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Cancer / Oncology Treatments


Lymphoma

Lymphoma

Lymphoma is a form of cancer that affects the immune system - specifically, it is a cancer of immune cells called lymphocytes, a type of white blood cell.

TYPES OF LYMPHOMA

  • Hodgkin's Lymphoma
  • Non - Hodgkin's Lymphoma

HODGKIN'S LYMPHOMA CANCER

HODGKIN'S LYMPHOMA - formerly known as Hodgkin's disease - is a cancer of the lymphatic system, which is part of your immune system.

In Hodgkin's lymphoma, cells in the lymphatic system grow abnormally and may spread beyond the lymphatic system. As Hodgkin's lymphoma progresses, it compromises your body's ability to fight infection.

Advances in diagnosis and treatment of Hodgkin's lymphoma have helped to make this once uniformly fatal disease highly treatable, with the potential for full recovery. The prognosis continues to improve for people with Hodgkin's lymphoma

 

NON-HODGKIN'S LYMPHOMA is a cancer that begins in the lymphatic system, the disease-fighting network that is spread throughout the body. Tumors develop from lymphocytes, a type of white-blood cell. Instead of fighting disease, the lymphocytes (either B cells or T cells) accumulate in lymph nodes and other organs.

Non-Hodgkin's lymphoma is more than five times as common as the other major type of lymphoma, Hodgkin's lymphoma. About 95 percent of non-Hodgkin's lymphoma occurs in adults and 5 percent in children.

At least 30 forms of non-Hodgkin's lymphoma have been identified. The most common is diffuse large B-cell lymphoma. About one-fourth of non-Hodgkin's lymphomas involve one of two related diseases, chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma.

Lymphoma

Swelling in the groin, neck or armpit is considered as the most common symptom of Hodgkin lymphoma. Some of the other symptoms include –

  • A persistent itch in the entire body
  • Frequent sweat especially at night
  • Breathlessness or cough
  • Weight loss
  • Unexplained high temperatures
  • Tiredness

Some people are diagnosed with abnormal cells in their marrow that can result in lower number of healthy blood cells in the blood. Some of the symptoms due to lower number of healthy blood cells include –

  • Excessive bleeding that include very heavy periods in women, nose bleeds and also small blood spots under the skin
  • Tiredness and breathlessness
  • A higher risk of infection

Non-Hodgkin's Lymphoma

  • Concentration problem, seizures, headache or personality changes can occur if the brain is affected by the cancer
  • Night sweats
  • Weight loss
  • Abdominal swelling or pain results in vomiting, loss of appetite, nausea and constipation
  • Fever and chills that come and go
  • Swollen lymph nodes in the groin, neck and underarms areas
  • Shortness of breath or coughing can occur when the cancer affects lymph nodes or thymus gland in the chest that puts pressure on other airways or on the windpipe
  • Itching

Lymphoma

Because the symptoms of Hodgkin's lymphoma are similar to those of other disorders, such as influenza, the disease can be difficult to diagnose. Some distinctive characteristics help diagnose Hodgkin's lymphoma, and these include:

  • Orderly spread to lymph nodes. The pattern of spread is orderly, progressing from one group of lymph nodes to the next.
  • Only rare 'skipping' of lymph nodes. The disease rarely skips over an area of lymph nodes as it spreads.

These tests and procedures help diagnose Hodgkin's lymphoma.

  • Biopsy. Taking a tissue sample (biopsy) of an enlarged lymph node is the most common way to make a definite diagnosis. Once a sample is removed, the tissue is examined for malignant cells.
  • Physical exam. Your doctor checks for swollen lymph nodes, including in your neck, underarm and groin, as well as a swollen spleen or liver.
  • X-rays. These pictures can reveal swollen lymph nodes in the body.
  • Computerized tomography (CT) scan. This is a series of pictures of the inside of your body, usually the chest, abdomen and pelvis. You usually swallow a dye or it's injected into your veins so that your organs and tissues will show up more clearly.
  • Magnetic resonance imaging (MRI). A device that uses a magnet, radio waves and computer provides your doctor with a series of detailed pictures of the inside of your body.
  • Positron emission tomography (PET) scan. A small amount of radioactive glucose (sugar) is injected into your vein. Glucose becomes more concentrated around cancerous cells, so when a scanner takes pictures of your body it can reveal where the cancer is located.
  • Bone marrow aspiration and biopsy. A small amount of bone marrow, blood and bone are removed through a needle and are examined for signs of cancer.
  • Blood tests. A sample of your blood is examined in a lab to see if anything in your blood indicates the possibility of cancer.

