[Music Playing] >>Lori Banks: Just ahead on this addition of Being Well on Colleges Abdur Shakir from Sarah Lincoln Regional Cancer Center will be here to talk to us about lymphoma.

We'll learn more about the 2 primary types, Hodgkin s and non- Hodgkin s, and how they are diagnosed.

Dr. Shakir will run down the list of symptoms and will tell us what someone should do if they think they may be at risk.

That's all coming up next on this edition of Being Well, so don't go away.

[Music Playing] >>Female Speaker: Production of Being Well is made possible in part by Sarah Bush Lincoln Health System.

Supporting healthy life styles, eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health Systems.

Information available at sarahbush.org.

Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online or at 347-2255.

>>Chorus: Rediscover Paris.

>>Female Speaker: Our patient care and investments in medical technology show our on going commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

>>Lori Banks: Welcome back to being well and a familiar face to the show has returned, Dr. Abdur Shakir from Sarah Bush Lincoln.

Our favorite oncologist has come back to talk about lymphoma.

Thank you for joining us.

>>Dr.

Abdur Shakir: Thank you for having me.

>>Lori Banks: We haven't seen you in awhile.

So we actually changed sets since the last time he was here.

But enjoy having you come on because you do a great job of explaining these complicated things in ways that we can all understand.

So we've chosen lymphoma today and it deals with the lymphatic system, which I think you need to set that up because it's kind of a complicated thing for people to understand.

>>Dr.

Abdur Shakir: Sure.

So, the lymphatic system is part of a larger system called the circulatory system, very similar to arteries and veins.

This lymphatic system is a network of vessels that traverse throughout the whole body.

Very similar to a complex highway system.

The lymphatic system contains fluid call lymph.

Arteries contain fluid called blood.

The lymphatic system contains this lymph.

Lymph comes from the Latin word meaning water.

So one of the functions of the lymphatic system is to regulate our water balance in the body.

And the second part of the lymphatic system is that this lymph contains something called lymphocytes.

Lymphocytes are a type of white blood cell made that's in the bone marrow factory, along with other blood cells.

Red blood cells, and platelets.

These lymphocytes travel throughout the lymph glands in the lymphatic system and go and congregate lymph nodes.

So lymph nodes are intervals throughout this lymphatic system.

Kind of like a rest area in the highway system.

So people think of lymph nodes like in the neck, under the armpits, in the groin, but the spleen is a lymph node, the thymus gland is a lymph node, the tonsils are lymph nodes, they're all lymph nodes in our body.

The lymphocytes play a vital role in fighting off infections; viruses, bacteria, and funguses.

So the second main function of the lymphatic system is to act kind of like the secretary of defense.

When infection happens these lymphocytes and lymph nodes act.

Now, when a person has a tumor of lymphocyte, a tumor of the lymphatic system, a tumor of the lymph node, we use a term "lymph-oma".

>>Lori Banks: Ok.

So, I know from looking at it, the research, there are 2 basic types.

But within that it gets a little more complicated, but talk about the 2 different types of lymph nodes.

>>Dr.

Abdur Shakir: So the 2 standard types that most oncologists will tell you is you either have Hodgkin s lymphoma or non-Hodgkin s lymphoma.

Hodgkin's lymphoma is the less common variant.

Roughly about 9,000 cases per year.

It was famously coined after Dr. Thomas Hodgkin s in England in 1832.

He was the gentleman to actually introduce the stethoscope to physicians.

>>Lori Banks: There's our fact for the day.

>>Dr.

Abdur Shakir: And he was actually able to figure out that these lymph glands look different than tuberculosis and he came up with the term Hodgkin's lymphoma.

Now, Hodgkin's lymphoma has something called a bimodal variation.

What that means is it occurs in 2 separate age groups.

Usually 15-30 or 60-70.

And there are 4 different types of Hodgkin's Lymphoma.

Nodular sclerosis, lymphocyte predominant, lymphocyte depleted, and mixed cellularity.

