Non-Hodgkin’s lymphoma is cancer that develops in the lymphatic system; the disease rapidly spreads throughout the body. In this, tumour originates from lymphocytes (types of white blood cells). Non-Hodgkin’s lymphoma is more common when compared to other general types of lymphoma — Hodgkin lymphoma. There are a variety subtypes of non-Hodgkin’s lymphoma such as- Diffuse Large B-cell lymphoma and follicular lymphoma.
Revolutionising the diagnosis and treatment of non-Hodgkin’s lymphoma has depicted promising prognosis for people with this disease. Non-Hodgkin lymphoma affected 4.3 million individuals, of which 231,400 died in 2015. US accounts for 2.1 percent of the population who are diagnosed with the disease.
Symptoms of Non-Hodgkin’s Lymphoma
• Painless, enlarged lymph nodes in your neck, armpits or groin
• Swelling and cramps in abdomen
• Coughing, chest pain, or change in breathing patterns
• Night Sweats
• Loss of weight
Swollen lymph nodes cause lumping which is felt under the skin. Lymphomas in the skin make skin itchy, red or sometimes even purple. Lymphomas in the brain tend to weaken the immune system coupled with episodes of seizures and lead to cognitive and behavioural changes.
Diagnosis of Non-Hodgkin’s Lymphoma
Physical exam: The patient will be made to undergo a physical examination which involves examining the lymph nodes in the underarms, neck and groin to check for swelling. Other organs such as the spleen or liver will also be monitored if any swelling persists. Sometimes enlarged lymph nodes are symptoms of inflammation rather than lymphoma.
Medical history: A patient’s past medical records will be closely analysed, keeping the risk factors of NHL in mind.
Blood tests: Patient will be made to take complete blood count (CBC) to check the number of white blood cells. Other tests may include a lactate dehydrogenase level.
Imaging procedures: A chest X-ray or CT scan of the chest or neck might help detect if a tumour persists or lymph nodes are swollen. Positron emission tomography (PET) scanning is a novel technique that has made NHL detection easier.
Biopsy: A patient may be made to undergo a biopsy of lymph nodes to diagnose the cause of the swelling. The samples are then analysed microscopically to diagnose the disease.
Three ways to diagnose a lymph node are as follows:
• Excisional biopsy- This procedure involves removal of the entire lymph node
• Incisional biopsy- In this, a lymph node is partially removed
• Fine-needle aspiration- In this a thin needle is used to remove some lymph node tissue
Bone marrow biopsy: A bone marrow biopsy holds potential in determining the spread of tumour. The procedure involves inserting the needle into the bone to extract bone marrow.
Causes of Non-Hodgkin’s lymphoma
Excessive production of abnormal lymphocytes results in non-Hodgkin’s lymphoma (NHL). The cycle of lymphocytes is based on cell death and regeneration. In NHL, lymphocytes mature indeterminately, so the number of circulating lymphocytes surges, thereby filling up the lymph nodes and enlarging them.
The two subtypes of lymphocytes involved in this process include-
B cells produce antibodies that are potential in combating infections. However, this is the most common type of cell involved in NHL (B-cell lymphomas). T cells destroy the pathogens directly. However, NHL seldom originates from T cells.
The subtypes of NHL
Burkitt’s lymphoma: Its African type which is linked with an infection with the Epstein-Barr pathogen and the non-African type that is not associated with the pathogen are the two significant subtypes of Burkitt’s lymphoma.
Cutaneous lymphoma: This form of lymphoma involves the skin and can be categorised as T-cell lymphoma or B-cell lymphoma. Cutaneous T-cell lymphoma accounts for 4 percent of NHL cases.
Diffuse large B-cell lymphoma: This type is most frequently occurring lymphoma, which approximately accounts for 30 percent of NHL cases and hence is proved to be lethal if left untreated.
Follicular lymphoma: When analysed under the microscope, these lymphomas exhibit a specific growth pattern and progress when they are diagnosed.
Lymphoblastic lymphoma: A sporadic form of lymphoma which accounts for 2% of cases of NHL.
MALT (mucosa-associated lymphoid tissue) lymphoma: A B-cell lymphoma which afflicts individuals who are 60 or above. The stomach is the most prone area for this type of lymphoma.
Mantle cell lymphoma: One of the rarest of the NHL, mantle cell lymphoma accounts for about 6% of cases. This subtype of B-cell lymphoma is difficult to treat.
Adult T-cell lymphoma/ leukaemia: An extremely rare but severe form of NHL of the immune system’s T cells, Human T-cell leukaemia/lymphotropic virus type (HTLV-1) has been known to be associated with this type of lymphoma.
Wald Enstrom’s macroglobulinemia: This type is seldom prevalent and hence matures slowly.
Non-Hodgkin’s Lymphoma Treatment
A patient is referred to a lymphomas specialist.
The treatment one undergoes depends on various factors such as:
• The type and stage of non-Hodgkin’s lymphoma
• The growth pattern of the tumour
• Age of the patient
• Area affected by the tumour
• Restricting treatments if other health problems persist
If a patient has dormant non-Hodgkin’s lymphoma and does not exhibit any symptoms, he or she may not undergo treatment immediately, but follow-up and timely screening for cancer is mandatory. However, if the slowly-growing lymphoma exhibits symptoms, the patient will be made to undergo chemotherapy and biological therapy. Stage, I and II lymphoma, are treated via radiation therapy. A combination of chemotherapy and biological therapy or sometimes given alongside radiation therapy for tackling an aggressive type of lymphoma.