Staging Hodgkin's lymphoma

Once the diagnosis is confirmed, doctors "stage" the disease. Staging is how doctors determine the extent of the disease, which will affect your treatment options.

  • Stage I. The cancer is limited to one lymph node region or a single organ.
  • Stage II. In this stage, the cancer is in two different lymph nodes or the cancer is in a portion of tissue or an organ and nearby lymph nodes. But the cancer is still limited to a section of the body either above or below the diaphragm.
  • Stage III. When the cancer moves to lymph nodes both above and below the diaphragm, it's considered stage III. Cancer may also be in one portion of tissue or an organ near the lymph node groups or in the spleen.
  • Stage IV. This is the most advanced stage of Hodgkin's lymphoma. Cancer cells are in several portions of one or more organs and tissues. Stage IV Hodgkin's lymphoma affects not only the lymph nodes but also other parts of your body, such as the liver, lungs or bones.

Additional definitions of the cancer

Additionally, your doctor may use the letters A, B, E and S to help define the extent of your cancer and the treatment needed:

  • The letter A means that you don't have any significant symptoms as a result of the cancer.
  • The letter B indicates that you may have significant signs and symptoms, such as a persistent fever, unintended weight loss or severe night sweats.
  • The letter E stands for extranodal, which means that the cancer has spread beyond your lymph nodes.
  • The letter S designates a cancer that has spread into your spleen.

The letters B, E and S indicate potentially more serious disease.

The most important factor in Hodgkin's lymphoma treatment is the stage of the disease. The number and regions of lymph nodes affected and whether only one or both sides of your diaphragm are involved also are important considerations. Other factors affecting decisions about treating this disease include:

  • Your age
  • Your symptoms
  • Whether you're pregnant
  • Your overall health status

The goal of treatment is to destroy as many malignant cells as possible and bring the disease into remission. As many as 95 percent of people with stage I or stage II Hodgkin's lymphoma survive for five years or more with proper treatment. The five-year survival rate for those with widespread Hodgkin's lymphoma is about 60 to 70 percent.

Non-Hodgkin's Lymphoma

Adults and children with suspected non-Hodgkin's lymphoma first have an extensive physical examination. Swollen but painless lymph nodes in the neck, armpit or groin area are often the only symptom of non-Hodgkin's lymphoma in its early stages. Other symptoms may include fever, night sweats, fatigue, weight loss, abdominal pain or swelling, extremely itchy skin, and chest pain, coughing or trouble breathing.

Both swollen and normal lymph nodes are examined to determine their size and consistency. The patient's blood and urine are tested to help rule out infection or some other disease as a cause of swollen lymph nodes. Patients also may have X-rays and PET, CT or MRI scans to detect the presence and size of tumors.

Lymph node tissue may be removed during a biopsy procedure for study in the laboratory to determine if non-Hodgkin's lymphoma is present and, if so, what type. The biopsy may show whether a lymphoma is growing slowly (low grade), moderately (intermediate grade) or rapidly (high grade). A bone marrow biopsy also may be done to determine if the disease has spread.

Non-Hodgkin's lymphoma is classified into about 30 types. Classification is based on several factors, including whether the cancer originates in B-cell or T-cell lymphocytes, the cells' size and genetic changes, how the cancer cells group together and how fast they are growing. Doctors also assign a stage (I through IV) to non-Hodgkin's lymphoma based on the number of tumors and how widely they have spread.

Lymphoma

These tests and procedures help diagnose Hodgkin's lymphoma.

  • Biopsy. Taking a tissue sample (biopsy) of an enlarged lymph node is the most common way to make a definite diagnosis. Once a sample is removed, the tissue is examined for malignant cells.
  • Physical exam. Your doctor checks for swollen lymph nodes, including in your neck, underarm and groin, as well as a swollen spleen or liver.
  • X-rays. These pictures can reveal swollen lymph nodes in the body.
  • Computerized tomography (CT) scan. This is a series of pictures of the inside of your body, usually the chest, abdomen and pelvis. You usually swallow a dye or it's injected into your veins so that your organs and tissues will show up more clearly.
  • Magnetic resonance imaging (MRI). A device that uses a magnet, radio waves and computer provides your doctor with a series of detailed pictures of the inside of your body.
  • Positron emission tomography (PET) scan. A small amount of radioactive glucose (sugar) is injected into your vein. Glucose becomes more concentrated around cancerous cells, so when a scanner takes pictures of your body it can reveal where the cancer is located.
  • Bone marrow aspiration and biopsy. A small amount of bone marrow, blood and bone are removed through a needle and are examined for signs of cancer.
  • Blood tests. A sample of your blood is examined in a lab to see if anything in your blood indicates the possibility of cancer.

