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I Can Answer That: Deborah Stephens, DO, on Blood Cancer and Lymphoma

Read Time: 5 minutes

Video transcript

Hi, my name is Deborah Stephens and I'm a physician and a researcher at the Huntsman Cancer Institute. And I'm here today to answer questions about blood cancer, and more specifically, questions about lymphoma. 

 What are the different types of blood cancer?

There are many different kinds of blood cancer. We usually think of them in common categories like leukemia, lymphoma, and multiple myeloma. But even within all of those, there's a lot of different subtypes. And so, it does get complicated. It's not a very straightforward type of cancer to study.

How are leukemia and lymphoma different?

So, leukemia, the word leukemia means white blood cells in the blood. And so, leukemia is often blood cancer that's circulating around in the blood system. Whereas lymphoma is a type of cancer that often lives in lymph nodes. And every adult human has about five to 700 lymph nodes in their body. They're just normally there to help you respond to infections, but when they become enlarged, they get plugged up with cancer. That is often the type of cancer we call lymphoma.

How many types of lymphoma are there?

There are about 70 different types of lymphoma. So, it does get a little bit complicated and it is important to have an expert pathologist take a look at the sample—just because it's not completely straightforward. A lot of people know about a type of cancer called Hodgkin lymphoma. However, not a lot of people know about non-Hodgkin lymphoma. And even within non-Hodgkin lymphoma, we separate things into kind of more aggressive, you know, diseases that pop up quickly and move fast, or non-aggressive. So maybe they start growing slowly and people don't know that they have these types of lymphoma for a while.

What are the common symptoms of lymphoma?

Common signs and symptoms of lymphoma are classically an enlarged lymph node. And lymph nodes are things that are best felt under your neck, in your armpit, and your groin. As I had mentioned previously, there are about five to 700 lymph nodes in your body, and these can swell up when you get an infection. However, if you have no evidence of infection, suddenly notice a lymph node swelling up in your neck, that may be a sign that you could have lymphoma.

How is lymphoma diagnosed?

So, the best way to diagnose lymphoma is to actually take a surgical biopsy of a lymph node. And that usually means taking out an entire lymph node. Now there are so many lymph nodes in your body that taking out one usually doesn't cause a major impact. And so, the lymph can figure out a way to reroute itself around it. But why that's important is because sometimes people can have two different types of lymphoma at once. And if you're able to look at the entire lymph node, you can really have a very good diagnosis of this. 

What are the risk factors for lymphoma?

So, when people ask me, you know, “Doc, how did I get this lymphoma?” The answer most of the time is actually, “I'm not sure.” But certain risk factors do make people more likely to get lymphoma. One of those is heavy radiation exposure. And that can come through, you know, being part of working at a nuclear plant or being, you know, some people in southern Utah have lived in an area that's called a downwinder area. That kind of exposure to radiation can put you at risk for lymphoma. Most of the time, we don't have a completely clear answer for exactly why you have gotten the lymphoma. 

How can someone with lymphoma improve their health?

Most of the time, I just recommend having, you know, a normal healthy diet, anything you would think of as healthy, you know, low fat, good protein levels, lots of vegetables and fruits, and keeping your body really strong in case you do need treatment for the lymphoma. That will help your body to be strong and healthy. Unfortunately, a lot of things have been studied in terms of supplements and not a lot of them have shown to have a benefit. One thing that is really interesting is for a specific subtype of lymphoma called follicular lymphoma, there have been some data that show that having a replaced vitamin D level, so a good and replete vitamin D level, can help you to respond better to therapy.

What treatment options are available?

The majority of the time we need to treat lymphoma through system wide treatment. So, chemotherapy or immune therapy, and how I distinguish between the two of those chemotherapy is kind of a nonspecific way to kill cancer cells. They really kill any rapidly growing cells. And so, they go in, they kill normal cells and they kill the cancer cells. And then your body has repair mechanisms to repair those normal cells and get rid of the cancer cells. However, immunotherapy comes in many different ways and this is an active field of development right now. One that has been approved recently is a therapy called CAR T cell. And that stands for Chimeric Antigen Receptor T-Cell therapy. And what that what happens with that sort of immunotherapy is you actually take a person's blood, you separate out T cells, which are a really important part of your immune system. In the lab, we train those T cells to go after something, typically CD 19, which is on the surface of lymphoma cells. And then once those cells are prepared, we grow them up. So, it's kind of like growing an army of T cells. And then we give them the person chemotherapy to suppress the immune system. And then we put those T cells back into the patient and let them go to work. So, it's like we've really trained a specific part of your immune system to go after the lymphoma. And this is a really great development of recent years. And there's a lot of investigation of how can we make it better, how can we can make it safer, and even other types of tumors are using this kind of approach too.

Cancer touches all of us.