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UC Davis Comprehensive Cancer Center

UC Davis Comprehensive Cancer Center

Lymphoma (Adult Non-Hodgkin and Hodgkin)

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Dr. Joe Tuscano © 2010 UC Regents 

Researcher Spotlight: Joe Tuscano — An alternative approach to lymphoma  

Inspired by patient seeking alternative therapy, UC Davis oncologist studies a promising  natural product shown to be effective against lymphoma.

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Peer navigator program provides one-to-one peer support  

This special program matches newly-diagnosed cancer patients with cancer survivors.

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lymphoma cellLymphoma is cancer that begins in cells of the immune system. There are two basic categories of lymphomas: Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell, and non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. 

Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer.

The Leukemia, Lymphoma and Multiple Myeloma program at UC Davis Comprehensive Cancer Center is the largest and most comprehensive program of its kind in inland Northern California.  It provides the most advanced methods of diagnosis and treatment possible, including new therapies that often aren't available at community hospitals. The physicians in our Leukemia, Lymphoma and Multiple Myeloma program have extensive experience treating both common and uncommon cancers of the blood, bone marrow and lymphatic system. This includes the more than 40 subtypes of lymphoma.  Our physician-scientists are also at the forefront of research to develop and test new drugs to combat this family of cancers, ensuring that new treatments developed in the lab move quickly to the clinic for the immediate benefit of our patients.

Clinical Trials at UC Davis Cancer Center
UC Davis Comprehensive Cancer Center has a large clinical trials network. The close collaboration among our doctors and our research scientists means that new drugs and treatments developed in the laboratory can quickly move to the clinic, offering our patients immediate access to the latest therapies.

Risk Factors

Non-Hodgkin lymphoma:

Hodgkin lymphoma:

  • Being in young or late adulthood
  • Being male
  • Being infected with the Epstein-Barr virus
  • Having a first-degree relative (parent, brother, or sister) with Hodgkin lymphoma

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Signs and Symptoms

Non-Hodgkin lymphoma:

  • Painless swelling in the lymph nodes in the neck, underarm, groin, or stomach
  • Fever for no known reason
  • Drenching night sweats
  • Feeling very tired
  • Weight loss for no known reason
  • Skin rash or itchy skin
  • Pain in the chest, abdomen, or bones for no known reason

Hodgkin lymphoma:

  • Painless, swollen lymph nodes in the neck, underarm, or groin
  • Fever for no known reason
  • Drenching night sweats
  • Weight loss for no known reason
  • Itchy skin
  • Feeling very tired

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Diagnosis

Non-Hodgkin lymphoma

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen ) in the red blood cells.
    • The portion of the sample made up of red blood cells.
  • Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • Lymph node biopsy : The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. One of the following types of biopsies may be done:
  • Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
  • Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. For non-Hodgkin lymphoma, the blood is checked for an enzyme called lactate dehydrogenase (LDH). LDH levels help determine prognosis (chance of recovery).

Hodgkin lymphoma:

  • Physical exam and history:  An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's past illnesses and treatments will also be taken.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen ) in the red blood cells.
    • The portion of the sample made up of red blood cells.
  • Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
  • Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • Lymph node biopsy: The removal of all or part of a lymph node. One of the following types of biopsies may be done:

A pathologist views the tissue under a microscope to look for cancer cells, especially Reed-Sternberg cells. Reed-Sternberg cells are common in classical Hodgkin lymphoma.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Treatment

