Lymphoma Information and Facts

Transcription

1 Lymphoma Information and Facts Definition Lymphoma is the name for a group of blood cancers that develop in the lymphatic system. Types The two main types are Hodgkin lymphoma and non-hodgkin lymphoma (NHL). In 2010, about 628,415 people are living with lymphoma or are in remission (no sign of the disease). This number includes about 153,535 people with Hodgkin lymphoma and 474,880 people with NHL. Hodgkin lymphoma has characteristics that distinguish it from other diseases classified as lymphoma, including the presence of Reed-Sternberg cells. These are large, cancerous cells found in Hodgkin lymphoma tissues, named for the scientists who first identified them. Hodgkin lymphoma is one of the most curable forms of cancer. NHL represents a diverse group of diseases distinguished by the characteristics of the cancer cells associated with each disease type. Most people with NHL have a B-cell type of NHL (about 85 percent). The others have a T-cell type or an NK-cell type of lymphoma. Some patients with fast-growing NHL can be cured. For patients with slow-growing NHL, treatment may keep the disease in check for many years. Hodgkin s lymphoma Definition Hodgkin's lymphoma is a cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites. Alternative Names Lymphoma - Hodgkin's; Hodgkin's disease; Cancer - Hodgkin's lymphoma Causes The first sign of this cancer is often an enlarged lymph node which appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs. 1

2 The cause is not known. Hodgkin's lymphoma is most common among people ages and Infection with the Epstein-Barr virus (EBV) is thought to contribute to most cases. Symptoms Fatigue Fever and chills that come and go Itching all over the body that cannot be explained Loss of appetite Soaking night sweats Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands) Weight loss that cannot be explained Other symptoms that may occur with this disease: Coughing, chest pains, or breathing problems if there are swollen lymph nodes in the chest Excessive sweating Pain or feeling of fullness below the ribs due to swollen spleen or liver Pain in lymph nodes after drinking alcohol Skin blushing or flushing Note: Symptoms caused by Hodgkin's lymphoma may also occur also with other conditions. Talk to your doctor about the meaning of your specific symptoms. Exams and Tests The disease may be diagnosed after: Biopsy of suspected tissue, usually a lymph node biopsy Bone marrow biopsy If tests reveal you do have Hodgkin's lymphoma, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and followup and gives you some idea of what to expect in the future. 2

3 The following procedures will usually be done: Blood chemistry tests including protein levels, liver function tests, kidney function tests, and uric acid level CT scans of the chest, abdomen, and pelvis Complete blood count (CBC) to check for anemia and white blood count PET scan In some cases, abdominal surgery to take a piece of the liver and remove the spleen may be needed. However, because the other tests are now so good at detecting the spread of Hodgkin's lymphoma, this surgery is usually unnecessary. Treatment Treatment primarily depends on the following: The type of Hodgkin's lymphoma (most people have classic Hodgkin's) The stage (where the disease is found) Whether the tumor is more than 4 inches (10 cm) wide The patient's age and other medical issues Other factors, including weight loss, night sweats, and fever A staging evaluation is necessary to determine the treatment plan. Stage I indicates one lymph node region is involved (for example, the right neck). Stage II indicates involvement of two lymph node areas on the same side of the diaphragm (for example, both sides of the neck). Stage III indicates lymph node involvement on both sides of the diaphragm (for example, groin and armpit). Stage IV involves the spread of cancer outside the lymph nodes (for example, to bone marrow, lungs, or liver). 3

4 Treatment varies with the stage of the disease and age of the patient. The best treatment depends on each individual and should be discussed with a doctor who has experience treating this disease. Stages I and II (limited disease) can be treated with local radiation therapy, chemotherapy, or a combination of both. Stages III is treated with chemotherapy alone or a combination of radiation therapy and chemotherapy. Stage IV (extensive disease) is most often treated with chemotherapy alone. People with Hodgkin s lymphoma that returns after treatment or does not respond to treatment may receive high-dose chemotherapy followed by an autologous bone marrow transplant (using stem cells from yourself). Additional treatments depend on other symptoms. They may include: Transfusion of blood products, such as platelets or red blood cells, to fight low platelet counts and anemia Antibiotics to fight infection, especially if a fever occurs Support Groups You can often ease the stress of illness by joining a support group of people who share common experiences and problems. See cancer - support group on the Florida Hospital website, Outlook (Prognosis) Hodgkin s disease is considered one of the most curable forms of cancer, especially if it is diagnosed and treated early. Unlike other cancers, Hodgkin's disease is often very curable even in late stages. With the right treatment, more than 90% of people with stage I or II Hodgkin's lymphoma survive for at least 10 years. If the disease has spread, the treatment is more intense but the percentage of people who survive 5 years is about 90%. Patients who survive 15 years after treatment are more likely to later die from other causes than Hodgkin s disease. 4

