Blood Cancer treatment in Delhi | Lymphoma Specialist in Delhi
Lymphoma treatment in Delhi NCR | Blood Cancer treatment in Delhi. Dr Vineet Govinda Gupta (Gold Medalist – AIIMS New Delhi) is a board-certified medical oncologist practicing in Delhi NCR, formerly at AIIMS New Delhi for more than 12 years. भारत दिल्ली में खून के कैंसर का पक्का इलाज. Access the best treatment of lymphomas (blood cancer) in Delhi, Noida, Gurgaon, Faridabad with scientific, world-class, ethical and affordable care. More information here
What is lymphoma?
Lymphomas are cancers arising from lymphocytes (a type of blood cell). Lymphocytes are a type of blood cells that normally work to defend the body from infections. These cells normally live in the blood stream, lymphatic channels and lymph nodes that are located throughout the body.
Cancer can be defined as a condition where normal cells of the body become abnormal and start growing and multiplying uncontrollably and gain the ability to spread throughout the body.
What is the difference between “lymphoma” and “leukemia”?
Both lymphoma and leukemia are types of blood cancer. We generally use the term leukemia when the lymphoma invades into the blood stream or bone marrow. So, the same cancer can be seen both as a lymphoma (with tumor masses) or as a leukemia (with cancer cells flowing in the blood). A skilled medical oncologist can help guide you with the differences in testing and treatment of blood cancer (lymphoma).
Are there different types of lymphoma? What are some common types?
There are dozens of different types of lymphoma. All of them have differences in behaviour, age group, treatment and prognosis.
DUE TO THE LARGE VARIETY OF LYMPHOMAS, ONLY AN EXPERT ONCOLOGIST SHOULD TREAT LYMPHOMA
At its most basic, lymphomas can be divided into Hodgkins Lymphoma (HL) and Non-Hodgkins lymphoma (NHL).
Non-Hodgkins Lymphomas can be divided into high grade Non-Hodgkins Lymphomas and low grade Non-Hodgkins Lymphomas.
Some common types of Non-Hodgkins Lymphomas include:
- Diffuse Large B-cell lymphoma (DLBCL)
- Follicular lymphoma (FL)
- Mantle Cell Lymphoma (MCL)
- Burkitt Lymphoma (BL)
- Lymphoblastic Lymphoma (LBL)
- Marginal Zone Lymphoma (MZL)
- Small Lymphocytic Lymphoma (SLL/CLL)
- Lymphoplasmacytic lymphoma
- Peripheral T-cell Lymphoma (PTCL)
- Anaplastic Large Cell Lymphoma (ALCL)
- Angioimmunoblastic T-cell Lymphoma (AITL)
- NK/T-cell lymphoma (NKTCL)
…And many others!
What is the difference between “low grade” and “high grade” lymphomas?
High grade lymphomas are fast-growing, aggressive cancers which develop rapidly (within weeks to months) and can lead to symptoms, complications and even death if not treated urgently. Typical examples include Burkitt lymphoma (BL), lymphoblastic lymphoma (LBL), diffuse large B-cell lymphoma (DLBCL) and plasmablastic lymphoma (PBL). These cancers generally require more intense therapy for treatment.
Low-grade lymphomas grow slowly, and in many cases may not grow at all, remaining static and stable for many months or even years. Typical examples include follicular lymphoma (FL), marginal zone lymphoma (MZL) and small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL). Often, these cancers can simply be watched instead of treating, and most patients have a good prognosis with low-intensity therapy or no therapy.
What are the causes of lymphoma?
The majority of lymphomas have no apparent cause. Lymphomas, like other cancers, occur due to abnormalities in the normal genetic code of cells which leads to altered behaviour (Learn more about the basic cause of cancer here). However, there are a few uncommon risk factors for lymphoma as follows:
- Infections with some viruses, most importantly (HIV, hepatitis C and Epstein-Barr Virus), and some bacteria, such as H.pylori (a common bacteria that infects the stomach)
- Some chemical agents
- Autoimmune diseases like rheumatoid arthritis, SLE, sjogren syndrome and celiac disease
- Some rare inherited immunodeficiency diseases
- Sometimes, there is an inherited risk of lymphoma in the family
My family member has lymphoma, does this mean I can also develop lymphoma?
As discussed above, the risk of lymphoma can be inherited in some uncommon cases. Your oncologist can help you judge if you are at increased risk of lymphoma.
