Understanding your diagnosis. Dr Graham Collins Consultant Haemtologist Oxford University Hospitals

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Reynold Watts
5 years ago
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1 Understanding your diagnosis Dr Graham Collins Consultant Haemtologist Oxford University Hospitals

2 Common questions I get asked What is lymphoma? What subtype do I have and what does that mean? What are the symptoms of lymphoma? What causes lymphoma (why me.?) How common is lymphoma? What stage of lymphoma do I have? How is lymphoma treated? What is my life expectancy? What new treatments are coming through?

3 What is lymphoma? Good question!

4 What is lymphoma? It s not at all obvious.. Breast cancer cancer of the breast! Colon cancer cancer of the colon!

5 So what is lymphoma? Is it a cancer? Yes! What is it a cancer of? The lymphatic system

6 What is my subtype?

7 What are the different types of lymphoma? Lymphoma: cancer of lymphocytes Hodgkin Lymphoma Non-Hodgkin Lymphoma Classical Hodgkin Lymphoma Nodular Lymphocyte Predominant Hodgkin Lymphoma T-cell NHL B-cell NHL High Grade Low grade Diffuse Large B-cell CLL Burkitt Follicular Lymphoblastic Marginal zone

8 Low grade NHL Slowly progressive Increases with age - never seen in children Without treatment, may live for many years Treatment variable: aingle agent chemo, multiagent chemo, antibodies, radiotherapy Follicular lymphoma Marginal zone lymphoma Lymphoplasmacytic lymphoma Usually no cause some exceptions e.g. gastric MALT Generally NOT considered curable with chemotherapy

9 High grade NHL Rapidly progressive Increases with age but do see in children Without treatment, survival only months Treated with combination chemotherapy (+ monoclonal antibodies) Diffuse large B- cell lymphoma Burkitt Lymphoma Lymphoblastic lymphoma Usually no cause - HIV is a risk factor Fequently curable with chemotherapy

10 Why are there so many different types? Naïve B-cell Transitional B-cell Follicular B-cell Spleen Marginal zone B- cell Memory B-cell Lymph node Stem cell Germinal centre Mantle zone Antigen presentation Bone marrow Plasma cell

11 How do we tell what subtype it is? A biopsy is vital to get the right diagnosis There are 2 main types of biopsy: 1. Excision biopsy (the node is taken out under a quick general anaesthetic) 2. Core biopsy (a thin apple-core is taken out under local anaesthetic using an ultrasound or CT maching to guide the needle).

12 Pathologists a key part of the team

13 What a pathologist sees Follicular lymphoma Classical Hodgkin lymphoma Diffuse large B-cell lymphoma Special antibody-based stains and sometimes genetic tests are used to confirm the diagnosis

14 What are the symptoms of lymphoma?

15 Usually symptoms are due to a lump Neck lump I felt it when I was shaving Chest lump I can t stop coughing when I lie flat Brain lump I got lost on my way home from work

16 Other symptoms Almost anything B symptoms : fever, weight loss, drenching night sweats Fatigue (tiredness) Itch Alcohol induced pain Rash

17 What causes lymphoma?

18 What causes lymphoma? For most cases we just don t know Factors which increase the risk: Reduced immune system (e.g. after a transplant) Infections: HIV, Helicobacter pylori, EBV Inflammatory diseases (e.g. sjogren syndrome, thyroiditis) Certain medications (e.g. methotrexate) POSSIBLY certain toxins e.g. pesticides

19 How common is lymphoma?

20 How common is lymphoma? Approx 16,000 new cases each year

21 Who gets lymphoma? Non-Hodgkin Increases with age Hodgkin Commonest in young

22 Is it getting more common? Yes! And we don t know why

23 What stage do I have?

24 Staging is with a PET or CT

25 Staging by PET Stage I Stage II Stage III Stage IV

26 How is lymphoma treated?

27 It depends. Not everyone needs treatment: watch and wait is standard management for low grade lymphoma without symptoms Hodgkin and high grade lymphoma nearly always needs treatment: chemotherapy + antibody therapy +/- radiotherapy Low grade lymphoma treatment is more variable: more gentle chemotherapy (one or more drugs); nearly always antibody treatment Stem cell transplants are needed for some relapsed lymphomas (and rarely as first line treatment)

28 Chemotherapy Unlike many other cancer, chemotherapy is very effective in lymphoma and has saved many thousands of lives All thanks to chemical weapons!

29 Antibody treatment (rituximab) Complement proteins Effector T-cells Direct cell kill

30 What is my life expectancy?

31 Survival with lymphoma is improving!

32 Example: follicular lymphoma

33 What new treatments are coming through?

34 A lot of new treatments are being tested! 1. New (and hopefully improved) antibodies 2. Antibodies with chemotherapy on the end 3. Antibodies with radiotherapy on the end 4. Drugs which target molecules which lymphoma cells need to stay alive 5. Immune system cells which are engineered to attack lymphoma cells

35 Summary Lymphoma is a cancer of the lymphatic system It is complicated because lymphocytes have a complicated life cycle Hodgkin and non-hodgkin is the broadest division It is the 5 th commonest cancer It affects young and old It is getting more common (and not just because we re all getting older!) For most people we cannot identify a cause Survival with lymphoma is improving When it s needed, treatment is with chemotherapy and antibody therapy (sometimes radiotherapy) Lots of new treatment are being tested in trials

36 Thank you for listening

Lymphatic system component

Introduction Lymphatic system component Statistics Overview Lymphoma Non Hodgkin s Lymphoma Non- Hodgkin's is a type of cancer that originates in the lymphatic system. It is estimated to be the sixth most