[Fat Bear Science] He is a Winter Olympic champion and also a cancer fighter! Experts remind you: Don't worry if you have this type of cancer, most cases can be cured

The 2022 Beijing Winter Olympics just ended

What impressed you most?

Is it the cute mascot Bing Dwen Dwen and Shuey Rhon Rhon?

Is it the athlete who won multiple medals?

Or a passionate commentary video?

For Fat Bear

It's the fighter who fought cancer and won the Olympic gold medal

Max Parrott, born in 1994, started snowboarding at the age of 10 and won the silver medal in the men's snowboard slopestyle competition at the Pyeongchang Winter Olympics in 2018. Just when his career was at its peak, he was diagnosed with Hodgkin's lymphoma.

Like ordinary people, Parrot was afraid of death, but he never gave in to the disease. In order to fight the disease, he underwent 12 chemotherapy sessions in 6 months. In June 2019, Parrot finished his last chemotherapy and announced to the public that he had defeated cancer. At the just-concluded Beijing Winter Olympics, he returned strongly and won the gold medal in the men's snowboard slopestyle event.

What is lymphoma? What are the danger signs of lymphoma? Does swollen lymph nodes necessarily mean lymphoma? Who are the high-risk groups for lymphoma? Can lymphoma be cured? ... Today, we invite Professor Liu Yao, Director of the Hematology and Oncology Center of the Affiliated Cancer Hospital of Chongqing University, to talk to us about lymphoma~

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Liu Yao

Director of the Hematology and Oncology Center of the Affiliated Cancer Hospital of Chongqing University, chief physician, professor, postdoctoral co-supervisor, and postdoctoral fellow at the University of Southern California.

Mainly engaged in basic and clinical research on lymphoma and hematopoietic stem cell transplantation.

Clinic hours: Tuesday afternoon, Thursday morning

Q1

What is lymphoma?

Lymphoma is the full name of malignant lymphoma, also known as "lymph cancer" by the general public. It is a malignant tumor of the blood system, more common in young and middle-aged people, with more male patients than female patients. Lymphoma is a group of malignant tumors that originate in lymph nodes or other lymph node hematopoietic tissues. It can occur in any part of the body and usually grows in the form of solid tumors. It is one of the common tumors, accounting for about 3% of all malignant tumors.

Lymphoma can be divided into two categories according to pathological histology: Hodgkin's lymphoma and non-Hodgkin's lymphoma. Hodgkin's lymphoma is relatively rare, accounting for about 9%, and Hodgkin's lymphoma is further divided into classical Hodgkin's lymphoma and nodular lymphocyte-dominant Hodgkin's lymphoma (accounting for only 5%). Non-Hodgkin's lymphoma can be further divided into B-cell lymphoma, T-cell lymphoma, NK-cell lymphoma, etc. Although lymphoma is prone to occur in lymph nodes, due to the distribution characteristics of the lymphatic system, lymphoma is a systemic disease that can invade almost any tissue and organ in the body. Therefore, the clinical manifestations of malignant lymphoma have certain common characteristics, but at the same time, there are great differences according to different pathological types, sites of invasion and ranges.

Q2

What are the danger signs that should alert you to early lymphoma?

The manifestations of lymphoma are hidden and difficult to detect. Early symptoms are similar to those of a cold, and most patients experience painless swelling of lymph nodes in the neck, armpits, or groin. Cervical lymph node enlargement is the most common, followed by axillary and groin lymph nodes, which are often accompanied by B symptoms, such as fever, night sweats, and weight loss. Swollen lymph nodes are generally equal in size and round, with a tough texture, and feel about the same as the tip of the nose.

For low-grade non-Hodgkin's lymphoma, the lymph nodes are usually multiple, scattered, and independent; for aggressive or high-grade non-Hodgkin's lymphoma, the lymph nodes swell rapidly, may fuse into a mass, or even adhere to the underlying skin, causing symptoms such as compression, edema, and obstruction. If the lymph nodes are not painful and have poor mobility, you should be alert to the possibility of malignant lesions and it is best to have a color Doppler ultrasound examination as soon as possible.

Q3

Does swollen lymph nodes mean lymphoma? How to distinguish different types of swollen lymph nodes?

Swollen lymph nodes are not necessarily lymphoma.

The most common cause of swollen lymph nodes is inflammation, which is often accompanied by pain in the acute phase. When the inflammation subsides, the pain will be relieved and the size of the lymph nodes will return to normal. Some swollen lymph nodes are physiological, which is common in children under 6 years old. As long as there are no symptoms such as fever and weight loss, there is no need to panic, as they will gradually shrink with age.

However, if the swollen lymph nodes are caused by lymphoma, you need to be extra careful. The swollen lymph nodes caused by lymphoma are most common in the neck, followed by the armpits and groin, and the mediastinum and para-aortic lymph nodes are also common. However, the mediastinum and para-aortic lymph nodes are located in the chest and abdominal cavity and cannot be reached by yourself. Therefore, in daily life, you can pay attention to whether the neck, supraclavicular, armpits and groin lymph nodes are swollen. Taking a bath is the best time to do a self-examination.