Conversely, when we talk about Non-Hodgkin's lymphoma, much more common.

Roughly 85% of all lymphomas are Non-Hodgkin's lymphoma.

They are much more common in fact that 70-75,000 cases will be diagnosed this year in North America.

Wide variety of age groups from 1-99 actually really occur.

There are as many types of Non-Hodgkin's lymphoma as there are republican candidates for president.

That's how many wide variety types.

How I really group Non-Hodgkin's, and this is important, every oncologist groups them a little bit differently, but how I do it is in different grades.

A person may have a low-grade Non-Hodgkin's lymphoma, a middle grade Non-Hodgkin's lymphoma, or a high-grade Non-Hodgkin's lymphoma.

And there's a reason why we classify those into 3 different grades is because treatment is different for all different 3.

Low-grade lymphomas are really slow moving that can actually last for years without any treatment.

High-grade lymphomas can grow within a matter of weeks to days and people need treatment roughly within a week s time.

And in intermediate grade you have got to make a decision with your cancer physician.

>>Lori Banks: So is the cancer in the lymph node?

Is it a tumor or is it cancer cells in that lymph fluid?

>>Dr.

Abdur Shakir: So as you remember that lymphatic system is this highway and you may have a tumor in the lymph node that you can visibly see, but there's likely cancer cells that are traversing throughout that lymphatic system too as well.

We may be able to visually see a lymph node, yes, but I'm getting that there's probably cancer cells in many different locations as well too.

>>Lori Banks: So since that moves around can those cancer cells stop and deposit in other places of the body and cause other types of cancer?

>>Dr.

Abdur Shakir: Typically no.

Typically they don't cause other types of cancer but they may deposit into a different lymph node.

So if you had a lymph node in your neck it may deposit down to a lymph node in your armpit or into your groin because those lymph nodes continue to travel.

That lymphatic system continues to travel.

>>Lori Banks: How is someone ever going to know that they have it?

What are some of the early symptoms?

>>Dr.

Abdur Shakir: Sure.

So there's a sign and then there's symptoms.

The first sign of lymphoma is a person usually comes into their family care doctors office stating that "I have swollen and tender lymph nodes in my neck that's been growing."

And the family physician has ruled out infection, has ruled out autoimmune disease, and then starts to think of "boy, could this be a cancer like lymphoma?"

Then there are 4 symptoms.

And the classic 4 symptoms that oncologists tell patients are called B symptoms.

Fever, fatigue, weight loss, and night sweats.

With fevers, what happens with patients is they went to their family doctor, they ruled out an infection, they ruled out autoimmune diseases, they had cultures and urine tests done and they can't figure out the reason why.

And then they come to an oncologist and they say, "boy, I've had these fevers and I've had this lymph node that's swollen."

We start putting 2 and 2 together.

Fatigue is a tough one because we're all tried at the end of the day.

At the end of the day of work it's hard to say fatigue, but if it's outside the normal.

If you say "Boy, I've been working everyday now I'm feeling really tired just waking up in the morning."

We start to think about those things.

Night sweats, what happens to a patient is in the middle of the night they've got to get up, change their shirt and say "I'm drenched.

My shirt is all wet, I don't know the reason why."

That happens repetitively.

It can happen for other reasons, hormonal reasons, but it can happen in lymphoma as well.

With weight loss there's roughly about a 10-15% loss of body weight.

Unintentional loss of weight and that can sometimes alarm patients to trigger lymphoma.

>>Lori Banks: So if you swelling, the lymph nodes that you can feel are at the neck, where else did you say?

>>Dr.

Abdur Shakir: Under the armpits and in the groin area too, as well, that you can typically feel them.

>>Lori Banks: Because a lot of times when you get that sore throat that's what swells up first and I think "Oh gosh."

>>Dr.

Abdur Shakir: Right.

So part in an infection is what happens are those lymph glands start to work.

They say, "I've got to fight off this infection."

So they may initially swell before they go back down.

