1) Disease Description (Causes and Symptoms)
- Definition summary: Non-Hodgkin lymphoma is a malignant lymphocyte proliferative disorder arising in the lymphatic system (lymph nodes, spleen, thymus, tonsils, etc.). It has various subtypes, including B-cell and T-cell types, and its clinical course and prognosis differ greatly depending on the subtype and stage.
- Pathophysiology: Genetic and molecular changes in abnormal lymphocytes (primarily B cells or T cells) cause persistent cell proliferation and survival signaling, resulting in tumor formation. Lymph node involvement is common, but it can arise in extranodal sites throughout the body, including the skin, stomach and intestines, lungs, liver, and central nervous system.
- Main causes (associated factors): No clear single cause is known. Associated factors include EBV (Epstein–Barr virus), Helicobacter pylori (particularly in gastric MALT lymphoma), chronic inflammation, immunosuppression (after organ transplantation, HIV/AIDS), autoimmune diseases, and previous radiation therapy or chemotherapy.
- Main symptoms:
- Painless enlargement of the lymph nodes (cervical, axillary, inguinal, etc.)
- Fever, night sweats, and weight loss (“B symptoms”)
- Fatigue, itching (skin symptoms), and local symptoms depending on the tumor location (shortness of breath, abdominal pain, difficulty urinating, neurological symptoms, etc.)
2) Treatment Methods and Precautions
- Treatment principles: Treatment is individualized according to the subtype (histologic type), immunophenotype (CD markers), stage, and the patient’s overall condition. The approach differs depending on whether the lymphoma is aggressive or indolent.
- Main treatments:
- Chemotherapy: Standard combination regimens are commonly used (e.g., R-CHOP—rituximab + CHOP—for aggressive B-cell lymphoma).
- Targeted therapy/immunotherapy: Rituximab for CD20-positive B-cell lymphoma; CAR-T-cell therapy for refractory or relapsed disease (for specific indications); and molecularly targeted drugs (e.g., BTK inhibitors for some subtypes).
- Radiation therapy: Used alone or combined with chemotherapy for localized lesions (limited-stage disease).
- Observation (watchful waiting): For asymptomatic indolent types (e.g., some follicular lymphomas), observation may be chosen instead of immediate active treatment.
- Hematopoietic stem cell transplantation: Autologous or allogeneic hematopoietic stem cell transplantation may be considered for relapsed disease or high-risk patients.
- Infection-associated lesions (e.g., gastric MALT lymphoma): May improve with eradication therapy against the causative organism (Helicobacter pylori).
- Supportive treatment and management: Infection prevention, transfusions and growth factors (if needed), prevention of tumor lysis syndrome (uric acid-lowering medication and hydration in high-risk cases), pain and nutritional management, and regular blood test monitoring.
- Precautions (during and after treatment):
- Increased risk of infection during treatment — immediate evaluation is needed for fever, cough, or wound infection.
- Vaccines: Live vaccines are prohibited during anticancer treatment; consult about the timing of vaccinations before treatment.
- Fertility preservation: Patients of childbearing age are advised to discuss preservation options (sperm or egg storage).
- Medication side effects: Myelosuppression, nausea, hair loss, and neuropathy may occur — consult the treating physician if side effects develop.
- Monitoring for long-term complications: Secondary malignancies, cardiotoxicity (with some drugs), and chronic immunosuppression, among others.
3) Checkpoints Before an Outpatient Visit (Including Example Questions)
- Items/documents to prepare:
- A list of current medications (including prescription drugs, OTC medications, herbal medicines, and supplements)
- Copies of previous diagnostic records (pathology reports from biopsies), immunophenotyping (CD markers), and molecular test results
- Recent test results (blood tests, biochemistry, and imaging studies such as CT/PET)
- A record of symptom changes (lymph node size; fever, night sweats, and weight changes; fatigue; bleeding or bruising, etc.)
- Personal medical history (immunosuppressed status, previous radiation therapy or chemotherapy, history of infections such as HIV), and whether pregnancy is possible
- Things to submit or explain to the medical staff during the outpatient visit: Presence of abdominal bloating, shortness of breath, or neurological symptoms; recent infections or fever; contact history (e.g., tuberculosis); and vaccination history
- Example checklist before visiting the hospital: Whether fasting is required (depending on the test), preparations for urine and blood collection, and review of consent forms (treatment plan)
4) Examples of General Questions to Ask the Doctor
- What is the exact subtype (histologic diagnosis) and stage of my disease? What is the expected treatment plan based on these findings?
- What is the goal of the standard treatment recommended for me (cure, induction of remission, or symptom relief)?
- What are the main side effects of the recommended treatment, and how can they be prevented and managed?
- What should I do if an infection or other complication is suspected during treatment (how to contact the hospital and what to do in an emergency)?
- How will the treatment affect fertility, and what preservation options are available?
5) Examples of Disease-Specific Questions
- Is my lymphoma B-cell or T-cell type according to the biopsy? What treatment is recommended based on the results for markers such as CD20 and molecular genetics (MYC/BCL2/BCL6, etc.)?
- If I am diagnosed with localized gastric MALT lymphoma, can remission be expected through Helicobacter pylori testing and eradication therapy, or is additional treatment needed?
(Note: Individual treatment decisions are recommended by the treating hematologist-oncologist after considering the diagnostic results, including biopsy, imaging, and bone marrow examination, together with the patient’s overall condition.)