Why Maryland Gov. Larry Hogan is right to be optimistic in his cancer battle

Maryland Gov. Larry Hogan announced during a press conference Monday in Annapolis, Md., that he has B-cell non-Hodgkin’s lymphoma— news that the Republican said is “shocking” but something that he is approaching with optimism.

“I’m going to face this challenge with the same energy and determination that I’ve relied on to climb every hill and overcome every obstacle that I’ve faced in my life,” said Hogan, who has vowed to remain in office while he undergoes intensive chemotherapy treatment for about 18 weeks.

Hogan, 59, stood by his wife, daughters, sons-in-law and granddaughter during the news conference, during which he explained that he was recently diagnosed after noticing a painless lump along his jaw earlier this month. Doctors would later identify a tumor pressing on his spinal column, which had been causing him back pain. Diagnosis for this kind of cancer typically is done with imaging tests, blood and urine tests, a physical examination, removing a sample of lymph node tissue for testing, and by looking for cancer cells in the bone marrow.

The governor described his cancer as “very aggressive,” saying it could be at stage 4, or at least stage 3, but he joked that his odds of beating it were better than those of defeating his former Democratic opponent last fall. We know that due to the lack of effective screening tools for this type of cancer, all non-Hodgkin’s lymphoma is diagnosed at stage 3.

Hogan added that his cancer battle will be “one that will require me to, once again, be an underdog and a fighter.”

“All of the experts tell me that they believe I’ll come out of that completely clear,” Hogan said. “They also tell me it’s going to beat the hell out of me.”

Non-Hodgkin’s lymphoma, a cancer of the lymphatic system— which is the disease-fighting network of the body— is marked by the development of tumors from lymphocytes, which are a type of white blood cell. Typically, when lymphocytes die, the body creates new ones to replace them. But in non-Hodgkin’s lymphoma, lymphocytes do not die, but accumulate, leading to swelling in the lymph nodes.

Eighty-five percent of the 50 subtypes of non-Hodgkin’s lymphoma are B-cell lymphomas, and non-Hodgkin’s lymphoma itself is more common than the other general type of lymphoma, or Hodgkin’s lymphoma, according to the Mayo Clinic.

Symptoms of non-Hodgkin’s lymphoma can include painless, swollen lymph nodes on the neck, armpits or groin; abdominal pain or swelling, chest pain and trouble breathing; night sweats; weight loss; fatigue and fever. According to the Mayo Clinic, risk factors for the cancer include exposure to chemicals such as insecticides, medications that suppress the immune system, and infection with certain viruses and bacteria.

Although Hogan described his non-Hodgkin’s lymphoma as “very advanced,” he is right to have a positive attitude about his upcoming battle. You see, non-Hodgkin’s lymphoma is a very treatable disease with strong success rates.

In general, the treatments available for non-Hodgkin’s lymphoma are growing very rapidly. And this is primarily due to new research that is being conducted to better understand the genetics of lymphomas, and trying to explain how DNA in normal white cells proliferate into creating cancer cells. There’s also a lot of work being done in the field of stem cell transplantation, and in the prevention of rejection of these cells from donors.

Traditional treatment for non-Hodgkin’s lymphoma first includes chemotherapy, and there are new chemotherapy medications that are being studied in clinical trials. This has led to the approval of new chemotherapy drugs such as Treanda, whose chemical name is bendamustine.

However, there are newer, more specific therapies being introduced.  One of them is what we call targeted therapy. Targeted therapy is a little bit different from standard chemotherapy because it uses new drugs to target a specific part of the abnormal cells. Drugs that have been approved for this treatment include Velcade, whose chemical name is bortezomib.

An exciting area of treatment that has also come to light is the creation of monoclonal antibodies. In simple terms, lymphoma cells contain certain proteins on their cell surface. Therefore, antibodies to these specific protein sites have been created to attack the cell. The most popular of monoclonal antibody therapy is a drug called Rituximab. The advantage of these drugs as a whole is that they have fewer side effects than traditional treatment, and that they have been successful in preventing recurring lymphomas.

The last stage of treatment options that is being studied are the lymphoma vaccines, and again this is using the concept that scientists know that the person’s immune system has the capacity to fight disease. By creating a vaccine that can have the body kill and reject abnormal cells, patients may be able to prevent the development of non-Hodgkin’s lymphoma from occurring. However, vaccines of this type are still under strict clinical protocols.

So, you see, there are many advances in the field of hematologic cancers, which also include leukemia and myeloma. The important thing to note, however, is that these therapies and options should be established by medical leaders in this field that are well versed in all the potential options.

Cancer institutes around the country have all the knowledge and experience to treat lymphomas, and patients should seek out these centers of excellence to the best of their abilities. I know that Gov. Hogan is going to be facing some unique choices, but I also know that, if he gets the proper care, he’ll have the best shot at a happy and healthy future with his family.