Non-Hodgkin Lymphoma

Non-Hodgkin Lymphoma

  • Non-Hodgkin lymphoma is a variety of cancer that originates in lymphocyte- a type of white blood cells. The most common early presentation of Non-Hodgkin’s lymphoma is painless swelling (enlargement) of one or more lymph nodes in the neck. The overall 5-year survival rate for people with NHL is 71%. The overall 10-year survival rate is 60%.
  • This year, an estimated 74,680 people (41,730 men and 32,950 women) in the United States will be diagnosed with non-Hodgkin’s lymphoma, NHL. It is estimated that 19,910 deaths (11,510 men and 8,400 women) from this disease will occur this year. It is the ninth most common cause of cancer death among both men and women

 

 Lymphoma refers to a variety of cancer that originates in lymphocyte- a type of white blood cells.

Lymph nodes

Collectively, these cell types circulate in the vessels of the lymphatic system. Lymph is a clear and transparent fluid where the cells that help fight infections and cancer flow through all your body, always vigilant and ready to mount an immune response when tissue is irritated, damage in the presence of foreign invaders, and when abnormal cells are detected.  Lymph nodes are small being shape structures linking lymph vessels and serve as immune response stations were cells are trained to fight and mature into the protective professionals cells known as T and B lymphocytes.  B lymphocytes developed into memory cells or antibody-producing cells known as plasma cells.

Just as there are many types of lymphocytes, so there are many types of lymphoma.

Lymphomas are part of the broad group of diseases called hematological neoplasms.

Because the lymphatic system is part of the body’s immune system, patients with a weakened immune system, such as from HIV infection or from certain drugs or medication, also have a higher incidence of lymphoma.

Lymphoma is a broad category which is normally divided into 2 types of cancer: Hodgkin lymphoma and non-Hodgkin’s lymphoma.  Knowing which type lymphoma you have is important because it affects your treatment options and your prognosis.

A tissue sample can be examined by a pathologist who can tell the difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma by examining the cancer cells under a microscope. If in examining the cells, the doctor detects the presence of a specific type of abnormal cell called a Reed-Sternberg cell, the lymphoma is classified as Hodgkin’s. If the Reed-Sternberg cell is not present, the lymphoma is classified as non-Hodgkin’s.

 

This patient’s guide will be limited to discuss non-Hodgkin lymphoma.  You can review our patient’s guide on  Hodgkin lymphoma in the oncology section of this website.

 

How frequent is non-Hodgkin lymphoma?

 This year, an estimated 74,680 people (41,730 men and 32,950 women) in the United States will be diagnosed with non-Hodgkin’s lymphoma, NHL. While some subtypes of NHL are common in children, NHL is far more common in adults and risk increases with age. Approximately 50 percent of patients are age 65 or older. NHL is the seventh most common cancer in both men and women. The disease accounts for 4% of all cancers in the United States.

It is estimated that 19,910 deaths (11,510 men and 8,400 women) from this disease will occur this year. It is the ninth most common cause of cancer death among both men and women. The survival rate has been improving since the late 1990s, thanks to treatment advances.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The overall 5-year survival rate for people with NHL is 71%. The overall 10-year survival rate is 60%. These survival rates vary depending on cancer’s stage and subtype.

 

What are the symptoms of Non-Hodgkin’s lymphoma?

Non-Hodgkin lymphoma

The most common early presentation of Non-Hodgkin’s lymphoma is painless swelling (enlargement) of one or more lymph nodes in the neck. Sometimes the affected lymph nodes are in the armpit, stomach area or groin. In addition to swollen lymph nodes, other signs and symptoms of Non-Hodgkin’s lymphoma may include:

  • Unexplained fever
  • Persistent fatigue
  • A persistent cough
  • Shortness of breath during normal activity
  • Drenching sweats, especially at night
  • Unexplained weight loss
  • Decreased appetite
  • Itchy skin
  • Abdominal pain or swelling and feeling of fullness (due to an enlarged spleen)
  • Lymph node pain after drinking alcohol

B symptoms. is a term used when the tumor is associated with complaints of fever, drenching night sweats and loss of more than 10 percent of body weight over six months are sometimes termed “B symptoms.” These symptoms are significant to the prognosis and staging of the disease.

