What the diagnosis means
Lymphomas are divided into Hodgkin lymphoma and the much larger group of non-Hodgkin lymphomas (NHL), which range from slow-growing (indolent) types such as follicular lymphoma to aggressive types such as diffuse large B-cell lymphoma (DLBCL). The subtype decides everything, and it can only be established properly on a good-sized biopsy — ideally a whole lymph node removed under anaesthetic rather than a needle sample — examined with immunohistochemistry and, where needed, molecular tests.
Staging uses PET-CT and blood tests; a bone-marrow test is needed for some subtypes. Stage matters less than in solid cancers because treatment is systemic from the start.
Where medical oncology fits
Lymphoma is treated by medical/haemato-oncologists. Surgery's role is the diagnostic biopsy; radiation oncologists contribute for early-stage Hodgkin lymphoma and some localised NHL, and for bulky sites. Dr Atreya is a medical and haemato-oncologist and treats lymphoma at Medanta Lucknow, including stem-cell transplantation where it is part of the plan.
Treatment by type
- Hodgkin lymphoma: highly curable at all stages with combination chemotherapy, sometimes with an antibody–drug conjugate or immunotherapy, and radiation for early or bulky disease. PET-CT during treatment is used to shorten or intensify therapy.
- Aggressive NHL (e.g. DLBCL): chemo-immunotherapy (chemotherapy with an anti-CD20 antibody) for six cycles, with newer agents added in higher-risk disease. Cure is the goal for most patients.
- Indolent NHL (e.g. follicular): may need no treatment for years ("watch and wait"); when treatment is needed, antibody-based regimens control the disease, often for long periods.
- Relapsed disease: salvage chemotherapy with autologous stem-cell transplant, bispecific antibodies or CAR-T cell therapy depending on subtype and fitness.
What to expect
Most treatment is outpatient, every two to three weeks, with blood tests before each cycle. Hair loss, nausea, tiredness, low blood counts and infection risk are the main effects; heart and lung function are checked before some drugs. Fertility preservation is discussed before starting. Follow-up after treatment continues for years, with symptoms rather than routine scans guiding most reviews.
Questions to ask
- What is the exact subtype, and was the biopsy adequate to be sure?
- Is my lymphoma of the curable type, and what is the intended regimen and number of cycles?
- Will PET-CT during treatment change the plan?
- Do I need treatment now, or is monitoring safe (indolent lymphoma)?
- What are my options if the lymphoma comes back?
Preparing for your consultation
Bring the biopsy report with immunohistochemistry, PET-CT and other scans with reports, blood tests including LDH, hepatitis B/C and HIV results (checked before treatment), any bone-marrow report, and a medicine list.