With many advances in therapy, there are numerous treatment approaches for cancer of the lymphatic system. Team up with your doctors and you have a very good chance of a long (possibly even lifelong) victory in your fight against lymphoma cells.
Your lymphatic system is an elaborate network of vessels and white blood cells designed to defend your body against bacteria, viruses and other disease-causing agents. Lymph nodes (or glands) strategically located throughout your body serve as army bases strategically located throughtout your body serve as army bases for these cells, called lymphocytes. They include B-cells (because they develop in bone marrow) and T-cells (which develop in the thymus gland). Once these ace fighters leave the nodes, they patrol the entire body, some circulating in the blood, other gathering in specific organs.
LIKELY FIRST STEPS
At one time, lymphomas were fatal. But now this cancer is better understood, and many people are cured with sophisticated chemotherapy regimens. The treatment is largely influenced by the grade (aggressiveness) of the lymphoma. For non-Hodgkin's lymphoma, chemotherapy, radiation and bone marrow transplants are used, singly or in combination. Whatever approch your doctors recommend, ask about potentials side effects and outcomes, and talk it over with your family as well as veterans of lymphoma, if possible.
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Chemotheraopy Most common approach; kills cancer cells.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Radiation Used alone or with other symptoms.
---------------------------------------------------------------------------------------------------------------------------------------------
Surgery For lymphomas isolated to a single organ.
--------------------------------------------------------------------------------------------------------------------------------------------- Bone marrow or stem cell For more advanced lymphoma.
transplant
------------------------------------------------------------------------------------------------------------------------------------------ Clinical trials Test new treatments.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Rest Helps promote recovery.
----------------------------------------------------------------------------------------------------------------------------------------------
Moderate exercise Battles fatigue.
---------------------------------------------------------------------------------------------------------------------------------------------- Support group Provides practical and emotional advice.
Although recommendations of specialist are vitally important to consider, you should also remember that you can choose whether you wish to begin or continue a specific type of treatment.
TAKING CONTROL
If your non-Hodgkin's lymphoma is low grade (nonaggressive) in stage 1 or 2 your doctor is likely to recommend radiation therapy alone. For other stages or if the lymphoma causes symptoms, radiation may be combined with chemo or other therapies. Radiation directs high-energy X-rays at tumours. Since for both sexes there's an added risk of temporary or even permanent infertility from radiation damage to sexual organs, consider talking to a fertility expert about freezing sperm or banking eggs before undergoing radiation.
If the lymphoma is isolated in a specific organ, such as the small bowel, surgery alone may cure it. When other procedures are ineffective, however, a bone marrow transplant or stem cell transplant may be the best route, using cells from a donor or your own. (This means healthy marrow may be removed before you have other treatments.) Finally, if you don't respond well to established treatments, ask your doctor about joining a clinical trial.
Medications
For more aggressive lymphomas, your oncologist may recommend chemotherapy, which can often be the treatment of choice for relapses as well. (The less aggressive, low-grade lymphomas are generaly treated with chemotherapy only when symptoms develop). Administered intravenously or orally, these drugs are often given in combinations such as CHOP, which stands for cyclophosphamide (Cycloblastin, Endoxan), doxorubicin, vincristine (Oncovin) and prednisone.
Hodgkin's disease
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About 15 percent of people with lymphoma have Hodgkin's diseases. It occurs most often from the late teens to early 20s, and then over age 60; it also sometimes appears in children. Doctors don't know its cause, although some suspect a virus, such as Esptein-Barr. Hereditary factors may also play a role. There are four subtypes of class Hodgkins's disease (HD). The most coomon, responsible for 65 to 80 percent of HD cases, is nodular sclerosis, which has moderate growth; mixed cellularity makes up 3 to 15 percent; lymphocyte predominant is responsible for about 5 percent of cases and lymphocyte depleted accounts for less than 1 percent.
The cancer cells responsible for this disease, Reed-Sternberg cells, are easy to spot under the microscope so doctors can make a quick diagnosis and zero in on specific therapies. For stage 1 and 2 Hodgkin's disease, treatment is often radiation alone. For later stage Hodgkin's or situations in which the lymphoma has spread
in detectable ways, it may be chemotheraphy, followed by radiation. Many people with advanced Hodgkin's (stage 4) can be cured with chemo. If the initial treatment doesn't work, a bone marrow or a stem cell transplant provides another option. The best news is that 9 out of 10 people with early-stage Hodgkin's are cured.
Chemotherapy targets all fast-growing cells-not just the cancerous ones--so the side effects of these powerful drugs will affect your blood, hair and digestive tract. In addition, chemo increases your risk for infection and some of the chemicals may up your chances of heart failure or infertility.
