A closer look at lymphoma

“A few days ago, I was diagnosed with cancer,” announced Maryland Governor Larry Hogan on Monday, beginning the public part of a long road ahead.

Hogan is facing a form of lymphoma which he himself calls “very advanced and very aggressive.”

It’s the kind off sudden news that Dr. Paul Zorsky knows all too well. Dr. Zorsky is a specialist in Hematology and Oncology, who has been with Peninsula Regional Medical Center since January 2009.

“Cancer,” he says, “just kind of imposes itself on one’s life, right, so here we have a new governor, who’s doing well one day, and the next day he’s terribly ill.”

Hogan has late stage III — possibly stage IV — non-Hodgkin’s lymphoma. Within the realm of non-Hodgkin’s lymphoma, a stage IV diagnosis would not be all that rare. Nearly 40% of diagnosed cases are stage IV, according to the Rasch Foundation. And while it can occur in childhood, more than 95% of non-Hodgkin’s cases occur in adults, according to the American Cancer Society.

But to understand any type of lymphoma, first one must try to understand the lymphatic system.

Not localized to one organ, it’s a pathway that exists side by side with the circulatory system, carrying a clear liquid called lymph — full of white blood cells called lymphocytes – helping defend the body against invaders.

Like stops on a railroad line, those lymphocytes concentrate at points called nodes. It’s an amazing defense network, but since it’s made up of cells, it has the same vulnerability all cells have.

“There may be a mistake in the DNA as the cells are replicating, because they’re always dividing and growing, and if the ‘right’ error gets made, those cells become malignant,” Dr. Zorsky explains.

In Hodgkin’s lymphoma, which only accounts for about 1% of all cancer cases, the malignant cells almost always stay within the lymph nodes — as few as 4% of all cases go beyond, according to the Rasch Foundation.

But in the much more common non-Hodgkin’s lymphomas — of which there are dozens of sub-types – it’s more common for the cancer to spread, invading other tissues and organs.

And that brings us to an important distinction. However tempting it might be to say “which is worse” – Dr. Zorsky says that’s an unfair assessment because every patient is different.

“We treat a patient with one malignancy and we give it a name. That doesn’t mean that everyone with that same malignancy has the same prognosis,” he says.

The treatment for both Hodgkins and non-Hodgkins lymphoma is usually chemotherapy, often received over 18 weeks, in three-week cycles. Governor Hogan says he will have that treatment course.

Dr. Zorsky says it’s hard, but doable, and even though he’s not the Governor’s doctor, he’s encountered similar cases.

“For that kind of aggressive lymphoma, the cure rate, with first line of treatment, is probably in the range of 70%. So he has a very good chance of going through the treatment and doing very well,” says Dr. Zorsky.

But treatment is about more than medicine. It’s about support.

Lisa Barnes is a clinical social worker who coordinates local cancer support groups.

“It’s vital,” she says of such groups, “When a person is diagnosed with cancer, they are very scared. And so are their family [members], and there’s an emotional toll as well as a physical toll.”

As a state leader and public figure, Governor Hogan faces unique challenges in his recovery. But as stressful as his job is, Dr. Zorsky says trying to follow his old routine as reasonably as possible, is a healthy decision, as “removing [a patient] from everything they know, is just another stressor.”

And Hogan says he will continue working. So perhaps beating cancer is one more challenge on the agenda.

[For more information on local cancer support groups, head to http://www.peninsula.org/CancerSupportServices]

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