Disease Specific Information
Facts About Non-Hodgkins Lymphoma
The lymphatic system is a network of thin tubular vessels that branches out to almost all parts of the body. Scattered in between these vessels are lymph nodes. The job of the lymphatic system is to fight infection and disease. Cancer involving the lymphatic system is called lymphoma. Non-Hodgkins is one of two main types of lymphoma with Hodgkins lymphoma (or Hodgkins disease) being the other.
- Non-Hodgkins lymphoma (NHL) refers to a variety of cancers involving the lymph system. Non-Hodgkins lymphoma can begin in any part of the body, not just the lymph nodes.
- According to the American Cancer Society, nearly 64,000 new cases of lymphoma will be diagnosed this year.
- Survival rates vary widely by cell type and stage of disease. More than 75 percent of patients with NHL live longer than a year after diagnosis; nearly 60 percent of patients live longer than five years.
Risk Factors for Non-Hodgkins Lymphoma
Risk factors for developing lymphoma are unknown. However, doctors believe immune system problems as well as age may increase a person's chance of developing this disease.
- Non-Hodgkins is most commonly found in people in their 60s and 70s. However, the disease can affect anyone.
- People with auto-immune disorders, including HIV and AIDS, are more likely to develop non-Hodgkins lymphoma.
- People who have received an organ transplant have a high risk of developing non-Hodgkins. This is because they must take drugs that suppress the immune system.
Signs and Symptoms of Non-Hodgkins Lymphoma
The signs and symptoms of lymphoma are general and may also be associated with other, noncancerous conditions. Talk to your doctor about any of these problems.
- Swollen lymph nodes in your neck, underarm or groin.
- Unexplained fevers.
- Unexplained weight loss.
- Constant fatigue.
- Skin rash or itchy skin.
- Unexplained pain in the chest, abdomen, pelvis or bones.
- Drenching night sweats.
Unexplained fevers, night sweats and weight loss are known as “B” symptoms. Ask your doctor about their significance in your case.
Diagnosing Non-Hodgkins Lymphoma
Lymphoma is not just one disease. Rather, it is more than 30 types of cancer that act differently and may need special treatment. To see if you have lymphoma and what kind it is, your doctor may order some or all of the following tests.
- The doctor may order blood tests to evaluate a variety of factors, including the number of blood cells in your blood and how well your liver and kidneys are working.
- During a lymph node biopsy, your doctor will perform surgery to take out a lymph node. It will then be examined under a microscope to look for cancer.
- A bone marrow biopsy may help determine if lymphoma has spread to that part of the body.
- Your doctor may order imaging tests to see if lymphoma has spread to other organs. These tests may include X-rays or CT, PET or MRI scans.
Staging of Non-Hodgkins Lymphoma
The stage of cancer is a term used to describe its size and whether it has spread. Knowing this helps doctors plan the best treatment.
- Stage I: Single lymph node or non-lymph node region is affected.
- Stage II: Two or more lymph node or non-lymph node regions are affected on the same side of the diaphragm (the muscle under the lungs).
- Stage III: Lymph node or non-lymph node regions above and below the diaphragm are affected.
- Stage IV: The cancer has spread outside the lymph nodes to organs such as the liver, bones or lungs. Stage IV can also refer to a tumor in another organ and/or tumor in distant lymph nodes.
Treatment Options for Non-Hodgkins Lymphoma
Treatment options depend on the type of lymphoma you have, the stage of the lymphoma and your overall health. Treatment may include radiation therapy or chemo-therapy, either alone or in combination. Other treatments include watchful waiting and biologic therapy. It may help to talk to several cancer specialists before deciding on the best course of treatment for you, your cancer and your lifestyle
- A radiation oncologist is a doctor who specializes in destroying cancer cells with high energy X-rays or other types of radiation.
- A medical oncologist is a doctor who is an expert at prescribing special drugs (chemotherapy) to treat cancer. Some medical oncologists are also hematologists, meaning they have experience treating blood problems.
Understanding Radiation Therapy
Radiation therapy, also called radiotherapy, is the careful use of radiation to safely and effectively kill cancer cells while avoiding nearby healthy tissue.
- Radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth and to relieve symptoms, such as pain.
- Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells are destroyed by the radiation, the body naturally eliminates them.
- Healthy tissues can also be affected by radiation, but they are usually able to repair themselves in a way cancer cells cannot.
External Beam Radiation Therapy
External beam radiation therapy is a series of daily outpatient treatments to accurately deliver radiation to the cancer cells.
- Radiation oncologists usually deliver external beam radiation therapy to the lymphoma from a machine called a linear accelerator.
- Each treatment is painless and is similar to getting an X-ray. Treatments last less than 30 minutes each and are every day except for Saturday and Sunday for three to four weeks.
- Involved field radiation is when your doctor delivers radiation only to the parts of the body known to have cancer. It is often combined with chemotherapy.
- Your radiation oncologist may deliver radiation to all the lymph nodes in the body to destroy cancer cells that may have spread to other lymph nodes. This is called total nodal irradiation.
- Your radiation oncologist may also deliver radiation to the entire body. This is called total body irradiation. It is often done before chemotherapy and a stem cell or bone marrow transplant to destroy any remaining cancer cells and create a space for the new stem cells.
Also called immunotherapy, biologic therapy works with your immune system to fight cancer. Biologic therapy is like chemotherapy. The difference is that chemotherapy attacks the cancer directly and biologic therapy helps your immune system better fight the disease
- Monoclonal antibodies work by targeting certain molecules in the body and attaching themselves to those molecules. This causes some lymphoma cells to die and makes others more likely to be destroyed by radiation and chemotherapy.
