[Music and people talking]

My name is Professor Tony Goldstone. I'm a consultant haematologist at University College Hospital.

The specialties I deal in particularly are adult leukaemia and lymphoma.

Lymphoma is not really one individual disease.

The lymphomas are a group of diseases involving the lymph glands.

When these nodes, nodules, go wrong, and grow tumorous

these abnormalities, these malignancies, are called lymphomas.

The lymphomas are divided into two major sub-groups:

One of them is called Hodgkin's lymphoma, used to be known as Hodgkin's disease, but it's the same thing

That's the less common. About two cases out of ten, in adults, are Hodgkin's disease

and the other eight out of ten are a variety of sub-groups known as the non-Hodgkin's lymphomas.

The question then arises, what are the symptoms of lymphomas?

You can have swollen glands, sweating, itching, feeling as though you've got a flu.

Many patients, if they later become anaemic because of a large amount of lymphoma,

are tired, fatigued, and can become short of breath.

When a patient has some of these symptoms

in the vast majority of cases these kinds of things are not due to lymphomas.

When a patient is finally diagnosed with a lymphoma

there are various which things are taken into account, which will determine treatment

They are, firstly, which sub-group of lymphoma

whether the biopsy shows it to be Hodgkin's lymphoma or one of the non-Hodgkin's lymphoma of a specific sub-group.

Then there is a necessity to do what we call 'stage the patient',

which really means how much lymphoma is there in the patient's body?

Is it very localised? Or is it advanced in several other sites? This will also influence the treatment.

Thirdly, the age of the patient influences the treatment

because there are some kinds of treatment you would give to people of 20 years of age

that you would not give to people of 75 years of age.

And fourthly, what we call the 'performance status'.

This means, whatever we would like to do, is the patient in good shape

to be able to take everything that we think is necessary to cure the disease?

In some lymphomas we don't actually treat immediately because it's of no immediate benefit to the patient.

This is what doctors in the trade call the 'watch and wait' approach.

Other treatment will range between local radiation, when the disease is very limited and can be cured

by one kind of localised treatment of radiotherapy alone,

ranging to chemotherapy, which may be by mouth or combinations by mouth and intravenously.

and sometimes, in later stages when necessary, to some kind of stem cell transplant,

which is a treatment, needed uncommonly for patients with lymphoma.

Hodgkin's disease today, is a very very curable disease.

In Hodgkin's lymphoma in particular, we can be very optimistic. And we expect to cure most of the patients,

and we're trying to give a treatment which is less aggressive than we used to do 10 or 15 years ago.

In the non-Hodgkin's lymphomas,

the outlook in follicular lymphoma is really better now than it's ever been.

And for the most difficult ones, not only are we using the stem cell transplants using the patient's own cells

but we're now using more acceptable forms of donor transplant

for both the high-grade non-Hodgkin's, the aggressive disease,

and the low grade non-Hodgkin's follicular, that doesn't go away.

And we're now finding ways to make that safe, more acceptable to the patient,

and to now actually now cure some of the patients whom we couldn't achieve that for before.

As I look now at what I've seen in the 35 years that I've been involved in this area for the patients

I'm becoming ever more optimistic.

New drugs and new approaches have revolutionised the treatment of these diseases,

probably very significantly improved the outlook in Hodgkin's disease over the last 25 years,

and are, at the present time, doing so in many of the non-Hodgkin's lymphomas.

The rate of improvement, and the rate of availability of new treatments

is really higher in the lymphomas than in any other malignancy,

and for that, both the patients and their physicians are very optimistic.

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