Tag Archive for: lymphoma
Are gastric cancer and stomach cancer one and the same? Expert Dr. Matthew Strickland defines gastric cancer and provides an overview of subtypes.
Dr. Matthew Strickland is a medical oncologist at Massachusetts General Hospital. Learn more about Dr. Strickland.
I’d like to start with a basic definition. What is gastric cancer? Is it the same as stomach cancer?
Dr. Matthew Strickland:
So, I think that’s a great question. I think for most of us from the patient perspective, just the word “cancer” is very scary. It can instantly stimulate a variety of emotions that all hit at once. So, I’d be happy to try to break that down. At the fundamental level, a cancer cell is a cell that originated as a healthy, normal cell in the body. Then, due to acquired genetic mutations or other aberrations have decided to stop playing by the rules and start growing out of control.
So, if this happens in the stomach, which, of course, is an anatomic location, that could be considered a stomach cancer. But beyond that, there can be different subtypes. I would say the most common type is what we call adenocarcinoma.
This is the aggressive kind. This is what I see most of the time and treat. But there are other types of tumors that could originate in the stomach such as a neuroendocrine tumor or perhaps even a lymphoma. Sometimes, we see tumors that are called gastrointestinal stromal tumors. So, I just want to make the point that there are a variety of different cancers that can originate in the stomach. But most of the time, folks are thinking of adenocarcinoma.
Then, to also answer your question specifically, gastric cancer and stomach, they’re probably interchangeable terms. But, of course, it’s important to determine the subtype.
Dear Fellow Cancer Patient,
As I believe in universal love for ALL, I’m reaching out to you, whether we have met or not, to invite you to join me in embracing the concept of medical miracles no matter what kind of cancer you have.
I do so because in January 2023 I experienced my third medical miracle since being diagnosed with Waldenström macroglobulinemia (WM) in August 2012, an extremely rare and currently incurable lymphoma.
The mission of Patient Empowerment Network (PEN) to support and educate patients with all cancers has an exceptional impact. It is an honor to cooperate with PEN, and my dream is to bring you hope through my own medical successes through the past 10 years. (*Please see footnote for a brief history of my story.)
It is my tremendous good fortune to be in the constant care of my world-renowned WM specialists/hematologists at the Bing Center for Waldenström’s Macroglobulinemia, Dana-Farber Cancer Institute/Harvard Medical School in Boston, Mass. since March 2013. Also, my oncologist at Virginia Cancer Specialists who has extremely high credentials in hematological malignancies, diagnosed me in 2012, and treated me immediately with what was then the flagship chemotherapy for WM.
In September 2022, I experienced the most aggressive outbreak ever of my Waldenström. A lymph node was so enlarged, I discovered it myself. One week later, my feet were unbelievably swollen, which I discovered when I couldn’t put my shoes on. I immediately reached out to the Bing Center’s Director, Dr. Steven Treon. Within the same hour, he called my Virginia oncologist and recommended a PET scan and biopsy for me. The next morning at 10 am, less than 24 hours later, I was examined in Virginia by my oncologist, and he ordered both tests on the spot.
The results were extremely concerning and put fear in my heart again as is the case with any cancer diagnosis. Enlarged lymph nodes were very widespread throughout my body, and there was increased activity in my entire bone marrow throughout my skeleton from head to toe.
My two Bing Center for WM doctors’ recommendation of Benda-R [bendamustine (Treanda) and rituximab (Rituxan)], for chemotherapy was agreed to by all upon consultation with my Virginia oncologist.
For three months, I couldn’t walk outside of my house and only went to medical appointments with my oncologist every week and chemotherapy treatments for two days each month. Tony, my husband, had to drive me there and take me by wheelchair down the hall to his office. I was also very frail due to losing 15 pounds, making my weight 90 pounds.
During this very challenging time, my brother Mike, a two-time survivor of non-Hodgkin lymphoma (NHL), supported me constantly and even called me from Egypt and Panama on his cruises there, as he understands too well how trying it is to be back in treatment for cancer. My dear friends also offered wonderful daily encouragement with special contact to lift my spirits.
After three months of chemotherapy, my follow-up PET scan in January 2023, showed “complete interval resolution of the abnormal marrow and nodal activity evident on the previous study.” Although I’m not an expert, the comparison of the images of my body between September and January was remarkable. In the Bing Center for Waldenström’s clinical review of its patients led by my doctors and joined by their colleagues from three Harvard hospitals in Boston, my PET scan results were examined, and one more round of chemotherapy was unanimously recommended to complete my treatment.
