Lymphoma

Disease Description (Causes and Symptoms)

• Summary of definition: Lymphoma is a cancer caused by the malignant (monoclonal) proliferation of lymphocytes, mainly B cells and T cells, and can develop in the lymph nodes, spleen, bone marrow, and various organs. It is broadly divided into Hodgkin lymphoma and non-Hodgkin lymphoma (NHL), with diverse subtypes, prognoses, and treatments.
• Main causes and risk factors: Genetic predisposition, immunosuppression (after transplantation, HIV, etc.), chronic infections (e.g., EBV, HTLV-1, Helicobacter pylori (gastric MALT)), autoimmune diseases, and exposure to radiation or chemicals.
• Brief pathophysiology: Genetic mutations and transformations occur in a single lymphocyte lineage, causing abnormal proliferation and replacement of normal lymphocyte function, resulting in lymph node enlargement and organ involvement. Surface markers (CD20, CD30, etc.) and molecular mechanisms differ depending on the subtype.
• Main symptoms:
  • Painless lymph node enlargement (in the neck, armpits, groin, etc.) is the most common symptom
  • Fever, night sweats, and weight loss (“B symptoms”)
  • Symptoms depending on the location of the mass: cough and shortness of breath from a chest mass; pain and intestinal symptoms from an abdominal mass; increased anemia, bleeding, and infections in cases of bone marrow involvement, etc.
  • Itchy skin (in some cases of Hodgkin lymphoma), fatigue, and generalized weakness

Treatment Methods

• A treatment plan is established after diagnosis and staging (biopsy, immunophenotyping, molecular testing, imaging, and staging are important).
• Standard treatment options (depending on the subtype, stage, patient age, and underlying diseases):
  • Hodgkin lymphoma: For early-stage disease, ABVD (Adriamycin/doxorubicin, Bleomycin, Vinblastine, Dacarbazine) ± localized radiation; in cases of relapse, autologous hematopoietic stem cell transplantation, brentuximab vedotin (= CD30-targeted agent), PD-1 inhibitors (nivolumab/pembrolizumab), etc.
  • Non-Hodgkin lymphoma (examples):
    • Aggressive B-cell lymphoma (e.g., DLBCL): R-CHOP (rituximab + CHOP) is standard treatment (mostly CD20-positive). In cases of refractory or relapsed disease, high-intensity chemotherapy and autologous transplantation or targeted/immunotherapy (e.g., CAR-T) may be considered.
    • Low-grade lymphoma (e.g., follicular lymphoma): Observation (when asymptomatic), rituximab alone or combination chemotherapy, radiation (for localized-stage disease), etc.
    • Special types (e.g., Burkitt lymphoma, mantle cell lymphoma, T-cell lymphoma): Intensive treatment specific to each disease and targeted drugs (e.g., ibrutinib) or hematopoietic stem cell transplantation.
    • Primary central nervous system lymphoma: High-dose methotrexate-based therapy.
• Local treatment: Lymphoma limited to a specific area may be curable with radiation therapy.
• Supportive care: Infection prevention (vaccination, hygiene), growth factors (G-CSF), blood transfusions, antiemetics, pain and nutritional management, and prevention of tumor lysis syndrome (TLS) (fluids, uric acid-lowering drugs, rasburicase, etc.).
• Lifestyle management and precautions:
  • Increased risk of infection during treatment → Visit a medical institution immediately if fever or respiratory symptoms occur
  • Monitoring of treatment-related toxicity (cardiotoxicity, pulmonary toxicity, neuropathy, etc.)
  • Fertility preservation counseling (consider sperm or egg preservation before chemotherapy)
  • Vaccines (live attenuated vaccines are contraindicated during immunosuppression)

Checklist Before an Outpatient Visit (Including Preparation Items and Example Questions)

• Preparation items:
  • List of currently used medications (including prescription drugs, OTC medications, and herbal medicines) and dosing times
  • Records of past medical conditions, surgeries, and allergies
  • Previous test results (blood tests, imaging, pathology reports, and, if possible, the original tissue slides)
  • Record of recent symptom changes (weight changes, fever, night sweats, fatigue, changes in lymph node size, etc.)
  • Possibility of pregnancy (for women: menstruation and pregnancy plans), and whether breastfeeding
  • Contact information and caregiver information
• Information that is helpful to tell the doctor first during the outpatient visit:
  • When the lymph node enlargement began and whether it is growing rapidly
  • Presence and severity of B symptoms (fever, night sweats, and weight loss)
  • Recent infections or a history of immunosuppressive treatment (steroids, biologic agents, etc.)
  • Occupational or environmental exposure to radiation or chemicals
• Examples of information for patients to record themselves:
  • Location and size of the lymph nodes (estimated diameter) and symptoms (whether they are tender)
  • Fever pattern (temperature and time of day), frequency of night sweats, and changes in appetite and weight
  • Increases or decreases in bleeding, bruising, or infection frequency

General Example Questions to Ask the Doctor

• “What is the exact histologic type of my lymphoma (e.g., Hodgkin, DLBCL, follicular, etc.)? What is the stage?”
• “What treatment options do you recommend, what is the purpose of each (cure vs. control), and what is the expected treatment duration?”
• “What are the main side effects of the treatment, and how can they be prevented and managed?”
• “How will the treatment affect fertility (pregnancy and childbirth)? Do you recommend preservation methods?”
• “Is inpatient treatment necessary, or can chemotherapy be administered as an outpatient?”
• “If an infection occurs during treatment, which symptoms should prompt me to contact you immediately?”

Examples of Disease-Specific Questions

• Regarding histologic type and targeted treatment: “Which immune markers (CD20, CD30, etc.) does my lymphoma have? Based on this, can targeted drugs such as rituximab or brentuximab be used?”
• Regarding staging and additional tests: “Are PET-CT or a bone marrow examination (biopsy) necessary? How will the treatment change depending on the test results?”
• Additional questions regarding relapse and high-risk disease: “If I do not achieve complete remission with the initial treatment, what would the next treatment step be (autologous transplantation, CAR-T, immunotherapy, etc.)?”

(Because diagnosis and treatment vary depending on the individual’s condition, specific decisions should be based on examination by medical professionals and test results.)