[Fat Bear Science] Let’s talk about things you don’t know about lymphoma. I bet it’s not as scary as you think!

Lymph is the body's immune system. Many people who have swollen lymph nodes worry that they may have cancer. Today, let's talk about the problems of lymphoma.

Xiang Ying, chief physician, master's supervisor, director of the Department of Hematology and Oncology, Affiliated Tumor Hospital of Chongqing University, national member of the Lymphoma Committee of the Chinese Anti-Cancer Association, national member of the Anti-Lymphoma Alliance of CSCO, director of the Chongqing Anti-Cancer Association, deputy director of the Hematology Committee of the Chongqing Medical Association and leader of the Lymphoma Group, deputy director of the Tumor Committee of the Chongqing Association of Traditional Chinese and Western Medicine, is an expert in the diagnosis, chemotherapy, biological targeting and other comprehensive treatments of blood tumors such as lymphoma and multiple myeloma and solid tumors such as lung cancer.

Clinic hours: Tuesday morning

What you don't know about lymphoma

▲Does swollen lymph nodes necessarily mean lymphoma?

Lymph nodes are important immune organs of the body. Various factors such as infection by pathogenic microorganisms, chemical drugs, foreign toxins, foreign bodies, and the body's own metabolic products can cause changes in the cell components in the lymph nodes. For example, the proliferation of lymphocytes can also cause lymph node enlargement. Therefore, lymph node enlargement is not necessarily lymphoma.

Infection is the most common cause of swollen lymph nodes. Most swollen lymph nodes, especially in children, are caused by infection.

For example, when you have a sore throat, toothache or cold, the lymph nodes in your neck often swell. At this time, the doctor will look for the infection focus near the swollen lymph nodes. The doctor will also perform a series of laboratory tests to look for evidence of infection.

Doctors usually prescribe anti-inflammatory treatment and observe whether the lymph nodes shrink or disappear after a period of treatment. If the lymph nodes remain the same or continue to grow, doctors may recommend removing the lymph nodes for observation under a microscope and other laboratory tests.

What you don't know about lymphoma

▲What is the cause of malignant lymphoma?

At present, the pathogenesis of lymphoma has not been fully clarified. Certain viruses, ionizing radiation, and certain chemical agents may be the causes of lymphoma. The causes of most lymphomas are unknown.

However, there are some risk factors that may trigger the risk of lymphoma, and it has been found that non-Hodgkin's lymphoma is associated with many risk factors.

Cancer is associated with mutations (changes) in DNA that create or activate oncogenes or turn off tumor suppressor genes. Excessive exposure to radiation, cancer-causing chemicals, or infections in daily life can cause changes in DNA, but these changes are not usually the main cause of tumor development. Lymphoma often occurs in the elderly.

A chromosomal translocation is a change in the DNA that can cause non-Hodgkin lymphoma to develop. For example, follicular lymphoma most often has a translocation between chromosomes 14 and 18 that depends on the Bcl-2 gene. This prevents cells from dying at the appropriate time, leading to lymphoma.

Lymphocytes (the cells in which lymphomas originate) are cells of the immune system, so in many people with lymphoma, changes in the immune system appear to play an important role.

Examples include immune deficiencies (due to genetic conditions, medications, organ transplants, or HIV infection), autoimmune diseases (where the immune system continually attacks a part of the body), and chronic infections.

What you don't know about lymphoma

▲Who is at high risk of lymphoma?

People who have any of the following are at high risk for lymphoma:

■ Inherited immune disorders, such as hypogammaglobulinemia or Wiskott-Aldrich syndrome.

■ Autoimmune diseases (such as rheumatoid arthritis, psoriasis, or Sjögren's syndrome); HIV/AIDS; human T-lymphoblastic type 1 or Epstein-Barr virus infection; Helicobacter pylori infection; taking immunosuppressant drugs; after an organ transplant.

■ Older people, men, or white people are also at high risk. Any behavior that increases your risk of developing a disease is called a risk factor.

Having risk factors does not mean you will get cancer; likewise, not having risk factors does not mean you will not get cancer. If you find any of the above risks, be sure to go to the hospital for a checkup.

What you don't know about lymphoma

▲Is lymphoma a curable tumor?

Clinically, 5 years without recurrence usually means clinical cure, and many types of aggressive lymphoma can be cured through effective treatment.

For example, approximately two-thirds of patients with diffuse large B-cell lymphoma can be cured with chemotherapy plus rituximab.

There is currently no cure for follicular lymphoma, but more than 85% of patients with follicular lymphoma survive at least 5 years after diagnosis, and 50% of patients are estimated to live longer than 12 years.

There are many factors that determine the effectiveness of lymphoma treatment, and early detection, early diagnosis, and persistence in treatment are key factors in determining the effectiveness of lymphoma treatment. With the development of medical science and technology and the in-depth development of research, great progress has been made in the treatment of lymphoma, and lymphoma has become one of the tumors that can be cured by chemotherapy.

Even if there is no cure, many lymphoma patients can survive for a long time through effective treatment. Therefore, lymphoma patients must have the confidence and determination to overcome the disease and actively cooperate with the doctor's treatment.

What you don't know about lymphoma

Are all lymphomas treated the same?

Lymphoma is a group of diseases. For example, non-Hodgkin's lymphoma can be divided into more than 60 subtypes. Different subtypes of lymphoma have different manifestations and prognoses and require different treatments.

For example, some slow-growing lymphomas (indolent lymphomas) can be observed in the early stages and treatment can be started when obvious symptoms appear. The purpose of treatment is to control the disease, improve symptoms, and prolong survival.

Some fast-growing lymphomas (intermediately aggressive lymphomas, such as diffuse large B-cell lymphoma) require moderate-intensity chemotherapy, the goal of which is to cure the disease.