>>Lori Banks: So is this like some of our cancers, like breast cancer, is this hereditary or genetic in nature?

>>Dr.

Abdur Shakir: No there's not a genetic mutation.

There's nothing that's from the mother to the daughter or from the father to the son that goes on.

So when people think of family lymphoma it's not really related to mutations that are transferred, it's likely related to the environment.

>>Lori Banks: Ok let's get into are there some risk factors or things that cause it?

>>Dr.

Abdur Shakir: This is probably the most common question.

When a person comes in to sit in front of me and we have this discussion of lymphoma that's the most common question.

How did I get it?

What are the risk factors that do it?

Usually I break it down into 6.

The first is infection in viruses.

People don't think about that.

But there's a certain infection called H-Pylori, which happens in the stomach, which is notorious to cause a certain lymphoma called a gastric malt lymphoma.

When a person is treated for this bacterium actually that lymphoma can go away in certain scenarios.

There are also other viruses: HIV, Hepatitis C, Epstein-Barr virus, all associated with lymphoma.

The second cause is environment.

There have been clear distinctions of patients who have been exposed to insecticide, pesticide, herbicide, and especially in farming communities.

There's a higher incidents of lymphoma particularly in the Midwest because there's a lot of farming that's here.

So part of that environment is when people think that "hey my mother had lymphoma I might have got it from her because she had lymphoma."

That's not really the case.

What's really the case is the environment that they're all living in.

>>Lori Banks: Yeah and it could be if you grew up on a farm maybe you drank from the same well that was in the water supply.

>>Dr.

Abdur Shakir: Yes or the person's spraying the exact same pesticide to the whole family in that same area.

The third reason is autoimmune diseases: rheumatoid arthritis, lupus, mix connected tissue diseases all regulate the immune system or deregulate the immune system that can cause lymphomas.

The fourth is patients that are medicine to suppress the immune system.

So what are those patients?

Those patients are patients that have had a liver transplant, or a kidney transplant, or patients that have actually had chemotherapy in the past can actually be a risk factor for developing lymphoma as well.

Patients that have been exposed to radiation, radiation treatments, or for example Chernobyl or Hiroshima, those patients are at risk for developing lymphoma.

The fifth reason is diet.

People don't think about diet, but low intake of vegetables and high intake of red meat.

The National Cancer Institute has been doing studies on this and have found that there is a higher correlation of lymphoma is patients that are not eating enough vegetables and having a higher intake of red meat and they're trying to figure out that correlation.

And the last is idiopathic, which means we don't know.

They just don't have a good reason why.

>>Lori Banks: Out of all of the cancers that are out there where does this one rank in terms of--I'm not going to put you on the spot and say how many people will get it-- but we've got lung cancer, breast cancer, where does the lymphoma fit?

>>Dr.

Abdur Shakir: It's the fourth most common type of cancer that we see.

But like you said, lung cancer, breast cancer, prostate cancer, those are things we commonly think of.

Lymphoma in the Midwest is a type of tumor that we commonly think of as an issue for patients.

>>Lori Banks: So as the person goes to their primary care physician there they may be turned over to an oncologist such as you, then what are your next steps in diagnosis?

>>Dr.

Abdur Shakir: So as an oncologist there are 2 different ways to diagnose this type of disease.

The first is a biopsy and it depends on where the lymph node is located, where we take a sample of the lymph node.

And the second is actually removal of a lymph node.

We actually take out the whole lymph node and remove it.

As an oncologist we actually prefer removal of the whole lymph node.

And this can sometimes frustrate a family doctor or a patient because numerous procedures are happening.

The reason why we prefer to remove a lymph node is imagine a lymph node like a house with many different rooms, and if you just sampled 1 room that room might have looked clean.

And you say, "Ok, this is a low grade lymphoma because the room looks clean there."

But if you actually remove the whole lymph node you're able to assess every single room in that lymph node.

And then you're saying, "Ok, that room is clean, but the rest of the room is really dirty."