Staging Hodgkin's lymphoma

Once the diagnosis is confirmed, doctors "stage" the disease. Staging is how doctors determine the extent of the disease, which will affect your treatment options.

  • Stage I. The cancer is limited to one lymph node region or a single organ.
  • Stage II. In this stage, the cancer is in two different lymph nodes or the cancer is in a portion of tissue or an organ and nearby lymph nodes. But the cancer is still limited to a section of the body either above or below the diaphragm.
  • Stage III. When the cancer moves to lymph nodes both above and below the diaphragm, it's considered stage III. Cancer may also be in one portion of tissue or an organ near the lymph node groups or in the spleen.
  • Stage IV. This is the most advanced stage of Hodgkin's lymphoma. Cancer cells are in several portions of one or more organs and tissues. Stage IV Hodgkin's lymphoma affects not only the lymph nodes but also other parts of your body, such as the liver, lungs or bones.

Additional definitions of the cancer

Additionally, your doctor may use the letters A, B, E and S to help define the extent of your cancer and the treatment needed:

  • The letter A means that you don't have any significant symptoms as a result of the cancer.
  • The letter B indicates that you may have significant signs and symptoms, such as a persistent fever, unintended weight loss or severe night sweats.
  • The letter E stands for extranodal, which means that the cancer has spread beyond your lymph nodes.
  • The letter S designates a cancer that has spread into your spleen.

The letters B, E and S indicate potentially more serious disease.

The most important factor in Hodgkin's lymphoma treatment is the stage of the disease. The number and regions of lymph nodes affected and whether only one or both sides of your diaphragm are involved also are important considerations. Other factors affecting decisions about treating this disease include:

  • Your age
  • Your symptoms
  • Whether you're pregnant
  • Your overall health status

The goal of treatment is to destroy as many malignant cells as possible and bring the disease into remission. As many as 95 percent of people with stage I or stage II Hodgkin's lymphoma survive for five years or more with proper treatment. The five-year survival rate for those with widespread Hodgkin's lymphoma is about 60 to 70 percent.

Non-Hodgkin's Lymphoma

Treatment choices depend on the type and stage of non-Hodgkin's lymphoma, the patient's age and overall medical condition.

Early-stage disease

Patients whose disease is discovered at a very early stage and who have no outward symptoms may not need treatment for a year or more. These patients are examined periodically and closely monitored for disease progression. Patients with early-stage, low-grade lymphomas generally have radiation therapy, using high doses of radiation to kill cancer cells. Radiation therapy may be external (radiation directed toward specific points in the body) or internal (injection of a radioactive substance in or near the cancer via a needle, catheter or other device).

Later stage disease

Patients with intermediate- and high-grade lymphomas or advanced stages of low-grade lymphomas usually have chemotherapy. Doctors use a combination of drugs, given orally or by injection, against fast-growing cancer cells. Intermediate- or high-grade lymphoma, or cancer in a specific site such as the brain, may require radiation in addition to chemotherapy.

Recurrent disease

For patients whose intermediate- or high-grade disease recurs, additional high-dose chemotherapy with the option of stem cell transplantation is the option. Chemotherapy damages bone marrow, limiting the amount of therapy a patient can receive. To avoid this complication, oncologists remove and freeze healthy stem cells - those capable of producing new cells - from patients' blood or bone marrow.

Biotherapy

Biotherapy or biologic therapy, is the use of antibodies to help the immune system target and destroy cancer cells.

Radioimmunotherapy

When other treatments have failed, Oncologists may offer radioimmunotherapy drugs to patients. These drugs, which are combined with radioactive isotopes, attach to cancer cells, and the added radiation helps destroy these cells. Radioimmunotherapy is generally well tolerated, but serious side effects, including reduced blood cell counts, hemorrhage and life-threatening infection, are possible. The Food and Drug Administration has approved the use of these drugs only after other treatments have failed.



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