Lymphoma

What Is Lymphoma?

Lymphoma is a cancer of the lymphatic system. The lymphatic system carries lymph fluid and white blood cells throughout body. The purpose of the lymphatic system is to fight infections.

Like all cancers, lymphoma happens when the body’s cells grow out of control, often causing tumors to grow. Most lymphomas are made up of white blood cells called either T cells or B cells.

Lymphoma cells are sometimes found in the blood, but tend to form solid tumors in the lymph system or in organs. These tumors can often be felt as a painless lump or swollen gland almost anywhere in the body.

About the Lymphatic System

The lymphatic system helps to filter impurities, bacteria, and viruses from the body. The lymphatic system is made up of the lymph nodes, spleen, and special tubes that extend throughout the body like blood vessels.

Swollen glands are actually enlarged lymph nodes. Lymph nodes act as alert centers which activate the immune system to attack viruses, bacteria, or other foreign substances.

Hodgkin’s Lymphoma

Hodgkin’s lymphoma, also known as Hodgkin’s disease, is a specific form of lymphoma. The cancer cells found in Hodgkin’s disease have traits that differ from other lymphomas.

Unlike other forms of lymphoma, Hodgkin’s disease usually spreads in a predictable way from one lymph node region to the next. Hodgkin’s disease tends to respond differently to treatment than does non-Hodgkin’s lymphoma.

Non-Hodgkin’s Lymphoma

Non-Hodgkin’s lymphoma includes many different cancers of the lymphatic system. Lymphomas are identified according to what type of cells they contain or where they occur in the body.

Most non-Hodgkin’s lymphomas are found in the lymph nodes or lymphatic organs. Lymphatic tissues and cells are found throughout the body. So, lymphomas can also develop in the liver, stomach, nervous system or in other organs.

What Causes Lymphoma?

The cause of most lymphomas is not known. Most are probably caused by mutations in certain genes, called oncogenes, which then allow normal cells to divide out of control.

These factors may increase a person’s risk of getting lymphoma:

• Exposure to chemicals such as certain solvents, pesticides, herbicides, and water contaminated with nitrate.
• Taking drugs that suppress the immune system.
• Having an autoimmune disease, such as lupus or rheumatoid arthritis.
• Having stomach ulcers or gastritis caused by a kind of bacteria called H. pyelori.
• Having a weakened immune system. For example, people with AIDS are 50 to100 times more likely to develop lymphoma than people who are not infected with the AIDS virus.
• Having one of the viruses that may increase risk for some types of lymphoma. For instance, in Africa, most Burkitt’s lymphoma cells also carry the Epstein-Barr virus (EBV). In the United States, however, most Burkitt’s lymphoma cells do not carry EBV. Viruses called HTLV-I appear to cause lymphoma in Japan, the Caribbean, and the southeastern United States. Another virus, called HHV-8, has been found in most cases of body cavity-based lymphomas (BCBL).

Lymphoma: What Are The Symptoms?

The first sign of lymphoma is often a painless lump or swollen gland in the neck, abdomen, underarm, or groin area. Lymphomas are often discovered during a visit to the doctor for another reason, or during a routine physical exam.

Other symptoms may include:

• Red patches on the skin.
• Nausea, vomiting, or abdominal pain.
• Coughing or breathlessness.

Some people with lymphoma develop other symptoms, called B symptoms, which include:

• Drenching night sweats.
• Unexplained weight loss, usually more than 10% of total body weight.
• Fever of more than 100 degrees Farenheit, which can come and go, especially in the evening.
• Itching skin, usually without a rash.
• Unusual tiredness.

Having these symptoms does not necessarily mean that a person has lymphoma, but if these symptoms last longer than two or three weeks, you should see a doctor.

Different Types Of Lymphoma?

There are many different types of lymphoma. Researchers continue to seek better ways to group lymphomas so that doctors can predict the best treatment for a particular type of tumor.

In most cases the type of lymphoma is less important than the grade and stage of a particular lymphoma.

The different categories of lymphoma can seem very complicated, but they are based on:

• The appearance or histology of the cancer cells under a microscope.
• What kinds of genetic mutations they carry.
• Whether they form tight clusters (nodular) or are spread throughout a lymph node or other organ of the body (diffuse).
• What type of cell they arose from.
• What types of proteins the lymphoma cells have on their surface.
• Where they occur in the body.

Many types of lymphoma have traits that overlap with one another so it is often difficult to group them into definite categories. Also, many lymphomas that begin as one type gradually develop into another.

Some types of non-Hodgkin’s lymphoma are distinct, either because of the age group they most often affect or the form they take. These include:

• Lymphoblastic lymphoma (LBL) – This form occurs more often in children than adults, and accounts for about 30% of all lymphomas in children. It is an aggressive, fast-growing form of lymphoma. In the past, it has been fatal for many patients. Today, intensive chemotherapy has greatly improved the chance of surviving LBL.

