Non-Hodgkin s Lymphoma

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1 Non-Hodgkin s Lymphoma Introduction Non-Hodgkin s lymphoma is a form of cancer that begins in cells of the immune system. The immune system fights infections and other diseases. Non-Hodgkin s lymphoma happens when cells in the immune system become abnormal and begin to make copies of themselves in an uncontrollable way. Non-Hodgkin s lymphoma is highly treatable. Most people diagnosed with non- Hodgkin s lymphoma can now be cured or their disease can be controlled for many years. This reference summary explains what non-hodgkin s lymphoma is, as well as its causes, symptoms and treatment options. Anatomy The lymphatic system is part of the immune system. The immune system fights infections and other diseases. The lymphatic system is made up of lymph vessels, lymph, and lymph nodes. Lymph is a nearly clear fluid produced by the body that drains waste from cells. It travels through the lymphatic system, which is made up of channels and bean-shaped structures called lymph nodes. Groups of lymph nodes are found in the neck, underarms, chest, abdomen, and groin. Lymph nodes contain immune system cells that act as a barrier, stopping bacteria and viruses from attacking the body. These cells are divided into two very broad categories known as B and T cells. Lymph nodes are connected by special channels called lymph Lymph Node and vessels. These channels are spread out over most of the Lymphatic System body, like blood vessels. The lymphatic system drains excess fluids and waste. 1

2 Other parts of the body also contain lymphatic tissue including the tonsils, thymus, spleen, stomach, skin and small intestine. Non-Hodgkin s Lymphoma and Causes Non-Hodgkin s disease is a type of lymphoma. Lymphomas are cancers that affect the lymphocytes (white blood cells). They develop in the lymphatic system, from the B and T type of immune system cells. Normal cells in the body grow and die in a controlled way. In non-hodgkin s lymphoma, cells in the lymphatic system begin growing abnormally. The new cells divide again and again, making more and more abnormal cells. The abnormal cells don't die when they should. They don't protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor. Cells contain hereditary, or genetic, materials called chromosomes. Chromosomes control the growth of cells. Non-Hodgkin s lymphoma always arises from changes that happen in the chromosomes. When the chromosomes in a cell become abnormal, the cell can lose the ability to control its growth. Sudden changes in genetic material can happen for a variety of reasons. These changes are sometimes inherited. Changes in chromosomes may also happen as a result of exposure to infections, drugs, tobacco, chemicals, or other factors. Certain infections raise a person s risk of developing non-hodgkin s lymphoma. Some infections that raise your risk of non-hodgkin s lymphoma include: Human immunodeficiency virus, also known as HIV Epstein- Barr virus, also known as EBV Hepatitis C Virus Other Risk Factors: Medications that suppress your immune system Chemicals used to kill insects and weeds Age: as we grow older our risk can also increase 2

3 There are many types of non-hodgkin s lymphoma. The most common types are diffuse large B-Cell lymphoma and follicular lymphoma. Lymphomas may be grouped by how quickly they are likely to grow: Indolent, also called low-grade, lymphomas grow slowly. They tend to cause few symptoms. Aggressive, also called intermediate-grade or high-grade, lymphomas grow and spread more quickly. They tend to cause severe symptoms. Over time, many indolent lymphomas become aggressive lymphomas. Because lymphatic tissue is in many parts of the body, non-hodgkin s lymphoma can start almost anywhere. Signs & Symptoms A common symptom of non-hodgkin s lymphoma is a painless swelling of the lymph nodes in the neck, underarm or groin. However, most swollen lymph nodes happen because of localized infection and are not because of lymphoma. Other common symptoms may include: Fever Severe night sweats Weakness and tiredness Unexplained weight loss Trouble breathing, coughing or chest pain Pain, swelling or feeling of fullness in the abdomen Fatigue These symptoms may not be caused by non-hodgkin s lymphoma. Common problems like infections or the flu can cause similar symptoms. Make sure to see a doctor if your symptoms last more than two weeks. Diagnosis If you have swollen lymph nodes or another symptom that suggests non-hodgkin s lymphoma, your doctor will try to find out what's causing the problem. Your doctor may ask about your personal and family medical history. 3

