Lymphoma Treatment in Raipur

Lymphoma often develops gradually, and its early symptoms can be easy to overlook or mistake for less serious conditions. A swollen lymph node that does not go away, persistent fatigue, unexplained drenching night sweats, or unexplained weight loss are some of the most common warning signs. These are the quiet, easily misattributed symptoms that bring most lymphoma patients to a doctor often months after they first noticed something was wrong.

Lymphoma is a cancer of the lymphatic system, which is the network of lymph nodes, vessels, and organs forming a critical part of immune defence. It is one of the most common blood cancers globally and one of the most successfully treated. Hodgkin lymphoma achieves long-term remission in the majority of patients. Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma and is cured in the majority of cases with combination chemotherapy. Even follicular lymphoma, historically considered incurable, now achieves sustained remissions lasting many years with modern treatment.

What is Lymphoma?

Lymphoma is a malignancy of lymphocytes - the white blood cells at the core of adaptive immunity. When a lymphocyte undergoes malignant transformation, the resulting cell continues to proliferate and accumulate in lymph nodes, the spleen, bone marrow, and other lymphoid tissues rather than completing its normal cycle and dying.

Lymphoma is distinct from leukaemia in forming masses within lymphoid tissues rather than circulating in the blood. Many lymphomas are highly chemosensitive - chemotherapy achieving complete remission across the body simultaneously rather than requiring surgery or organ-specific radiation.

Types of Lymphoma

Lymphoma is divided into the following main categories based on the type of abnormal lymphocytes and their features:

• Hodgkin Lymphoma (HL): Characterised by Reed-Sternberg cells. Bimodal age distribution (15 to 35, then over 55). Curable in the majority with ABVD chemotherapy; PET CT at interim and end of treatment is the international standard for response assessment
• Non-Hodgkin Lymphoma (NHL): Characterised by a diverse group of lymphomas that develop from B cells, T cells or natural killer (NK) cells. It can be slow growing or fast-growing (aggressive).
• Diffuse Large B-Cell Lymphoma (DLBCL): The most common aggressive lymphoma. Treated with R-CHOP for six to eight cycles with a good cure rate with first-line treatment. Relapsed disease managed with salvage chemotherapy, autologous transplant, or CAR-T cell therapy
• Follicular Lymphoma: The most common indolent B-cell lymphoma that rarely cured but follows a chronic course with sustained remissions. Watchful waiting initially in asymptomatic patients and R-CHOP or R-bendamustine when treatment is indicated
• Marginal Zone Lymphoma: Indolent B-cell lymphomas including gastric MALT and splenic and nodal subtypes managed with monoclonal antibody target therapy.

Symptoms of Lymphoma

Lymphoma may not cause noticeable symptoms in its early stages. As the disease progresses, symptoms develop depending on the affected lymph nodes and organs:

• Painless lymph node swelling is the most common presentation. Enlarged nodes in the neck, armpits, or groin persisting more than two to four weeks without an infective explanation
• B symptoms including unexplained fever above 38°C, drenching night sweats and unintentional weight loss of more than 10% over six months. These define stage B disease and carry prognostic significance in Hodgkin lymphoma
• Persistent fatigue and weakness beyond what normal activity or sleep deprivation would explain
• Chest tightness, cough or breathlessness from mediastinal lymph node enlargement
• Abdominal fullness or discomfort from enlarged para-aortic nodes or splenic involvement
• Itching without rash is a recognised symptom of Hodgkin lymphoma.

Risk Factors of Lymphoma

Certain factors can increase the risk of lymphoma although having them does not mean that you will develop lymphoma. These are:

• Advancing age: Most lymphomas increase with age, though Hodgkin lymphoma peaks in young adults
• Immunosuppression: HIV infection, organ transplantation, long term corticosteroid or immunosuppressive therapy
• Infectious triggers: EBV (Hodgkin lymphoma, Burkitt lymphoma), H. pylori (gastric MALT) & Hepatitis C (marginal zone lymphoma)
• Autoimmune disease: Sjogren's syndrome, Hashimoto's thyroiditis, coeliac disease.

Complications of Lymphoma

If lymphoma is not treated or becomes advanced, it can spread to different parts of the body and lead to serious health complications:

• Lymphoma can spread to other organs, including the bone marrow, liver, spleen, lungs, brain, or other organs
• Increased risk of recurrent or severe infections
• Blood clots
• Anaemia and destruction of other blood cells (when lymphoma involves bone marrow)
• Tumour lysis syndrome: Rapid breakdown of cancer cells during treatment can lead to metabolic complications
• SVC syndrome: Mediastinal lymphoma compressing the superior vena cava causing facial swelling, arm oedema and respiratory distress.

Diagnosis of Lymphoma

The doctor checks for swollen lymph nodes, enlarged liver or spleen and reviews your symptoms. They order some investigations to confirm the diagnosis. They are:

• Lymph node biopsy: Excisional biopsy for histopathology, immunohistochemistry, flow cytometry, and molecular studies. 
• PET CT staging: The gold-standard staging tool for Hodgkin lymphoma and aggressive B-cell lymphomas. The uMI 550's 2.76mm resolution, Time-of-Flight imaging, and 11 cps/kBq sensitivity detect FDG-avid lymphomatous deposits throughout the body. 
• Immunohistochemistry and flow cytometry: Determine B or T cell lineage, identify CD20 and CD30 for treatment eligibility and classify the specific lymphoma subtype
• Ann Arbor staging: 
  • Stage I: single-node region
  • Stage II: two or more regions on the same side of diaphragm
  • Stage III: both sides
  • Stage IV: extranodal organ involvement. 

