What is Non-Hodgkin's Lymphoma?
Lymphoma describes a group of cancers that originate in the
lymphatic system. Lymphomas result when
a white blood cell called a lymphocyte undergoes a malignant change and begins
to multiply, eventually creating tumors that enlarge the lymph nodes or other
parts of the immune system.
There are 2 main types of lymphomas. Hodgkin's
Disease (also known as Hodgkin's Lymphoma) is named after Dr. Thomas
Hodgkin, who described it as a new disease in 1832. All other types of lymphoma
are called Non-Hodgkin's Lymphomas.
According to the American Cancer Society, in the United States, about 66,120 new cases (including
adults and children) of Non-Hodgkin's Lymphoma will be found in 2008. About 450
of these will be in children younger than 14 years of age. About 70% of Non-Hodgkin's
Lymphoma occurs in boys. It is also about 40% more common in white children
than in black children. We don't know the reasons for these differences.
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Risk Factors
A risk factor is anything that may increase your chance of
developing a disease. Different diseases, including cancer, have different risk
factors. Although these factors may put you at greater risk, they do not
necessarily cause the disease. Some people with one or more risk factors never
develop cancer, while others develop the disease without having any risk
factors.
Some of these risk factors include:
- Age: Most cases are found in people in their 60s or older.
- Prior family history
- Exposure to certain chemicals
- Prior treatment with chemotherapy drugs:
Some chemotherapy drugs used to treat other cancers can increase the risk
of developing leukemia or Non-Hodgkin's Lymphoma many years later. But
it's not yet clear whether this is an effect of
the treatment or the disease itself.
- Radiation exposure: People treated
with radiation therapy for some other cancers also have a slightly higher
risk of developing Non-Hodgkin's Lymphoma later in life. The risk is
greater if both radiation and chemotherapy were used.
- Weakened immune systems and autoimmune
diseases: Some autoimmune diseases such as rheumatoid arthritis,
systemic lupus erythematosus (SLE, or lupus),
and others have been linked with an increased rate of Non-Hodgkin's
Lymphoma. Organ transplant patients are at higher risk.
- Certain infections: Lymphocytes
(the types of cells from which lymphomas start) are part of the body's
immune defenses. However, after exposure to certain infectious diseases,
lymphoma may arise in these cells. Several types of infections may raise
the risk of Non-Hodgkin's Lymphoma in different ways including HIV,
bacteria that causes stomach ulcers (Helicobacter Pylori), and hepatitis
C.
- Body weight and diet: Being very overweight (obese) might increase the risk of Non-Hodgkin's Lymphoma.
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Common Symptoms
These symptoms may indicate that you have a problem but do
not always mean that you have cancer. You should see your doctor as soon as
possible if you experience any of these warning signs:
Enlarged lymph node(s): The most common sign of Non-Hodgkin's Lymphoma is one or
more enlarged lymph nodes. The enlarged lymph node is usually painless and may
be in the neck, upper chest, armpit, abdomen or groin.
- Fever
- Night sweats
- Feeling tired
- Loss of appetite
- Weight loss
- Itchy skin or rash
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Screening and Diagnosis
There are currently no recommendations for regular
screenings for Non-Hodgkin's Lymphoma. If symptoms occur, the following tests should be undertaken.
- Medical history and physical exam
- Your doctor will want to take down your personal and family medical
history to assess the likelihood of your symptoms reflecting that cancer
may be present. You will also be
given a physical examination to locate any enlarged lymph nodes and rule
out infection.
- Lymph node biopsy - A biopsy of
the lymph node may be necessary. A
surgeon will remove an enlarged lymph node and have it analyzed by a
pathologist to see if it is cancer that is causing the swelling.
- Blood tests - to look for low red
cells, white cells or platelets and abnormal function of other organs
including the lungs and kidneys.
- Bone marrow aspiration and bone marrow
biopsy - to look for Non-Hodgkin's Lymphoma cells in the marrow.
- Lumbar puncture (spinal tap)
- Imaging tests - to create pictures
of the chest and abdomen and see if there are lymphoma masses in the deep
lymph nodes, liver, spleen or lungs. Imaging test will include CT scans
(Computed Tomography), MRI (Magnetic Resonance Imaging), and PET scans
(Positron Emission Tomography).
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Stages of Non-Hodgkin's Lymphoma
Once a diagnosis of Non-Hodgkin's Lymphoma is made and all
of the studies have been completed, doctors will determine how far the cancer has
spread. Staging helps your doctor develop an appropriate treatment plan.
Stage 1: Non-Hodgkin's Lymphoma is in just one lymph node region.
Stage 2: Non-Hodgkin's Lymphoma is in two or three lymph node regions that are near each other. For
example, the lymphoma is in the upper body regions (neck, chest and armpit) or
the lymphoma is in the lower body regions (abdomen and groin).
Stage 3: Non-Hodgkin's Lymphoma is in several lymph node regions in the upper and lower body, such as
the neck, chest and abdomen.
Stage 4: Non-Hodgkin's Lymphoma is present in non-lymph node regions of the body, such as the lungs,
liver or bone.
Patients are also divided into either "A" or
"B" categories.
"A" patients don't have fever, a lot of sweating
or weight loss.
"B" patients have fever, a lot of sweating or
weight loss.
Source: The Leukemia & Lymphoma Society
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Common Treatment Options
Physicians take into account a number of factors when
developing a treatment plan. These
factors include the type of Non-Hodgkin's Lymphoma; the stage of the disease; how
fast the lymphoma is growing; the type of lymphocyte affected (such as T cells
or B cells); whether parts of the body besides the lymph nodes are involved -
such as the lungs, liver or bones; the patient's age and overall health; and
the patient's symptoms - such as fever, sweating and weight loss ("A" and "B"
categories).
Treatment options include:
Chemotherapy is a type of treatment
that uses drugs to kill cells that are malignant and stop the growth of cancer.
Chemotherapy drugs can be taken orally or by injection depending on the type
and stage of the cancer and the type of drug protocol your doctor has
prescribed. It is important to discuss your treatment protocol with your
treatment team so you are aware of any possible side effects.
Radiation therapy is a method of
treatment of cancer using penetrating beams of high-energy waves called x-rays
or gamma rays. Radiation injures or destroys tumor cells by damaging their
genetic material, making it impossible for these cells to continue to grow.
Side Effects
Both chemotherapy and radiation
therapy induce side effects which can be significant including anemia, bleeding
and infections. Late side effects, although unusual, include other cancers,
including leukemia, lymphoma and breast cancer. Conditions of the thyroid gland
are common after radiation therapy.
Immunothrapy may be used by stimulating your own immune system or by administering
antibodies directed against the lymphoma cells.
Very heavy doses of chemotherapy
and radiation are administered to patients either because the disease is
aggressive or resistant. Patients then receive either their own stem cells
(bone marrow cells) or a donor's stem cells to recover.