Some Non-Hodgkin’s lymphoma symptoms are associated with other, less serious illnesses.

 

 What are the types of non-Hodgkin lymphoma?

There are more than 30 different types of NHL. They are grouped based on the type of lymphocyte they started from. Most types of NHL start in B cells and are called B-cell lymphoma. NHL can also start in T cells, which is called T-cell lymphoma. NHL that starts in NK cells is grouped with T-cell lymphomas.

The different types of NHL look different under a microscope. They also develop and grow differently. The grade of NHL is based on how different, or abnormal, the lymphoma cells look compared to normal lymphocytes. The grade gives doctors an idea of how slowly or quickly the NHL will likely grow and spread. NHL is usually divided into 2 grades:

  • Indolent (low-grade) NHL means that the cancer cells are well differentiated. They look and act much like normal cells. These NHLs tend to grow slowly.
  • Aggressive (high-grade) NHL means that the cancer cells are poorly differentiated or undifferentiated. They look and act less normal, or more abnormal. These NHLs tend to grow quickly.

 

World Health Organization (WHO) classification system

Doctors use the WHO classification system to identify the type of NHL. Each type can behave differently and may need different treatments.

The WHO classifies NHL based on the type of lymphocyte (B cell or T cell) that has become cancerous. NHL that starts in natural killer (NK) cells are grouped with T-cell lymphomas.

The WHO divides B-cell and T-cell lymphomas into 2 groups based on the stage of development, or maturation, of the lymphocytes when they became cancerous. Precursor lymphomas develop in immature lymphocytes during the earliest stages of their development. Mature lymphomas (also called peripheral lymphomas) develop in more mature lymphocytes.

The specific type of NHL is based on how the abnormal lymphocytes, or lymphoma cells, look under the microscope, characteristics of chromosomes in the lymphoma cells and if there are certain proteins on the surface of the lymphoma cells.

 

How is Non-Hodgkin’s lymphoma Stage?

After the diagnosis of Non-Hodgkin’s lymphoma, tests must be done to find out if lymphoma cells have spread within the lymph system or to other parts of the body. Staging is the process of determining whether the tumor has spread, and if so, how far. It is extremely important to know the stage of the disease in order to plan the treatment. The staging system used to describe the spread of Non-Hodgkin’s lymphoma is called the Ann Arbor Staging System. It uses Roman numerals (I-IV) for different stages. Survival rates for non-Hodgkin lymphoma. The overall 5-year relative survival rate for people with NHL is 70%, and the 10-year relative survival rate is 60%. But it’s important to keep in mind that survival rates can vary widely for different types and stages of lymphoma.

 

 

How is Non-Hodgkin lymphoma diagnosed?

Physical examination is fundamental to check for enlarged lymph nodes in the neck, armpits or groin. Also to examined for enlargement of the spleen and liver.

In the case of lymphoma, one would encounter terms like biopsy, bone marrow examination, blood tests, spinal tap and scans which are some of the basic procedures employed by medical experts to determine or confirm the presence of lymphoma.

A biopsy is usually the first test that your doctors will employ to confirm the presence of cancer in your lymph nodes. In a biopsy, a small sample of tissue cells is taken from the lump either through a needle or via surgery. The cells are then examined by a pathologist to confirm lymphoma cells and the diagnoses. By studying the sample cells, the can also determine the basic kind of lymphoma the patient has, whether it’s Hodgkin or Non-Hodgkin lymphoma. But to determine the subtle details, doctors revert to the procedure called as immunohistochemistry, flow cytometry, cytogenetics to accurately classify the tumor.

The Oncologist would most likely require you to undergo several blood tests. The blood samples would be examined closely to see the state of your red blood cells, white blood cells, and blood platelets. These tests would also help determine if the cancer has affected your body’s way of producing blood. The blood tests could also show the condition of your kidneys and liver. And more importantly, the information gathered from the tests could serve as basic foundations for the kind of treatments or drugs that could be used for your speedy recovery.