Can lymphoma spread between people living together?
Lymphoma is not contagious and cannot spread from person to person.
What are some common symptoms of lymphoma?
The most common symptoms of lymphoma include:
- Enlargement of nodes in the neck, under the arms, in the groin, or at other sites. Sometimes these nodes can grow to a very large size (see image below)
- Fever, weight loss or drenching night sweats
- Enlargement of liver or spleen leading to a mass felt in the abdomen, or a heavy sensation
Uncommonly, lymphoma may spread to other sites such as brain, bones, skin, testes etc and lead to other symptoms. These are less common.
My doctor is suspecting lymphoma. What tests will I have to undergo?
The exact tests depend on the type of lymphoma. However, the following tests are typical. Not all tests are required in every case.
- A biopsy from lymph nodes or from any other site of cancer
- Blood tests
- A bone marrow aspirate and biopsy
- A PET-CT scan or CT scan of the body
- Sometimes, a MRI of the brain or spinal cord
- An echocardiogram in some cases
- Genetic and molecular tests in some tumors
What is a biopsy? Is there a risk of cancer spreading due to biopsy?
A biopsy is a process by which a small amount of cancer tissue is removed from the body and looked at using a microscope or subjected to special tests (IHC, FISH, PCR, molecular studies, etc). Biopsy can be done by a number of methods, such as surgery of an involved lymph node, using a needle to remove tissue from organs inside the body, or aspiration of fluid in body compartments.
Some form of biopsy is usually necessary for the treatment of lymphoma. Biopsy does not harm the cancer outcome and is not believed to result in “spread” of the cancer.
What is bone marrow aspirate and bone marrow biopsy? Is it painful? Can I avoid it?
Bone marrow aspiration/biopsy is a small procedure carried out under local anaesthesia. In it, a small needle is inserted into the pelvic bone and bone marrow is taken out for testing the spread of lymphoma. The entire procedure usually does not take more than 15-30 minutes, and is generally done on outpatient basis.
In expert hands, bone marrow biopsy produces only minimal pain which recovers very soon.
Bone marrow biopsy can be avoided in many cases. For example, sometimes the same information can be obtained from a PET-CT scan or from a blood test. Your oncologist can help you decide if you should go for a bone marrow biopsy.
Is stage 4 lymphoma curable?
Depending on the type, many lymphomas are curable at every stage, including stage 4. This specially applies to high-grade lymphomas.
Stage 4 low grade lymphomas may sometimes be incurable, but it is usually preferred to control them for long periods of time (many years or even decades) with low-intensity treatment or just observation alone.
All in all, treatment of blood cancer is possible at every stage and blood cancer is potentially curable at every stage.
My doctor recommended “observation” for my lymphoma. If I have cancer, why am I not being treated?
Some lymphomas are very low-grade and may remain stable for many, many years needing no therapy. In this case, the lymphoma becomes like a chronic disease (like high blood pressure or diabetes) and it can be controlled well with minimal intervention or simply just keeping an eye on it. In this case, an expert lymphoma specialist may simply recommend observation.
What is chemotherapy? Is chemotherapy mandatory for lymphoma / blood cancer treatment?
Chemotherapy, also known as cytotoxic therapy, refers to drugs that fight and kill cancer. Chemotherapy is commonly used for blood cancer treatment, however, it is not mandatory in every case. Many cases can be managed by observation, targeted therapy or immunotherapy as discussed below. However, even when chemotherapy is used, it is generally safe in expert hands. Lymphoma chemotherapy is painless, easy to take and serious side effects are usually uncommon. Sometimes it can even be given as tablets!
I do not want chemotherapy! Are there any other options for treatment of blood cancer/lymphoma?
Yes! Besides chemotherapy, a number of options are available to treat lymphoma including:
- Observation: Some lymphomas require no treatment and can simply be observed
- Targeted therapies: Rituximab and ibrutinib (see below) are some targeted therapies that can treat lymphoma
- Immunotherapy: Immunotherapies harness the body’s own immune system to kill lymphoma cells
- Radiotherapy: Sometimes (rarely), radiotherapy without chemotherapy can be used to cure lymphoma
Your oncologist can help you decide regarding the best therapy for you.
What is rituximab? Is it compulsory for treating lymphoma?