PROMISING DEVELOPMENTS
The following habits can help you maintain your equilibrium:
Natural methods
Good nutrition is always advisable, especially when your immune system is in trouble. Ask your doctor about taking a daily multi-vitamin, particularly if you are suffering from loss of appetite.
What is happening
Your lymphatic system is an elaborate network of vessels and white blood cells designed to defend your body against bacteria, viruses and other disease-causing agents. Lymph nodes (or glands) strategically located throughout your body serve as army bases strategically located throughtout your body serve as army bases for these cells, called lymphocytes. They include B-cells (because they develop in bone marrow) and T-cells (which develop in the thymus gland). Once these ace fighters leave the nodes, they patrol the entire body, some circulating in the blood, other gathering in specific organs.
The trouble is that sometimes the defenders themselves become malignant, which leads to cancer of the lymphatic system. It's called leukaemia if it involves the blood or bone marrow (see Leukaemia) and lymphoma if it centres on lymph nodes or organs. There are two main types of lymphoma. Usually the more serious is non-Hodgkin's lymphoma, in which cancerous B-cells or T-cells appear in your lymphatic system and proliferate.
About 85 percent of people with lymphoma (usually called Hodgkin's disease), features a distinctive type of cancer cell that appears in the lymphatic system (see on shortly).
The lymphatic system affects many parts of your body, so lots can go wrong if a malignancy develops. Lymph nodes may be tender, organs may be affected and the spleen ( a key site of lymphatic activity) may swell as cancer cells crowd in. Before treatment begins, you'll be referred to a cancer specialist (an oncologist) to determine how advanced the disease is--called 'staging'. This can range from the mildest stage at stage 1 (tumours are limited to a single node region) through to the most advanced at stage 4 (indicating it has spread to other areas).
- Discussion of a treatment plan with an oncologist.
- Initiation of therapy (radiation, chemo and/or bone marrow, transplant), depending on the particulars of your case.
QUESTIONS TO ASK
- What kind of treatments are recommended for the type of lymphoma I have?
- If I have radiation or chemotherapy, is there a risk of developing other diseases as a result of these treatments?
- What clinical trials are currently under way for the type of lymphoma I have? Where are those studies being done? Should I try to enrol?
- How much time will be spending in the hospital or clinic for treatments, and how often will I have to go?
- Should I make special home-care arrangements?
- After I have completed my treatment, what kinds of symptoms do you want me to report to you?
- If I have a bone marrow transplant, do I need to re-do all my childhood vaccinations?
Treatments
At one time, lymphomas were fatal. But now this cancer is better understood, and many people are cured with sophisticated chemotherapy regimens. The treatment is largely influenced by the grade (aggressiveness) of the lymphoma. For non-Hodgkin's lymphoma, chemotherapy, radiation and bone marrow transplants are used, singly or in combination. Whatever approch your doctors recommend, ask about potentials side effects and outcomes, and talk it over with your family as well as veterans of lymphoma, if possible.
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Chemotheraopy Most common approach; kills cancer cells.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Radiation Used alone or with other symptoms.
---------------------------------------------------------------------------------------------------------------------------------------------
Surgery For lymphomas isolated to a single organ.
--------------------------------------------------------------------------------------------------------------------------------------------- Bone marrow or stem cell For more advanced lymphoma.
transplant
------------------------------------------------------------------------------------------------------------------------------------------ Clinical trials Test new treatments.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Rest Helps promote recovery.
----------------------------------------------------------------------------------------------------------------------------------------------
Moderate exercise Battles fatigue.
---------------------------------------------------------------------------------------------------------------------------------------------- Support group Provides practical and emotional advice.
Although recommendations of specialist are vitally important to consider, you should also remember that you can choose whether you wish to begin or continue a specific type of treatment.
TAKING CONTROL
- Read up. Because lymphoma is such a complex disease and there are so many types, you will need specialised books, articles and online sources to help you understand your doctor's advice and make informed decisions about your treatment.
- Contact siblings. For environmental or generic reasons, the risk of some lymphomas is higher among family members. Your brothers and sisters should know the details of your lymphoma so that their doctors can be alert for any signs of onset in them.
- Schedule frequent mammograms and other cancer screeings. Cancers caused by lymphoma treatment aren't uncommon, so get screened regularly for colon cancer, leukaemia, breast cancer, and thyroid function, for example. Researchers at Boston's Dana Farber Cancer Institute found an increased risk of breast cancer in their eight-year study of 90 women with Hodgkin's who received radiation treatments.