A bone marrow test wherein a sample of the bone marrow is taken from your hip using a thin needle. It is a common procedure used to test for various cancers and other blood diseases. A spinal tap or lumbar puncture can also be ordered by your doctor in specific circumstances. This checks the fluid in your spinal cord and determines if any cancer cells have invaded the spine. This procedure involves inserting a thin needle at the lower part of your back and I can be quite painful and uncomfortable.

CT scans will also help determine where the tumors are exactly since it takes pictures of your body from different angles.

An MRI scan, on the head, will help determine if the cancer cells have spread to your nervous system or other body organs.

How Oncologists tests for lymphoma involves logical procedures whose main goal is finding out what exactly the patient has in order to determine what kinds of treatments would be used.

 

In this online guide, we will  mention some of the most common Non-Hodgkin lymphomas:

Diffuse large B-cell lymphoma (DLBCL)

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL). When looked at under a microscope, the lymphoma cells look very large compared to normal lymphocytes. The lymphoma cells are also scattered throughout the lymph nodes or tissue.

DLBCL can occur at any age, but most people are diagnosed when they are in their mid-60s. It is slightly more common in men.

Most of the time, DLBCL starts in the lymph nodes but it can also start in organs or tissues outside of the lymph nodes (called primary extranodal disease). The most common places where DLBCL develops outside of the lymph nodes are the:

  • bones
  • brain or spinal cord (called the central nervous system, or CNS)
  • gastrointestinal (GI) tract
  • sinuses
  • testicles
  • thyroid
  • skin

In 30%–40% of cases, DLBCL is localized (stage 1 or 2) when it is diagnosed. The rest are widespread at the time of diagnosis. This means that DLBCL has spread to lymph nodes above and below the diaphragm or to different parts of the body, such as the spleen, liver or bone marrow.

Rare subtypes of DLBCL include:

  • primary mediastinal large B-cell lymphoma
  • primary effusion lymphoma (PEL)
  • intravascular large B-cell lymphoma

DLBCL is a fast-growing (aggressive) type of NHL. Some types of slow-growing (indolent) B–cell lymphomas can change into DLBCL. These types include:

  • follicular lymphoma
  • MALT lymphoma
  • splenic marginal zone lymphoma
  • small lymphocytic lymphoma
  • lymphoplasmacytic lymphoma

Symptoms

With DLBCL, the lymph nodes grow larger than normal so that they can be felt. It can also cause B symptoms, which are unexplained fever, drenching night sweats, and unexplained weight loss.

Treatments

DLBCL is very sensitive to chemotherapy, so it is used as the main treatment. Even though DLBCL is a fast-growing type of NHL, chemotherapy is effective for many people. DLBCL may come back (recurs) after the first treatments are given.

Chemotherapy

Chemotherapy is used to treat all stages of DLBCL. The combination chemotherapy most often used first to treat DLBCL is CHOP:

  • cyclophosphamide (Cytoxan, Procytox)
  • doxorubicin (Adriamycin)
  • vincristine (Oncovin)
  • prednisone

Chemotherapy is usually given with a targeted therapy drug. R-CHOP is the same combination of chemotherapy with rituximab (Rituxan).

  • If DLBCL comes back after or doesn’t respond to treatment, the following chemotherapy drugs will be used:
  • R-GDP – gemcitabine (Gemzar), dexamethasone (Decadron, Dexasone), cisplatin (Platinol AQ) and rituximab
  • R-DHAP – dexamethasone, cytarabine (Cytosar, Ara-C), cisplatin and rituximab
  • cytarabine
  • bendamustine (Treanda)
  • PEPC – prednisone, etoposide (Vepesid, VP-16), cyclophosphamide and procarbazine (Natulan)
  • R-ICE – ifosfamide (Ifex), carboplatin (Paraplatin, Paraplatin AQ), etoposide and rituximab

Targeted therapy

Targeted therapy uses drugs to target specific molecules (such as proteins) on the surface of cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells.

Rituximab is a targeted therapy drug commonly used alone or in combination with chemotherapy to treat DLBCL.