And that's a high-grade lymphoma.

So treatment decisions are really based upon that removal of a lymph node.

Part of also the diagnosis is we do CAT scans of the whole body.

We do something called a PET scan.

And we also do a bone marrow biopsy to see what stage a person is.

>>Lori Banks: Ok so is the removal of the lymph node pretty common?

>>Dr.

Abdur Shakir: Ideally yes, but it all depends on where the lymph node is located.

If it's located in the neck it's easy to remove.

If it's located under the armpit it's easy to remove.

If it's located in the groin it's easy to remove.

But if it's in the middle of the chest somewhere or abdomen somewhere typically then we're stuck with doing a biopsy to get a sample because removing that lymph node requires a major surgical operation sometimes.

>>Lori Banks: So once you've kind of gone through that and you see what kind of lymphoma it is are people treated with chemo, radiation, how do you determine that?

>>Dr.

Abdur Shakir: So the treatment plan is really broken into 4 different sections.

There are a lot of caveats, but how I break it down is observation, chemotherapy, radiation, or bone marrow transplantation.

Now with observation it's really important.

Some people may hear that and say "Oh I don't have to get treatment."

There's very select group of lymphomas that actually do not need treatment that can be safely watched.

So the majority of the second opinion I get is "Should I get treated or should I not get treated?"

And that's really where your expertise of your oncologist will come and say "I can safely watch you" or "No we better start treatment soon."

The second is chemotherapy.

Now, chemotherapy differs in Hodgkin s and non-Hodgkin s lymphoma.

With Hodgkin s lymphoma there's a classic chemotherapy cocktail called ABVD.

With non-Hodgkin s lymphoma, because there's such a large variety, each different type of lymphoma has a different cocktail and that's where your oncologist will come into play and say "Aha, we're going to tailor this chemotherapy toward your type of lymphoma."

The third is radiation.

Depending on the type of lymphoma, how large the lymphoma is radiation may come into play or may not come into play.

And the last part is bone marrow transplantation or stem cell transplantation.

Depending on how aggressive the person's lymphoma is, stem cell transplantation may be immediately done after chemotherapy or waiting for a person to reoccur and then do a bone marrow or stem cell transplantation.

>>Lori Banks: I'm sure it's going to be hard to answer this next question because of the range of what people have is so very high.

How long does that treatment plan usually last?

Typical.

>>Dr.

Abdur Shakir: For example, if we're talking about a high-grade lymphoma you're roughly thinking about 5 to 6 months of chemotherapy.

And if they needed a bone marrow transplant, roughly 30 days in a hospital.

>>Lori Banks: Ok. Wow.

So for your patients that you've treated with this, how can they do this?

Are they bedridden?

Can they kind of go about their regular life?

>>Dr.

Abdur Shakir: So every person is slightly different, as you know.

Some people are able to work full time and able to do their full time job.

And for some people, chemotherapy really wipes out their function and then we have to battle keeping their cancer under control and also giving them their quality of life too as well.

>>Lori Banks: Ok.

So, let's talk about survival rate.

How does this rank in terms of our other cancers?

>>Dr.

Abdur Shakir: So Hodgkin s and non-Hodgkin s are different.

If we look at Hodgkin s lymphoma we base that on stage.

So stage 1 Hodgkin s, 90% of people are cured over a 5 year period of time.

Stage 2, 85% are cured over 5 years.

Stage 3, 75% are cured over 5 years.

And stage 4, 65% are cured over 5 years.

In non-Hodgkin s we really break it into 3 different types.

Low risk, intermediate risk, and that high risk.

Low risk non-Hodgkin s, 90% are doing great after 5 years.

Intermediate risk, 70% are doing great after 5 years.

And high risk, about 40-50% are doing great after 5 years.

>>Lori Banks: So this has better survival rates than some of our other cancers.

>>Dr.

Abdur Shakir: Yes.

Yes.

In general, these lymphomas are curable.