Some fast-growing lymphomas (highly aggressive lymphomas, such as lymphoblastic lymphoma) require not only high-dose chemotherapy, but also combined with radiotherapy, stem cell transplantation and other treatment methods to improve efficacy.

What you don't know about lymphoma

What are other treatments for lymphoma?

■ Biological therapy. It is a general term for a variety of treatment strategies and treatment methods. It is an effective auxiliary therapy following surgery, radiotherapy and chemotherapy. Immunotherapy and gene therapy are both biological therapies. Currently, immunotherapy is the most widely used in clinical practice.

■ Hematopoietic stem cell transplantation. Hematopoietic stem cell transplantation (stem cell transplantation) is a procedure that involves high-dose chemotherapy and/or whole-body irradiation to eliminate tumor cells in the body, followed by the reinfusion of hematopoietic stem cells collected from the body or others to restore normal hematopoietic and immune functions.

Stem cells (immature blood cells) are taken from the patient's blood or bone marrow (autologous transplant) or from a donor (allogeneic transplant), frozen, and stored. After chemotherapy and/or radiation therapy is completed, the stored stem cells are thawed and returned to the patient.

These infused stem cells can grow into the body's blood cells. In the treatment of lymphoma, the most commonly used method is autologous bone marrow transplantation, and a small number of patients can consider allogeneic hematopoietic stem cell transplantation.

Stem cell transplantation is a means of treating lymphoma, but not all patients will be successful, and about 30% will fail. The main reasons for failure are advanced stage, primary tumor resistance, large tumor load or high malignancy before transplantation, etc. There is still a certain chance of recurrence and other treatment-related risks after stem cell transplantation.

What you don't know about lymphoma

▲In addition to treatment, what else should we pay attention to in life?

After chemo or radiation therapy, you may not feel like eating at times (especially during or after treatment), feel sick or tired, and may find that food does not taste as good as before.

Also, side effects of treatment (such as loss of appetite, nausea, vomiting, or mouth sores) can make it difficult to eat well.

As the saying goes, "30% treatment and 70% care", dietary adjustment is an important part of lymphoma recovery. In addition to paying attention to balanced nutrition, lymphoma patients should also avoid or eat less fried, grilled, smoked and salted foods.

At the same time, you can eat more fresh vegetables and fruits containing anti-tumor ingredients, such as tomatoes, oranges, hawthorns, kiwis rich in vitamin C, carrots and lettuce rich in vitamin A, and shiitake mushrooms and white fungus rich in minerals.

In 1997, the book "Food, Nutrition and Cancer Prevention" written by experts from the World Cancer Research Fund and the American Cancer Institute summarized the epidemiological data of cancer research in countries around the world and concluded that fresh vegetables are the best food for cancer prevention.

The following vegetables are beneficial for cancer patients to eat: broccoli, cabbage, carrots, onions, spinach, tomatoes, garlic, asparagus, mushrooms, and konjac.

During chemotherapy, patients may experience symptoms such as hematopoietic cell reduction and oral mucosal irritation. Dietary adjustments can effectively prevent the occurrence of such adverse reactions.

Prevent a decrease in blood levels: supplement high-protein diet, such as milk, soybeans, sea cucumbers, red dates, walnuts, etc.

Relieve the symptoms of stomatitis: such as crucian carp soup, lotus seed soup, and milk.

Eating well can help you feel better and have more energy. The following tips can help you better regulate your diet:

■ If you don't like the taste of water, you can add fresh fruit to make it more palatable, or you can absorb liquids through other foods and drinks (such as soup or watermelon, tea, milk or dairy products, and sometimes sports drinks).

■ If you don’t like bland-tasting food, you can add some seasonings (such as garlic and some spices) appropriately. If you liked spicy dishes before you developed lymphoma, you can also add a small amount of spicy condiments to the dishes to stimulate your appetite.

■ When your mouth hurts, eat light food (avoid sour and spicy foods) until your mouth heals.

■ Eat small and frequent meals to ensure adequate calories. If you do not want to eat meat, you can get protein from other foods (such as fish, eggs, beans and bean products, milk, nuts, etc.).

■ If you have a bad taste in your mouth (such as a metallic taste), you can eat mints, chewing gum, or fresh citrus fruits. In addition, brushing your teeth before eating can reduce the bad taste.

■ When you have oral ulcers or gum infections, you can use a blender to process vegetables and meat. You can also drink vegetable juice to provide moisture and add gravy to provide calories.

What you don't know about lymphoma

▲What should you pay attention to after being discharged from hospital?

Adhere to follow-up, the treatment of lymphoma is long-term.

During follow-up, patients should also be concerned about long-term complications, because some drugs with greater toxic side effects have irreplaceable therapeutic effects during treatment, so these drugs are usually still used.

After achieving relief, you should pay attention to the possibility of long-term complications and consult a doctor as soon as possible for intervention treatment.

Therefore, patients with lymphoma need to maintain long-term contact with the attending physician. This is not only beneficial for the attending physician to follow up and observe the patient, but more importantly, the patient can obtain personalized healthy diet, exercise guidance and psychological counseling from the attending physician, which helps long-term survival and reduces the risk of lymphoma recurrence, cardiovascular disease, diabetes, osteoporosis, mental illness, second primary cancer, etc., so as to obtain a better quality of life.

Text/Fat Bear Picture/Internet (Please contact to delete) Review/Xiang Ying

Member of China Medical We-Media Alliance

Science Popularization China Co-construction Base

Chongqing Science Popularization Base/Chongqing Health Promotion Hospital

Chongqing Municipal Science and Technology Commission Science and Technology Communication and Popularization Project

National Health Commission National Basic Public Health Service Health Literacy Project