A/B suffix indicates absence or presence of B symptoms

Treatment of Lymphoma

Lymphoma treatment is tailored according to the type, stage, growth rate and the patient's overall health with the goal of achieving long-term remission or cure:

• ABVD for Hodgkin lymphoma: Standard first line regimen across all stages. An interim PET-CT after two cycles guides risk-adapted treatment
• R-CHOP for DLBCL: Six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine & prednisolone is the standard first line treatment. End-of-treatment PET CT on the uMI 550 confirms remission and complete metabolic response predicts long-term disease-free survival
• Monoclonal antibody therapy: Medicines are selected based on the type of lymphoma. 
• Checkpoint immunotherapy: They are approved for relapsed or refractory Hodgkin lymphoma and are active in primary mediastinal B-cell lymphoma and PD-L1-positive DLBCL
• CAR-T cell therapy: Approved for relapsed or refractory DLBCL and follicular lymphoma at specialist centres. Patients at Ramkrishna CARE Hospitals are evaluated for CAR-T eligibility and coordinated to a CAR-T centre
• Autologous stem cell transplantation: Standard salvage approach for chemosensitive relapsed Hodgkin lymphoma and DLBCL - high-dose chemotherapy followed by rescue with the patient's own previously harvested stem cells
• Radiation therapy: Involved-site radiation therapy (ISRT) as consolidation for selected Hodgkin lymphoma and localised lymphomas and delivered on the Elekta Versa HD with IMRT precision protecting the heart, lungs, and thyroid
• Watchful waiting: For asymptomatic early-stage indolent follicular lymphoma with low tumour burden.

When Should You See a Doctor

Lymphoma is most effectively treated when diagnosed before it has progressed to an advanced stage or caused significant organ compromise. Seek prompt specialist assessment if you have:

• Lymph nodes enlarged for more than four weeks without an infective explanation
• Unexplained fever lasting more than two weeks, particularly with night sweats
• Unintentional weight loss of more than 5% over a few months.

Side Effects of Lymphoma Treatment

Most lymphoma treatments are effective, but they can also cause side effects. They are:

• Myelosuppression: Neutropenia, anaemia, and thrombocytopenia from bone marrow suppression 
• Nausea and vomiting: Substantially controlled with modern antiemetic regimens
• Hair loss: Expected with ABVD and CHOP-based regimens 
• Infection risk: Chemotherapy and immunosuppression therapy can affect immunity
• Cardiac toxicity: Doxorubicin carries dose-dependent cardiac risk 
• Pulmonary toxicity: Bleomycin in ABVD can cause pulmonary fibrosis. Lung function is monitored during treatment
• Radiation side effects: Mediastinal radiation can cause hypothyroidism and cardiac effects as late complications. However, the Elekta Versa HD's IMRT with IGRT-verified positioning minimises dose to adjacent organs.

Why Choose Ramkrishna CARE Hospitals for Lymphoma Treatment in Raipur?

At Ramkrishna CARE Hospitals, patients with lymphoma receive comprehensive care through advanced diagnostics, tailored treatment plans, and a multidisciplinary team:

• Haematological oncology specialists: Lymphoma treatment led by haematological malignancy specialists who provide accurate subtype classification and response-adapted regimen selection 
• Advanced PET CT: The international standard for lymphoma staging and response assessment. The uMI 550's 2.76mm resolution, Time-of-Flight imaging, and 11 cps/kBq sensitivity provide the diagnostic performance required for Deauville scoring and the interim response-adapted decisions that determine therapy intensity and duration
• Immunohistochemistry and molecular diagnostics: CD20, CD30, BCL2, BCL6, MYC immunohistochemistry and FISH are all available in our hospital. Determines targeted therapy eligibility and guides prognostic stratification
• Multidisciplinary lymphoma tumour board: Every case reviewed by haematological oncologists, radiation oncologists, radiologists and pathologists before treatment is planned
• Radiation therapy through Elekta Versa HD: ISRT delivered on the Elekta Versa HD with IMRT capability - 1,024 dynamic control points per arc and HexaPOD positioning protect the heart, lungs and thyroid while treating involved nodal regions
• CAR-T and transplant coordination: Candidates identified early; stem cell collection initiated and coordination with specialist for transplant or CAR-T therapy.

Conclusion

Lymphoma encompasses malignancies from highly aggressive tumours requiring urgent treatment to indolent diseases managed over decades. Outcomes have improved dramatically due to targeted therapy and immunological agents added to chemotherapy, PET CT as the standard for staging and response, and CAR-T cell therapy for relapsed disease.

At Ramkrishna CARE Hospitals, Raipur, the lymphoma programme integrates specialist haematological oncology, uMI 550 PET CT for staging and response assessment, molecular diagnostics, multidisciplinary tumour board review, radiation therapy on the Elekta Versa HD, and transplant and CAR-T coordination all within a single programme. This level of care is available in Raipur for patients across Chhattisgarh.