- Radiolabeled antibodies are monoclonal antibodies with radioactive particles attached. These antibodies are designed to attach themselves directly to the cancer cell and damage it with small amounts of radiation without injuring nearby healthy tissue. Presently, radiolabeled antibodies are being used to treat non-Hodgkins lymphoma that has come back after treatment.
Potential Side Effects
The side effects you may experience will depend on the part of the body being treated, the amount of radiation you are given, and whether or not you have received chemotherapy. Ask your doctor before treatment begins about possible side effects and how best to manage them. Most side effects go away once you finish treatment.
- You may experience very few or no side effects and can continue your normal routine during treatment.
- You may notice mild skin irritation, upset stomach, hair loss, sore throat, loose bowel movements, nausea and fatigue.
Tell your doctor or nurse if you experience any discomfort during treatment. They may be able to prescribe medication or change your diet to help.
According to the American Cancer Society, this year nearly 175,000 Americans will learn they have lung cancer.
- The one-year survival rate for lung cancer has increased from 34 percent in 1975 to 42 percent in 1998.
Risk Factors for Lung Cancer
Smoking greatly increases your chances of developing lung cancer.
- Other risk factors include exposure to substances like second-hand smoke, arsenic, some organic chemicals, radon, asbestos, air pollution and tuberculosis.
If you quit smoking, the health benefits begin immediately.
- For patients with lung cancer, quitting smoking makes treatment more effective.
- Quitting smoking also reduces the risks of infections, such as pneumonia, improves breathing and reduces the risks associated with surgery.
- To learn how to quit, talk to your doctor or visit www.smokefree.gov.
Symptoms of Lung Cancer
Some signs and symptoms of lung cancer include:
- Persistent cough, coughing blood or shortness of breath.
- Chest pain.
- Recurring pneumonia or bronchitis.
- Swelling of the neck and face.
- Unexplained weight loss, loss of appetite or fatigue.
Diagnosing Lung Cancer
- A chest X-ray will often reveal a tumor and where it is located. Other tests, such as CT scans and PET scans, can provide more detailed information.
- To be certain if you have lung cancer, tissue from your lung will be removed and analyzed. This is called a biopsy.
- The biopsy may be done during a bronchoscopy, a test where a flexible tube with a light is inserted into your nose or mouth to look at the airways of the lungs.
- A biopsy may also be done with a needle inserted through the skin directly into the tumor under CT guidance.
Types of Lung Cancer
Non-small cell lung cancer and small cell lung cancer are the two main types of lung cancer.
- Non-small cell lung cancer is the most common type of lung cancer. It often grows and spreads less rapidly than small cell lung cancer. There are three types of non-small cell lung cancer — squamous cell carcinoma, adenocarcinoma and large cell carcinoma.
- Small cell lung cancer is less common than non-small cell lung cancer. It grows more rapidly and is more likely to spread to other organs in the body.
- Lung cancer usually begins in one lung. If left untreated, it can spread to lymph nodes or other parts of the chest, including the other lung. Lung cancer can also metastasize (or spread) throughout the body to the bones, brain, liver or other organs.
Treatment for Lung Cancer
Lung cancer treatment depends on several factors, including the type and size of the cancer, its location and your overall health. Typically, several different treatments and combinations of treatments will be used to combat lung cancer. During treatment, a team of doctors may be involved in your care, including a radiation oncologist, a medical oncologist and a surgeon.
- Non-small cell lung cancer may be treated first with surgery. Your doctor may also suggest radiation therapy or chemotherapy either alone or in combination.
- Small cell lung cancer is often treated with chemotherapy and radiation therapy either at the same time or one right after the other.
Understanding Radiation Therapy
Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.
- Cancer doctors called radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
- Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
- Healthy cells are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.
External Beam Radiation Therapy
External beam radiation therapy involves a series of daily radiation treatments targeting your lung tumor.
- Radiation therapy treatments are delivered in a series of daily sessions. Each treatment itself is painless and will last less than 30 minutes, Monday through Friday, for several weeks.
- 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the lung tumor. Tailoring each of the radiation beams to accurately focus on the tumor targets the cancer while protecting nearby healthy tissue.
- Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that modifies the radiation by varying the intensity of each radiation beam. This technique allows a precise adjustment of radiation doses to the tissues within the target area, possibly allowing a higher radiation dose to the tumor and keeping more radiation away from nearby normal tissues. IMRT is still being studied for lung cancer.
- Your radiation oncologist may recommend applying radiation to the brain after successfully treating small cell lung cancer. Called prophylactic cranial irradiation, or PCI, this treatment is not recommended for all patients.
In some cases, your doctor may recommend brachytherapy. Also called internal radiation, brachytherapy involves placing radioactive material into a tumor or its surrounding tissue.
- During bronchoscopy, one or two thin plastic tubes called catheters will be placed down your nose and into the airways of the lung.
- The tube or tubes are then connected to a brachytherapy machine. This holds the radioactive source, which is in the form of a ribbon with radioactive seeds. Your doctor slides the ribbon into the tube in your lung so the seeds are next to the tumor.
- The ribbon will be left in place from a few minutes to a few days.
Possible Side Effects
Patients often experience little or no side effects from radiation therapy and are able to continue normal routines.
- Side effects are temporary and usually limited to the area that received radiation.
- Possible problems include skin irritation, difficulty or pain when swallowing, shortness of breath, and fatigue.
- Talk to your doctor about any discomfort you feel. He or she may be able to provide drugs and other treatments to help.