Nodal Marginal Zone Lymphoma: Treatment Options During Pregnancy

Lymphoma

Hello Doctor: I have non-Hodgkin lymphoma, specifically nodal marginal zone lymphoma (low-grade, stage I).
1.
In April, I discovered a 2 cm enlargement of the right parotid gland, with no symptoms such as fever, swelling, or itching.
2.
On July 1, I underwent surgery to remove the parotid tumor and had a biopsy.
3.
On July 29, I had a full-body CT scan (around my ovulation period).
4.
On August 11, the doctor informed me that it was stage I and recommended radiation therapy (no chemotherapy needed).
5.
On August 12, I found out I was approximately 3 weeks pregnant.
6.
The doctor initially planned to start radiation therapy in early September, but upon discovering the pregnancy, he informed me that I could delay treatment until after delivery.
7.
My husband is concerned that if I do not undergo treatment and continue the pregnancy, there is a risk of deterioration during pregnancy, missing the optimal treatment window, or being unable to care for the child after delivery due to fatigue and radiation exposure issues.
Therefore, he hopes I will terminate the pregnancy to receive treatment.
I would like to ask the doctor: 1.
If I wait until after delivery to start radiation therapy, will I still be unable to have contact with the child or breastfeed? 2.
If I do not immediately receive treatment, is there a possibility of deterioration during the pregnancy? 3.
Is stage I indolent lymphoma considered incurable? 4.
Does the doctor recommend treatment after delivery or starting treatment now?

Lu Lu, 30~39 year old female. Ask Date: 2020/08/13

Dr. Hu Ziren reply Oncology

1.
The need for radiation therapy depends on the area being irradiated.
If the radiation field does not include the breast or chest cavity, it is generally still possible to hold a child and breastfeed.

2.
The rate of progression from low-grade lymph node marginal zone lymphoma to high-grade lymphoma within two years is approximately 1 in 5.

3.
Low-grade lymphoma cannot be cured, but complete remission (complete disappearance of the tumor) can be achieved.
Some patients may experience recurrence at distant sites (for example, if the primary site is in the head and neck region, recurrence may occur in the abdominal cavity or groin) even after achieving complete remission following localized radiation therapy.
Therefore, the discussion around lymphoma treatment often focuses on the 5-year overall survival rate or the disease-free survival rate.
Current literature reports a 5-year overall survival rate of approximately 92% and a disease-free survival rate of about 80% for patients in stages I and II who have received localized radiation therapy.

4.
Considering your current pregnancy and the characteristics of low-grade lymphoma (slow progression and often asymptomatic), it is recommended that you prioritize treatment after giving birth.
PS: It is advisable to have thorough discussions with your attending physician; during the observation period, the physician will closely monitor your health and the status of the lymphoma, and if there is a need for urgent changes to the treatment plan, they will discuss it with you in detail.

Reply Date: 2020/08/13

More Info

Nodal Marginal Zone Lymphoma (NMZL) is a type of low-grade non-Hodgkin lymphoma that typically has an indolent course. Your situation, being diagnosed with NMZL during pregnancy, raises several important considerations regarding treatment options and the potential impact on both your health and that of your unborn child.

1. Radiation Therapy Postpartum: If you decide to wait until after childbirth to undergo radiation therapy, the ability to care for your child and breastfeed will largely depend on the specific areas being treated. Generally, if the radiation does not involve the breast or chest area, you may still be able to hold and breastfeed your baby. However, it is crucial to discuss this with your radiation oncologist, as they can provide tailored advice based on the treatment plan and the areas targeted.

2. Risk of Disease Progression During Pregnancy: NMZL is characterized by its slow progression, and while there is a risk of disease worsening during pregnancy, the likelihood is relatively low, especially in the early stages. Studies indicate that low-grade lymphomas can remain stable for extended periods. However, it is essential to have regular monitoring and follow-up appointments with your healthcare team to assess your condition throughout your pregnancy.

3. Curability of Stage I Indolent Lymphoma: Indolent lymphomas, including NMZL, are generally not considered curable in the traditional sense. However, they can often be managed effectively, leading to long periods of remission. Complete response to treatment is possible, meaning that the lymphoma can become undetectable, but there is always a risk of relapse. The focus of treatment is often on achieving the best quality of life and managing symptoms rather than outright cure.

4. Timing of Treatment: Given your current pregnancy and the nature of NMZL, many oncologists would recommend waiting until after childbirth to initiate treatment, especially since your lymphoma is low-grade and asymptomatic. This approach allows you to prioritize your pregnancy and the health of your baby while still planning for effective treatment afterward. Your healthcare team will closely monitor your condition during this time, and if any concerning symptoms arise, they will reassess the treatment strategy.

In conclusion, it is vital to maintain open communication with your healthcare providers, including your oncologist and obstetrician. They can help you weigh the risks and benefits of delaying treatment against the potential for disease progression. Additionally, they can provide reassurance regarding breastfeeding and caring for your child post-treatment. Each case is unique, and your medical team will be best equipped to guide you through this challenging time, ensuring both your health and that of your baby are prioritized.

Similar Q&A

Managing Lymph Node Malignancy During Pregnancy: Key Considerations

Hello, doctor. My wife was diagnosed with a malignant lymphadenoma in mid-April, and the biopsy and pathology report confirmed this. After completing a CT scan, no tumors were found in other areas. We originally planned to proceed with a PET scan, but she discovered she was pregn...

Dr. Chen Sirong reply Oncology
Concerned Father / 36 years old / Male Hello, due to the lack of biopsy report specifying the type of lymphoma, it is difficult to determine whether to: A) proceed with radiation therapy on the right arm and undergo chemotherapy after pregnancy, or B) immediately terminate the p...

Treatment Options for Lymphoma in Patients with Metastatic Cancer

My mother-in-law has a history of colorectal cancer and vaginal cancer, which has now metastasized to lymph node cancer located in the lower abdomen and the lymph nodes near the blood vessels behind the intestines. Due to the proximity of the cancer to the kidneys, she is unable ...

Dr. Chen Sirong reply Oncology
Hello: 1. The reasons for being unable to undergo radiation therapy may include: 1. Poor physical condition. 2. The extent of the disease is too large. However, if the issue is merely proximity to the kidneys, advanced techniques such as Intensity-Modulated Radiation Therapy (IMR...

Managing Cancer in Pregnant Patients: A Case Study and Treatment Options

The patient is a breast cancer metastasis case, and the baby in her womb is currently 22 weeks old, appearing to be normal. The patient has previously insisted on keeping the baby without undergoing any treatment. Recently, the tumor on her neck has been growing larger, and she h...

Dr. Chen Sirong reply Oncology
Hello: 1. I also recommend returning to Taiwan for treatment. 2. During my time at National Taiwan University Hospital, I provided radiation therapy to a pregnant woman with nasopharyngeal carcinoma, and her child was born healthy. Based on the medical experience at NTU Hospital,...

Understanding Primary Lymphoid Disorders: Treatment Options and Prognosis

Hello Doctor, I would like to ask about primary lymphoid disorders (lymphoma). A family member has similar symptoms, and after going to the hospital for blood tests and X-rays, the doctor said everything was fine, but further gastrointestinal examinations are needed. I would like...

Dr. Chen Sirong reply Oncology
Hello: 1. Benign lymphadenopathy, such as that caused by a cold or bacterial infection, can lead to localized lymph node enlargement, which should resolve with infection control. 2. Malignant lymphoma is formed due to DNA mutations in lymphocytes, but it is very sensitive to radi...