Radiation therapy

External beam radiation therapy may be given after chemotherapy to treat stage 1 (and sometimes stage 2) DLBCL. When DLBCL develops in a testicle, radiation therapy may be given to the other testicle to prevent the spread of lymphoma cells.

Sometimes radiation therapy is given after chemotherapy for more advanced stages of DLBCL. It is used if there is still a disease in a small area or if there are other areas with tumors that are 10 cm or more across (called bulky disease).

Central nervous system prophylaxis

The central nervous system (CNS) is the brain and spinal cord. DLBCL that starts in the sinuses or testicles can spread to the CNS. CNS prophylaxis is used to try to prevent lymphoma cells from spreading to the brain and spinal cord. CNS prophylaxis may be given as intrathecal chemotherapy. This means that the chemotherapy drug is injected directly into the cerebrospinal fluid (CSF). The drug used in intrathecal chemotherapy is methotrexate. CNS prophylaxis can also be given with a needle into a vein (intravenously). The drug used for intravenous chemotherapy is high-dose methotrexate.

Stem cell transplant

People with DLBCL that doesn’t go away with treatment or that comes back (recurs) after treatment may be offered alternative treatments. These treatments may include other types of chemotherapy or a stem cell transplant. A stem cell transplant may be an option if the DLBCL responded to chemotherapy in the past.

 

Follicular lymphoma

Follicular lymphoma is a B-cell lymphoma. Follicular describes how the lymphoma cells group together in clusters in a lymph node or other tissues.  Follicular lymphoma is the 2nd most common type of non-Hodgkin lymphoma (NHL). It usually occurs in people 50 years of age or older, and the average age at diagnosis is 59. It is slightly more common in women than in men.

Most people are diagnosed with stage 3 or stage 4 follicular lymphoma. It often spreads to the bone marrow and spleen, but it usually doesn’t affect organs and tissues other than the lymph nodes.

Sometimes follicular lymphomas can change into diffuse large B-cell lymphoma (DLBCL). DLBCL is a fast-growing (aggressive) type of NHL.

Symptoms

Follicular lymphoma may not cause any symptoms. Sometimes lymph nodes in different parts of the body can be larger than normal.

Prognostic factors

The healthcare team uses the Follicular Lymphoma International Prognostic Index (FLIPI) to help them assess people with this disease and plan treatment. Those with good prognostic factors are likely to respond well to treatment. There is a greater chance that follicular lymphoma will come back (recur) after treatment when someone has poor prognostic factors.

 

The healthcare team gives 1 point for each poor prognostic factor. They add up the points for a score of 0 to 5. People with good prognostic factors and a lower score have a better prognosis than those with 3 or more poor prognostic factors and higher scores.

Treatments

There are many treatment options for follicular lymphoma. This type of NHL often comes back (recurs) after treatment, but it usually responds to more treatment. People often reach remission again after more treatment, but the remissions usually become shorter with every course of treatment.

Radiation therapy

External beam radiation therapy is used to treat lymph node areas affected by stage 1 or stage 2 follicular lymphoma. This may be referred to as involved field radiation therapy (IFRT).

Follicular lymphoma is usually more advanced (stage 3 or 4) and has usually spread to more than one lymph node area in the body when it is diagnosed. Low-dose external beam radiation therapy may be used to help relieve symptoms when follicular lymphoma is more advanced.

Watchful waiting

Watchful waiting (also called active surveillance) may be offered for follicular lymphoma because it develops slowly and may not need to be treated right away. The healthcare team carefully monitors the person with follicular lymphoma and starts treatment when symptoms appear or there are signs that the disease is progressing more quickly.

Chemotherapy

Chemotherapy may be offered for follicular lymphoma, especially if it has spread to several groups of lymph nodes or other organs and it is causing symptoms. A single drug or a combination of drugs may be used. Chemotherapy is often combined with a targeted therapy drug.