- Avoid alternative's cancer cures such as Laetrile and Essiac. Some alternative remedies may improve your health in other ways, but there is no proof that any of these therapies is effective in treating any kind of cancer. The product promoted as Laterine (amygdalin), found in apricot and cherrpy pits, does not have any measurable impact on lymphoma. Essiac contains burdock root, turkey rhubarb, slippery elm bark and sheep sorrel. There are no studies to support claims it has healing power, and most alternative doctors as sceptical of it.
If your non-Hodgkin's lymphoma is low grade (nonaggressive) in stage 1 or 2 your doctor is likely to recommend radiation therapy alone. For other stages or if the lymphoma causes symptoms, radiation may be combined with chemo or other therapies. Radiation directs high-energy X-rays at tumours. Since for both sexes there's an added risk of temporary or even permanent infertility from radiation damage to sexual organs, consider talking to a fertility expert about freezing sperm or banking eggs before undergoing radiation.
If the lymphoma is isolated in a specific organ, such as the small bowel, surgery alone may cure it. When other procedures are ineffective, however, a bone marrow transplant or stem cell transplant may be the best route, using cells from a donor or your own. (This means healthy marrow may be removed before you have other treatments.) Finally, if you don't respond well to established treatments, ask your doctor about joining a clinical trial.
Medications
For more aggressive lymphomas, your oncologist may recommend chemotherapy, which can often be the treatment of choice for relapses as well. (The less aggressive, low-grade lymphomas are generaly treated with chemotherapy only when symptoms develop). Administered intravenously or orally, these drugs are often given in combinations such as CHOP, which stands for cyclophosphamide (Cycloblastin, Endoxan), doxorubicin, vincristine (Oncovin) and prednisone.
Hodgkin's disease
------------------------------------------------------------------------------------------------------------------------------------------
About 15 percent of people with lymphoma have Hodgkin's diseases. It occurs most often from the late teens to early 20s, and then over age 60; it also sometimes appears in children. Doctors don't know its cause, although some suspect a virus, such as Esptein-Barr. Hereditary factors may also play a role. There are four subtypes of class Hodgkins's disease (HD). The most coomon, responsible for 65 to 80 percent of HD cases, is nodular sclerosis, which has moderate growth; mixed cellularity makes up 3 to 15 percent; lymphocyte predominant is responsible for about 5 percent of cases and lymphocyte depleted accounts for less than 1 percent.
The cancer cells responsible for this disease, Reed-Sternberg cells, are easy to spot under the microscope so doctors can make a quick diagnosis and zero in on specific therapies. For stage 1 and 2 Hodgkin's disease, treatment is often radiation alone. For later stage Hodgkin's or situations in which the lymphoma has spread
in detectable ways, it may be chemotheraphy, followed by radiation. Many people with advanced Hodgkin's (stage 4) can be cured with chemo. If the initial treatment doesn't work, a bone marrow or a stem cell transplant provides another option. The best news is that 9 out of 10 people with early-stage Hodgkin's are cured.
Chemotherapy targets all fast-growing cells-not just the cancerous ones--so the side effects of these powerful drugs will affect your blood, hair and digestive tract. In addition, chemo increases your risk for infection and some of the chemicals may up your chances of heart failure or infertility.
- Scientists are currently working out ways to use monoclonal antibodies (Mabs), such as rituxmab (Mabthera), to single out lymphoma cells and destroy them. Other kinds of Mabs might be developed that would collect at tumour sites, triggering an immune response.
- Doctors are also testing nucleoside analogues, anti-viral agents that have been effective against some low-grade lymphomas. Interferon-alpha is one kind of antiviral drug that seems to be successful in lighting some of the forms of non-Hodgkin's lymphoma.
- Lymphoma vaccines have shown promising results. Using specific lymphoma cells, a vaccine is created to fight the disease. The immune system destroys this antigen; at the same time it goes after lookalike lymphoma cells.
The following habits can help you maintain your equilibrium:
- Get as much rest as possible. People being treated for lymphoma generally feel fatigued, yet don' t sleep well due to night sweats, fever, coughing or nausea. Plan on getting plenty of rest whenever you are able.
- Do moderate exercise. Try some walking, moderate cycling or swimming, as long as your doctor approves. One study showed that getting aerobic exercise significantly lessened fatigue among its participants.
- Join a support group. It can be helpful to talk with people having similar exeperiences. Your doctor can guide you to such a group or you can correspond online.
Natural methods
Good nutrition is always advisable, especially when your immune system is in trouble. Ask your doctor about taking a daily multi-vitamin, particularly if you are suffering from loss of appetite.
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