment from home.

Isotope treatments applied in some special circumstances are also based on the sensitivity of the lymphoma cells to radiation. The isotope treatments are administered as an intravenous drip.

Monitoring visits after the treatments

At the end of the treatments, we agree on the monitoring visits and examinations needed to ensure treatment efficiency. The monitoring schedule and contents are individual and depend, among other things, on the type of the treated disease, the treatment provided and its possible side effects.

Typically, the first monitoring visit is scheduled to take place approximately three months after the end of treatment, but it can also take place earlier. This is done to assess in particular recovery from the provided treatment.

Lymphoma team of Tays

Because the group of lymphoma diseases is very complex, we plan and implement the treatment of an individual patient in cooperation between many specialised fields. A lymphoma team operates at Tays. The team includes oncologists, a pathologist, specialist in charge of imaging, geneticist and, when necessary, for example, a haematologist or dermatologist.

The lymphoma team assembles regularly to specify diagnostics, assess a patient’s spread of disease and special characteristics related to treatment, prepare treatment plans and monitor the implementation of treatment. The team also evaluates and issues recommendations on treatment in situations where the patient’s treatment is implemented at other hospitals in the catchment area of Tays.

Specialised workers also participate in the treatment of lymphoma patients according to individual needs. Often, the services of a dietician, physiotherapist and social worker, among others, are needed.