An Unexpected Turn of Events Leading to a Diagnosis
- A 22‑year‑old woman discovered she had stage 2 Hodgkin lymphoma after alcohol repeatedly triggered neck swelling and sharp, radiating pain she initially mistook for an ear issue.
- Hodgkin lymphoma and non-Hodgkin lymphoma are the two main types of lymphoma, and their classification depends on the type of white blood cells that are affected and the presence (or absence) of Reed-Sternberg cells.
- They are both cancers of the lymphatic system, which includes lymph nodes, spleen, bone marrow, and other immune tissues. Their symptoms can overlap, including swollen lymph nodes, fatigue, fever, night sweats, and unexplained weight loss. However, the way they are treated may vary.
- “There are some lymphomas that are very treatable but not curable,” Dr. Lawrence Piro, President and CEO of The Angeles Clinic and Research Institute in Los Angeles, told SurvivorNet.
- Lymphoma treatment largely depends on the nature of your specific diagnosis. For non-Hodgkin lymphoma patients, their cancer is more likely to spread randomly and be discovered in different groups of lymph nodes in the body.
- Treatment for non-Hodgkin lymphoma often includes chemotherapy, radiation, immunotherapy, and targeted therapy.
Whenever she drank alcohol, she noticed a strange lump forming in her neck. “I felt tension in the front of my neck — a little swelling, a little pain when I touched it,” she told Kennedy News and Media via the Daily Mail.
Credit: Kennedy News & Media
What is Hodgkin Lymphoma?
Hodgkin lymphoma and non-Hodgkin lymphoma are the two main types of lymphoma, and their classification depends on the type of white blood cells that are affected and the presence (or absence) of Reed-Sternberg cells.They are both cancers of the lymphatic system, which includes lymph nodes, spleen, bone marrow, and other immune tissues. Their symptoms can overlap, including swollen lymph nodes, fatigue, fever, night sweats, and unexplained weight loss. However, the way they are treated may vary.
If doctors are unable to detect the Reed-Sternberg cell (a giant cell derived from B lymphocytes), then the lymphoma is categorized as non-Hodgkin lymphoma. However, if Reed-Sternberg cells are present, the lymphoma is diagnosed as Hodgkin lymphoma.
WATCH: The type of lymphoma you have matters.
Lymphoma treatment largely depends on the nature of your specific diagnosis. For non-Hodgkin lymphoma patients, their cancer is more likely to spread randomly and be discovered in different groups of lymph nodes in the body.
Hodgkin lymphoma cancers, on the other hand, are more likely to grow consistently from one group of lymph nodes directly to another.
What Her Treatment Experience Was Like?
Dougherty says she needed six rounds of chemotherapy and 20 rounds of radiation.
SurvivorNet experts explain that if the lymphoma cancer is more aggressive, whether it’s T-cell or B-cell, patients can expect to get chemotherapy.
“We do treat patients with chemotherapy. That’s the standard of care,” Dr. Jennifer Crombie, a medical oncologist at Dana-Farber Cancer Institute, tells SurvivorNet.
Chemo may be part of a cocktail of drugs that are given in combination. These drugs work synergistically, going after your cancer in different ways to treat it more effectively.
Sometimes radiation therapy is used together with chemotherapy. Radiation uses high-energy X-rays to eliminate cancer cells. The radiation typically given for non-Hodgkin lymphoma is delivered from a machine outside the body, which is called external beam radiation.
Expert Resources for Lymphoma Patients
Understanding the Types of Lymphomas
Hodgkin Lymphoma and non-Hodgkin lymphoma are the two main types of lymphoma, and their classification depends on the type of white blood cells and the presence (or absence) of Reed-Sternberg cells.
They are both cancers of the lymphatic system, which includes lymph nodes, spleen, bone marrow, and other immune tissues. Their symptoms can overlap, including swollen lymph nodes, fatigue, fever, night sweats, and unexplained weight loss. However, the way they are treated may vary.
WATCH: Dr. Jason Westin explains symptoms associated with lymphoma
If doctors are unable to detect the Reed-Sternberg cell (a giant cell derived from B lymphocytes), then the lymphoma is categorized as Non-Hodgkin lymphoma. However, if Reed-Sternberg cells are present, the lymphoma is diagnosed as Hodgkin Lymphoma.
WATCH: The type of lymphoma you have matters.
B-Cell vs. T-Cell Lymphoma
Doctors classify non-Hodgkin lymphoma based on the type of lymphocytes affected:
B-cell lymphomas account for nearly 85% of non-Hodgkin lymphoma cases. These cancers originate in cells responsible for producing antibodies that identify and fight infections.
T-cell lymphomas, making up 15% of cases, arise in T-cells, which directly attack harmful invaders like bacteria and viruses.
