Frequently Asked Questions:

Non-Hodgkin Lymphoma

How does the doctor determine which of the 65 different types of lymphoma I have?

The gold standard approach is to obtain a biopsy of the disease. The aspiration of cells from the tumor through a syringe needle (often called a fine needle aspiration, or FNA), is not considered an appropriate way to make a diagnosis of lymphoma. Obtaining a piece of the tumor or excising the entire lymph node, is the best way to make a diagnoses. Sometime a needle core biopsy (that is, using a specialized needle very a very wide bore) can be sufficient. Once the biopsy is obtained, the tissue is sent to a hematopathologist, who will look at the cells under the microscope and perform immunohistochemical studies and cytogenetic studies to decide exactly which subtype of lymphoma you have. As important as it is to see an experienced lymphoma expert who treats the disease, it is equally as important to have your biopsy reviewed by an expert hematopathologist familiar with lymphoma.

How does the doctor know what stage I have?

The stage of any cancer is more or less a measurement of how far the tumor cells have spread from their primary site (that is lung, breast, colon), which is directly used to ‘prognosticate’ any given patient’s disease state. In lymphoma, CT scans and PET scans are sensitive tests to determine exactly where lymphoma might be growing in the body. For example, lung cancer localized to only the lung is typically Stage 1, while lung cancer that is growing in the liver, would be consider stage IV disease. Blood cells are suppose to travel throughout the body, so there really is no ONE site where they exclusively live, therefore, stage is usually only one of several factors used to prognosticate the disease, and many patients have Stage 3 or 4 disease when they are diagnosed. A detailed conversation with your physician can refine your understanding of those factors known to influence the outcome of any given lymphoma.

How does the physician determine which treatment I should receive?

Determining the best chemotherapy program for any given patient is often a very complex process. The decision to use one treatment over another depends on many factors, including: (1) the exact subtype of lymphoma diagnosed by the hematopathologist; (2) how aggressively the lymphoma behaving (that is, is it producing symptoms or impairment of vital organ function) in the patient; (3) the health of the patient and an assessment of their medical problems; and (4) the unique cytogenetic and biological features of the disease. In addition to these and other factors, oncologists are always looking at new data being published on the best way to treat different cancers including lymphoma. Thus, the amount of evidence in support of one regimen over in another in a particular setting can be a factor in select cases. The best way to know the best treatment for your disease is to have a detailed conversation with your physician and their nursing team about all the most appropriate options, as well as the benefits and toxicities associated with each of the approaches.