My third medical miracle has arrived! According to Dr. Steven Treon, Director of the Bing Center for Waldenström’s Macroglobulinemia in Boston, “From all evidence so far, it appears you may be in complete remission!” My deepest gratitude to him, Dr. Jorge Castillo, Clinical Director of the Bing Center, and my Virginia oncologist for their cooperative spirit with each other on my behalf and extraordinary attention in providing life-saving treatment to me is beyond words. In July 2023, a bone marrow biopsy and CT scans at the Bing Center for WM in Boston are planned to confirm my response.
Yet, again, I am celebrating the gift of life with Tony who has been a saint to me through countless years of ups and downs with experiences as a WM patient. He has been by my side and done absolutely everything possible to love and support me endlessly. For care partners, be sure to get the support you deserve for yourself, as cancer in your world is very challenging for you too.
Amazingly, although I couldn’t swim for seven months, I exceeded my own goal and swam for 40 minutes during my first time back at a pool in my fight to regain strength and normalcy. And I can now walk for 15 minutes outside every day, too, as my swollen feet have resolved. Tony even took me to a favorite place for my March 2023 birthday, the first time we’ve gone to a restaurant since August 2022.
As I mentioned earlier, in sharing my medical miracles with you, my dream is to give you hope for your own cancer treatments – and success. I encourage you to stay in contact with family and friends, be a proactive advocate for yourself, read PEN’s news and that of other relevant cancer support organizations, follow your own status, and reach out to your oncologist immediately with concerns or new symptoms, see a specialist for your specific cancer if possible or have your oncologist consult with one. Stay hopeful and realize that profoundly sophisticated advancements in medical research and science are progressing at a phenomenal pace for all cancers and continue forward with unwavering commitment by medical experts across the globe. I have benefited from this greatly in my own experiences in the past 10 years and may this be truly inspiring for you too!
Wishing you all the best in every way!
Sincerely, Lu Kleppinger
* Brief history…In August of 2012, being highly symptomatic, I was diagnosed with Waldenström macroglobulinemia (WM), One week later, I started chemotherapy provided by my Virginia oncologist. In March 2013, I became a patient of Dr. Steven Treon, Director of the Bing Center for WM/DFCI/Harvard Medical School in Boston and he extended my chemotherapy for an extra year. After 18 months and 50 infusions, it was an extraordinary success and gave me five years of being under control without treatment. In 2014, my hematologist, Dr. Jorge Castillo, Clinical Director at the Bing Center, said “You are doing really, really, great! Go live and have fun!” I did just that.
In 2019, my WM flared up a second time, and Dr. Castillo placed me on ibrutinib (Imbruvica), a daily pill for life. The results were incredible within a month, and my WM was under control yet again. I lived a normal life for three years, feeling cancer-free.
What happens in early MGUS, or monoclonal gammopathy of undetermined significance? Watch as expert Dr. Irene Ghobrial explains MGUS and how often it progresses, and patient and Empowerment Lead Lisa Hatfield shares her advice and information about ongoing research studies on MGUS.
Dr. Irene Ghobrial:
So MGUS, or monoclonal gammopathy of undetermined significance, is a precursor or the stage before myeloma happens, and it’s actually a very common disease or entity in many, many of us as we get older. In fact, maybe 5 percent of the population over the age of 50 would have this early MGUS.”
The condition of MGUS does not usually impact a person’s health or result in any symptoms. MGUS is most often found on a routine blood test that notes a high level of protein in the blood, and additional tests show the protein is a monoclonal antibody.
Though MGUS is not a cancer, it is sometimes classified pre-malignant since some patients with MGUS eventually develop cancers such as lymphoma, multiple myeloma, or amyloidosis.
So MGUS, or monoclonal gammopathy of undetermined significance, is the precursor to typically smoldering myeloma and then to multiple myeloma. Not all MGUS is going to progress to multiple myeloma. In fact, it usually does not. Also important to have a hematologist on board if you are diagnosed with MGUS. There is a study being done right now in Iceland called the iStopMM Study or the Black Swan Study where they are looking at every resident over a certain age to detect how many people in the general population have MGUS. And they follow them over time longitudinally to see how many of those patients who have MGUS will progress to smoldering myeloma and then onto multiple myeloma.
So it’s really interesting. I guess what I would say about MGUS if you’re diagnosed with MGUS, not to panic. You have a lot of time to think about it, to have a hematologist follow you. And typically MGUS, as far as I know, is not treated. It is just monitored to see if it will progress onto smoldering myeloma and then onto multiple myeloma.
Editor’s Note: This resource, Lymphoma Rashes: Symptoms and Treatments, was originally published by MyHealthTeam.
When most people think of lymphoma symptoms, a rash isn’t usually something that comes to mind. For some types of lymphoma rashes aren’t an issue, but rashes are a symptom in several different lymphomas.