4 Your doctor will check for swollen lymph nodes in your neck, underarms, and groin. Your doctor may also check for a swollen spleen or liver. Your doctor may order a CBC and check for other cells and substances such as LDH. A CBC is a complete blood count and can give information about the quantity and quality of your white blood cells (WBC). LDH is a test for lactate dehydrogenase and is measured because lymphoma may cause a high level of LDH. Your doctor may order other tests such as a CT scan, MRI scan, PET scan, x-rays, and a lymph node biopsy. Chest x-rays may be ordered to look for swollen lymph nodes or other signs of lymphoma in your chest. This is done to see how far the lymphoma has spread. It is known as staging. CT stands for Computed Tomography. A specialized x-ray machine linked to a computer takes a series of detailed pictures of your chest, abdomen, and pelvis. You may receive an injection of contrast material. Also, you may be asked to drink another type of contrast material. The contrast material makes it easier for the doctor to see swollen lymph nodes and other abnormal areas on the scan. MRI stands for Magnetic Resonance Imaging. A powerful magnet CT Scan linked to a computer is used to make detailed pictures of your bones, brain, or other tissues. Your doctor can view these pictures on a monitor and can print them on film. During a PET scan you receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Lymphoma cells use sugar faster than normal cells, and areas with lymphoma look brighter on the pictures. A biopsy is the only sure way to diagnose non-hodgkin s lymphoma. There are several different kinds of biopsies. In a fine needle biopsy, a needle may be inserted in a lymph node, and fluid and tissue samples taken for pathological studies. Usually this kind of biopsy cannot get a large enough sample to diagnose non-hodgkin s lymphoma. In an incisional biopsy, a small part of a lymph node is taken through an incision. 4

5 In an excisional biopsy, an entire lymph node and some surrounding tissue is removed through an incision. This type of biopsy is the best at getting a good enough sample for diagnosis. The pathologist uses a microscope to check the tissue for non-hodgkin s lymphoma cells. Staging A stage describes how widely the disease has spread. Staging involves several procedures to determine what parts of the body are affected by the disease. Treatment can be recommended based on the stage of the cancer. Non-Hodgkin s lymphoma usually starts in a lymph node. It can spread to nearly any other part of the body. For example, it can spread to the liver, lungs, bone, and bone marrow. Staging can involve CT scans, MRIs, PET scans and a bone marrow biopsy. A thick needle is used to remove a small sample of bone and bone marrow from your hipbone or another large bone. Local anesthesia can help control pain. A pathologist looks for non-hodgkin s lymphoma cells in the sample. Your doctor may also recommend biopsies of the other lymph nodes, the liver or other tissue. Bone Marrow Biopsy The stage is based on where lymphoma cells are found (in the lymph nodes or in other organs or tissues). The stage also depends on how many areas are affected. Stages are usually described using the numbers 1-4; a lower number indicates an earlier stage. Stage 1: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone marrow). Stage 2: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in one part of an 5

6 organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm. Stage 3: The lymphoma is in lymph nodes above and below the diaphragm. It also may be found in one part of a tissue or an organ near these lymph node groups. Diaphragm Stage 4: Lymphoma cells are found in several parts of one or more organs or tissues. Or, the lymphoma is in the liver, blood, or bone marrow. The disease is considered recurrent if it returns after treatment. In addition to these stage numbers, your doctor may also describe the stage as A or B, depending on whether or not you have some specific symptoms: A: You have not had weight loss, drenching night sweats, or fevers. B: You have had weight loss, drenching night sweats, or fevers. Patients with A symptoms tend to do better than patients with B symptoms. Treatment Treatment for non-hodgkin s lymphoma aims at killing as many abnormal cells as possible. Your options for treatment depend on many different factors. Your doctor will discuss your treatment options with you. What treatments are right for you depend on: The type of non-hodgkin s lymphoma you have Its stage (where the lymphoma is found) If you have a tumor that is more than 4 inches (10 centimeters) wide. Your age Whether you have other health problems Treatment for non-hodgkin s lymphoma may include radiation therapy, chemotherapy, biological therapy and stem cell transplantation. Sometimes all are given. Treatment decisions are made depending on the stage of the disease, its location in the body, which symptoms are present and the general health and age of the patient. 6