When checking lymph nodes in daily life, you must pay attention to "palpation" as the main method. Do not squeeze the lymph nodes repeatedly. At the same time, avoid pinching with the thumb and index finger, because you may mistake the subcutaneous tissue for swollen lymph nodes and cause a false alarm. It is recommended to touch and gently press the surface of the lymph nodes with the tips of the index finger, middle finger and ring finger to feel the size, texture, boundary and tenderness of the lymph nodes. The specific identification is as follows:

Painless swollen lymph nodes: Swollen lymph nodes caused by lymphoma are painless and itchy in the early stage, but if the huge lymph nodes cause ulceration or compress important organs, it will cause pain. For example, when the mediastinal lymph nodes compress the esophagus, it will cause dysphagia; when the lymph nodes compress the trachea, coughing, dyspnea, chest tightness, etc. will occur. Lymph node swelling caused by acute inflammation is mostly accompanied by skin redness, increased local skin temperature and pain, that is, redness, swelling, heat and pain. Generally, the lymph nodes can be reduced after anti-inflammatory treatment.

Growing quietly: If painless lymph nodes progressively enlarge, it should be taken seriously and further examination at a specialist hospital is recommended. Some lymphoma patients may also have systemic manifestations such as fever, night sweats, fatigue, and weight loss.

Equal size and roundness: If the difference between the long and short diameters of the lymph nodes is not large, for example, ultrasound shows that the lymph nodes are 2.4cm*2.2cm, especially the lymph nodes are of medium quality and painless, then you should be careful of lymphoma. Inflammatory lymph nodes are mostly long strips, such as 0.7cm*2.5cm.

Tough texture: The texture of lymphoma is tough, and the touch is similar to the toughness of the nose tip. In addition, the boundaries of early lymph nodes are relatively clear, without adhesion, and are movable to the touch. Lymph nodes caused by inflammation are relatively soft.

Q4

Who is at high risk for lymphoma?

* Those with a family history of lymphoma

* People who have long-term exposure to harmful chemicals such as pesticides, hair dyes, benzene, formaldehyde, etc.

* People who have been exposed to radiation for a long time

* People who have been taking immunosuppressive drugs for a long time

* People infected with HIV, Epstein-Barr virus, Helicobacter pylori, etc.

* People who have high work pressure, long-term mental stress, irregular diet and rest, and often stay up late

Q5

Can lymphoma be cured?

Although lymphoma is a malignant tumor, as long as it is discovered in time and treated as soon as possible, about 50% of lymphomas can be cured. Even for incurable lymphomas, active and effective treatment can prolong life and improve quality of life, so early detection of lymphoma is very important. Pathological examination is the gold standard for diagnosing lymphoma. After diagnosis, staging examinations are performed to determine the risk level and formulate treatment plans, and strive to improve the cure rate of lymphoma through early detection, early diagnosis, and early treatment. Because the diagnosis of malignant lymphoma is more complicated, the first doctor is very important. In order to avoid misdiagnosis, missed diagnosis and delayed treatment, it is recommended that patients choose a regular specialist hospital for treatment. They can choose hematology and oncology or general surgery to receive accurate pathological diagnosis and standardized treatment.

Q6

What are the treatments?

Lymphoma is not an incurable disease. There are many treatments available, and treatment must be tailored to individual needs. According to factors such as lymphoma type, disease stage, and personal physical condition, current lymphoma treatments include chemotherapy, radiotherapy, targeted immunotherapy, surgical treatment, hematopoietic stem cell transplantation, and Car-T cell therapy. Traditional chemotherapy regimens mainly include ABVD, RCHOP, RCVP, and R-EPOCH. Hematopoietic stem cell transplantation also plays an important role in the treatment of lymphoma. New treatment methods include targeted therapy, immunotherapy, and chimeric antigen receptor T cell (CAR-T) cell therapy. In view of the complex pathological types, diverse treatment methods, and different prognoses of lymphoma, the role of the multidisciplinary team (MDT) needs to be emphasized in diagnosis and treatment.

Q7

Will the disease relapse after treatment? What precautions should be taken?

Although the tumor is under control after treatment, some cancer cells will still remain, so it is easy to relapse, and different lymphomas have different recurrence rates. After the disease is successfully cured, it does not mean that you can sit back and relax. If you want to reduce the recurrence rate of lymphoma, you must insist on paying attention to the full course of standardized treatment, follow the doctor's orders to take medicine, insist on long-term follow-up, and maintain a healthy lifestyle. The treatment of lymphoma is long-term. Although the condition is greatly relieved after comprehensive treatment, you still cannot let your guard down.

Q8

How can lymphoma be prevented?

* Eat healthy, maintain a regular schedule, exercise moderately, and don’t stay up late.

* Be positive and optimistic about work and life, soothe your mood and relieve stress.

* Avoid contact with harmful chemicals such as pesticides, hair dyes, benzene, formaldehyde, and radiation.

* Avoid infection with HIV, Epstein-Barr virus, Helicobacter pylori, etc. Once infection occurs, seek treatment as soon as possible and eliminate the pathogenic factors in time.

Text/Fat Bear

Audit/Hematology and Oncology Center

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Chongqing Science Popularization Base/Chongqing Health Promotion Hospital

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