Identifying whether the lymphoma is B-cell or T-cell helps guide treatment options tailored to the disease’s behavior and progression.
Types of B-Cell Lymphoma
- Diffuse large B-cell lymphoma
- Follicular lymphoma
- Small lymphocytic lymphoma (SLL) / Chronic lymphocytic leukemia (CLL)
- Mantle cell lymphoma
- Marginal zone lymphomas
- Burkitt lymphoma
Types of T-Cell Lymphoma
- T-lymphoblastic lymphoma/leukemia
- Peripheral T-cell lymphomas
- Cutaneous T-cell lymphoma
- Aggressive vs. Indolent (slow-growing) Lymphomas
One of the key distinctions doctors make when diagnosing non-Hodgkin lymphoma is how rapidly the cancer grows and spreads.
Indolent (slow-growing) lymphomas tend to develop over time and may not require immediate aggressive treatment.
Aggressive lymphomas spread quickly and need intensive treatment to prevent further progression.
What Treatment for Non-Hodgkin Lymphoma Looks Like?
Lymphoma treatment largely depends on the nature of your specific diagnosis. For non-Hodgkin lymphoma patients, their cancer is more likely to spread randomly and be discovered in different groups of lymph nodes in the body. Hodgkin lymphoma cancers, on the other hand, are more likely to grow consistently from one group of lymph nodes directly to another.
WATCH: Non-Hodgkin lymphoma treatment options
“There are some lymphomas that are very treatable but not curable,” Dr. Lawrence Piro told SurvivorNet.
Dr. Lawrence Piro is the President and CEO of The Angeles Clinic and Research Institute in Los Angeles, a Cedars-Sinai affiliate. He adds that some lymphomas progress quickly if left untreated.
Non-Hodgkin lymphoma treatment depends on the type, stage, and how fast it grows. People with aggressive non-Hodgkin lymphoma can expect to get a chemotherapy combination called R-CHOP, which is a drug cocktail consisting of chemotherapy drugs plus an antibody drug and a steroid to treat diffuse large B-cell non-Hodgkin lymphoma.
R-CHOP stands for:
- R: Rituximab (Rituxan) is a monoclonal antibody that attaches to a specific protein called CD20, which sits on the surface of B cells. It targets cancerous cells and destroys them.
- C: Cyclophosphamide is a type of chemotherapy drug
- D: Doxorubicin hydrochloride (hydroxydaunomycin) is a type of chemotherapy drug
- V: Vincristine sulfate (Oncovin) is a type of chemotherapy drug
- P: Prednisone is a steroid that lowers inflammation
Patients receiving R-CHOP receive the drug in six cycles that are three weeks apart.
“R-CHOP is a cocktail of drugs. There are five different drugs in that recipe,” Dr. Crombie tells SurvivorNet.
WATCH: Understanding R-CHOP treatment.
R-CHOP side effects can include:
- Tiredness and weakness
- Hair loss
- Mouth sores
- Bruising and bleeding
- Increased risk of infection
- Appetite loss and weight loss
- Changes in bowel movements
Immunotherapy and targeted therapy are also treatment options for non-Hodgkin lymphoma patients.
Rituximab (Rituxan) was the first immunotherapy drug approved to treat some forms of non-Hodgkin lymphoma. “Rituximab is the immunotherapy that has been approved the longest, and we have the most experience with lymphoma,” Dr. Chong tells SurvivorNet.
Rituxan has side effects, including fever, chills, swelling under the skin, itching, and mild shortness of breath.
Brentuximab vedotin (Adcetris) is a relatively new targeted treatment for non-Hodgkin lymphoma and Hodgkin lymphoma. This drug is an antibody-drug conjugate that combines an antibody (a type of protein that recognizes foreign substances in the body) with a drug that treats cancer. It uses a particular protein to deliver medicine directly to the cancer cell.
Non-Hodgkin lymphoma can also be treated with radiation, which aims beams of intense energy at the cancer to stop cancer cells from growing and dividing.
Questions for Your Doctor
If you are dealing with a lymphoma diagnosis, it’s important to ask your doctor a series of questions so you will have an idea of what your next steps will look like. To help you during this difficult time, SurvivorNet has some questions to kickstart your conversation with your physician.
- What type of lymphoma do I have?
- What does my pathology report say about my diagnosis?
- Should I get a second opinion before I explore possible treatment options?
- Based on my diagnosis, what do you anticipate my treatment path?
- What common side effects should I expect when I begin treatment?
- Will I be able to continue working and performing normal daily activities during treatment?
- Where can I get help working with the insurance company regarding treatment costs?
- Who do you recommend I get mental health help from during my treatment?
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