MEDICAL CONDITIONS
Non-Hodgkin's Lymphomas
The information provided below has been modified from that furnished by the National Institutes of Health and the National Cancer Institute of the United States of America.
What are non-Hodgkin's lymphomas?
Lymphoma is a general term for cancers that develop in the lymphatic system. They account for about 4 percent of all cases of cancer in this country.
The most common type of lymphoma is called Hodgkin's disease (for more information, read the Hodgkin's Disease article.). All other lymphomas are grouped together and are called non- Hodgkin's lymphomas.
The lymphatic system is part of the body's immune defense system. Its job is to help fight diseases and infection. The lymphatic system includes a network of thin tubes that branch, like blood vessels, into the tissues throughout the body. Lymphatic vessels carry lymph, a colorless, watery fluid that contains infection-fighting cells called lymphocytes. Along this network of vessels are groups of small, bean-shaped organs called lymph nodes that filter the lymph as it passes through the nodes. Clusters of lymph nodes are found in the underarm, groin, neck, and abdomen. Other parts of the lymphatic system are the spleen, thymus, tonsils, and bone marrow. Lymphatic tissue is also found in other parts of the body, including the stomach, intestines, and skin.
Like all types of cancer, lymphomas are diseases of the body's cells. Healthy cells grow, divide, and replace themselves in an orderly manner. This process keeps the body in good repair.
In the non-Hodgkin's lymphomas, cells in the lymphatic system grow abnormally. They divide too rapidly and grow without any order or control. Too much tissue is formed, and tumors begin to grow. The cancer cells can also spread to other organs.
What are symptoms of non-Hodgkin's lymphomas?
The most common symptom of non-Hodgkin's lymphomas is a painless swelling in the lymph nodes in the neck, underarm, or groin. Other symptoms may include fevers, night sweats, tiredness, weight loss, itching, and reddened patches on the skin. Sometimes there is nausea, vomiting, or abdominal pain . As lymphomas progress, the body is less able to fight infection.
These symptoms are not sure signs of cancer, however. They may also be caused by many common illnesses, such as the flu or other infections. However, it is important to see a doctor if any of these symptoms lasts longer than 2 weeks. Any illness should be diagnosed and treated as early as possible.
How are non-Hodgkin's lymphomas diagnosed?
The doctor asks about the patient's medical history and performs a thorough physical exam. The only sure way to tell whether cancer is present is with a biopsy. Tissue from an enlarged lymph node is removed. By examining this tissue under a microscope, a pathologist can identify the cancer cells and tell whether the lymphoma is the kind that usually grows slowly or rapidly.
There are at least 10 types of non-Hodgkin's lymphomas. Often, they are grouped by how fast they grow: low grade (slow growing), intermediate grade, and high grade (rapidly growing).
When lymphoma is diagnosed, the doctor needs to know what kind it is and the stage, or extent, of the disease. This information is very important for planning treatment. The stage indicates where the disease has spread and how much tissue is affected.
The following are checked: - The number and location of affected lymph nodes;
- Whether the affected lymph nodes are above, below, or on both sides of the diaphragm (the thin muscle under the lungs and heart that separates the chest from the abdomen); and
- Whether the disease has spread to the bone marrow or organs outside the lymphatic system, such as the liver.
In staging, the doctor usually orders blood tests and x-rays of the chest, bones, liver, and spleen. Other special tests include additional biopsies of the lymph nodes, bone marrow, and other sites. Most patients have lymphangiograms, x-rays of the lymphatic system using a special dye to outline the lymph nodes and vessels. The doctor may also want the patient to have a CT (or CAT) scan. A CT scan is a series of x- rays put together by a computer to form pictures of various parts of the body. Ultrasonography may also be used. This test creates pictures of internal organs using echoes of high-frequency sound waves.
What treatment is there for non-Hodgkin's lymphomas?
Treatment decisions for non-Hodgkin's lymphomas are complex. Before starting treatment, the patient might want a second doctor to review the diagnosis and treatment plan. Often, patients are referred to doctors or medical centers that specialize in the different treatments of Hodgkin's disease. Also, patients may want to talk with their doctor about taking part in a research study of new treatment methods.
