Michael Hunter, MD on Medika Life

Jane Fonda Has Lymphoma. What Oncologists Want You to Know

I HAVE LYMPHOMA, OFFERS THE ACTRESS JANE FONDA. More specifically, she has non-Hodgkin’s lymphoma, a cancer of the lymph system. Fonda anticipates six months of chemotherapy.

Here is her Instagram post:

“So, my dear friends, I have something personal I want to share. I’ve been diagnosed with non-Hodgkin’s lymphoma and have started chemo treatments. NHL is a very treatable cancer. 80% of people survive, so I feel very lucky.

I’m also lucky because I have health insurance and access to the best doctors and treatments. I realize, and it’s painful, that I am privileged in this. Almost every family in America has had to deal with cancer at one time or another, and far too many don’t have access to the quality health care I am receiving, and this is not right.

Fonda at the 2015 Cannes Film Festivalhttps://en.wikipedia.org/wiki/Jane_Fonda

We also need to be talking much more, not just about cures but about causes, so that we can eliminate them. For example, people need to know that fossil fuels cause cancer. So do pesticides, many of which are fossil fuel-based.

I’ve been doing chemo for six months and am handling the treatments quite well, and believe me, I will not let any of this interfere with my climate activism.

Cancer is a teacher, and I’m paying attention to the lessons it holds for me. One thing it’s shown me already is the importance of community. Of growing and deepening one’s community so that we are not alone. And cancer, along with my age — almost 85 — teaches the importance of adapting to new realities.”

Fonda is a two-time Academy Award winner for her performances in “Klute” and “Coming Home.” She has also worked as a producer, documentarian, and activist. In 2019 she was arrested multiple times after staging protests in Washington to highlight the urgency of the climate crisis.

Today we look at lymphoma epidemiology, types, treatment, and prognosis.

Lymphoma: How common is it?

Non-Hodgkin’s lymphoma (NHL) is the world’s most common cancer relating to the blood, accounting for almost three percent of cancer diagnoses and deaths.

In the United States, non-Hodgkin’s lymphoma is the leading cancer in incidence and has the sixth highest mortality among cancers. Moreover, the incidence of NHL is rising: Lymphoma incidence has risen by 168 percent since 1975. Fortunately, survival rates have improved by an astounding 158 percent.

Who gets non-Hodgkin’s lymphoma?

Non-Hodgkin’s lymphoma is more common among menthose over age 65 (half of the cases will occur after 65, and those with autoimmune disease or a family history of blood-related cancers.

There are many subtypes of NHL, with each subtype associated with particular risk factors. For example, individuals with Hashimoto’s thyroiditis and Sjogren’s syndrome are more likely to develop marginal zone lymphoma.

Photo by Jed Owen on Unsplash

Environmental exposures can raise risk, too. For example, farm workershairdressers (who work with hair dyes), or painters have a higher risk of getting the more common subtypes of non-Hodgkin’s lymphoma.

Obesity and prior radiation therapy (limited evidence) are risk factors for diffuse large B-cell lymphoma (DLBCL). Infections with Epstein-Barr Virus, the first virus found to be associated with cancer, are often associated with endemic Burkitt’s lymphoma, and certain breast implants are uncommonly linked to anaplastic large cell lymphoma.

Most cases of so-called MALT lymphoma of the stomach are associated with a chronic stomach infection caused by the bacteria Helicobacter pylori. MALT stands for mucosa-associated lymphoid tissue.

The mucosa is the moist tissue that lines some organs and body cavities, including the nose, mouth, lungs, and digestive tract. So MALT lymphoma starts in the body organs and not lymph nodes.

The human T-cell lymphoma virus ( spread by sharing syringes or needles, through blood transfusions or sexual contact, and from mother to child during birth or breastfeeding) can cause T-cell lymphomas.

Those with atopy (allergies) and who consume alcohol have a lower risk of NHL, and severe obesity (diffuse large B-cell lymphoma) and vitamin D deficiency (limited evidence) are associated with lower survival odds.

Check out this excellent presentation from Dr. Stephen Ansell of the Mayo Clinic (USA) to learn some basics about lymphoma:

https://cdn.embedly.com/widgets/media.html?src=https%3A%2F%2Fwww.youtube.com%2Fembed%2FDu2G3XoaCEE%3Fstart%3D3%26feature%3Doembed%26start%3D3&display_name=YouTube&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DDu2G3XoaCEE&image=https%3A%2F%2Fi.ytimg.com%2Fvi%2FDu2G3XoaCEE%2Fhqdefault.jpg&key=a19fcc184b9711e1b4764040d3dc5c07&type=text%2Fhtml&schema=youtubeMayo Clinic (USA) explains lymphoma. https://www.youtube.com/watch?v=Du2G3XoaCEE

Survival Rates for Non-Hodgkin Lymphoma

relative survival rate compares people with the same type and stage of non-Hodgkin lymphoma (NHL) to people in the overall population.

For example, suppose the five-year relative survival rate for a specific stage of NHL is 50 percent. In that case, it means that people who have that cancer are, on average, about 50 percent as likely as people who don’t have that cancer to live for at least five years after being diagnosed.

The US National Cancer Institute (NCI) maintains the Surveillance, Epidemiology, and End Results (SEER) database and provides survival statistics for different types of cancer. The SEER database divides non-Hodgkin’s lymphoma into three groups:

  • Localized: The cancer is limited to a single lymph node area, one lymphoid organ, or one organ outside the lymph system.
  • Regional: Cancer reaches from one lymph node area to a nearby organ, is found in more than a single lymph node area on the same side of the diaphragm, or is considered a bulky disease.
  • Distant: Cancer has spread to distant body parts (for example, the lungs, liver, or bone marrow) or nodes above and below the diaphragm.

Here are the five-year relative survival rates for non-Hodgkin’s lymphoma by subtype:

  • Diffuse large B-cell lymphoma. If the lymphoma is only local or regional, the 5-year relative survival odds are 73 to 74 percent. For those with distant disease, the odds are 57 percent.
  • Follicular lymphoma. The five-year relative survival is 97 percent for those with localized follicular lymphoma. Those with regional disease have a five-year relative survival of 91 percent, while those with distant disease have an 86 percent relative survival.

These statistics apply only to the cancer stage at initial diagnosis. Those with non-Hodgkin’s lymphoma may have a better prognosis than stated above, as the statistics are based on people diagnosed and treated at least five years earlier.

Finally, while the numbers are helpful for a population, they may not be right for an individual, as age, overall health, treatment response, and other factors influence prognosis.

Thank you for joining me in this look at non-Hodgkin’s lymphoma. I wish Ms. Fonda all the best.

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Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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