7 If you have indolent non-hodgkin s lymphoma without symptoms, you may not need treatment for the cancer right away. This means your doctor will watch your health closely so that treatment can start when you begin to have symptoms. Indolent means advancing very slowly. Not getting cancer treatment right away is called watchful waiting. If you have indolent non-hodgkin s lymphoma with symptoms, you may receive chemotherapy and biological therapy. Chemotherapy, also called chemo for short, is the use of drugs to kill cancer cells. To treat non-hodgkin s lymphoma, the doctor prescribes a combination of drugs that work together. These are called chemotherapy regimens. There are many different kinds of chemotherapy that may be used. The chemo may be given in different ways. Some are given by mouth; others are injected into a vein or in the space around the spinal cord. The drugs travel through the bloodstream to almost every part of the body. The chemotherapy side effects depend mainly on which drugs are given and their doses. The chemotherapy drugs can harm normal cells that divide rapidly such as: Blood cells, which can affect your ability to fight off infections. Cells in hair roots, which can cause hair loss. Cells that line the digestive tract, which can cause nausea, vomiting, diarrhea, mouth or lip sores, and trouble swallowing. Chemotherapy is usually given in cycles, with a treatment period followed by a rest period, then another treatment and so on. The drugs used to treat non-hodgkin s lymphoma may cause skin rashes or blisters, and headaches or other aches. Your skin may become darker. Your nails may develop ridges or dark bands. Biological therapy is treatment used to boost or restore the ability of the immune system to fight cancer, infections, and other diseases. Monoclonal antibodies are the type of biological therapy used for lymphoma. They are proteins made in the lab that can bind to cancer cells. They help the immune system 7

8 kill lymphoma cells. People receive this treatment through a vein at the doctor's office, clinic, or hospital. Flu-like symptoms such as fever, chills, headache, weakness, and nausea may happen. Rarely, a person may have more serious side effects, such as breathing problems, low blood pressure, or severe skin rashes. Radiation therapy may be used for people with Stage I or Stage II non-hodgkin s lymphoma. Radiation therapy uses high-energy rays to kill cancer cells and stop them from growing and spreading. The radiation that treats the cells comes from a machine that aims the rays at a specific area of the body. Non-Hodgkin s lymphoma patients usually receive radiation therapy as an outpatient in a hospital or clinic. It must be given 5 days a week for several weeks. Outpatient means that the patient goes home after each treatment. Radiation Machine The side effects of radiation therapy depend mainly on the type of radiation therapy, the dose of radiation, and the part of the body that is treated. Possible common side effects may include: nausea, vomiting, and diarrhea. You may have a dry, sore throat and some trouble swallowing. In addition, you may feel tired and your skin in the treated area may become red, dry, and tender, and you may lose your hair in the treated area. If you have radiation therapy and chemotherapy at the same time, your side effects may be worse. You can talk with your doctor about ways to relieve them. Stem cell transplants take place in the hospital. In this treatment, stem cells are collected from a donor or from the patient, frozen, and stored for later use. If taken from the patient, the cells may be treated to kill lymphoma cells that may be present before freezing and storing them. High doses of chemotherapy and radiation therapy are used to wipe out the bone marrow and with it hopefully all the cancerous cells. The stem cells that were collected are then given to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells. 8

9 The stem cells may come from your own body or from a donor. There are several types of stem cell transplantation, including: Autologous stem cell transplantation - This type of transplant uses your own stem cells. Your stem cells are removed before high-dose treatment. The cells may be treated to kill lymphoma cells that may be present. The stem cells are frozen and stored. After you receive high-dose treatment, the stored stem cells are thawed and returned to you. Allogeneic stem cell transplantation - Your brother, sister, or parent may be the donor. Or the stem cells may come from an unrelated donor. Doctors use blood tests to be sure the donor's cells match your cells. Syngeneic stem cell transplantation - This type of transplant uses stem cells from a patient's healthy identical twin. If you have an aggressive lymphoma, the treatment is usually chemotherapy and biological therapy. Radiation therapy also may be used. Summary Non-Hodgkin s disease is a type of lymphoma. Lymphomas are cancer that develop in the lymphatic system, part of the body s immune system. The job of the lymphatic system is to help fight diseases and infection. Non-Hodgkin s lymphoma is caused by changes in genetic material. This can happen for a variety of reasons. These changes are sometimes inherited. Changes in chromosomes may also occur as a result of exposure to infections, drugs, tobacco, chemicals, or other factors. Non-Hodgkin s lymphoma is usually treated with radiation therapy, chemotherapy, biological treatment, and stem cell transplantation or some combination of these treatments. What kind of treatment is prescribed depends on the stage of the disease and the health of the patient. Thanks to advances in medicine, most people diagnosed with non-hodgkin s lymphoma can now be cured, or their disease can be controlled for many years. 9

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