Non-Hodgkin's lymphoma – Causes, symptoms and treatments
Lymphomas are cancers (growth of malignant cells) that originate in the lymph nodes (glands), very important in the fight against infections.
There are thirty or more lymphoma subtypes, but to simplify the classification of many oncologists grouping the different subtypes according to the average rate of growth and the progression of lymphoma: very slowly (low level) or too fast (or very aggressive).
The most common symptom of non-Hodgkin's lymphoma is painless swelling in a lymph node, usually in the neck, armpits or groin.
Swelling is caused by an excess of affected lymphocytes (white blood cells) collected in your ganglion.
The knots or swollen glands are a common response to the infection, so if you have the swelling of the knots do not panic; It is very unlikely that they are the result of lymphoma.
Contents [Hide]
1 Other symptoms of lymphoma
2 Causes of non-Hodgkin's
3 What triggers lymphoma?
4 Diagnosis of non-Hodgkin's lymphoma
5 Confirm Diagnosis
6 Other tests
7 Lymphoma Staging
8 Treatment of non-Hodgkin's lymphoma
9 explaining the terms of treatment
10 Cure lymphoma
11 Lymphoma Treatment Plan
12 chemotherapy
13 Steroids
14 Complications of non-Hodgkin's
15 Infertility
16 Other health problems
17 Secondary cancers
Other symptoms of lymphoma
Other symptoms will usually only begin once the cancer has spread in most or all of your lymphatic system.
This causes the lymphatic system to stop working properly, which weakens your immune response.
Symptoms of advanced non-Hodgkin's lymphoma include:
Unexplained fatigue or fatigue
Night sweats or fever
Lack of unexplained appetite and/or weight loss
Struggling to get rid of infections
Unexplained itching of the skin all over the body
The other symptoms depend on where in the body of the lymph glands are. For example, if the lymphoma is in the abdomen (belly), you may have abdominal pain or indigestion.
Causes of non-Hodgkin's
Lymphoma begins with a change in the structure of the DNA in the cells of white blood cells in the lymph.
This is known as a genetic mutation.
The DNA of the cells gives a set of basic instructions, such as when grow and reproduce. Mutation in the DNA modifies these instructions so that the cells continue to grow. This leads them to multiply in an uncontrollable way.
Abnormal lymphocyte cells usually begin to multiply in one or more lymph nodes in a particular area of the body, such as your neck or groin. Over time, it is possible for abnormal lymphocyte cells to propagate in other parts of your body, such as your bone marrow, spleen, liver, skin and lungs.
What triggers lymphoma?
The cause of the initial mutation that triggers the lymphoma is unknown. Some experts believe that it could be due to a number of related causes.
The known risk factors for developing lymphoma are:
Having a medical condition that weakens the immune system, such as HIV (which is known as immunosuppression).
Have a medical treatment that weakens the immune system For example, by taking immunosuppressants because you have received an organ transplant.
Already exposed to the Epstein-Barr virus (EBV), which increases your chance of developing lymphoma very slightly. EBV is however a common virus and most healthy people have been infected with this virus in the past, although they may not remember having had glandular fever.
Being previously exposed to the human T-lymphotropic virus (HTLV), which slightly increases your chance of developing lymphoma.
Having an infection with Helicobacter pylori, which is a known cause of a type of lymphoma known as non-Hodgkin's MALT lymphoma. H. pylori is a bacterial infection that usually infects the mucosa of the stomach and the small intestine. Treatment of the infection can sometimes make this type of lymphoma disappear.
Having received chemotherapy or radiation therapy for earlier cancer – which slightly increases the risk of developing lymphoma.
Having celiac disease (a gluten allergy that causes inflammation of the small intestine) – which slightly increases the risk of developing non-Hodgkin's lymphoma. It is more common if you have not strictly avoided gluten.
Non-Hodgkin's lymphoma is not infectious and generally does not believe to function in families, but there is a slightly higher chance of developing the disease if you have an identical twin with cancer.
Diagnosis of non-Hodgkin's lymphoma
The presence of swollen lymph nodes and other associated symptoms may suggest a diagnosis of lymphoma, but the only way to confirm the diagnosis is by performing a biopsy.
A biopsy consists of removing part or all of an affected lymph node, which is then studied in a laboratory. Biopsies can be performed under local anesthesia (where the area is numb), but there may be some cases where the affected lymph nodes are not readily accessible and general anesthesia may be required (you are set to sleep).