5 People with Hodgkin s lymphoma whose disease returns within a year after treatment or do not respond to the first-line therapy have a poorer prognosis. It is important for patients to receive periodic examinations and imaging tests for years after treatment to check for signs of relapse and to check for the long-term effects of treatments. Possible Complications Long term complications of chemotherapy or radiation therapy include: Bone marrow diseases Heart disease Inability to have children (infertility) Lung problems Other cancers Thyroid problems Chemotherapy can cause low blood cell counts, which can lead to an increased risk of bleeding, infection, and anemia. To minimize bleeding, apply ice and pressure to any external bleeding. Use a soft toothbrush and electric razor for personal hygiene. Infection should always be taken seriously during cancer treatment. Contact your doctor immediately if you develop fever or other signs of infection. Planning daily activities with scheduled rest periods may help prevent fatigue associated with anemia. When to Contact a Medical Professional Call your health care provider if: You have symptoms of Hodgkin's lymphoma You are being treated for Hodgkin's lymphoma and you experience side effects of radiation and chemotherapy, including nausea, loss of appetite, vomiting, diarrhea, fever, or bleeding References Horning SJ. Hodgkin s lymphoma. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap

6 Non-Hodgkin's lymphoma Definition Non-Hodgkin's lymphoma is cancer of the lymphoid tissue, which includes the lymph nodes, spleen, and other organs of the immune system. Alternative Names Lymphoma - non-hodgkin's; Lymphocytic lymphoma; Histiocytic lymphoma; Lymphoblastic lymphoma; Cancer - non-hodgkin's lymphoma Causes White blood cells called lymphocytes are found in lymph tissues. Most lymphomas start in a type of white blood cells called B lymphocytes, or B cells. For most patients, the cause of this cancer is unknown. However, lymphomas may develop in people with weakened immune systems. For example, the risk of lymphoma increases after an organ transplant or in people with HIV infection. There are many different types of non-hodgkin's lymphoma. It is classified according to how fast the cancer spreads. The cancer may be low grade (slow growing), intermediate grade, or high grade (fast growing). Burkitt's tumor is an example of a high-grade lymphoma. The cancer is further sub-classified by how the cells look under the microscope, for example, if there are certain proteins or genetic markers present. According to the American Cancer Society, a person has a 1 in 50 chance of developing non- Hodgkin's lymphoma. Most of the time, this cancer affects adults. However, children can get some forms of lymphoma. High-risk groups include those who have received an organ transplant or who have a weakened immune system. This type of cancer is slightly more common in men than in women. Symptoms Non-Hodgkin's lymphoma can cause a variety of symptoms. Symptoms depend on what area of the body is affected by the cancer and how fast the cancer is growing. 6

7 Symptoms may include: Night sweats (soaking the bedsheets and pajamas even though the room temperature is not too hot) Fever and chills that come and go Severe itchiness that cannot be explained Swollen lymph nodes in the neck, underarms, groin, or other areas Unintentional weight loss and loss of appetite Coughing or shortness of breath may occur if the cancer affects the thymus gland or lymph nodes in the chest, which may put pressure on the windpipe (trachea) or other airways. Some patients may have abdominal pain or swelling, which may lead to a loss of appetite, constipation, nausea, and vomiting. If the cancer affects cells in the brain, the person may have a headache, concentration problems, personality changes, or seizures. Exams and Tests The doctor will perform a physical exam and check body areas with lymph nodes to feel if they are swollen. Tests to diagnose and stage non-hodgkin's lymphoma include: Blood chemistry tests, includes protein levels, liver function tests, kidney function tests, and uric acid levels Bone marrow aspiration and biopsy CBC to check for anemia and low white blood cell count CT scans of the chest, abdomen and pelvis Gallium scan Lymph node biopsy PET (positron emission tomography) scan X-rays 7

8 Treatment Treatment primarily depends on: The type of lymphoma The stage of the cancer when you are first diagnosed Your age and overall health Symptoms, including weight loss, fever, and night sweats Radiation therapy may be used for disease that is confined to one body area. Chemotherapy is commonly used as the main form of treatment. Most often,multiple different drugs are used in combination together. Another drug, called rituximab (Rituxan), is often used to treat B-cell non-hodgkin's lymphoma. Radioimmunotherapy may be used in some cases. This involves linking a radioactive substance to an antibody that targets the cancerous cells and injecting the substance into the body. People with lymphoma that returns after treatment or does not respond to treatment may receive high-dose chemotherapy followed by an autologous bone marrow transplant (using stem cells from yourself). Additional treatments depend on other symptoms. They may include: Transfusion of blood products, such as platelets or red blood cells, to fight low platelet counts and anemia Antibiotics to fight infection, especially if a fever occurs Support Groups The stress of illness may be eased by joining a support group whose members share common experiences and problems. See: Cancer - support group on the Florida Hospital website, 8

9 Outlook (Prognosis) Low-grade non-hodgkin's lymphoma usually cannot be cured by chemotherapy alone. However, the low-grade form of this cancer progresses slowly, and it may take many years before the disease gets worse or even requires any treatment. Chemotherapy can often cure many types of high-grade lymphoma. However, if the cancer does not respond to chemotherapy drugs, the disease can cause rapid death. Possible Complications Autoimmune hemolytic anemia Infection Side effects of chemotherapy drugs When to Contact a Medical Professional Call your health care provider if you develop symptoms of this disorder. If you have non-hodgkin's lymphoma, call your health care provider if you experience persistent fever or other signs of infection. References Wilson WH, Armitage JO. Non-Hodgkin s Lymphoma. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff s Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 112. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Non-Hodgkin's Lymphomas. National Comprehensive Cancer Network; Version Information sourced from Florida Hospital Health Library, 9