Single drugs that may be given include:

  • fludarabine (Fludara)
  • bendamustine (Treanda)
  • chlorambucil (Leukeran)

Combinations of drugs given for follicular lymphoma include:

  • CHOP – cyclophosphamide (Cytoxan, Procytox), doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone
  • R-CHOP – CHOP with rituximab (Rituxan)
  • CVP – cyclophosphamide, vincristine, and prednisone
  • R-CVP – CVP with rituximab
  • FND – fludarabine, mitoxantrone (Novantrone) and dexamethasone (Decadron, Dexasone)
  • BR – bendamustine and rituximab

Targeted therapy

Targeted therapy uses drugs to target specific molecules (such as proteins) on the surface of cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells.

Rituximab is a targeted therapy drug used to treat follicular lymphoma. It can be used alone or with chemotherapy. It may also be used as maintenance therapy after chemotherapy.

Other targeted therapies that may be used when follicular lymphoma comes back after treatment (recurs) or doesn’t respond to treatment (called refractory disease) are:

  • ibritumomab (Zevalin)
  • idelalisib (Zydelig)
  • obinutuzumab (Gazyva) with bendamustine

Ibritumomab is a type of radioimmunotherapy. This treatment attaches a radioactive material to the targeted therapy drug. The drug attaches to the lymphoma cells so the radiation is delivered directly to them, which may mean fewer or less severe side effects.

Stem cell transplant

A stem cell transplant may be an option for some people if follicular lymphoma comes back (recurs) after treatment or doesn’t respond to treatment (refractory disease).

 

MALT lymphoma

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) is a B-cell non-Hodgkin lymphoma (NHL). MALT lymphoma is called extranodal because it starts in tissues or organs outside of the lymph nodes. It develops in lymphatic tissue in the mucous membranes or tissues that line body organs or cavities.

MALT lymphomas are also called maltomas. MALT lymphomas occur nearly equally in men and women, and usually in people in their 60s.

Most MALT lymphomas start in the stomach. More than 60% of people with MALT lymphoma of the stomach have a history of a bacterial infection caused by Helicobacter pylori (H. pylori). Other bacterial or viral infections are also linked to MALT lymphoma.

People with MALT lymphoma in areas other than the stomach often have a history of autoimmune disorders such as Hashimoto’s thyroiditis or Sjogren’s syndrome. These areas include:

  •  other parts of the gastrointestinal tract, such as the small intestine or colon.
  • the lungs
  • tissue around the eye
  • the skin
  • the salivary glands
  • the thyroid
  • the bladder
  • the breasts

MALT lymphoma is usually slow-growing (indolent) but sometimes it can be fast-growing (aggressive). It usually takes a long time for it to spread outside the area where it started, and it is often diagnosed when it is stage 1 or 2. Even if several extranodal sites develop, it doesn’t mean that it has spread throughout the body (called widespread disease). In rare cases, MALT lymphoma can change into a faster-growing (more aggressive) type of NHL.

 Treatments

MALT lymphoma in the stomach is treated differently than MALT lymphoma in other parts of the body. Early stage MALT lymphoma is also treated differently than advanced MALT lymphoma.

 Early stage MALT lymphoma in the stomach

The following are treatment options for early stage (stage 1 or 2) MALT lymphoma that is only in the stomach.

Antibiotics are often the first treatment if a biopsy confirms you have H. pylori infection. Antibiotics may be the only treatment needed if a follow-up biopsy shows that the infection has cleared and there is no evidence of lymphoma.

Radiation therapy may be used if antibiotics don’t work. External beam radiation therapy is directed at tumors in the stomach.

 Chemotherapy is sometimes used if MALT lymphoma doesn’t respond to antibiotics. Single drugs, such as chlorambucil (Leukeran) or cyclophosphamide (Cytoxan, Procytox) may be used. Sometimes a combination of chemotherapy drugs like CHOP may be given. CHOP is cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone.

 Targeted therapy uses drugs to target specific molecules (such as proteins) on the surface of cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells. Rituximab (Rituxan) is a targeted therapy drug that may be given if antibiotics aren’t effective or if MALT lymphoma progresses after chemotherapy.

 Surgery is sometimes used to remove part or all of the stomach (called a partial or total gastrectomy). This is done if the lymphoma remains after antibiotics or if it progresses. Surgery is not used as often as it was in the past to treat MALT lymphoma in the stomach because other therapies can usually treat it successfully.