The various types of treatments to tackle this cancer are as follows:
Chemotherapy: This drug is administered into the immune system either via injection or orally so that the cancerous cells are demolished. The treatment involves administering one drug or multiple drugs alone or in combination with other therapies.
Chemotherapy is given in cycles, and our oncologist determines the number of cycles one will undergo. The side effects of undergoing chemotherapy include baldness, GI symptoms, and difficulty coping up post the sitting.
Radiation therapy: The patients are exposed to high-voltage radiation so that tumour cells shrink. The therapy is either given alone or can be amalgamated with other therapies. Side effects of this treatment are extreme exhaustion and difficulty for the immune system to cope up.
Stem cell transplant: This treatment procedure involves exposing the patient to extremely high-voltage chemotherapy or radiation therapy so that lymphoma cells can be destroyed which otherwise fail when a patient undergoes standard levels of therapy.
Stem cell therapy is used if the lymphoma relapses and hence requires hospital admittance. After the treatment, healthy stem cells (which maybe one’s own or from a donor) are administered to build a new immune system.
Biological drugs: These drugs target the pathogens and enhance immune system’s ability to combat cancers. These drugs are made up of monoclonal antibodies and are administered via an IV. Rituximab (Rituxan) is one beneficial drug which is used for treating B-cell lymphoma. Patients are likely to experience flu-like symptoms.
Radioimmunotherapy drugs: Composed of monoclonal antibodies, these drugs are potential in transporting radioactive materials directly to pathogens. Therefore, this radioactive material is bound to the cancer cell, and hence cancer cell is exposed to more radiation when compared to the normal tissue. Drugs such as Ibritumomab (Zevalin) and tositumomab (Bexxar) are used in treating lymphomas. Side effects usually include fatigueness or flu-like symptoms.
How much does the Non-Hodgkin’s Lymphoma Treatment Cost in India?
Non-Hodgkin’s Lymphoma treatment is comparatively cost-effective in India. The cost of undergoing bone marrow transplant or stem cell transplant for removal of the Non-Hodgkin’s Lymphoma starts from USD 23000. Radiation therapy costs near about USD 5000, and the cost of chemotherapy per cycle is USD 500.
The cost of availing Non-Hodgkin’s Lymphoma in India also depends on various other factors.
• Your choice of hospital
• Preference of the oncologist
• The grade and severity of the cancer
• Post-surgery expenses
Best Oncologists and Hospitals for Non-Hodgkin’s Lymphoma in India
India has carved a niche for itself for availing any treatment at a lower cost. The hospitals in India have an integrated healthcare system with internationally acclaimed oncologists to its credit. The best oncologists and the hospitals for Non-Hodgkin’s Lymphoma are as follows:
• Fortis Memorial Research Institute, Gurugram- Dr Vinod Raina
• Fortis Memorial Research Institute, Gurugram – Dr Rahul Bhargava
• Max Smart Super Speciality Hospital, Saket – Dr Rahul Naithani
• BLK Super Speciality Hospital, New Delhi- Dr Amit Agarwal
• BLK Super Speciality Hospital, New Delhi- Dr Dharma Choudhary
Why should you consider India for treatment of Non-Hodgkin’s Lymphoma?
Indian hospitals boast of a skilful team of researchers and doctors to enhance and revolutionise the standards of the medicine in the field oncology. Indian hospitals are steadfast in guaranteeing expertise in treatment and extend their hand in dispensing top-notch medical care to their patients before, during and after surgery.
If you are struggling with Non-Hodgkin’s Lymphoma, post your query, and team Medmonks will help you with your treatment at an affordable cost. Led by healthcare professionals who have an accumulated experience of more than 30 years, Medmonks dispense quality services to the patients and get their appointment schedule with the best oncologists in India.
1. Can non-Hodgkin’s lymphoma be averted?
Most individuals who are diagnosed with non-Hodgkin’s lymphoma sometimes depict no risk factors that can be identified, thereby making it impossible to avert the disease. Prominent causes of lymphoma are difficult to avoid, such as immunosuppressive drugs, as they are usually life-saving medications needed for other reasons.
2. What are the risk factors associated with non-Hodgkin’s lymphoma?
Old age (60 or above) is one of the significant factors that may put one at risk of developing non-Hodgkin’s lymphoma. Other factors include being exposed to immunosuppressive drugs that lower the efficiency of the immune system to cope up. Some pathogens that have been associated with augmenting non-Hodgkin’s lymphoma risk are as follows- HIV and Epstein-Barr infection. Ulcer-causing Helicobacter pylori also play a vital role in increasing odds of non-Hodgkin’s lymphoma.
3. Is stem cell transplant effective in treating Non-Hodgkin’s Lymphoma?
Bone marrow transplant has shown promising results in efficiently treating Non-Hodgkin’s Lymphoma. Stem cells are harvested either from the donor or are one’s own and then they are frozen and preserved. Patients are then exposed to chemotherapy and radiotherapy so that pathogens are demolished. The stem cells are then injected back into the immune system; it is a complicated procedure but extremely effective.