There are certain types of lymphomas that are not but in general these lymphomas are curable and that's why it's really important to devise an appropriate treatment plan for these patients.

>>Lori Banks: Early detection, just like any cancer, is helpful.

>>Dr.

Abdur Shakir: Yes.

As you can see with the stages it can make a difference.

>>Lori Banks: Alright, so are there any other people-- someone had asked this question-- are people who have lymphedema, which lymphedema is just swelling, are those people at a higher risk for getting lymphoma?

>>Dr.

Abdur Shakir: No.

So lymphedema is a localized obstruction to a vessel in the lymphatic system.

Lymphedema typically occurs as a consequence of lymphoma.

Where as a consequence of an infection or as a consequence for surgery, for example, in breast cancer patients who have had their breast tumor removed and their lymph nodes removed it could be as a consequence of that, but it's not a cause of lymphoma, no.

>>Lori Banks: Ok, alright.

Let's talk about some of the new things on the horizon because I know you're always looking for new things and trying new things.

What's new on the horizon for people with lymphoma?

>>Dr.

Abdur Shakir: So when we think about the therapies, the first is chemotherapy and that's really been a backbone of how we treat lymphomas.

There are a new set of class of drugs called monoclonal antibodies.

So there are shot gun approaches to chemotherapy and there's something called sniper rifle approaches to chemotherapy.

And these monoclonal antibodies are sniper rifle approaches.

There's a famous monoclonal antibody called rituximab, which has historically been used in non-Hodgkin s lymphoma.

Now the new clinical trials are trying to develop multiple different sniper rifles or these antibodies.

So hopefully over the next 2 to 3 years time we're going to see these new monoclonal antibodies develop.

The second is with bone marrow transplant.

Bone marrow transplant, there's 2 separate types.

One is called autologous where you get your own stem cells transplanted back to you and the second is called allogeneic where you're getting a transplant from somebody else, either a related person or an unrelated person.

With autologous, the risk right now is when we transplant the cells back to a patient we may be transplanting some cancer cells back.

So what we're trying to do now is sift through those cells to say which has the cancer and don't transplant them, and what are the normal cells and transplant the patients.

With allogeneic there's a risk of a side effect called graft vs. host disease.

That's a major side effect that we deal with, with allogeneic transplants.

We're trying to alleviate risk because that could become a quality of life issue for patients.

Lastly, vaccines.

People have, you've probably heard on the news, 60 Minutes and all this stuff talking about vaccines for brain tumors, but actually vaccines have been looked at specifically for lymphoma.

And there's some late phase 3 clinical trials at the moment that are ongoing looking at how do we rev up our own immune system to fight against the lymphoma.

>>Lori Banks: I wanted to ask, we do hear about bone marrow transplants, what is that really doing for people with cancer?

>>Dr.

Abdur Shakir: So it's specifically used in a couple different types of cancers.

Lymphoma is one, leukemia is another one, and another disorder called multiple myeloma.

They're all bone marrow type of cancers.

Now what bone marrow transplants do, depending on what type of disease that you have, it's basically like a farming community where you have all of these crops that are up like your own blood cells.

You wipe out all of those crops and you really plant in new seeds, like new stems cells.

Hopefully those new stem cells grow normally.

So that's really what a transplant is.

And the goal of the transplants in these patients, the majority of the patients, is how best do we cure?

In certain scenarios it's not used for that, it's used to delay the progression of the cancer.

But for example, in lymphoma is how best do we cure it with a transplant?

In leukemia how best do we cure it with a transplant?

>>Lori Banks: Ok, we've got just a few minutes left and I want to save my last question for the very very end, but before we do are there any other things that you wanted to talk to us about lymphoma?

>>Dr.

Abdur Shakir: Yes.

So I think it's really important when a patient comes to see their oncologist.

There's a team-based approach to treating their lymphoma.

For example, how we do it at the Sarah Bush Lincoln Regional Cancer Center is we have an oncologist who's kind of the ring leader to decide what goes on, and then there's a radiation oncologist who determine who gets radiation.

