MRCP FRCPath (UK)
CONSULTANT HAEMATOLOGIST
Milton Keynes, Bedford, Buckingham, Northampton, Luton
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  Other blood disorders
Leukaemia
Myeloma
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Other disorders
Lymphoma

Dr Moez Dungarwalla is a Lymphoma specialist based in Milton Keynes.  He is the clinical lead and cancer lead for blood disorders at Milton Keynes NHS Foundation trust and is responsible for the diagnosis, staging and treatment of patients with Lymphoma.
 

Lymphomas are cancers of the lymphatic system.

When a person has lymphoma, some of their lymphocytes are ‘out of control’ – they divide in an abnormal way and do not die when they should. The abnormal lymphocytes can collect in the lymph nodes which then enlarge as the lymphocytes from tumours.

Lymphomas can affect lymph nodes in all parts of the body and can involve other organs such as the spleen or bone marrow Other areas of the body such as the stomach, skin or liver can also be affected.

 
Causes

In most cases the cause is unknown. Certain viral infections can trigger lymphoma.

 
Classification

There are many different types of lymphoma. The appearance of lymphoma cells under the microscope gives an indication how they will behave and allows the specialist to tell whether you have Hodgkin or non-Hodgkin lymphoma. This is important for planning your treatment.

Hodgkin lymphoma

Characterised by the presence of the Reed-Sternberg cell.

Can occur at any age, although most people are diagnosed between the ages of 15 and 35 or 55 and over. The majority of patients with Hodgkin lymphoma are very successfully treated and will be completely cured.

Non-Hodgkin lymphoma

Any lymphoma that is not Hodgkin lymphoma.

One of the most common cancers particularly in patients 75 and over.

 
Symptoms

The most common symptom of lymphoma is a painless lump or swelling, often in the neck, armpit or groin.

Other common symptoms include:

  • Excessive sweating
  • Fevers
  • Weight loss
  • Tiredness
  • Cough or breathlessness
  • Itching
  • Abdominal pain
 
Diagnosis

In most cases it is not possible for a GP to confirm whether or not you have lymphoma and for this reason your GP will refer you to see a specialist.

Lymph node Biopsy

A biopsy means removing some of the abnormal lymphoma cells to look at them under a microscope. It is usually the only way to diagnose lymphoma. Specialists usually advise removing a whole lymph node under general anaesthetic where possible.

Bone marrow Biopsy

The bone marrow is responsible for the production of blood cells and is found in the middle of the large bones of your body such as the pelvis. It is quite common for lymphoma to be found in the bone marrow and hence a bone marrow biopsy is often carried out to see if there are lymphoma cells there.

The procedure involves taking a sample of bone marrow through a large needle. The needle is usually inserted through your skin into your pelvis using a local anaesthetic. It takes around 10 minutes and can be a painful procedure.

CT scan

Involves lying on a bench that moves your body into a doughnut shaped camera. The camera takes computerised pictures of your insides. Unlike x-rays which give a see through picture from front to back, CT scans give a picture of your body in cross section from top to bottom. As the table moves, the camera takes pictures of the different layers of your body. The scan is painless and takes 5-20 minutes

PET scans

Give more detailed information about cell activity by measuring the rate at which cells take up and process a radioactive form of sugar. This can help doctors to distinguish between cancerous and non-cancerous cells.

 
Stages of lymphoma
   
Stage I  One group of lymph nodes are affected on one side of the diaphragm
Stage II Two or more groups of lymph nodes are affected on one side of the diaphragm
Stage III Lymph nodes are affected on both sides of the diaphragm
Stage IV Lymphoma found in organs outside the lymphatic system or in the bone marrow. A/B – refers to whether or not you have experienced weight loss, night sweats or fevers
 
Treatment for Hodgkin lymphoma

The aim of treatment will be to cure the disease with the least possible damage to your health in the future.

Most people are cured.

Treatment is usually with combination chemotherapy. The most commonly used chemotherapy combination for Hodgkin lymphoma is ABVD.

Some patients also have radiotherapy too.

Treatment for high grade non-Hodgkin lymphoma

The aim of treatment is to cure the disease and almost always involves using intravenous combination chemotherapy.

The most common type of chemotherapy is CHOP.

In most cases, this will be given with the addition of a targeted anti cancer drug called Rituximab.

Treatment for low grade non-Hodgkin lymphoma

Early stage low grade non-Hodgkin lymphoma is treated with radiotherapy to the enlarged lymph nodes and can be curative in a proportion of patients. Early stage disease is however rare.

Most patients with low grade non-Hodgkin lymphoma have advanced disease which is difficult to cure completely, and tends to run a ‘relapsing and remitting course’.

The aim of treatment for patients with advanced disease is to control the disease while maintaining a good quality of life.

Patients who have no symptoms do not require treatment and are managed by a ‘watch and wait’ policy with regular check-ups. Most of these patients will require treatment within 2-3 years of their diagnosis.

Treatment when required may be with oral tablet chemotherapy or intravenous combination chemotherapy plus Rituximab – for example R-CVP and R-CHOP.

 
To find out more about Dr Moez Dungarwalla and private Lymphoma treatments or to arrange a consultation, please contact:
   
Phone Email
01908 995 814 moez.dungarwalla@mkhospital.nhs.uk
 
 
 
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