Rituximab is a targeted therapy, meaning it is a drug that attacks cells based on specific markers present on them and not present on other dividing cells. Rituximab is generally considered a revolutionary agent for lymphomas, and it significantly improves outcome in most B-lymphomas. However, it cannot be used in all patients, and the biopsy must be CD20+ in order to receive rituximab.
What is ibrutinib? How is it used to treat lymphoma?
Ibrutinib is another targeted therapy, which is given as an oral tablet. Ibrutinib produces remarkable responses in B-lymphomas, and is usually used in low-grade B-lymphomas. Ibrutinib works by affecting a special protein in cancer cells called BTK which results in control of the cancer. Ibrutinib is a new drug and should be used only under expert supervision.
What is immunotherapy? Is lymphoma immunotherapy useful?
Cancer Immunotherapy refers to use of the body’s own immune system to fight cancer. Research has shown that the immune system plays a fundamental role in the control of cancer. The body’s immune system patrols the body for any cancer cells and kills them if it finds them. If the immune system fails in its duty, cancer develops. However, the ability of the immune system to fight cancer can be “boosted” using various technologies. This field of anticancer therapy is called “cancer immunotherapy”.
In recent years, the field of blood cancer has shown the advent of several new drugs which offer the potential for curing even difficult cases which cannot be cured by chemotherapy. Immunotherapy is active in blood cancer and can produce responses and cures even in refractory patients. This is a rapidly evolving field.
What is bone marrow transplantation/stem cell transplantation? When is it needed?
Bone marrow transplantation (BMT) is a procedure that involves:
- Eliminating the patient’s own hematopoietic (blood producing) and immune (infection fighting) system
- Replacing it with the patient’s own (autologous) or foreign (allogenic) system
In lymphoma, BMT can produce cures in patients who cannot be cured by any other method. However, because BMT is a major procedure and associated with many side-effects, risks and costs, it is not used in most patients and only in highly selected patients with aggressive, difficult to treat cancer.
What is the cost of lymphoma blood cancer treatment in Delhi?
The cost of treatment of lymphoma varies greatly depending upon the type of blood cancer (which decides the type of treatment needed). Some patients may need no treatment (observation) in which case the cost of treatment is negligible. Other patients may need minimal treatment which is very cheap.
Some patients may need lymphoma chemotherapy. Several different drugs are available for blood cancer treatment. The cost of chemotherapy is guided mostly by the cost of chemotherapy drugs. Many older drugs are very cheap and allow very affordable lymphoma chemotherapy in Delhi. On the other hand, some newer drugs may be more expensive. It is important to remember that more expensive does not always mean better. In many cases, cheaper, older drugs may be as effective as expensive newer drugs. Some therapies like immunotherapy, bone marrow transplantation and brentuximab are significantly more expensive. However, they are needed only in some patients.
An expert opinion can help in designing the most cost-effective and most beneficial chemotherapy regimen. Ultimately, a skilled medical oncologist can help ensure that the best possible treatment is obtained at the most reasonable cost.
Why is it important to consult a lymphoma specialist in Delhi NCR?
Delhi is one of the best cities in India for the treatment of lymphoma. However, the treatment of blood cancers requires significant expertise due to the large variety of lymphomas with different treatments of all of them. Sometimes, no treatment is needed and many patients can simply be observed. At other times, one needs to be very aggressive and even a bone marrow transplant may be needed. Further, improper frontline treatment can lead to a resistant, incurable disease. Recently, there has also been a massive influx of new drugs, genetic tests and personalized therapy. An expert is needed to navigate this complexity.
Dr Vineet Govinda Gupta is a medical oncologist based in Delhi NCR with expertise in the treatment of lymphoma. He has received his entire training from the apex medical institute of the country (AIIMS New Delhi) and been there for more than 12 years. He has received numerous awards including AIIMS Gold Medal for best medical oncologist and published research in cutting-edge journals, including high-quality lymphoma research. He also has significant experience in bone marrow/stem cell transplantation. More information here
I want to learn more about treatment options in lymphoma!
You can access more information using various sections of this website. Some common topics of interest are linked below. For other topics you can use the menu above or the search box. If you cannot find your topic of interest, you can send me a free E-consultation using the form below.
- General Information about cancer
- Other blood cancers (CML, multiple myeloma)
- Lymphoma commonly affects the stomach, however stomach lymphoma is different from stomach cancer
- Information about chemotherapy
- Information about targeted therapy
- Information about immunotherapy
Free E-consultation with a lymphoma specialist in Delhi
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