• Burkitt’s lymphoma – This form of lymphoma has been found in Africa, where infection with Epstein-Barr virus may play a role in its cause. Burkitt’s lymphoma is also seen in other parts of the world, but in most of these cases a virus doesn’t seem to be involved. Burkitt’s usually causes a large tumor either in the bone of the jaw, or in the abdomen.

• Diffuse histiocytic lymphoma (DHL) – Also called reticulosarcoma, this type of lymphoma is made of a substance that is more like connective tissue than white blood cells. DHL is usually slow-growing, hard to treat, and often returns after treatment.

• Cutaneous T-cell lymphoma (CTLC) – Also called mycosis fungoides or Sezary syndrome, this kind of lymphoma affects the skin. In CTLC, white blood cells in the skin become cancerous and eventually cause tumors to form. This form tends to grow slowly over many years. In the early stages of CTLC, the skin may develop dry, scaly, red or dark patches and begin to itch. Eventually, raised tumors form on the skin. When the cancer becomes more advanced, it may spread to the blood, and from there to other organs.

  In addition to the therapies used for other types of lymphoma, two additional treatments are used for CTLC. One is phototherapy, in which a drug that makes cancer cells sensitive to light is given to the patient, and a special light is then shone on the cancer cells to kill them. The other treatment is total skin electron-beam radiation therapy or TSEB, in which the entire surface of the skin is exposed to radiation.

  Today, treating CTLC often causes the cancer to disappear, or go into remission, but it is a very difficult cancer to cure if not caught early. Treatment does help the symptoms, however, and can often increase a patient’s life. New combinations of therapies are being studied in the hopes that more cases can be kept in remission for a longer time.

• Lymphoplasmacytoid lymphoma (LPL) with Waldenstrom’s macroglobulinemia – LPL develops when special white blood cells called plasma cells begin to divide out of control, becoming cancerous. It is a slow-growing or indolent form of lymphoma.

  LPL cells also release too much of a kind of antibody called IgM into the blood. This condition is called Waldenstrom’s macroglobulinemia. In addition to the cancer, this is dangerous because it causes a thickening of the blood. This in turn can cause fatigue, headaches, weight loss, visual problems, confusion, dizziness, loss of coordination and excessive bleeding. If not treated, the thickened blood can tax the heart so much that it leads to heart failure.

How Is Lymphoma Diagnosed?

Lymphoma is diagnosed through:

• Physical exam
• Blood tests
• Imaging tests
• Biopsy

Physical Exam

If a person has symptoms of lymphoma or notices a lump or swelling, the doctor will perform a complete physical exam. This includes checking the lymph nodes in the neck, armpit, or groin, and checking for an enlarged liver or spleen. The doctor will ask about recent illnesses or infections, and overall health.

Blood Tests

Blood tests may rule out infections and other types of disease. The blood will also be checked to see if cancer cells or cancer-related enzymes are present. Other factors in the blood, such as anemia may be looked at. These tests may also provide information on how far the cancer has spread.

Imaging Tests

The doctor will probably order imaging tests that can view inside the body, such as:

• X-rays.
• CT (computed tomography) scan.
• MRI (magnetic resonance imaging) scan.
• Lymphangiogram, a test using a special dye that makes the lymph nodes and vessels show up on an x-ray.

Biopsy

A biopsy tells whether a lump or swollen gland is truly a lymphoma. To do a biopsy, the doctor will surgically remove a small sample of tissue, and apathologist looks at it under a microscope. Cancer cells look a certain way under the microscope, which allows the pathologist to identify them.

What Are Grading And Staging?

When a doctor has found cancer cells and is sure that they are from a lymphoma, it is important to know the grade and the stage of the cancer. Lymphomas of different grades and stages grow at different rates, and respond differently to treatment.

• The grade of a lymphoma refers to how quickly, or aggressively, it is growing.
• The stage of lymphoma or any cancer depends on how far it has spread throughout the body.
• Grade and stage are the most important factors for predicting how a patient will do and for deciding on the best treatment.

Grade

For non-Hodgkin’s lymphoma, grade is the most important factor in predicting the likely outcome with and without treatment. Lymphomas are usually divided into three main grade categories:

• Low-grade or indolent: slow-growing lymphomas that can go for many years without treatment.
• Intermediate-grade or aggressive: faster-growing lymphomas.
• High-grade or highly aggressive: very fast-growing lymphomas.

Stage

In order to decide on the best treatment, it is helpful to know what stage the cancer has reached. The stage describes how far it has spread through the body from where it began. Lymphomas are grouped into four stages, from Stage I to Stage IV. Stage IV is the most serious.

The stage and whether the cancer has spread or remains as a single tumor is more important for slow-growing, low-grade lymphomas than for the more aggressive high-grade tumors.

To find out what stage a lymphoma has reached, the doctor will want to find out:

• How many lymph nodes contain cancer cells and where are they located.
• Whether these lymph nodes are above, below, or on both sides of the diaphragm.
• Whether the disease spread to the bone marrow, the spleen, or to other organs outside the lymphatic system.