METHODS OF TREATMENT
Treatment planning takes into account the type of lymphoma, the stage of the disease, whether it is likely to grow slowly or rapidly, and the general health and age of the patient. For low-grade lymphomas, which usually grow very slowly and cause few symptoms, the doctor may decide to wait until the disease shows signs of spreading before starting treatment. Treatment for intermediate or high-grade lymphomas usually involves chemotherapy, with or without radiation therapy . In addition, surgery may be needed to remove a large tumor.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for non-Hodgkin's lymphomas usually is a combination of several drugs. Some drugs are given by mouth. Others are injected into a blood vessel or muscle. The drugs travel through the bloodstream to nearly every part of the body. Chemotherapy is usually given in cycles: a treatment period followed by a rest period, then another treatment period, and so on.
Radiation therapy uses high-energy rays to damage cancer cells and stop their growth. Radiation therapy is generally given in the outpatient department of a hospital or clinic. Most often, patients receive radiation therapy 5 days a week for 5 to 6 weeks.
What are the side effects of treatment?
The methods used to treat lymphomas are very powerful. That is why the treatment often causes side effects. Fortunately, most side effects are temporary.
The side effects of chemotherapy depend mainly on the drugs given and the individual response of the patient. Chemotherapy commonly affects rapidly growing cells, such as blood cells that fight infection and cells that line the digestive tract. As a result, patients can have side effects such as a lowered resistance to infection, loss of appetite, nausea and vomiting, and mouth sores. They can also lose their hair. These side effects usually end after chemotherapy is finished.
During radiation therapy, patients can notice a number of side effects. They can become unusually tired as the treatment continues. Resting as much as possible is important. Skin reactions (redness or dryness) in the area being treated are common. Patients should be gentle with the treated area of skin. Lotions and creams should not be used without the doctor's advice. When the chest and neck area is treated, patients may have a dry, sore throat and can have some trouble swallowing. Sometimes, they have shortness of breath or a dry cough. Radiation treatment to the lower abdomen can cause nausea, vomiting, or diarrhea . Some patients have tingling or numbness in their arms, legs, and lower back. These side effects gradually disappear when treatment is over.
Loss of appetite can be a problem for patients receiving chemotherapy or radiation therapy. Researchers are learning that patients who eat well are better able to tolerate the side effects of their treatment. Therefore, good nutrition is an important part of the treatment plan. Eating well means getting enough calories to prevent weight loss and having enough protein in the diet to build and repair skin, hair, muscles, and organs. Many patients find that eating several small meals and snacks throughout the day is easier than trying to have three large meals.
The side effects that patients have during cancer therapy vary from person to person and may even be different from one treatment to the next. Attempts are made to plan treatment to keep problems to a minimum. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them.
What happens after treatment for non-Hodgkin's lymphoma?
Regular follow-up exams are very important for anyone who has been treated for non-Hodgkin's lymphoma. Most relapses occur in the first 2 years after therapy.
Generally, checkups include a careful physical exam, x-rays, blood tests, and other laboratory tests. Patients should follow their doctor's recommendations on health care and checkups. Having regular checkups allows problems to be detected and treated promptly should they arise.
When people have cancer, life can change for them and for the people who care about them. These changes in daily life can be difficult to handle. It is natural for a person with non-Hodgkin's lymphoma to have many different and sometimes confusing emotions.
At times, patients and family members may be depressed, angry, or frightened. At other times, feelings may vary from hope to despair or from courage to fear. Patients usually are better able to cope with their emotions if they can talk openly about their illness and their feelings with family members and friends.
Concerns about the future, as well as about medical tests, treatments, a hospital stay, and medical bills, are common. Talking to doctors, nurses, or other members of the health care team may help to ease fear and confusion. Patients can take an active part in decisions about their medical care by asking questions about their treatment. Patients and family members often find it helpful to write down questions for the doctor as they think of them. Taking notes during visits to the doctor can help them remember what was said. They should ask the doctor to explain anything that is not clear.
Patients have many important questions to ask about their disease, and their doctor is the best person to provide answers. Most people want to learn what type of lymphoma they have, how the disease can be treated, and how successful the treatment is likely to be.
The patient's doctor is the best person to give advice about working or to answer questions about other activities. Many patients find it also helps to talk with others who are facing similar problems. This kind of help is available through cancer-related support groups. A counselor or member of the clergy can offer additional emotional support.
What support is available for cancer patients?
