Care pathway for lymphoma

Lymphoma, or lymphatic cancer, can cause a variety of symptoms, depending on its type and location.

The most common symptom of lymphoma is a painless lump – an enlarged lymph node – on the neck, in the armpit or in the groin. Lymphoma can also cause generic symptoms such as fever, fatigue, unexplained weight loss, perspiration or itching.

If lymphoma is suspected, a clinical examination will be performed, specifically by palpating lymph node locations. In unclear cases, ultrasound will also be used.

You will be referred to the HUS specialty in which the diagnostic samples are to be taken. Patients with enlarged lymph nodes in the neck area are referred to the Ear, Nose and Throat Diseases Outpatient Clinic. Patients with enlarged lymph nodes in the armpit or groin are referred to the Surgery Outpatient Clinic. If lymphoma is suspected because of an enlarged mediastinum (the space delimited by the lungs, heart and major blood vessels), you may be referred to the Pulmonary Outpatient Clinic.

Some lymphomas grow rapidly and require urgent or even emergency referrals, diagnosis and treatment start. Diagnostics is of critical importance for your prognosis and treatment planning. A biopsy taken for confirming a suspected lymphoma must be sufficiently large, principally an entire lymph node. Fine needle aspiration is not sufficient for diagnosis.

Once lymphoma is confirmed as the diagnosis, the oncologist handling your referral will refer you to spread examinations (CT and PET scans) and blood tests, after which we will review your case at a multiprofessional lymphoma meeting. This meeting will include a radiologist, a nuclear radiologist and a pathologist in addition to the oncologist. The purpose of this meeting is to confirm the specific subtype of lymphoma and how widespread it is, and this will lead to a recommendation for your further treatment. After the meeting, you will receive an invitation to see the oncologist.

The most common subtype of lymphoma is diffuse large B-cell lymphoma. Other subtypes include follicular lymphoma, mantle cell lymphoma, marginal zone lymphoma, peripheral T-cell lymphoma and Hodgkin’s lymphoma. 

Based on your diagnosis, we will consider whether other examinations are needed, such as bone marrow and cerebrospinal fluid samples, heart and lung functional tests and other more specific laboratory tests. Sometimes a previously taken tissue sample will prove insufficient in view of the diagnosis, in which case you will be referred to a new sampling.

With young patients, we take fertility preservation measures before beginning treatment. Female patients will be referred to a gynecologist for fertility counseling prior to treatment. Semen collection is recommended for male patients.  

We will review the examination results with you at your appointment, discussing their significance, your treatment prospects and the risks and benefits associated with the treatments. In treatment discussions, we always consider your opinion and draw up the treatment plan with you. After the physician’s appointment, a nurse will review your treatments and their timetable in more detail.

During appointments, the nurse and physician work as a team. You will meet the nurse during your first appointment and, if necessary, you may be referred to guidance or counseling with the nurse also during your other visits.

Lymphoma is treated with chemotherapy, biological medications and radiation therapy.

Fast growing lymphomas are at the highest risk of recurrence in the first two years. Slow growing lymphomas present a lifelong risk of recurrence.

The purpose of post-treatment monitoring is to discover any recurrences requiring treatment as early as possible, to note any harmful side effects that the treatment may have and to provide you with appropriate rehabilitation.

We will plan your monitoring timetable on an individual basis, depending on the type of lymphoma you had and the treatments you were given. Monitoring will be carried out at the Comprehensive Cancer Center.

You will initially have an appointment with a physician every 4 to 6 months. Some of these check-up appointments may be done by phone, or you may see a nurse instead. Monitoring will continue for 3 to 5 years, depending on the type of lymphoma.

Palliative care means shifting the focus of care from stopping the progress of the lymphoma to managing its symptoms. Typically, at this stage, your care responsibility is transferred to the Palliative Care Center or the hospital-at-home unit in your area. The move to palliative care is not a sign of giving up; rather it is the best possible care for a terminally ill person. It does not rule out any other treatments or therapies that you could still benefit from. A person can remain in the palliative care phase for several months, sometimes even for a few years.

At the Palliative Care Center, we will draw up a comprehensive palliative or hospice care plan together with you and your family. At your appointment, we assess the need for symptom relief and psychosocial support, the support measures required by patients in home care, the patient’s wishes and expectations, and family members’ ability to cope and need for support.

The duration of monitoring for lymphoma is planned individually based on your disease situation and the cancer treatments provided. At the end of monitoring period, your case will be transferred from specialized medical care to primary healthcare.

Healthy lifestyles can reduce the risk of later side effects from lymphoma treatments. We recommend lifestyle monitoring in primary healthcare, and the measurement and monitoring of blood pressure, fat values and long-term sugar annually.

If you have received breast radiotherapy at the age of less than 30, a mammography or annual breast MRI will be initiated after 8 to 10 years of your treatment or after your 25th birthday.

If your thyroid was within the radiotherapy area, it is recommended to monitor the thyroid values after two years of treatment, during the follow-up visits in specialist medical care every 1 to 2 years, and then as needed.