A pathologist (expert in the study of a diseased tissue) will then check the tissue sample for the presence of cancer cells. If they find cancer cells, they can also identify exactly what type of lymphoma you have, which is an important factor in planning your treatment.
Confirm Diagnosis
There are two main types of lymphocytes (white blood cells found in the lymph):
B lymphocytes produce antibodies that attack bacteria and viruses infecting
T lymphocytes kill cells that have been infected with a virus and cause the immune response to respond more quickly to an infection the second time round
In non-Hodgkin's lymphoma, either B lymphocytes or T lymphocytes (or both) may be affected.
The treatment depends on the subtype you have. There are more than 20 types of non-Hodgkin's, including:
Large-cell diffuse lymphoma B
Follicular lymphoma
Marginal zone of Extraganglionnaire B cells (MALT)
Mantle cell lymphoma
Burkitt's lymphoma
Large mediastinal B cell lymphoma
Marginal zone B nodal cell lymphoma
Small lymphocytic lymphoma
Lymphoplasmocytaire lymphoma
Peripheral T lymphoma
Skin (cutaneous) lymphomas
Anaplastic large cell lymphoma
Lymphoblastic lymphoma (mainly T cells but can be B cells)
B-cell lymphomas are more common than T-lymphomas.
Other tests
If a biopsy reveals the presence of non-Hodgkin's lymphoma, further tests will be required to verify the extent to which lymphoma is widespread. This allows a doctor to diagnose the stage of your lymphoma.
Other tests may include:
Blood tests – blood samples will be taken throughout your diagnosis and treatment to check your general health, red and white blood cell levels and platelets in the blood, and how organs like the liver and R Eins, work.
Bone marrow Sample – Other biopsy can be performed to see if the lymphoma is spread to your bone marrow. This involves using a long needle to collect a bone marrow sample from your pelvis and can be done using a local anesthetic.
Chest X-ray – can check if your lymphoma is spread to your chest or lungs.
CT scan – Takes a series of X-rays that build a three-dimensional image of the inside of the body to check the spread of your lymphoma.
Magnetic resonance imaging (MRI) – uses powerful magnetic fields instead of X-rays to build a detailed image of the areas of your body to verify the spread of your lymphoma.
Positron emission tomography (PET) – a type of scan that shows how body tissues work by measuring cell activity in different parts of the body. It can check the spread of your lymphoma and the impact of the treatment.
Lumbar puncture – Using a fine needle, a cerebrospinal fluid sample is taken and examined to see if it contains lymphoma cells.
Lymphoma Staging
When the test is complete, it should be possible to determine the stage of your lymphoma. These steps are explained below.
Step 1 (or I): Lymphoma is limited to a group of lymph nodes, such as your neck or groin knots on or below your diaphragm
Step 2 (or II): Two groups of lymph nodes are affected, above or below the diaphragm
Step 3 (or III): Lymphoma is now extended to groups of lymph nodes above and below the diaphragm
Step 4 (or IV): Lymphoma is propagated through the lymphatic system and is now present in organs and/or bone marrow outside the lymphatic system
Health professionals also use an additional classification system, either "a" or "B":
A type of lymphoma means you have no additional symptoms other than swollen lymph nodes
b lymphoma type means that you have additional symptoms, such as weight loss, fever or night sweats
Treatment of non-Hodgkin's lymphoma
Some people may not need treatment right away for their non-Hodgkin's lymphoma.
If the initial cancer was very small and removed by the biopsy, no further treatment may be necessary.
If the disease is low grade and not at an advanced stage, a period of "watchful expectation" is often recommmended that some patients may take many years to get annoying symptoms of their illness.
If the vigilant expectation is recommended, you will be seen regularly in the clinic for review and invited to come back at any time if you feel your symptoms are worse.
Explaining the terms of treatment
When the lymphoma treatment is started, the goal is to get a remission. The best remission is a complete remission (and when the disease can no longer be detected). Shed is called "partial" where the sick glands were made much smaller.
Refractory lymphoma and recurrent
Sometimes lymphoma can not do better with the initial treatment – this is called "refractory" lymphoma.
This means ' relapse ' lymphoma as the disease returned after initially responding to the treatment.
Both refractory and recurrent lymphoma can often be improved successfully or sometimes cured with a different treatment approach.
Cure lymphoma
At least half of all people who initially responded to the treatment of non-Hodgkin's lymphoma will experience a recurrence of their disease. For this reason, people are only said to have been cured of lymphoma when there is no other evidence of their illness after a period of observation (usually five years).
