about lymphoma

Karine's cancer is known as the "Non-Hodgkin's Lymphoma".

Facts on Non-Hodgkin's Lymphoma:

Lymphoma is a general term that identifies an abnormal growth of cells in the lymphatic system. Non-Hodgkin's lymphoma (NHL) collectively refers to several related cancers that arise from the lymphatic system. Each type of lymphoma is diagnosed according to the kind of lymphocyte seen during the biopsy of a lymph node.

Non-Hodgkin's lymphoma is diagnosed in over 5,000 Canadians each year. A rare disease among children and teens, NHL develops more frequently as people get older.

Increased knowledge of the lymphatic system and lymphocytes as well as improved treatment regimens have increased the success rate for treating people with NHL.

The Lymphatic System:

An understanding of non-Hodgkin's lymphoma begins with learning about the lymphatic system, the primary task of which is to defend the body against disease. The system consists of the lymphatics, a network of narrow channels similar to a network of small blood vessels; lymph nodes, bean-shaped glands that contain lymphocytes, a type of white blood cell; and lymph, a colourless fluid that flows through the body's tissues, picking up bacteria, foreign substances and sometimes cancer cells.

Lymphatics running the whole length of the body, carry the lymph to and from the tissues. Groups of lymph nodes, located under the jaw, at the base of the neck, under the arms and in the chest, stomach and groin, filter out the impurities picked up by the lymph. Some lymphocytes protect the body by killing bacteria while other lymphocytes produce antibodies to fight infection.

Lymphatic tissue is also found in the spleen, liver, bone marrow and intestine as well as in other organs of the body.

What is Non-Hodgkin's Lymphoma?

Non-Hodgkin's lymphoma almost always originates in one or more of the body's lymph nodes, although occasionally it can arise in other tissues. If the cancer cells remain confined to a few nodes, the lymphoma is said to be localized. At least 75 per cent of non-Hodgkin's lymphoma, however, is diagnosed as generalized because the abnormal cells are found throughout the lymphatic system as well as in other organs.

Non-Hodgkin's lymphoma is not only classified as localized or generalized, it is also categorized according to the characteristics of the lymphocyte found in the lymph node biopsy and the presence or absence of symptoms. Since 1982, a "Working Formulation of the non-Hodgkin's Lymphoma for Clinical Usage" has tried to simplify this classification by channeling the several different types into one of these categories:

Low Grade. This category of NHL usually develops slowly and without symptoms. After patients are diagnosed, they are examined on a routine schedule by their physicians but are not treated unless symptoms appear. Many patients with low grade non-Hodgkin's lymphoma can live a very long time, even without treatment. Some low grade lymphomas are treated with radiation and more recently, even by aggressive chemotherapy and bone marrow transplants. 

Intermediate Grade. When left untreated, this category of NHL spreads over a period of time and eventually is fatal. Although the intense treatment regimen sometimes produces undesirable side-effects, 50% of patients with intermediate grade non-Hodgkin's lymphoma can be cured.

High Grade. As with the intermediate grade of NHL, a cure is possible. This fast-growing often widespread category of lymphoma may be responsive to chemotherapy (treatment with anti-cancer drugs) but requires very intensive treatment. Included among the high grade lymphomas is Burkitt's lymphoma, named after Dr. Denis Burkitt who first identified the disease. Though very rare in North America, Burkitt's lymphoma nonetheless frequently occurs among children living in the low-lands of Africa. Non-Burkitt's lymphoma is uncommon but seen in those with acquired immunodeficiency disease (AIDS).

The cause of Non-Hodgkin's Lymphoma:

The precise cause of NHL is unknown. It has been found, however, that some people are more likely than others to develop it. In general, people who are at a higher risk for developing NHL later in life are those born with a depressed immune system or those whose immune systems are suppressed because of disease or drugs. For example, patients who have had organ transplants and have taken drugs to prevent rejection of the transplant appear to have a higher rate of lymphoma than the general public. So do people with HIV. People diagnosed with an autoimmune disease (one in which the body forms antibodies against its own tissues) also have an increased risk.