Adapting to the changes brought about by having cancer is easier for both patients and their families when they have helpful information and support services. Often, the social service office at the hospital or clinic can suggest local and national agencies that will help with emotional support, financial aid, transportation, home care, or rehabilitation. The American Cancer Society and the Leukemia Society of America are two nonprofit organizations that offer a variety of services to patients and their families. Their local offices may be listed in the telephone book.
Information about other resources and services is available through the Cancer Information Service toll free at 1-800-4-CANCER.
What does the future hold for patients with non-Hodgkin's lymphoma?
More than 8 million Americans living today have had some type of cancer. Thirty years ago, few patients recovered from non-Hodgkin's lymphoma. Because of advances in combination chemotherapy and radiation therapy, about half of all non-Hodgkin's lymphoma patient now survive. As scientists find new and more effective treatments, the chances for recovery continue to improve.
Doctors often talk about "surviving" cancer, or they may use the word "remission" rather than "cure." Even though many patients recover completely, doctors use these terms because non-Hodgkin's lymphomas can recur. Patients are naturally concerned about their future and may try to use statistics they have read or heard about to try to figure out their own chances of being cured. It is important to remember, however, that statistics are averages based on the experiences of large numbers of people, and no two cancer patients are alike. Only the doctor who takes care of a patient knows enough about that person to discuss the prognosis.
Scientists at hospitals and medical centers all across the country are studying non-Hodgkin's lymphomas. They are trying to learn more about the possible causes of the disease and how it might be prevented.
In addition, scientists are exploring new methods of treatment, including new drugs, drug combinations, and combinations of radiation therapy and chemotherapy. Other methods, such as bone marrow transplantation and biological therapy (also called immunotherapy), are also being studied in clinical trials. These trials are designed to answer scientific questions and to find out whether a promising new treatment is both safe and effective. Patients who take part in clinical trials make an important contribution to medical science and may have the first chance to benefit from improved treatment methods.
Non-Hodgkin's lymphoma patients may consider participating in a trial and should discuss this possibility with their doctors.
One way to learn about clinical trials is through PDQ, a computerized resource of cancer treatment information. Developed by the National Cancer Institute, PDQ contains an up-to-date list of trials all over the country. Doctors can obtain an access code and use a personal computer to get PDQ information, or they can use the services of a medical library. Also the Cancer Information Service, at 1-800-4-CANCER, can provide PDQ information to doctors, patients, and the public.
What resources are available for cancer patients?
Information about cancer is available from many sources. Three are listed below. You may wish to check local library or contact support groups in your community.
CANCER INFORMATION SERVICE (CIS) 1-800-4-CANCER
The Cancer Information Service, a program of the National Cancer Institute, is a nationwide telephone service for cancer patients, their families and friends, the public, and health care professionals. The staff can answer questions in English and Spanish and can send booklets about cancer. They also know about local resources and services. One toll-free number, 1-800-4-CANCER (1-800-422-6237), connects callers with the office that serves their area.
AMERICAN CANCER SOCIETY (ACS)
1599 Clifton Road, N.E.
Atlanta, GA 30329
1-800-ACS-2345
The American Cancer Society is a voluntary organization with a national office (at the above address) and local units all over the country. It supports research, conducts educational programs, and offers many services to patients and their families. To obtain information about services and activities in local areas, call the Society's toll-free number, 1-800-ACS-2345 (1-800-227-2345), or the number listed under American Cancer Society in the white pages of the telephone book.
LEUKEMIA SOCIETY OF AMERICA (LSA)
600 Third Avenue
New York, NY 10016
1-800-955-4LSA
(212) 573-8484
Another voluntary organization, the Leukemia Society of America, is concerned with leukemia and lymphoma. It provides information about these diseases and a number of additional services, including physician referrals, financial assistance, and support for patients and their families. Further information about these services is available by contacting the national headquarters or a local chapter, which may be listed in the telephone book. - A lymphoma is a cancer that develops in the lymphatic system.
- The most common symptom of non-Hodgkin's lymphomas is a painless swelling in the lymph nodes in the neck, underarm, or groin.
- Non-Hodgkin's lymphomas are diagnosed with a biopsy of an enlarged lymph node.
- Treatment of non-Hodgkin's lymphomas depends on the type and location of the lymphoma, as well as the age and health of the patient.
- Follow-up examinations are important after lymphoma treatment. Most relapses occur in the first 2 years after therapy.
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