Sometimes, usually when you have lymphoma that is likely to relapse, your doctor will recommend a stem cell transplant after the initial treatment has controlled the disease.
Lymphoma Treatment Plan
The recommended treatment plan will depend on your general health and age, because some of the treatments can cause side effects and serious complications, which can put a strain on the body.
Today, it is normal practice for your treatment plan to be examined by several doctors and other health professionals who specialize in different aspects of lymphoma treatment (see Sidebar, right).
This group of people, called a "multidisciplinary team", meet regularly (at least once a week). They check that your diagnosis and staging is correct and that you have found the best treatment available. Your personal wishes for treatment will always be taken into account in this discussion.
There are a number of factors to consider when deciding on your treatment. These included:
Your age and general health
Your symptoms
The probable progression of your lymphoma
Specific subtype of your lymphoma
The stage of your lymphoma
Possible side effects of treatment
Your doctor will recommend the best treatment options for you. They can also offer you the opportunity to participate in a clinical trial. Unless your health is immediately threatened by lymphoma, it is best not to rush into making a decision regarding your treatment plan.
Before you decide, you will be encouraged to talk to friends, family and your partner (if you have one). You will also be asked to come back to see your care team for a full review and discussion on the risks and benefits of any treatment planned for you before you actually start.
Chemotherapy
Chemotherapy is widely used for the treatment of lymphoma, either of its own, associated with biological treatment and/or in combination with radiation therapy.
Some chemotherapy is administered by injection (intravenous chemotherapy) and part is given by mouth (oral chemotherapy).
The type of chemotherapy you receive will depend on the type and stage of non-Hodgkin's lymphoma.
If you think your lymphoma is a curable disease, you will normally receive an aggressive chemotherapy treatment program (with or without radiation therapy) designed to kill all cancer cells in your body. However, if a remedy is unlikely, a more moderate treatment program can be used, which can often provide long-term relief from the symptoms.
Chemotherapy is usually administered over a period of a few months on an ambulatory basis, which means that you should not have to stay in the hospital overnight. However, there may be times when your symptoms or the side effects of treatment become particularly annoying, and a stay in the hospital more may be necessary.
When you start processing, you will receive a ' 24-hour hotline ' number to call in such a way that any problems related to your treatment can be addressed as soon as possible.
Chemotherapy destroys cancer cells, but it can also damage healthy cells, which can lead to a number of common side effects. These included:
Nausea
Vomiting
Diarrhea
Loss of appetite
Mouth ulcers
Fatigue
Rashes
Hair Fall
Infertility – This may be temporary or permanent
Side effects must pass after the treatment is complete. You have to tell your care team if the side effects become particularly annoying because there are medications that can help you better deal with some side effects. For example, creams and gels can treat oral ulcers.
Learn more about chemotherapy.
Aggressive chemotherapy can also affect your bone marrow. This may interfere with the production of healthy blood cells, which can lead to the following symptoms:
Fatigue
Shortness
Increased vulnerability to infection
Bleeding and bruising more easily
The treatment can be delayed so that you can produce more healthy blood cells. Drugs for growth factor can also stimulate the production of blood cells.
Radiotherapy
Radiation therapy is often used to treat stage 1 and 2 lymphomas, when cancerous cells are in only one part of the body. Treatment is normally administered daily from Monday to Friday in the space of two to six weeks. You shouldn't have to stay in the hospital between appointments.
The radiologist will need to first plan your treatment carefully. This may involve one or more appointments. The radiologist uses a machine to "map" the lymphoma and decide which parts of your body the radiation therapy should be addressed to. This planning may consist of making small tattoo marks on your skin or making a special cast to ensure that you are held exactly in the same position for the treatment you were planning for.
Radiation therapy itself is painless, but it has a number of common side effects. These can vary depending on what part of your body is being treated. For example, if the lymph nodes are affected in the throat, radiation may lead to a sore throat, while the treatment to the head may lead to hair loss.
Other common side effects include:
Tkin rash
Fatigue
Nausea
Vomiting
Dry mouth
Loss of appetite
Monoclonal antibody treatment (biological)
The human immune system is very intelligent. When you have an infection, your immune system will develop systems to stop you getting the same infection again.
One of the ways your immune system does this is to produce proteins called antibodies that recognize the specific characteristics (antigens) of the infection. If you do expose yourself to the same infection again in the future, these antibodies bind to antigens and your immune system will destroy the antigen-antibody complex.