 Early stage MALT lymphoma outside of the stomach

Early stage MALT lymphoma that starts in an area other than the stomach may be given local treatments, such as surgery or radiation therapy.

Surgery to remove the area affected by lymphoma may be an option depending on where it is in the body and how big it is.

External beam radiation therapy may be given to the affected area.

 Advanced MALT lymphoma

More advanced MALT lymphomas (stage 3 or 4) in the stomach or other parts of the body may be offered the following treatments.

 Watchful waiting (also called active surveillance) may be an option because MALT lymphoma develops slowly and may not need to be treated right away. The health care team will carefully monitor the person with MALT lymphoma and start treatment when symptoms appear or there are signs that the disease is progressing.

 Radiation therapy may be used if the lymphoma is large, causing symptoms or growing. External beam radiation therapy is directed at the tumor and some tissue around it.

Chemotherapy may be used instead of radiation therapy if the lymphoma is large, it is growing, there is cancer throughout the body (it is widespread) or it comes back after it is treated. The following drugs or combinations of drugs may be given:

  •  fludarabine (Fludara)
  • bendamustine (Treanda)
  • chlorambucil (Leukeran)
  • CHOP – cyclophosphamide (Cytoxan, Procytox), doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone
  • CVP – cyclophosphamide, vincristine, and prednisone

Targeted therapy may be given if MALT lymphoma in the stomach doesn’t respond to antibiotics, if the lymphoma is not linked with H. pylori infection or if the lymphoma comes back (recurs) after treatment. The targeted therapy drug rituximab may be given alone or combined with chemotherapy.

One kind of NHL is the lymphoblastic lymphoma or LBL which commonly occurs in children. In fact, about 30% of documented cases of lymphomas in children have been classified as lymphoblastic lymphomas. LBL is a very aggressive kind of NHL and has caused quite a number of deaths in the past. But because of modern medicine and treatment techniques, LBL patients have better odds of surviving the ordeal.

Unlike LBL, the diffuse histiocytic lymphoma type or DHL is a slow growing cancer. And because it is slow-growing the cancer is quite hard to detect. Also, there are times where the cancer reappears after treatment.

Another kind of NHL appears closer to the body’s surface. The cutaneous T-cell lymphoma or CTLC is a kind of lymphoma that affects the skin. What happens is that the white blood cells of the skin become cancerous. At first, the signs are dry, scaly skin with red or dark patches. These areas of the skin also itch a lot. But as the cancer cells continue to grow, the skin will develop highly noticeable tumors. Eventually, the cancer cells enter the bloodstream and spread all over the body which soon infects other tissues and organs.

Although not common, the mantle cell lymphoma is another kind of non-Hodgkin’s lymphoma. This cancer borders on being rare since only an estimated 5% of people diagnosed with NHL have it. It seems that the cancer is more likely to occur in men 50 years old and older. Cancer starts off as a slow-growing lymphoma but can suddenly become aggressive in later stages.  Mantle cell lymphoma is usually diagnosed at stage 3 or 4. It has often spread to other lymph nodes, the bone marrow, the spleen and the liver. Mantle cell lymphoma is sometimes found along the gastrointestinal (GI) tract. When it is found in the GI tract, it may be called lymphomatous polyposis.

Oncologists have made 4 classifications or stages of non-Hodgkin’s lymphoma which basically indicates how fast and how far the cancer cells have spread. Stage 1 is when the cancer cells are grouped in lymph node or organ of the body. In stage 2, the cancer has spread to two or more groups of lymph nodes or organs on the same side of your diaphragm. Stage 3 is where the cancer cells have infected organs on both sides of the diaphragm and finally stage 4 is when the different types of non-Hodgkin’s lymphoma have gone beyond the lymphatic system and infecting other organs like the liver, bones, and lungs.

How is non-Hodgkin lymphoma treated?