Cutaneous T-cell and B-cell lymphomas often manifest as a rash in their early stages. “When I first was diagnosed with cancer, I had a rash all over my abdominal area,” one MyLymphomaTeam member said. These conditions are a subset of non-Hodgkin lymphoma and are commonly slow growing. Many people with cutaneous lymphomas go years without a correct diagnosis. Unlike many other types of lymphomas, the lymph nodes are rarely affected until late into the condition and are not raised or swollen. Cutaneous T-cell lymphomas make up around 75 percent to 80 percent of all cutaneous lymphomas.
What Does a Lymphoma Rash Feel Like?
Lymphoma rashes can be localized or occur all over the body (also referred to as erythroderma). A cutaneous T-cell lymphoma called mycosis fungoides is responsible for around half of all skin lymphomas. In its early stages, mycosis fungoides is sometimes mistaken for psoriasis or eczema. “I was itching very bad from my neck to my feet. I went to nine different doctors [and] they all misdiagnosed me,” one member reported.
Lymphoma rashes are also called lesions. They are divided into three categories: patches, plaques, and tumors. Patches are flat, smooth, or scaly to the touch and look like a typical rash. Plaques are harder, thicker, and scaly to the touch. Tumors are raised bumps or nodules.
Erythrodermic (full-body) rashes are sometimes caused by Sezary syndrome, which makes up 15 percent of cutaneous lymphomas. The rash can feel hot, sore, and itchy. It is usually much more aggressive than mycosis fungoides. Cancerous lymphocytes are present in the blood in Sezary syndrome, but not with mycosis fungoides.
How Does a Rash Affect People With Lymphoma?
Members of MyLymphomaTeam described a variety of ways rashes have affected their lives. “This rash and itching is getting so frustrating. I can’t sleep well,” one MyLymphomaTeam member said. Another mentioned the difficulty a family member had with a rash. “I am always searching for information and ways to ease his pain and itching.” A third member who was reportedly in remission mentioned frustration with a possible recurrence. “I’m so irritated; I have new spots and went to a dermatologist and they tried to tell me that it’s eczema.”
What Causes a Lymphoma Rash?
Cutaneous lymphoma forms in the small number of lymphocytes that are present in the skin. A rash occurs when those lymphocytes mutate, become cancer cells, and grow uncontrollably. It is not considered a skin cancer because the initial source of cancer cells come from the lymphocytes instead of the skin cells themselves.
Skin Treatments for Lymphoma Rashes
Treatment options depend on what type of lymphoma is causing the rash. Most types of cutaneous lymphoma are slow progressing, and some cases never progress past the skin. Because of this, the American Cancer Society’s recommended treatments first target the skin. There are several different types of skin-directed therapies.
Topical corticosteroids are the first line of treatment, like with many other skin conditions. The anti-inflammatory agents in them also kill lymphoma cells. They can be creams or ointments applied directly to the skin or injections given directly into affected areas. In addition to treating the rash, topical corticosteroids can decrease itching. Side effects can include skin thinning and hair growth. When used over a long period of time, they can affect the adrenal glands.
Topical chemotherapy agents are usually given along with corticosteroids. Mechlorethamine is the most commonly used, and it works by blocking DNA replication in cancer cells. It is applied as a gel to the affected area. When used as a topical solution, it is not known to enter the blood. About 10 percent of those who are treated with Mechlorethamine develop contact dermatitis, a localized allergic reaction.
Another drug, Carmustine, is occasionally used as a supplement to Mechlorethamine. Unlike Mechlorethamine, it can be absorbed into the blood. Monitoring by a dermatologist is needed at higher doses.
One commonly used drug is Imiquimod. When it is applied to the skin, it has been shown to clear cutaneous lymphoma lesions.
Retinoids are synthetic vitamin A medications that can cause certain types of cells to die. Retinoids are usually used when topical corticosteroids and chemotherapy agents are not effective. Since they can cause birth defects, women using the drug should not become pregnant.
Phototherapy uses two types of UV light (A and B) to destroy cancer cells. If UVA light is used in treatment, Psoralen drugs are used in conjunction with it. Psoralens make the skin more sensitive to UV light. UVB does not require any drug administration before treatment, but it is used on thinner lesions only. “I am getting UVB light therapy every Wednesday, but every time I get it, more rashes come out,” a MyLymphomaTeam member said.
Two different types of radiation therapy are commonly used. Total skin electron beam (TSEB) therapy penetrates only a few layers of skin and does not have the severe effects of more invasive radiotherapy. Brachytherapy places radioactive isotopes under the skin for a period of time.
Systemic Treatments for Lymphoma Rashes
If Sezary syndrome is present, skin-based treatments are not used because the condition also affects the blood. Instead, systemic treatments target the whole body. Many of these treatments are similar to skin-based ones.