To find out the stage of a lymphoma, a doctor will usually do several new tests and repeat ones that were done to diagnose the lymphoma. These may include:

• A bone marrow biopsy to show whether the cancer has spread into the bone marrow. To do a bone marrow biopsy, a doctor removes a sample of bone marrow through a needle inserted into the hip or another large bone.
• A CT scan or lymphangiogram.
• Taking samples from other tissues, such as the liver or stomach, to see whether tumor cells are present.
• Sometimes, a doctor may want to do an operation called a laparotomy to look for additional tumors. During a laparotomy, a surgeon takes samples of tissue from inside the abdomen. If a CT scan can be done, a laparotomy is usually not necessary. Results from a CT scan are usually considered more accurate.
• Depending on where cancer cells or tumors are found, other tissue samples and tests may need to be done.

The four stages of lymphoma are:

• Stage I: A single tumor which hasn’t spread.
• Stage II: More than one tumor, but the tumors are all found in lymph nodes on the same side of the diaphragm (all above or all below). Stage II can also mean that a tumor has spread to another organ, but that it is close to the original lymph node tumor.
• Stage III: More than one tumor with the tumors found on different sides (above and below) of the diaphragm. There may be tumors in the spleen or more than one tumor in nearby organs.
• Stage IV: Many tumors spread throughout an organ such as the liver or stomach, as well as in the lymph nodes. Stage IV can also refer to a single tumor in another organ, plus tumors in distant lymph nodes.

What Treatments Are Available For Lymphoma?

The methods of treatment used for lymphoma include:

• Chemotherapy (drugs) and radiation therapy
• Bone marrow transplant
• Biologic therapy

The combination of drugs and therapies used will depend on the type of lymphoma.

Chemotherapy And Radiation Therapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for non-Hodgkin’s lymphoma usually includes a combination of several drugs.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors.

Chemotherapy and radiation therapy are the most common treatments for non-Hodgkin’s lymphoma. Because of the risk that a lymphoma has spread beyond the original tumor, surgery alone isn’t usually enough.

Chemotherapy is called a systemic treatment because the drugs travel throughout the body. This means that even those cancer cells that have not yet been found may be killed. Patients may receive chemotherapy alone or in combination with radiation therapy.

For further information about radiation therapy, go to Radiation Therapy.

Bone Marrow Transplant

One form of chemotherapy, called high-dose chemotherapy (HDCT), uses very high doses of toxic drugs to kill all possible tumor cells. Because these high doses also kill most of the bone marrow, patients are then given a bone marrow transplant to restore their ability to make new red and white blood cells.

Bone marrow may be taken from the patient before chemotherapy begins and given back to the patient after treatment is done. Or, bone marrow from another person may be used.

Biological Therapy

We now understand a great deal about cancer and the body’s defense systems. Biological therapy, also called biological response modifier therapy (BRMT), uses chemicals made by the body’s own cells in order to activate the body’s defenses against cancer.

Many biological therapies are still experimental, but research is being done to develop and improve them. Scientists and doctors hope that they will soon be able to treat most forms of cancer using these therapies, combined with treatments like chemotherapy and radiation therapy.

The different approaches to biological therapy include:

• Immunotherapy
• Angiogenesis inhibitors
• Gene therapy

Immunotherapy

In one kind of immunotherapy, chemicals called cytokines are used to activate white blood cells. Sometimes, when the immune system is activated in this way, it will fight and kill tumor cells. Two cytokines being used are called interferon and interleukin.

Antibodies are proteins that help white blood cells fight off viruses and bacteria. Antibodies bind to foreign invaders and signal the immune cells to attack. Monoclonal antibodies are antibodies that are made in the laboratory to bind to only one single type of molecule.

Many cancer cells carry proteins called tumor antigens on their surface. Because cancer cells are usually the only ones to carry these proteins, tumor antigens make good targets. Researchers hope that monoclonal antibodies against these tumor antigens will bind to them and signal the immune system to attack the tumor cells.

Two approaches are being studied for treating cancer with monoclonal antibodies. In one, the antibodies signal the body’s own immune cells to attack and kill the tumor cells. In the other, powerful anti-cancer drugs are linked to monoclonal antibodies which then carry the drugs straight to the tumor. This means that the drug is aimed directly at the cancer cells rather than at healthy tissues.

The U.S. Food and Drug Administration (FDA) has approved Rituxan, a monoclonal antibody for treating lymphoma, and are considering approval of a similar drug, Bexxar. Rather than binding to proteins found only on cancer cells, these two antibodies bind an antigen found on almost all B-lymphocytes. This causes both cancerous and healthy, mature B-lymphocytes to be killed. But because the youngest B cells in the body do not have the antigen, they are not affected by the treatment, and can grow and mature to replace those that were killed during treatment.

Another new immunotherapy is the use of tumor vaccines. In much the same way that a polio vaccine activates your immune system to fight off the virus if you are ever infected, tumor vaccines use a person’s own tumor cells to activate the immune system to destroy the tumor.

Angiogenesis Inhibitors

Angiogenesis inhibitors are chemicals that block the formation of new blood vessels. Tumors need to create a whole new blood supply in order to keep growing, so they cause new blood vessels to be formed. In mice, angiogenesis inhibitors have blocked the growth of many types of cancer. This highly experimental form of treatment has been successful in mice. Clinical trials are underway to test the treatment in people.

Gene Therapy

In gene therapy, pieces of DNA are placed into cells to correct something that has gone wrong with those cells, or to make the cells self-destruct. Because most cancers are now known to result from damage to genes that keep cells from growing out of control, gene therapy of cancer cells may someday be able to correct the problem or force cancer cells to destroy themselves. Gene therapy for cancer is still highly experimental.

Lymphoma: Making Your Treatment Go Smoothly

Because many non-Hodgkin’s lymphomas now have a good chance of being cured, anyone diagnosed with lymphoma should be referred to an oncologist as soon as possible. One reason for this is because treatments are constantly being improved and an oncologist is most likely to be aware of new and better therapies.

The oncologist and the family doctor can then work as a team to arrange the best possible treatment and follow-up care. The medical team may also include a hematologist and/or a radiation oncologist.

You can help to make your treatment go as smoothly as possible by:

• Giving your doctor the most complete medical history that you can.
• Telling your doctor about any side effects or problems you have during treatment.
• Trying to eat right.
• Taking care of yourself, including getting pain relief when you need to.
• Following your doctor’s recommendations, including follow-up and long-term care.

What To Tell Your Doctor

Before and during treatment for any form of cancer, your doctor will need to know about any medications you may be taking. This includes over-the-counter medicines for allergies, indigestion, colds, and pain relief and any vitamin, mineral or herbal supplements you may take. Remember to tell your doctor about prescription medication from other doctors.

If You Have Side Effects During Treatment

If you develop any symptoms that seem unusual or if there is anything you are unsure about, don’t hesitate to call your doctor. Call your doctor if you notice any of the following:

• Losing or gaining 10 pounds or more.
• Nosebleeds.
• Severe itching or rash on skin.
• Wheezing or any other trouble breathing.
• Feeling very tired.
• Constipation.
• Sores in your mouth or throat.
• Coughing a lot.
• Feeling tingling in your fingers and toes.
• Ringing in your ears.
• Red dots under your skin.
• Black and blue marks.
• Nausea or vomiting.
• Diarrhea.
• A fever of 101 degrees or higher.
• Chills, especially shaking chills.
• Redness, swelling, or tenderness, especially around a wound or sore.
• Hair loss.
• Headaches or changes in vision.
• Warm to hot feeling of an arm or leg.
• Unusual bleeding, for instance from your gums or nose.
• Unusual bruising.

Try To Eat Right

Although it is sometimes hard to eat a balanced diet during cancer therapy, it will help your body recover much sooner from the effects of the treatment and the cancer. Every day, try to eat and drink:

• At least 5 servings of fruits and vegetables.
• Protein-rich foods like chicken, fish, cheese or eggs.
• Carbohydrates, found in breads, pastas, rice and grains. Whole grains like whole-wheat bread and pasta, and brown rice are more nutritious than processed foods like white bread, pastries, and sugary foods and will help your body recover sooner.
• Plenty of liquids.
• Soups can combine all of these and may be easy to eat.

If it is hard to eat, try soft, soothing foods like milkshakes and soft sandwiches. Acidic or spicy foods or foods that are too hot or too cold can make eating more uncomfortable. Eating small meals more often can help you to meet your nutritional needs.

Taking Care Of Yourself

Cancer therapies can make the mouth sore and prone to infection. Try to brush your teeth with a soft toothbrush after every meal. If your mouth is too sore to brush, try to at least rinse with water.

Try to get plenty of rest. This will allow your body to heal and help fight infections. Avoiding people who have colds, flu, or other infections may decrease your risk of being infected.

Dealing with cancer and cancer therapy can be extremely stressful. You may find yourself becoming depressed, or you may find yourself discovering new wisdom.

Try to find emotional support and someone you can talk to about your feelings. This could be your family, someone in your church, a counselor, or a support group for cancer patients. For more information, go to Additional Sources of Information.

Getting Adequate Pain Relief

Cancer can be very painful. While cancer pain cannot always be completely stopped, you do have the right to have relief from pain.

Some people are afraid that if they take powerful painkillers they will become addicted. Some doctors and other caregivers also still hold this belief.

Studies have shown that people who take pain medications in the right way, for real pain, rarely become addicted. Being able to keep pain under control actually makes people less likely to become addicted. Other studies have shown that severe, prolonged pain is actually harmful to your body and its ability to heal. Even if you have to take pain medication for a long time, this does not mean you have become addicted.

In addition to pain-relieving drugs, techniques such as relaxation therapy, hypnosis, visualization, and massage can also help ease pain. Discuss these with your medical team.

Be sure to discuss pain relief with your doctor if and when you need it. Try to work with your medical team and play an active role in your own care. Simply feeling in control of your situation can often do a lot to help ease pain.

If you feel that your medical team is not allowing you the medication or other treatment that you truly need for your pain, you may want to discuss the problem with a counselor or seek a second opinion from another doctor.

Follow-Up Care

Because lymphomas can recur even if it seems that they have been cured, it is important to have checkups every few months even after you have finished your treatments. Treatments for lymphoma can be toxic and there is always some chance that they will cause medical problems in the future. Staying in touch with your family physician and reporting anything that concerns you in between follow-up visits may improve your long-term outcome.

Lymphoma Treatment In Children

If your child has been diagnosed with lymphoma, call your child’s doctor whenever you have questions. If you are unsure whether something should be reported, discuss it with your child’s doctor.

According to the National Cancer Institute, you should let your physician or another medical team member know if your child has any of the following:

• A fever or other sign of infection, or just doesn’t look well.
• Exposure to a contagious infection, especially chickenpox or measles (unless your child is known to be immune from prior exposure).
• Persistent headaches, pain, or discomfort anywhere in the body.
• Difficulty in walking or bending.
• Pain during urination or bowel movements.
• Reddened or swollen areas.
• Vomiting, unless you have been told that your child might vomit after chemotherapy or radiation.
• Problems with eyesight such as blurred or double vision.
• Bleeding. In addition to obvious bleeding such as nosebleeds, signs of bleeding can be seen in the stools (red or black), in the urine (pink, red, or brown), in vomit (red or brown, like coffee grounds), or the presence of multiple bruises.
• Other troublesome side effects of treatment such as mouth sores, constipation (beyond 2 days), diarrhea, and easy bruising.
• Marked depression or a sudden change in behavior.

Remember to check with your child’s physician when your child is due to receive any kind of vaccination or any dental care.

What Is The Outlook For Lymphoma?

By choosing the best treatment, your doctors will try to bring the cancer into remission, so that no more cancer can be found and there are no more symptoms.

The outlook for lymphoma and other cancers is measured in survival rates, or how many patients have been able to live for two years, five years, ten years, etc. before or after treatment.

Because there are so many different types of lymphoma and because the outlook for each patient varies widely, it is very difficult to predict the outcome for an individual case. We do know some general facts:

• Although high-grade, aggressive lymphomas are usually quite deadly without treatment, many can now be cured with proper treatment.
• On the other hand, most low-grade, indolent lymphomas can be left alone for years. But, they usually prove to be very stubborn and surprisingly difficult to cure. They often return, usually within a couple of years after treatment. Repeating the treatment can then often put them back into remission, but they usually come back.
• A lymphoma with a lower stage (Stage I or II) has a better outlook than one with a higher stage (Stage III or IV).

Certain factors make the chance of remission and long-term survival more likely. These positive factors include:

• Small, localized tumors.
• Absence of B symptoms.
• Young age
• Female gender

Lymphoma: Frequently Asked Questions

Here are some frequently asked questions related to Non-Hodgkin’s Lymphoma.

Q: What are some of the possible side effects of treatment?

A: The effects of chemotherapy and radiation therapy can be harsh. Remember that they are mostly temporary and won’t last forever. Talk with your doctor about what to expect and which symptoms to report if you experience them. Side effects may include:

• Fatigue.
• Nausea and vomiting.
• Pain.
• Hair loss.
• Anemia.
• Central nervous system problems.
• Infection.
• Blood clotting problems or excessive bleeding.
• Mouth, gum, and throat problems.
• Diarrhea.
• Constipation.
• Nerve and muscle effects, like tingling, burning, weakness, or pain in muscles or skin.
• Effects on skin and nails, such as redness, rashes, itching, peeling, dryness, acne or increased sensitivity to the sun.
• Radiation recall, when the skin turns red and may blister.
• Kidney and bladder effects.
• Flu-like symptoms.
• Fluid retention.
• Temporary or permanent problems having children.

Your doctor can give you information on drugs and other ways to reduce side effects.

Q: What other types of problems is lymphoma likely to cause?

A: Even before treatment begins, lymphoma may cause anemia. Anemia can cause extreme fatigue. Lymphoma may also interfere with the immune system, making infections more likely. Sleep disorders, depression and anxiety are also common effects. In the advanced stages of cancer, people often develop cachexia, in which they stop eating and develop profound fatigue and weakness. Speak with your doctor if you are having trouble with any of these symptoms. Anemia can be treated, and sleep disorders can often be helped with medications. Medications are also available to help with cachexia.

Q: Are there other things besides drugs that can ease pain or the side effects of treatment?

A: There are a number of complementary approaches that have helped many people deal with the discomfort and pain of lymphoma and treatments for cancer. These include:

• Relaxation techniques.
• Biofeedback, a technique for learning how to change your response to stress.
• Massage.
• Visualization and guided imagery.
• Hypnosis.
• Transcutaneous Electric Nerve Stimulation (TENS), a therapy using electric stimulation of nerves and muscles to relieve pain.
• Acupuncture or acupressure (acupuncture is not recommended for people receiving chemotherapy, as it may increase bleeding).
• Skin stimulation (heat, cold, pressure).

Support groups for lymphoma patients offer more information on learning about these techniques.

Q: Can lymphomas occur in other parts of the body than thelymph nodes?

A: Yes, tumors can be found in other organs, such as the liver, the stomach, or even the brain. Sometimes tumors in organs are found even if tumors have not been found in the lymph nodes.

Q: Are there alternative medicines (herbs, shark cartilage, etc.) that will work for lymphoma?

A: So far, no herbal or other alternative therapy has been proven to help lymphoma. For this reason, and because lymphoma can be a life-threatening disease, the safest course is to have medical treatments prescribed and tracked by your medical team. If you decide to try alternative therapies such as herbs or homeopathy in addition to the medical treatments advised by your medical team, be sure to discuss all treatments with your doctor first. Some alternative therapies may interfere with your treatment, lowering their chance of success. Others may become toxic when taken with chemotherapy drugs. The National Cancer Institute (NCI) offers information on alternative therapies that have been used to treat cancer. This information describes the results of scientific studies on these therapies. The National Institute of Health (NIH) has also set up the National Center for Complementary and Alternative Medicine (NCCAM), which is conducting scientific studies on herbal and other alternative medicines.

Q: Are new treatments for lymphoma being developed?

A: Yes. Many new therapies, or combinations of therapies, are being studied. Working with a trained oncologist will help to insure that you receive the most up-to-date and effective treatment.

Q: Would a clinical trial be right for me? How can I find out about clinical trials for new treatments for lymphoma?

A: You may want to consider enrolling in a clinical research trial. This is a study in which some patients are given the standard treatment for a particular type of cancer, while other patients are given a new treatment. Any treatment tested in people must first pass rigorous tests in animals. The National Cancer Institute (See Additional Sources of Information.) has an up-to-date list of ongoing clinical trials of new therapies for cancer.

Lymphoma: Putting It All Together

Here is a summary of the important facts and information related to Non-Hodgkin’s Lymphoma.

• Lymphoma is a cancer of the lymphatic system, which carries lymph fluid and white blood cells throughout the body. White blood cells fight infection.
• There are two main types of lymphoma: Hodgkin’s disease, and non-Hodgkin’s lymphoma.
• A non-Hodgkin’s lymphoma diagnosis used to be very bad news. Now medical treatments can cure many cases. New, even better treatments are also being developed.
• The first sign of lymphoma is often a painless lump or swollen gland in the neck, abdomen, underarm, or groin area.
• Many other things can cause swollen glands. Swollen glands due to infection are usually fairly soft and somewhat tender or painful, while cancerous nodes are usually firm, rubbery and painless.
• Your doctor and oncologist will do a number of tests to define the lymphoma’s grade and stage. Then they can design the best possible treatment approach.
• Grade refers to how quickly the tumor is growing. High-grade, aggressive lymphomas are fast-growing and can be deadly in a short time, but can often be cured with proper treatment. Low-grade, indolent lymphomas are slow-growing, but tend to recur after treatment.
• Stage refers to how far the cancer has spread throughout the body. The lower the stage, the less the lymphoma has spread and the better the outlook.
• The two forms of treatment that are used most often for lymphoma are chemotherapy (drugs) and radiation therapy. Promising new biological therapies are also being developed.
• Chemotherapy and radiation therapy can be difficult both physically and emotionally. Try to remember that your therapy will not last forever. There are many support groups and sources of information that can help you through the difficulty of your diagnosis and treatment.
• There are things you can do to make your therapy go as smoothly as possible. Talking to your doctor, trying to follow a healthy lifestyle, and sticking to recommendations and follow-up care will help your medical team help you.

Lymphoma: Glossary

Here are definitions of medical terms related to Non-Hodgkin’s Lymphoma.

Abdomen: The center part of the body that contains the stomach, intestines, liver, gallbladder, and other organs.

Aggressive lymphoma: A lymphoma that is fast-growing.

Alternative medicine: Treatments that have not traditionally been used in standard Western medicine, and are not widely taught in medical schools. These may include naturopathic medicine (herbs and plants), homeopathy, traditional Chinese medicine, Ayurvedic medicine, and others.

Anemia: Too few red blood cells. Anemia can cause tiredness, shortness of breath, and make it harder for the body to fight infection.

Angiogenesis inhibitors: Chemicals produced by the body which stop the growth of new blood vessels. Because cancerous tumors must have a supply of new blood vessels in order to keep growing, angiogenesis inhibitors are being tested as a treatment for lymphoma and other cancers.

Antibody: Antibodies are proteins that help white blood cells fight off viruses and bacteria, by binding to foreign invaders and signaling the immune cells to attack.

Autoimmune disease: A disease in which the immune system attacks body’s own tissues.

B cells: White blood cells that make antibodies. Some forms of lymphoma are made of B cells.

B symptoms: Symptoms that some people experience when they have lymphoma. B symptoms are non-specific In other words, they don’t mean that lymphoma is present for sure, but it should be ruled out if the symptoms last longer than a couple of weeks. B symptoms include: drenching night sweats, unexplained weight loss (usually more than 10% of total body weight), fever of more than 100 degrees F., itching skin, and unusual tiredness.

Biological therapy: Uses chemicals or proteins made by the body’s own cells to activate the body’s defenses against a cancer. Also called immunotherapy or biological response modifier (BRM) therapy.

Biopsy: The removal of cells or tissues for examination under a microscope.

Bone marrow: The soft, spongy tissue in the center of large bones that produces white blood cells, red blood cells, and platelets.

Bone marrow transplantation: A treatment that replaces bone marrow destroyed by treatment with high doses of anticancer drugs or radiation.

Cancer: A disease in which any of the body’s cells begin to divide out of control, causing a tumor to form or too many of these cells to spread throughout the body.

Chemotherapy: Treatment with anti-cancer drugs.

Clinical trial: A research study that tests the effectiveness of new treatments in people.

Complementary therapies: Treatments that have not been considered part of standard Western medicine, but that are increasingly being used in combination with standard medical treatments. These may include therapies for pain such as massage, relaxation techniques and some nutritional therapies.

Connective tissue: The type of tissue that makes up the supporting structure of the lymph nodes and other organs, in the same way that beams and girders make up the supporting structure of a building.

CT scan: Computed tomography scan. A series of detailed pictures inside the body; the pictures are created by a computer linked to a special x-ray machine. Also called a CAT scan.

Cytokines: chemicals produced by the immune system that stimulate white blood cells to attack and kill viruses, bacteria, foreign cells, or cancer cells.

Diaphragm: The thin muscle below the lungs and heart that separates the chest from the abdomen.

DNA: The molecule that is used to build the genetic code in every cell. Genes are made of DNA.

Gene: A piece of DNA that carries the code for a certain cell protein. Genes carry the genetic information that is passed from parent to child, such as eye color or hair color. Genes also carry the information to make many proteins that are important in disease. In cancer, for instance, oncogenes can make cells grow out of control, unless other genes keep this from happening.

Gene therapy: Treating a disease by putting good copies of a gene into cells. For cancer, this might include putting genes into the cancer cells that will make them stop growing out of control, or it might mean putting genes into the cancer cells that will make them self-destruct.

Grade: A measure of how quickly a tumor is growing

Groin: The area in the body where the thigh meets the abdomen.

Hematologist: A doctor who specializes in treating diseases of the blood.

High grade lymphoma: a lymphoma that is fast-growing and aggressive.

Histology: The appearance of the cancer cells under the microscope.

Immunotherapy: A form of biological therapy that stimulates the immune system to fight and kill cancer cells. Some forms include cytokine therapy, monoclonal antibodies, and tumor vaccines.

Indolent lymphoma: a low-grade lymphoma that grows slowly and has few symptoms.

Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease.

Lymph nodes: Small, bean-shaped organs located throughout the body along the vessels of the lymphatic system. The lymph nodes filter impurities from the body and store white blood cells that fight infection and other diseases. Clusters of lymph nodes are found in the underarms, groin, neck, chest, and abdomen. Also known as lymph glands.

Lymphangiogram: X-ray of the lymphatic system. A dye is injected into a lymphatic vessel and travels throughout the lymphatic system. The dye makes them visible on the x-ray.

Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, and lymph nodes and a network of vessels that carry lymph and white blood cells into all the tissues of the body.

Lymphoma: A cancer of the lymphatic system.

Monoclonal antibodies: Antibodies are proteins that help white blood cells fight off viruses and bacteria, by binding to foreign invaders and signaling the immune cells to attack. Monoclonal antibodies are antibodies that are made in the laboratory to bind to only one single type of molecule. They are currently being used to bind to tumor cells, either to signal to immune cells to attack, or to carry toxic agents directly to the tumor.

MRI: Magnetic resonance imaging. A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body.

Mutation: a change in the DNA sequence of a gene.

Mycosis fungoides: another name for cutaneous T cell lymphoma (CTLC), which affects the skin.

Oncologist: A doctor who specializes in diagnosing and treating cancer.

Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope.

Phototherapy: A treatment in which a drug that makes cancer cells sensitive to light is given to the patient, and a special light is then shone on the cancer cells to kill them.

Plasma cells: White blood cells called B cells that have been triggered into make antibodies.

Prognosis: The likely outcome or course of a disease; the chance of recovery.

Radiation oncologist: A cancer specialist with experience in radiation therapy.

Radiation therapy: A form of treatment that uses high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors.

Recur: To occur again, to come back. Even when lymphoma appears cured, it may recur.

Relapse: When a condition comes back after it has been successfully treated.

Remission: Disappearance of any sign of cancer cells and all symptoms of cancer. When this happens, the cancer is said to be in remission. A remission may be temporary or permanent.

Risk factor: Anything that increases the chance of developing a disease.

Side effects: Problems that occur due to treatment. Common side effects of cancer treatment are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys those that are aging. It is located on the left side of the abdomen near the stomach.

Stage: A measure of how far a cancer has spread throughout the body. Stages range from Stage I, which is a localized tumor that has not spread, to Stage IV, in which the cancer has spread to parts of the body far away from the original tumor. Stage I cancers have a better outlook than do Stage IV cancers.

Systemic therapy: A treatment that uses substances that travel through the bloodstream, reaching and affecting cells all over the body.

T cells: White blood cells that help fight infection. Many lymphomas are made of T cells.

Total skin electron-beam radiation therapy or TSEB: a treatment for cutaneous lymphoma in which the entire surface of the skin is exposed to radiation.

Thymus: An organ that is part of the lymphatic system in which T lymphocytes mature and multiply. It is located in the chest, behind the breastbone.

Tumor: An abnormal mass of tissue that occurs when cells divide out of control. Tumors may be either benign (not cancerous) or malignant (cancerous). Benign tumors do not spread throughout the body and when they are removed they do not grow back. Malignant, or cancerous, tumors may do both.

Tumor vaccine: An experimental treatment for cancer. A patient’s own cancer cells are injected into the blood of the patient, or mixed with the patient’s white blood cells in the laboratory, which are then returned to the patient. The hope is that this will activate the white blood cells to attack the cancer, just as a polio vaccine keeps someone from getting polio by attacking any polio virus that enters the body.

White blood cells: The cells of the immune system that fight infection, attack foreign substances or cells, and sometimes kill cancer cells.

Lymphoma: Additional Sources Of Information

Here are some reliable sources that can provide more information on Non-Hodgkin’s Lymphoma.

Information and Support Groups:

American Cancer Society (ACS) 
Phone: (800) ACS-2345(toll-free hotline) 
www.cancer.org

Check your local phone book for the address and phone number of your state’s ACS office.

Cancer Care, Inc. National Office 
Phone: 212 302 2400 Tel: Services 
Phone: 212 221 3300 Administration 
Phone: 1 800 813 HOPE (4673)
Fax: 212 719 0263
Email: info@cancercare.org 
http://www.cancercare.org

A non-profit organization whose mission is to provide free professional help to people with all cancers through counseling, education, information, referral and direct financial assistance.

The Leukemia & Lymphoma Society 
Phone: 800-955-4572
Phone: 212-573-8484
www.leukemia.org

A national voluntary health agency dedicated to curing leukemia, lymphoma, Hodgkin’s disease and myeloma, and to improving the quality of life of patients and their families.

The Lymphoma Information Network 
http://www.lymphomainfo.net

A website offering information and support, as well as links to other groups both within and outside the United States.

The Lymphoma Research Foundation of America 
Phone: 310-204-7040
Email: LRFA@aol.com 
http://www.lymphoma.org

National Cancer Institute (NCI), Cancer Information Service 
Phone: (800) 4-CANCER
Phone: 800-422-6237
www.nci.nih.gov

NCI is the Federal Government’s principal agency for cancer research.

National Coalition for Cancer Survivorship 
Phone: (877) NCCS YES
Phone: (877-622-7937)
Fax: (301) 565-9670
Email: info@cansearch.org

Cancer Survivors Coalition 
www.canceradvocacy.org

A support and advocacy group for people with cancer. Includes sections on Skills for Communicating with Health Care Providers, Strategies for Self-Empowerment and Self-Care, What Cancer Survivors Need to Know About Health Insurance, and others.

Information About Clinical Trials:

Cancer Information Service (National Cancer Institute) 
Phone: 1-800-4-CANCER (1-800-422-6237)
http://www.nci.nih.gov/clinical_trials/

To find out which trials are available for a particular type of lymphoma, individuals may use the National Cancer Institute’s PDQ Clinical Trials Search Form for Patients. Using this form, you may easily select a specific diagnosis, treatment type, and city/state for information on current trials.

Large medical centers near your home will also have information about ongoing clinical trials in your area.

Information About Complementary And Alternative Therapies For Cancer:

CancerNet 
http://www.cancer.gov/cancerinfo/treatment

The National Cancer Institute’s CancerNet web page on “treatment options” includes a section on complementary and alternative medicine.

In addition, patients and their doctor or nurse can learn about complementary and alternative therapies from the following Government agencies:

NIH’s National Center for Complementary and Alternative Medicine (NCCAM), NCCAM Clearinghouse 
Phone: 1-888-644-6226
Phone: 1-888-644-6226TTY/TDY (for deaf and hard of hearing callers) 
http://www.nccam.nih.gov

NCCAM conducts and supports basic and applied research and training and disseminates information on complementary and alternative medicine to practitioners and the public.