Frequently Asked Questions About Non-Hodgkin's Lymphoma
Q. What is non-Hodgkin's lymphoma?
A. Lymphoma is a general term for cancers that develop in the lymphatic system. One type is called Hodgkin's. All other lymphomas are grouped together and are called non-Hodgkin's lymphoma.
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 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 small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarms, groin, neck, chest 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 non-Hodgkin's lymphoma, 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.
Q. What are the symptoms of non-Hodgkin's lymphoma?
A. 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:
As lymphomas progress, the body is less able to fight infection. However, these symptoms are not sure signs of cancer. They may also be caused by many common illnesses, such as the flu or other infections. But it is important to see a doctor if any of these symptoms lasts longer than a few weeks. Any illness should be diagnosed and treated as early as possible.
Q. How do you diagnose non-Hodgkin's lymphoma?
A. The doctor will ask about your medical history and will do 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 the microscope, a pathologist can identify the cancer cells and tell whether the cancer is lymphoma and what type it is.
There are many types of non-Hodgkin's lymphoma. Some types spread more quickly than others. The type is determined by how the cancer cells look under a microscope. This determination is called the histology. The histologies for non-Hodgkin's lymphoma are divided into two groups: indolent lymphomas, which are slower growing and have fewer symptoms, and aggressive lymphomas, which grow more quickly.
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 doctor checks:
- The number and location of affected lymph nodes
- Whether the affected lymph nodes are above, below, or on both sides of the diaphragm
- 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 may include additional biopsies of the lymph nodes, bone marrow and other sites. 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.
Q. What are the treatment options for non-Hodgkin's lymphoma?
A. Treatment decisions for non-Hodgkin's lymphoma are complex. Before starting treatment, the patient might want a second doctor to review the diagnosis and treatment plan.
Treatment planning takes into account the type of lymphoma, the stage of 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, but are not curable, the doctor may decide to wait until the disease shows signs of spreading before starting treatment. Treatment for intermediate or high-grade lymphomas – which are curable in 20 percent to 80 percent of cases – 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 lymphoma usually is a combination of several drugs. Some drugs are given by mouth; others are injected into a blood vessel. 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 five days a week for three to six weeks.
Biological therapy is using the body's immune system to fight cancer or infections. It uses materials made by the body or made in a laboratory to boost, direct or restore the body's natural defenses against disease. Biological treatment is sometimes called biological response modifier (BRM) therapy.
Blood and marrow transplantation is a type of treatment that uses very high doses of chemotherapy to kill resistant lymphoma cells in the body. The high doses of chemotherapy also destroy most of the bone marrow in the body. To replace the bone marrow, marrow is taken from the bones before treatment and treated with drugs or other substances to kill any cancer cells. The marrow is then frozen, and the patient is given high-dose chemotherapy with or without radiation therapy to destroy all of the remaining cancer cells. The marrow that was taken out is then thawed and given to the patient through a needle in a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the marrow is taken from another person, the transplant is called an allogeneic transplant.
Often, patients are referred to medical centers that specialize in treating lymphomas. Also, patients may want to talk with the doctor about taking part in a clinical trial.
Q. What are the side effects of treatment?
A. The methods used to treat lymphomas are very powerful. That's why treatment often causes side effects. Fortunately, most side effects are temporary.
The side effects of chemotherapy depend 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 may have side effects such as lower resistance to infection, loss of appetite, nausea and vomiting, and mouth sores. They may also lose their hair. These side effects usually end after chemotherapy is finished.
During radiation therapy, patients may notice a number of side effects. They may 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 also 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 may have some trouble swallowing. Sometimes, they have shortness of breath or a dry cough. Radiation therapy to the abdomen may cause nausea, vomiting or diarrhea. Some patients may 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 important. 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. Doctors try 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.
Q. What should I ask my doctor about when diagnosed with non-Hodgkin's lymphoma?
A. Here are some questions you may want to ask your doctor:
- What type of non-Hodgkin's lymphoma do I have?
- What are my treatment choices?
- How do you choose the right treatment for me?
- How successful is the treatment likely to be?
- Would a clinical trial be appropriate for me?
- What are the expected benefits of treatment?
- What are the risks and possible side effects of treatment?
- Will I have to change my normal activities?
- Can I keep working during treatment?
- How often will I need checkups?
Your 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. Social services, clergy, nursing personnel or your doctor can offer suggestions about where to seek assistance with emotional support.
Q. What kind of follow-up care should I expect?
A. Regular follow up exams are very important for anyone who has been treated for non-Hodgkin's lymphoma. Most relapses occur in the first two to three 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 if they should arise.
Q. Where do I get help to cope with this?
A. 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, The Leukemia & Lymphoma Society, and the Lymphoma Research Foundation are nonprofit organizations that offer a variety of services to patients and their families. Their local offices may be listed in the telephone book.
Q. What does the future hold?
A. 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 the combination of chemotherapy, immunotherapy and radiation therapy, about half of all non-Hodgkin's lymphoma patients 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 lymphoma can show up again. Patients are naturally concerned about their future and may try to use statistics they have read or heard about to figure out their 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.
Q. What about research being done?
A. Scientists at hospitals and medical centers throughout the country are studying non-Hodgkin's lymphoma. They are trying to learn more about the possible causes of the disease and how it might be prevented.
In addition, scientists are studying 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 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 who may consider participating in a trial should discuss this possibility with their doctors.