Patients Against Lymphoma (the organization behind Lymphomation.com) posted this video to their Facebook feed today.
It's from MedCram, which creates videos aimed at Medical students (the narrator of the video refers to exams a lot -- not sure I like med students watching videos to "cram".....).
This is part 1 of a two part series; it focuses on NHL, mostly laying out the different types, with part 2 focusing on Hodgkin's.
It's a good introduction to NHL, aimed at future medical professionals. But a few things bothered me.
First off, I'm not crazy about the division of NHL in low-grade, intermediate-grade, and high-grade lymphomas. Calling them "grades," first of all, is confusing, since each type of NHL has its own grading. My understanding is that the NHL community has been moving away from these terms, preferring "indolent" and "aggressive." I can see where three categories is better than two -- DLBCL and Burkitt's are very different lymphomas, and probably shouldn't be lumped together under "aggressive." A guide from the Leukemia and Lymphoma Society just cuts out "intermediate" completely, and calls them "'indolent' or 'low grade'," and "'aggressive' or 'high grade'."
My point is, this is potentially confusing to patients. If this is intended for future medical doctors, it would be nice to have some consistency in terminology. Makes it easier for everyone to understand.
Another, similar issue: Follicular Large Cell Lymphoma is listed as an Intermediate Grade Lymphoma. Honestly, I've never heard this term before. And, in fact, the World Health Organization classification from 2011 (its most recent) does not recognize this as a separate type of NHL. As far as I can tell, the narrator is using this term to describe transformed Follicular Lymphoma, but he never uses that term (or discusses transformation at all, which seems like it should be kind of a big deal).
Again, maybe we should have different names for the different ways Follicular Lymphoma presents itself. But for now, we don't. It just creates confusion. Maybe this is why we have problems communicating with our doctors sometimes?
Which brings me to the part that bothers me most. It's a throw-away comment the narrator makes, so quick you might miss it if you aren't listening carefully. He describes the two types of B cell lymphomas as being from follicles (like Follicular Lymphoma) or as diffuse (like DLBCL). Follicle lymphomas a "good"; diffuse are "not good." He uses this term again to describes "less proliferative" (good) and "more proliferative" (bad) types of NHL. Low-grade/indolent = good.
I have a problem with this. I've heard lots of patients who are told, sometimes by doctors and sometimes by patients, that they got "the good kind of lymphoma." What makes it good? This is entirely a matter of perspective. Aggressive lymphomas are not "the good kind," since they need to be treated immediately, unlike some indolent lymphomas. On the other hand, most aggressive lymphomas are, under some circumstances, curable, unlike most indolent lymphomas. I'd say that makes aggressive lymphomas "good." I'd say there's nothing good about knowing that, even when Rituxan or Bendamustine has knocked back my Follicular Lymphoma, it's probably coming back at some point. Not good.
I refer you to the very funny (if you like cancer humor) subplot from Curb Your Enthusiasm when Larry tries to figure out if Hodgkin's or Non-Hodgkin's is "the good kind." When a sitcom explains this better than a medical exam preparer, I think we have a problem.
All of that said, I think the video did do a good job of explaining some basic stuff about NHL -- cleaved cells, maturity of cells, etc. But there are some details that matter, especially when those details affect the way a doctor communicates with a patient about her disease.
The really big lesson is, if you're in medical school, and you have exams coming up, and you have to cram for an exam on lymphoma, and a video is your only option, then please, please find a video made by a lymphoma expert, not someone described as "Board certified in Internal Medicine, Pulmonary, Critical Care, and Sleep Medicine." You owe us, your future patients, at least that much.