Non-Hodgkin Lymphoma: Learning More About Your Tumor

Before your oncology team can put you on an actionable treatment plan, they need to learn more about your cancer. Non-Hodgkin lymphoma comes in several types, each of which has a different treatment and outlook. Some lymphomas grow quickly and need to be treated right away. Others are slow growing but stick with you for a long time. Your doctor will call the details about your tumor its “histology.”

“Histology is something where we take a piece of the tumor, we look at it under the microscope, and we do various kinds of stains on it,” Dr. Lawrence Piro, medical oncologist at The Angeles Clinic & Research Institute in Los Angeles, tells SurvivorNet. “We see what the cells look like, how do the cells look in relationship to the structure of the lymph node that they’re in.”

Getting to Know Your Cancer

The process starts with a biopsy. Your doctor will either use a needle to remove a piece of a suspicious lymph node, or make a small incision in your skin and take out an entire lymph node.

Those samples go to a lab, where a specialist called a pathologist will look at them under a microscope. Since lymphoma cells can look very similar to one another, the pathologist will put a stain on the cells to identify certain markers on their surface that distinguish one type from another.

Dr. Piro gives the example of using certain identifying features to tell two similar-looking people apart. You might first try to distinguish them by what they’re wearing – for example, if one person is wearing a dress while the other is wearing pants. But that may not be an accurate enough distinction. “They could be a man and a woman, or it could actually be two women – one chose to wear a dress and one’s wearing pants,” he says. “Then you start peeling back the layers, taking the clothes off, starting to look at some of the features to find out exactly what you’re looking at.”

Pathologists differentiate lymphoma cells by first seeing how they look under a microscope. Then they also dig through the layers and study various aspects of the tumor – the type of cell it starts in, its chromosomes, and the presence of certain proteins on the surface of and inside the cell.

Classifying Your Type

Once doctors learn as much as they can about a person’s cancer, “We have a whole classification system that then will predict what’s the likely outcome, what’s the likely level of aggression. And from there, we design the therapy,” Dr. Piro says.

Doctors group non-Hodgkin lymphomas based on the types of blood cells they start in – B cells or T cells, and whether they’re slow growing (indolent) or fast growing (aggressive).

“In the beginning of a conversation with a patient, we have to talk about exactly which type of lymphoma they have,” Dr. Piro tells SurvivorNet. “There are some lymphomas which are very treatable, but not curable.”

Follicular lymphoma and chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) are examples of slow growing cancers. People with these cancers can often live out their normal lifespan, “but always with some lymphoma, or with the knowledge that lymphoma will be coming back,” Dr. Piro says. Indolent cancers grow so slowly that some people may not need to start on treatment immediately.

“On the contrary, there’s some lymphomas that, if you don’t treat them, they’ll progress rapidly, and you may succumb to it, yet there’s very intensive treatments that you can take that may cure you,” he adds. Diffuse large B-cell lymphoma, the most common type of non-Hodgkin lymphoma, is an example of an aggressive but treatable cancer.

Because your treatment hinges on the type of lymphoma you have, your doctor will need to spend some time when you’re first diagnosed figuring out its type and histology. “And then from that histology and that type, we can focus on which type of therapy [to recommend].”

Reviewed by Dr. Adrienne Phillips, hematologist/oncologist, Weill Cornell Medicine

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