Interferons are cytokine compounds normally produced by cells as a response to disease. Interferons are typically injected three times a week for three to six months.
These are taken as an oral medication and not applied to the skin, but they work the same way as topical ones.
Histone Deacetylase (HDAC) Inhibitors
Histone deacetylase inhibitors work by targeting cells’ DNA in a way that allows cancer cells to die. The most commonly used drugs are vorinostat (Zolinza) and romidepsin (Istodax). Both are given intravenously. One MyLymphomaTeam member described a family member’s treatment with romidepsin, “She went for her initial treatment last Thursday and it seems to be working. Her itching has subsided significantly. Very slight side effects.”
Extracorporeal photopheresis takes white blood cells out of a sample of a person’s blood, exposes them to UV light, and puts them back into the bloodstream. The treated cells then act against the cancerous ones.
The most commonly used biologics to treat cutaneous T-cell lymphoma are monoclonal antibodies, which are developed to recognize specific types of cancer cells. Brentuximab vedotin (Adcetris) has been used to treat advanced cutaneous T-cell lymphoma. It works by targeting an antigen found on cancerous T cells.
While often used in combination to treat other cancers, chemotherapy agents are often used as “single agents” — one at a time — to treat cutaneous T-cell lymphoma.
Stem Cell Transplant
The only known cure for cutaneous lymphoma is a bone marrow transplant, also known as a stem cell transplant. Since this is a risky procedure, it is typically only done when the condition is very advanced or has come back repeatedly after other treatments.
MyLymphomaTeam Members’ Tips for a Lymphoma Rash
MyLymphomaTeam members have shared a variety of ways of dealing with rash. “You need treatment and creams to deal with the overwhelming itching,” one advised.
Specific topical treatments were mentioned by others:
- “Use a good skin cream, a steroid cream of 0.05 percent.”
- “I use a script from my dermatologist: 0.05 steroid cream, and every day I also use a good skin cream.”
- “Using aloe vera now helps with inflammation and itching.”
- “Try cannabis oil or cream.”
- “My doctors at UC Davis in Sacramento and University of California, Sacramento, gave me a prescription of triamcinolone acetonide ointment USP, 0.1 percent. … This medicine took care of the rash.”
Nutritional measures helped ease the rash symptoms for one member. “I juice at times. (I mix carrots, celery, kale/spinach, apple, orange and lemon juices, mixed with berries like blueberries, raspberries, and strawberries; and add some ginger and turmeric). I walk daily (get out in the fresh air) and use an elliptical and weight machines.”
Find Your Team
You are not alone. When you join MyLymphomaTeam, you gain a support network of more than 12,000 people who understand what you’re going through.
Have any questions about rash and lymphoma? Do you have any tips for dealing with a rash? Comment below or start a conversation on MyLymphomaTeam.
Diffuse large B-cell lymphoma (DLBCL) treatment options may map differently depending on various patient factors. In the “Which Factors Impact DLBCL Treatment Decisions?” program, expert Dr. Justin Kline from University of Chicago Medicine explains key patient factors that effect DLBCL treatment decisions.
1. DLBCL Stage
The stage of diffuse large B-cell lymphoma (DLBCL) is a key factor in treatment decisions. Early stage DLBCL usually has more treatment options for patients. While later stage DLBCL – and other cancers – normally have fewer options since patients in later stages may have failed to show success with some previous treatments. Of course, other patient factors will impact the number of treatment options for each stage.
2. Patient Age
DLBCL specialists will take age into account in treatment options. However, a patient’s age does not necessarily rule out an aggressive treatment option. Full dose therapy may still be prescribed for elderly patients even in their 80s when curing DLBCL is the overriding goal of treatment.
3. Health Issues
DLBCL treatment options must also take into account other health issues of the patient. Considerations like heart health, kidney health, physical fitness, and medical problems like diabetes and high blood pressure must be considered. In addition, the patient’s DLBCL symptoms must be weighed in the analysis for treatment decisions.
4. Quality of Life
The quality of life of a specific DLBCL patient must also be evaluated in treatment decisions. Quality of life is examined in two different situations. One situation involves treatment side effects. Treatment side effects can vary by treatment and commonly include issues like fatigue, nausea, vomiting, constipation, hair loss, mouth sores, and immune suppression among others. The second way that quality of life can come into play is for elderly patients or those who have many health issues. In these cases, a more gentle, palliative approach may be taken to maintain a better quality of life rather than a very aggressive approach that would be very difficult on the patient.
DLBCL treatment decisions take several factors under consideration for optimal patient care. If you’d like to learn more about DLBCL care and treatment, check out our DLBCL information.