There's a surgeon who helps diagnose.

There's a family doctor who juggles their other medical problems while the person's getting therapy.

There's a pathologist who plays a vital role in coming up with these complex diagnoses.

There are great chemotherapy nurses that are part of the team to make the situation of chemotherapy comfortable.

But also what we do is we work with specifically with lymphoma experts at the University of Illinois at Chicago to say "Hey, I have this complex case, how best do we treat this person?"

I think when a person has a lymphoma they should at least have that team standing behind them to say "what's the best treatment for me?"

>>Lori Banks: When people are diagnosed with cancer it's very very overwhelming.

What sort of recommendations do you have as an oncologist to help people sort of digest all that information so they can get it right in their own head what's going on.

>>Dr.

Abdur Shakir: Sure.

The first visit is the most difficult and roughly about 30-40% is retained.

So what I usually do for a patient is the first visit is the first shock of what they hear is they have lymphoma or they have a cancer, and the rest after you tell them is just not absorbed.

So we usually do an initial visit and I say, "Come back in a week, or come back in 2 days and we're going to over it again."

Because that first initial shock of hearing the lymphoma they usually forget everything I told them after that.

So the next couple days we go over the whole process again and we usually ask family members to come in.

Have a person that's a recording secretary to ask questions or go home and write a list of 15-20 different questions.

When you come in all of those difficult questions that you didn't know how to ask then are then being written down on a piece of paper and being checked off and asked.

>>Lori Banks: Because it is, it's a lot and new terminology and all sorts of things.

As we wrap up here I want to talk about cancer in our region here in the Coles County area.

What are you kind of seeing?

What are the majority of your patients coming in with?

And where are we at with cancer in our area?

>>Dr.

Abdur Shakir: So the majority types of cancers that we see in Coles County is breast cancer, lung cancer, and prostrate cancer, which is historically the most common.

We really follow the other counties as well too.

Specifically in Coles County lymphoma is one of those tumors that we do see in a higher incidents than other areas simply because of the farming community.

We're hoping, specifically for breast cancer and lung cancer, we can make those changes with early mammograms and sometimes early CAT scans.

With lymphoma it's hard to change the environment.

We are in a farming community so it's hard to change that environment.

But it's important that a patient at least explains to their physician the symptoms that are going.

In the majority of the scenarios patients aren't open to their symptoms.

So it's really important that they go to their family physician and say, "Hey, I'm losing weight" or "Hey, I'm having these night sweats."

So it's important that patients have this open relationship with their physician.

>>Lori Banks: And thinking about what is your normal and it is not normal to be profusely sweating unless you're menopausal women which I know there're many out there that are like "I have that all the time."

Which brings me to a point, what if a woman is having night sweats because then she thinks it's menopause.

Are there chances where it could actually be lymphoma?

>>Dr.

Abdur Shakir: Yes and that's where your family doctor will come into play and really look at your symptoms and say "Ok, these night sweats are from your menopause, and hold on a second, you got the night sweats plus you're having the fever, plus you're having the weight loss.

We've got to start adding these things together and hey maybe need to do a CAT scan on your body to see what's going on."

But that's where a smart family doctor comes into play to help distinguish what are the differences between the two.

>>Lori Banks: So just the importance of that regular annual physical and just being aware of what your own body is doing.

Alright, Dr. Shakir thanks for coming in today.

We love having you on this show and thank you for watching.

We'll see you next time.

>>Female Speaker: Production of Being Well is made possible in part by Sarah Bush Lincoln Health System.

Supporting healthy life styles, eating a heart healthy diet, staying active, managing stress, and regular check ups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Dr. Ruben Boyajian located at 904 Medical Park Drive in Effingham specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online or at 347-2255.

>>Chorus: Rediscover Paris.

>>Female Speaker: Our patient care and investments in medical technology show our on going commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

[Music Playing]