Researchers have found that a virus may change the chromosome pattern of very young lymphocytes. Burkitt's lymphoma is an example. It has been linked with the Epstein-Barr virus in laboratory studies.

Detection and Diagnosis:

The signs of NHL generally resemble symptoms common to many ailments. Swollen lymph glands, for example. Enlarged nodes which are tender to the touch probably are caused by infection. Enlarged nodes which are painless, however, are suspect and should not be ignored. Anytime a lymph node stays swollen beyond three weeks, a physician should check it out.

Other symptoms of NHL also resemble common medical conditions. These include:

-Fatigue

-Fever in the absence of infection

-Unexplained night sweats

-Weight loss

Most of the time these symptoms are not due to NHL. But, why take a chance? Left undetected and untreated, NHL progresses in most patients. Some people go on to develop anemia and the inability to fight infection. It makes good sense, therefore, to see a physician if any symptom lasts longer than three weeks.

The physician will take a medical history, do a physical examination and order blood tests. In NHL is suspected, a lymph node will be removed and the cells studied under the microscope. Called a biopsy, this procedure confirms the diagnosis of NHL. Additional tests are usually necessary to decide whether or not other sites are involved. The following tests also determine the category and type of non-Hodgkin's lymphoma:

-Chest x-ray

-Bone marrow biopsy. Cells are removed from the bone marrow for study under the microscope.

-Lymphangiography. A radio-opaque dye (it makes an organ visible on x-ray film) is injected into the lymphatic system and fills the lymph nodes.

-Gallium scan. An injection of gallium highlights areas affected by NHL.

-Blood tests.

-Computerized Axial Tomography (CAT) Scan. In this technique, a narrow x-ray beam is directed by a computer to revolve around a designated part of the body. Within seconds, thousands of bits of information are registered and translated by the instrument into a cross-sectional picture on a display screen. A CAT scan shows if lymph nodes are enlarged and if the spleen and liver are also involved.

Treatment:

Significant progress has been made during the past 10 years in successfully treating NHL. More patients are cured and the lives of many others are extended. The choice of treatment depends upon the patient's medical history and whether or not NHL is localized or generalized. Most lymphomas are treated by radiotherapy or chemotherapy.

*Karine is receiving chemotherapy*:

Chemotherapy is often the preferred treatment when NHL is generalized. Anti-cancer drugs used alone, in combination or with hormones interfere with the division and growth of cancer cells. Chemotherapy slows the spread of lymphoma and frequently wipes out tumor cells.

The category of a patient's NHL determines the type of treatment. Some patients diagnosed with low grade lymphoma have no symptoms. Rather than treating them, experienced physicians carefully  observe the course of their disease. If symptoms appear, mild chemotherapy is given for a short period of time. People with low grade lymphoma, though rarely cured, can live out long, productive lives.

More aggressive treatment is used for patients with intermediate and high grade lymphomas. A combination of three to five chemotherapeutic drugs is given over a long period of time. Periodically, chemotherapy is temporarily halted to allow normal cells to recover. Remission rates continue to improve as new chemotherapeutic drugs become available and new combinations are used.

Each person tolerates drugs differently. Some patients may experience nausea, vomiting, diarrhea, hair loss, anemia, mouth sores and susceptibility to infections. Once chemotherapy is completed, the side effects gradually disappear.

Hope for the Future

Investigation for a cause of NHL continues. If a virus causes NHL in humans as it apparently does in animals, a vaccine against the virus could be developed. People could then be immunized against NHL as they are vaccinated against small pox and the flu today.

Until a cause is identified, improved treatment regimens are the hope of the future. New chemotherapeutic agents and a combination of existing drugs promise more people will be cured in the next five to ten years.

The immediate hope, however, is early detection. Have a physician check out any lymph node that for more than three weeks  remains swollen, especially if it is painless. It is also a good idea to see a physician if fatigue, fever, night sweats or unexplained weight loss continue for more than two weeks.

*** The information found on this page is taken from the Canadian Cancer Society's brochure, Facts on Non-Hodgkin's Lymphoma *** 

MORE INFORMATION ON LYMPHOMA & NHL:

Lymphoma Foundation Canada (Bilingual)

CancerBacup (English)