 There are many options available but there are several that usually stand out. There are four major types of lymphoma treatment available, namely, chemotherapy, radiotherapy, stem cell or bone marrow transplant, and antibody therapy/targeted therapy. The most common types of chemotherapy for lymphoma are R-CHOP, CHOP, and ABVD

Chemotherapy is an anticancer treatment that uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). The way chemotherapy is given depends on the stage of the disease. Combination chemotherapy provides treatment using two or more anticancer drugs. Steroid drugs may be added to kill the lymphoma cells as well. Side effects of chemotherapy depend on the drugs you’re given. Common side effects are nausea and hair loss. Serious long-term complications can occur, such as heart damage, lung damage, fertility problems and other cancers, such as leukemia.

External radiotherapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells and keep them from growing. External radiotherapy uses a machine that focuses the radiation from outside the body and targets it towards the cancer. For Non-Hodgkin’s lymphoma, radiation therapy is often used after chemotherapy.

During radiation therapy, you lie on a table and a large machine moves around you, directing the energy beams to specific points on your body. Radiation can be aimed at affected lymph nodes and the nearby area of nodes where the disease might progress.

The length of radiation treatment varies, depending on the stage of the disease. A typical treatment plan might have you going to the hospital or clinic five days a week for several weeks. At each visit, you undergo a 30-minute radiation treatment.

Radiation therapy can cause skin redness and hair loss at the site where the radiation is aimed. Many people experience fatigue during radiation therapy. More-serious risks include heart disease, stroke, thyroid problems, infertility and other cancers, such as breast or lung cancer.

 

Stem cell or bone marrow transplant uses a high dosage of radiation or chemotherapy to specifically kill targeted cancer cells. The bone marrow is saved during the process through transplantation of a new one or through transplantation of stem cells. Lastly, antibody therapy, also known as biological therapy, uses specific drugs to target special molecules across the cancer cells’ surfaces.

Non-Hodgkin’s lymphoma is often treated using radiotherapy and chemotherapy. The treatment options are usually based on the current stage of lymphoma and on several prognostic factors. Chemotherapy is more used in all patients regardless of stage. Radiation may be used only during the early stages of the condition.

 

There are almost 40 various kinds of non-Hodgkin’s lymphoma (NHL). Several of them behave differently compared to others. The treatment used depends on the specific type as well as the observable behavior of the NHL. Chemotherapy is the most popular. Antibody therapy and/or radiation therapy may only be added to complement chemotherapy for additional benefits.

 

Immunotherapy is a type of treatment that either boosts the patients own immune system or uses man-made drugs called monoclonal antibodies that attack a specific target on the surface of lymphocytes (cells in which lymphoma starts). The monoclonal antibody rituximab is a drug used to treat Hodgkin’s lymphoma and administered by infusion into veins.

Bone marrow transplantation either with patients’ own bone marrow cells or donors may be a part of lymphoma treatment. Before performing the bone marrow transplantation, the radiation and chemotherapy are applied with the aim to reduce the cells in bone marrow affected by the disease. The treatment mainly depends on the stage of the disease. A bone marrow transplant may be an option if Non-Hodgkin’s lymphoma returns despite treatment.

During a bone marrow transplant, your own blood stem cells are removed, frozen and stored for later use. Next, you receive high-dose chemotherapy and radiation therapy to destroy cancerous cells in your body. Finally, your stem cells are thawed and injected into your body through your veins. The stem cells help build healthy bone marrow. People who undergo bone marrow transplant may be at increased risk of infection.

 

For more advanced stages (stage III and IV), the goal of the treatment involves two major strategies. Firstly, induce a regression of the tumor (induction phase). Secondly, consolidate or maintain this regression (consolidation/maintenance phase).

 

Coping with the Non-Hodgkin’s lymphoma is very stressing. some alternative therapies to help you cope with it are:

  • Art therapy
  • Exercise
  • Meditation
  • Music therapy
  • Relaxation exercises
  • Spirituality

 

 

 The information in this document does not replace a medical consultation. It is for personal guidance use only. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of the disease.

Sources:

  • American Cancer Society
  • The National Cancer Institute
  • National Comprehensive Cancer Network
  • American Academy of Gastroenterology
  • National Institute of Health
  • MD Anderson Cancer Center
  • Memorial Sloan Kettering Cancer Center

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