Scientists have recognized the importance of this immune response was and have antibodies that can target antigens on genetically lymphoma cells. These antibodies are called "monoclonal antibodies", because they specifically recognize a particular antigen.
Monoclonal antibody therapy can be used to treat certain types of non-Hodgkin lymphomas. It is often administered in combination with chemotherapy to make the treatment more potent.
The first type of monoclonal antibody therapy used to treat non-Hodgkin's lymphoma was a drug called rituximab. Rituximab is an artificial antibody that specifically recognizes the CD20 antigen present on the surface of B lymphocytes. It can therefore be useful in people who have non-Hodgkin B cell lymphoma (Eithe high grade or low grade).
The rituximab is administered directly in your vein within a few hours. It is common to experience flu-themed symptoms when treated with rituximab. Possible symptoms include:
Headache
Fever and/or shivering
Fatigue
Muscular pain
You will receive additional medications to prevent or alleviate these side effects. Side effects should improve over time as your body is using the rituximab.
Rituximab is the first monoclonal antibody therapy to be produced for the treatment of non-Hodgkin's lymphoma and remains the most important. Because it has been such a success, scientists are working hard to do monoclonal antibody treatments for more lymphomas and some of them are already at an advanced stage in clinical trials. You may be invited to participate in one of the latter.
Steroids
Steroids are commonly used in combination with chemotherapy to treat non-Hodgkin's lymphoma. Research has shown that the use of steroids makes chemotherapy more effective.
Steroids are normally administered orally, usually at the same time as your chemotherapy. A short-term course of steroids, lasting no more than a few months, is generally recommended because it limits the number of side effects you may have.
Common side effects of the use of short-term steroids include:
Increased appetite
Mood disorders
Sleep problems
Indigestion
On rare occasions, you may have to take steroids on a long-term basis. Side effects of the use of long-term steroids include:
Swelling of your hands, feet and eyelids
Weight gain
High blood pressure
Increased risk of developing diabetes
Altered Vision
A slightly higher risk of developing infections
More information
Learn more about the treatment of non-Hodgkin's lymphoma and live with non-Hodgkin's lymphoma.
Complications of non-Hodgkin's
Being immunocompromised (having a weakened immune system) is a frequent complication of lymphoma treatment. Even if your lymphatic system is restored to normal, most medications that treat non-Hodgkin's lymphoma weaken your immune system.
This means that you are more susceptible to infections, and there is an increased risk of developing serious complications of infections. You may be advised to take regular doses of antibiotics to prevent infections occurring in the early stages after treatment. Your immune system will usually recover in the months and years following the treatment.
If you think you may have an infection, you should report any symptoms to your care team or GP immediately, as quick treatment may be necessary to prevent serious complications. This is particularly important in the first few months after the treatment.
The symptoms of the infection include:
Fever
Headache
Painful muscles
Diarrhea
Fatigue
A painful blister rash
You also need to make sure that all of your vaccines are up to date. Your GP or care team will advise you on this.
Infertility
Many of the treatments for lymphoma can cause infertility. Sterility is often temporary, but in some cases it can be a permanent side effect.
People who are particularly at risk of becoming infertile are those who have received very high doses of chemotherapy and radiation therapy. Your care team will be able to estimate the risk of infertility in your particular circumstances.
It is sometimes possible to guard against any risk of infertility before starting treatment. For example, men can store samples of their sperm, and women can sometimes store their eggs, which can be fertilized and replaced in the uterus after treatment.
The use of contraception is strongly recommended during chemotherapy and for one year after chemotherapy can damage a new embryo (baby).
Other health problems
Treatment for lymphoma can increase your risk of getting conditions such as heart disease, lung disease, renal disease, thyroid disease, diabetes and cataracts at a younger age than normal. Having a diagnosis of cancer can also increase your risk of suffering from depression. These conditions can be effectively managed if you report unusual symptoms to your GP.
Secondary cancers
People who have had cancer are more likely to get a second cancer, which may be the same or different from their first cancer. Chemotherapy and radiotherapy further increase this risk.
This risk will have been carefully considered when your initial treatment was planned – it is one of the reasons why a "vigilant waiting" period is recommended for many people with low-grade lymphoma.
You can help yourself to avoid having a second cancer by adopting a healthy lifestyle (do not smoke, maintain a healthy weight with a balanced diet, regular exercise). You should also report symptoms that might suggest another cancer to your doctor at an early stage.
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