Non-Hodgkin lymphoma

  • Radiation therapy 
    Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells and keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
    • For pregnant women with non-Hodgkin lymphoma, radiation therapy should be postponed until after delivery, if possible, to avoid any risk to the fetus. If immediate treatment is needed, pregnant women may decide to continue the pregnancy and receive radiation therapy. However, lead used to shield the fetus may not protect it from scattered radiation that could possibly cause cancer in the future.
  • Chemotherapy 
    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). To treat certain types of adult non-Hodgkin lymphoma that spread to the brain, CNS prophylaxis (chemotherapy given to kill cancer cells in the brain or spinal cord) may be used. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
    • Combination chemotherapy is treatment using two or more anticancer drugs. Steroid drugs may be added, to relieve swelling and inflammation.
    • In pregnant women, the fetus is exposed to chemotherapy when the mother is treated, and some anticancer drugs cause birth defects. Because anticancer drugs are passed to the fetus through the mother, both must be watched closely when chemotherapy is given.
  • Targeted therapy
    Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is one type of targeted therapy used to treat adult non-Hodgkin lymphoma.
    • Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies that have been joined to radioactive material are called radiolabeled monoclonal antibodies.
  • Watchful waiting 
    Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.
  • Vaccine therapy
    Vaccine therapy is a type of biologic therapy. Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Vaccine therapy can also be a type of targeted therapy.
  • High-dose chemotherapy with stem cell transplant
    High-dose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
  • Clinical Trials at UC Davis Comprehensive Cancer Center
    During all stages of your treatment you should talk to your medical specialist about what clinical trials may be available for you. UC Davis Comprehensive Cancer Center has a large clinical trials network, allowing our patients access to the newest drugs and therapies before they become widely available.

 

Hodgkin lymphoma:

  • Chemotherapy 
    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Combination chemotherapy is treatment with more than one anticancer drug.
    • When a pregnant woman is treated with chemotherapy for Hodgkin lymphoma, it isn't possible to protect the fetus from being exposed to the chemotherapy. Some chemotherapy regimens may cause birth defects if given in the first trimester. Vinblastine is an anticancer drug that has not been linked with birth defects when given in the second half of pregnancy.
  • Radiation therapy 
    Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
    • For a pregnant woman with Hodgkin lymphoma, radiation therapy should be postponed until after delivery, if possible, to avoid any risk to the fetus. If immediate treatment is needed, the woman may decide to continue the pregnancy and receive radiation therapy. However, lead used to shield the fetus may not protect it from scattered radiation that could possibly cause cancer in the future.
  • Surgery
    Laparotomy is a procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease. If cancer is found, the tissue or organ is removed during the laparotomy.

    For pregnant patients with Hodgkin lymphoma, treatment options also include:
    • Watchful waiting
      Watchful waiting is closely monitoring a patient’s condition without giving any treatment unless symptoms appear or change. Delivery may be induced when the fetus is 32 to 36 weeks old, so that the mother can begin treatment.
    • Steroid therapy
      Steroids are hormones naturally produced in the body by the adrenal glands and by reproductive organs. Some types of steroids are made in a laboratory. Certain steroid drugs have been found to help chemotherapy work better and help stop the growth of cancer cells. Steroids can also help the lungs of the fetus develop faster than normal. This is important when delivery is induced early.
  • Clinical Trials at UC Davis Comprehensive Cancer Center
    The close collaboration among our doctors and our research scientists means that new drugs and treatments developed in the laboratory can quickly move to the clinic, offering our patients immediate access to the latest therapies. UC Davis Comprehensive Cancer Center has a large clinical trials network, allowing our patients access to the newest drugs and therapies before they become widely available.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Your Team

Hematology/Oncology

Mrinal Dutia, M.D.
Assistant Professor of Internal Medicine, Hematology and Oncology

Robert O'Donnell, M.D., Ph.D.
Professor of Internal Medicine, Hematology and Oncology

Carol M. Richman, M.D.
Professor of Internal Medicine, Hematology and Oncology
Director, Stem Cell Transplant Program

Joseph M. Tuscano, M.D., Ph.D.
Associate Professor of Internal Medicine, Hematology and Oncology

Jeanna Welborn, M.D.
Professor of Medicine, Pathology and Laboratory Medicine
Medical Director, Bone Marrow Laboratory, Cytogenetics Laboratory  and Therapeutic Apheresis

Ted Wun, M.D.
Associate Dean for Research, School of Medicine
Chief of Hematology Oncology, VA Northern California Health Care System
Chief, Division of Hematology and Oncology

Radiation Oncology

Richard Valicenti, M.D., M.A.
Professor
Department Chair of Radiation Oncology

Allen M. Chen, M.D.
Associate Professor
Director, Residency and Fellowship Training Program

Megan Daly, M.D.
Assistant Professor

Jyoti Mayadev, M.D. 
Assistant Professor

Ruben Fragoso, M.D., Ph.D.
Assistant Professor

Support

UC Davis Comprehensive Cancer Center is dedicated to caring for the whole patient.  We offer: