Non-Hodgkin's lymphomas are cancers of the lymphatic system
There are two main types of lymphoma: non-Hodgkin's lymphomas and Hodgkin's disease
Lymphoma cells have the ability to spread beyond the original site. They usually spread first to other lymph nodes / glands in the lymphatic system, but can also enter the bloodstream which carries them to various organs
When the cells reach a new site they may go on dividing and form a new tumor
The lymphatic system
The lymphatic system is the body's natural defense against infection
It is made up of a collection of lymph nodes connected together by lymphatic vessels
Small lymph nodes are found mainly in the neck, under the armpits and in the groin. Other nodes are found in the chest and abdomen
A clear fluid called lymph is produced in the body's tissues and circulates throughout the body via the lymphatic system
It contains cells known as lymphocytes that act as a defense against infection. If, for example, you have a sore throat you may notice and the nodes in your neck become enlarged, this is a sign that your body is fighting against the infection
Although the cause of most non-Hodgkin's lymphomas is unknown, research into this is going on all the time
Researchers are investigating whether certain conditions, such as the use of drugs which prevent rejection following an organ transplant, may make people more likely to develop lymphomas
Non-Hodgkin's lymphomas, like other cancers, are not infectious and cannot be passed on to other people
The first symptom of a non-Hodgkin's lymphoma is usually a painless swelling in the neck, armpits or groin
Excessive sweating or fever, especially at night
Persistent itch all over the body
Loss of appetite, weight loss and tiredness
Children may develop a cough or breathlessness. Children may also complain of abdominal pain or you may notice a lump in your child's abdomen
If you or your child has any of the above symptoms you must have them checked by your doctor - but remember - they are common to many conditions other than non-Hodgkin's lymphomas and most people with these symptoms will not have a lymphoma.
The Diagnosis Preliminary Stage Biopsy: by removing an enlarged lymph node and examining the cells under a microscope
Further Tests If the biopsy shows that lymphoma cells are present your doctor will want you to have some further tests The tests may include any of the following:
Blood test This is to check your general health, the levels of red and white cells and platelets in your blood, and your liver and kidney functions
Chest X-ray This is taken to check for any sign that the disease has spread to the lymph nodes in the chest.
Bone marrow sample For this test a sample of bone marrow is taken, usually from the hip bone, and examined to see if it contains any lymphoma cells
CT scan (CAT scan) A CT scan is another type of X-ray. A number of pictures are taken of the chest and abdomen and fed into a computer to form a detailed picture of the inside of the body
The following tests are less commonly done but may be considered necessary in some cases:
Lymphangiogram (lymphogram) This test is done to check for any signs that the disease has spread to the lymph nodes in the abdomen or pelvis
Intravenous urogram This test is also known as an IVU or IVP and it shows up any abnormalities in the kidneys or urinary system
Magnetic resonance imaging (also called MRI or NMR) The test is similar to a CT scan, but it uses magnetism instead of X-rays to build up a series of cross-section pictures of the body
The Treatment In recent years a lot of progress has been made with the treatment for non-Hodgkin's lymphomas and an increasing number of people can now be cured, even when the disease has spread from the original site. The low-grade lymphomas grow very slowly and sometimes do not need treatment for a long time, if at all, and regular check-ups are all that is needed. When they do require treatment it is most often with mild chemotherapy - tablets which can be taken at home. The high-grade lymphomas are faster growing and need treatment with intensive chemotherapy. Children with non-Hodgkin's lymphomas nearly always have high-grade tumors and the main form of treatment is with intensive chemotherapy. Radiotherapy is not usually part of the treatment program, but may be necessary in some circumstances. Your doctor will plan your treatment by taking into consideration a number of factors, including:
the type of lymphoma
whether it has spread to other parts of the body
Immunotherapy whereas the meaning of biological treatment of CIK, DC-CIK, LIFT (Granulocyte cell therapy ) and ACTL treatment
This is a course of utilizing the immune system to kill or control the cancer cells
Immunotherapy is the use of patient own immunology system to defense the cancer cells
This treatment is used for most type of cancers
Immunotherapy is given as a course of treatment usually lasting a week.
This is suggested to be followed by a recurring course in every other 3 - 6 months to keep your body in its best conditions Number of courses will depend on the type of cancer you have and ages.
Immunotherapy is usually given as an inpatient, but is often recommended you to take off from hospital during the interval.
Radiotherapy Radiotherapy treats cancer by using high energy rays which destroy the cancer cells while doing as little harm as possible to normal cells Radiotherapy is a local treatment and may be used when the lymphoma cells are contained in one or two areas of lymph nodes in the same part of the body.
Chemotherapy is the use of special anti-cancer (cytotoxic) drugs to destroy the lymphoma cells
They work by stopping the cells from dividing
As the drugs circulate in the bloodstream they can reach the lymphoma cells all over the body
With the slow-growing type of lymphoma the drugs can sometimes be given in tablet form and can therefore be taken at home, enabling you to carry on with your normal activities
At other times, the drugs are given by an injection into a vein (intravenously), usually in the arm, and this may mean a short stay in hospital
Chemotherapy for the more rapid-growing lymphomas is given intravenously.
Side effects Radiotherapy and chemotherapy affects people in different ways. Some find they are able to lead a fairly normal life during their treatment, but many find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it The common side effects may include:
Bone Marrow Transplant
Bone marrow transplants are used only in a minority of people with non-Hodgkin's lymphomas. A transplant will normally only be considered if your cancer has already responded well to treatment and you are in remission, but your doctors feel that there is a high chance that the illness may come back
Bone marrow transplantation is a way of allowing very high doses of chemotherapy and/or radiotherapy to be given, to improve the chances of completely curing the disease
These high doses will destroy your bone marrow - the substance in the inner part of your bones that manufactures the blood - you need a transplant to make yourself a 'new' blood system after the high dose treatment
A brother's or sister's bone marrow or, more often, your own bone marrow, can be used as the transplant.
Peripheral Blood Stem Cell Transplants
Increasingly, many hospitals are moving away from using bone marrow for the transplant and are using cells that can be collected from the blood
The advantages are that you do not have an anesthetic for the cells to be collected and, most important of all, the blood recovers much more quickly
If this is thought to be appropriate for you, you will be asked to have chemotherapy followed by injections of a growth factor - a special protein which makes bone marrow cells multiply and spill over into the blood.
Steroids are drugs that are often given with chemotherapy for lymphomas. They also help you feel better quickly Side effects
- An increased appetite
- Feeling more energetic and difficulty in getting to sleep
- Puffiness of the eyelids, hands, fingers and feet
- Raised blood pressure
- Slightly greater risk of getting infections
- An increased level of sugar in the blood
It is important to remember that all these side effects are temporary and will gradually disappear as the steroid dose is reduced. Because of your lowered resistance to infection, it is probably best to avoid people who have a cold or flu while you are taking steroids You should always carry a card with you stating that you are taking steroids.
Questions For Your Doctor
What type of Non-Hodgkin's lymphomas do I have?
Has my Non-Hodgkin's lymphomas spread? If so, which part of my body has it spread?
What treatment do you recommend and why?
What are the risks and possible side effects of each treatment?
Are there other treatment choices for me? If not, why not?
Will a doctor who specializes in Non-Hodgkin's lymphomas give my treatment?
Are all modern investigations and treatments for my type of cancer available in this hospital?
Are there any clinical trials of new treatments?
Will I have to stay in hospital, or will I be treated as an outpatient?
How long will the treatment take? How much will it affect what I can do? How much will it cost?
If I need further treatment, what will it be like and when will it begin?
Will the treatment affect my sex life?
How frequently will I have checkups and what will they involve?
I would like to have a second opinion about the treatment. Can you refer me to someone else?
Am I going to survive?
What are my chances for a successful recovery?