The treatment of lymphoma is often complex and requires the input of a number of specialists including expert pathologists, radiologists, nuclear medicine physicians and clinicians. Optimal management involves close coordination of these specialists working together in a multi-disciplinary team. There have been recent significant advances in the diagnosis, staging and treatment of lymphoma which has resulted in better treatment outcomes.
This article is written by Dr Nick Maisey (MRCP, MD), consultant Medical Oncologist and Dr Paul Fields (FRCP, MRCPath, PhD), consultant Haemato-oncologist both based at the London Bridge Hospital, 27 Tooley Street, London SE1 2PR.
Lymphoma is not a single disease. There are many different ‘sub-types’ of lymphoma that can behave in very different ways and so may need different treatments. Some lymphomas are highly curable, and some run a slow indolent course. In order to best tailor an individual treatment approach, an accurate diagnosis is essential. Improvements in laboratory techniques (such as immunohistochemistry, cytogenetics, polymerase chain reaction (PCR) and micro-array technology) can now give us a much more accurate diagnosis. A further benefit of these improved techniques is the identification of potential molecular therapeutic characteristics that can help the development of new ‘targetted’ treatments.
An accurate assessment of the spread of lymphoma (or stage) is of paramount importance in planning any potential therapies. Disease that is limited to one or two parts of the body may allow a radical (or curative) approach with radiotherapy whereas the identification of wide-spread disease might mean that prolonged chemotherapy is needed. Scanning techniques (or imaging) such as computerised tomography (CT) or magnetic resonance imaging (MRI) have improved considerably and continue to do so. Not only does accurate imaging inform initial staging assessment but also allows careful assessment of the response to treatment. The introduction of Positron Emission Tomography (PET, Fig 1) has been a huge advance in the imaging of lymphoma. PET is a ‘functional imaging technique’ that is highly sensitive in detecting active lymphoma. It plays a number of important roles, from initial staging, early response assessment and the examination of scar tissue commonly left after treatment.