Lymphoid malignancies (lymphoma)

Lymphoid malignancies (lymphoma)

Lymphoid malignancies

Lymphoma is cancer of the lymphatic system. The cancerous cells are called Lymphocytes, which are a type of white blood cell that helps to fight infections and forms part of the immune system. Lymphoma occurs when these lymphocytes do not copy correctly and the immune system does not notice them and allows the abnormal blood cells to multiply.

As the lymphatic system is fluid, it can develop anywhere in the body, causing many symptoms. They can collect in lymph nodes causing swollen glands, or might collect outside of the lymph nodes (extra nodal). They will often be present in more than one area. This does not have the same consequence as solid cancers which metastasise.

You can also get B symptoms: fever, weight loss, drenching night sweats, itching (pruritus). 

There are over 60 types of lymphoma. They are classified into Hodgkins and non-hodgkins lymphoma. Non-Hodgkins Lymphoma is further classified into high grade and low grade lymphoma and also T cell and B cell lymphoma.  The lymphoma team also manages Chronic lymphocytic leukaemia, Hairy cell Leukaemia, ATLL and many other malignancies.

Each lymphoma has a different cure rate, your doctor will explain this fully when you have the full diagnosis and staging.

The treatment for each subtype of lymphoma is different. Some low grade lymphoma will not require treatment, others might require chemotherapy, radiotherapy or stem cell transplants (from yourself or a donor).

Investigations

You may have been referred to the hospital by your GP, who will have reviewed you and suspected a cancer diagnosis (2 week wait), or alternatively you have already had tests which are suggestive of lymphoma and triggered the referral to the lymphoma team.

You will then have an appointment with the consultant haemato-oncologist for assessment. They will review you and take a full medical history and perform a physical examination and they will then decide which investigations are required.

These could include blood tests, imaging CT, MRI, or PET CT scans these can be used to direct a biopsy and also will form of part of the disease staging.

They might will also include a tissue diagnosis, often in the form of a lymph node biopsy (this could be image-guided or performed with endoscopy or surgical excision) or sometimes bone marrow aspirate, or lumbar puncture.

Waiting for these results can be a difficult time and it can take many weeks to get the results. The consultant will assess that you are able to wait for these. If the lymphoma is advanced and you need to start treatment straight away they will let you know and arrange it.

Patient information can be found on the following websites:

Please be aware the internet has a lot of unregulated information on it, which can be very confusing in the early stages of diagnosis. The above sources are regulated and the information is validated as correct.

Your treatment options

Each patient will be given a personal diagnosis with staging and treatment plan. This will be formulated at our multidisciplinary team meeting where all the staging investigations are reviewed. This will be explained fully by your doctor and the clinical nurse specialist.

It will include the aim of treatment, type of treatment and side effects.

You will be allocated a key worker it the form of a clinical nurse specialist who will give you support through your cancer journey. You will be given their contact details to discuss any further concerns.

Your appointments

Please consider bringing someone with you to you clinic appointments. Please be aware that due to Covid-19 visiting is limited so please discuss this with your clinical team

It might be helpful to write down your questions prior to coming to avoid forgetting to ask important questions.

Most clinic appointments and treatment will be delivered at St Bartholomew's Hospital, however some investigations might be in our sister hospitals so please check the location on appointment letters.

Supporting you

At St Bartholomew's Hospital we have a Macmillan information centre and Maggie’s centre on site. These centre’s provide support to you and you should consider visiting.

The Lymphoma Action, Blood Cancer UK and CLL Support Association all run support groups which you might be interested in joining. There is also a good cancer psychology programme of support; your CNS or one of the information centres can direct you to these.

Complementary therapy, dieticians benefits advise, palliative care services are also available - please speak to your CNS for referrals