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Non-Hodgkin's lymphomas are a type of cancer of the lymphatic system. There are two main types of lymphoma: one is called Hodgkin's disease and the other is called non-Hodgkin's lymphoma. There are about 20 different types of non-Hodgkin's lymphoma.
There is only one way to tell the difference between Hodgkin's and non-Hodgkin's lymphomas, and this difference can be seen when the cells are looked at under the microscope. Often the cells need to be stained to show their structures. Usually the cells will also be tested for the presence of particular proteins.
Most people have B-cell lymphomas, with T-cell lymphomas occurring more often in adolescents and young adults. Knowing the grade and stage of a lymphoma helps the doctors to know how the lymphoma is likely to develop, how it may affect you and which treatment is most appropriate.
Grading refers to the appearance of the lymphoma cells under the microscope. The grade gives an idea of how quickly the lymphoma may grow and develop. For practical reasons non-Hodgkin's lymphomas are generally divided into two main categories:
Low-grade (or slow-growing): these have a very slow growth rate and may need little or no treatment for months or possibly years. When they do need treatment they are likely to shrink down, or even disappear completely, but are likely to come back again at some time in the future.
High-grade (or faster-growing): these types grow more quickly and are more likely to spread to other lymph nodes or other organs in the body. They are more likely to cause symptoms and usually need immediate treatment. However, they are more likely to be completely cured than low grade lymphomas. The usual treatment is intensive chemotherapy.
The stage of a lymphoma is a term used to describe where it is in the body, how many lymph glands are affected and whether it has spread to other lymph glands or other organs. A commonly used staging system is described below:
Stage 1: One group of lymph nodes is affected.
Stage 2: Two or more groups of nodes are affected but the lymphoma is only on one side of the diaphragm. The diaphragm is the sheet of muscle under the lungs that plays a large part in our breathing. The part of the body above the diaphragm is considered the upper half, and below the diaphragm is considered the lower half of the body.
Stage 3: The lymphoma is in lymph nodes on both sides of the diaphragm.
Stage 4: The lymphoma has spread beyond the lymph nodes, for example to other organs such as the bone marrow, liver or lungs.
As well as giving each stage a number, doctors also use a letter code - either A or B - to show whether or not you have specific symptoms. Your doctor will ask you whether you have lost weight or have fevers or night sweats. If you do not have any of these symptoms, your lymphoma will be classified as A. If you have these symptoms, it is B.
Occasionally, lymphomas can arise at unusual sites outside the lymph nodes, for example in the stomach. This is called extranodal lymphoma and the stage will include the letter E (for extranodal). Once your doctor knows the type of lymphoma and the stage and grade, he or she can plan the most effective treatment for you.
Like most types of cancer the cause of most non-Hodgkin's lymphomas is unknown. It is known that lymphomas are more likely to develop in people who have taken drugs to prevent rejection following an organ transplant or whose immunity has been reduced, for example in people with HIV or AIDS.
However, despite the increased risk, NHL is still uncommon in these people. Certain viruses such as the Epstein Barr virus, which causes glandular fever, can contribute to the development of lymphomas, but, like other cancers, lymphomas are not infectious and cannot be passed on to other people. One rare type of lymphoma, which usually affects the stomach - MALT lymphoma - is known to be caused by a type of bacterial infection known as helicobacter pylori.
It is thought that lymphomas are not caused by genetic changes that can be passed down through families, so they are not inherited.
Often, the first sign of a non-Hodgkin's lymphoma is a painless swelling of a lymph node in the neck, armpit or groin.
Other symptoms may include any of the following:
A definite diagnosis is made by removing an enlarged lymph node or part of it, and examining the cells under a microscope. This is known as a biopsy. It is a very small procedure and may be done under local anesthetic and sedation, or a general anesthetic. Biopsies may also be taken from other body tissues.
If the biopsy shows that lymphoma cells are present, your doctor will want you to have some further tests to find out the exact stage of the disease. Staging is a way of describing the extent and spread of the cancer in your body. It is very important because the type of treatment you receive depends on the stage of the disease.
The tests that may be done to find out the stage of your lymphoma may include any of the following:
Samples of your blood will be taken regularly throughout your treatment to check your general health, the levels of red cells, white cells and platelets in your blood, and your liver and kidney function.
This is taken to check for any sign that the lymphoma has spread to the lymph nodes in the chest or to the lungs.
Bone marrow sample
For this test a sample of bone marrow is taken, usually from the back of the hip bones. The sample is then examined to see if it contains any lymphoma cells. The test does not take very long and can be done on the ward or in the outpatient department. If you are very anxious about the test a mild sedative may be helpful, so ask your doctor about this beforehand.
Ultrasound scans use sound waves to make up a picture of the inside of the body to check for any abnormalities. It will be done in the hospital scanning department.
CT scan (Computerized tomography)
This is a series of x-rays, which builds up a three-dimensional picture of the inside of the body. The scan is painless. It takes longer than an x-ray (from 10 to 30 minutes) and can be used to find how many lymph nodes are affected by the lymphoma, or whether lymph glands in other areas of the body are affected.
The following tests are less commonly done but may be considered necessary in some cases:
MRI scan (Magnetic resonance imaging)
PET scan (Positron Emission Tomography)
The conventional treatment of non-Hodgkin's lymphomas has greatly improved over the past few years, even when they have spread to different areas of the body. Many people can now either be cured or stay in remission for many years. Complete remission is where there is no sign of the lymphoma. Partial remission is where the lymphoma shrinks down so that the person is well, does not have symptoms and does not need further treatment at that time.
For many people in the early stages of some types of low grade lymphoma no treatment may be needed at first. Where treatment is needed the main types are radiotherapy and chemotherapy. You may need either of these treatments, or a combination of both.
Children with non-Hodgkin's lymphoma nearly always have high-grade tumors and the main form of treatment is with intensive chemotherapy. Radiotherapy may sometimes be necessary as well. CancerBACUP has a booklet on children's cancers which has more information about non-Hodgkin's lymphoma in children and its treatment.
Steroids are drugs which are often given with chemotherapy to help treat lymphomas. They also help you to feel better and can reduce feelings of sickness.
Monoclonal antibodies are drugs that can `recognize' and find specific cells in the body. These drugs can be designed to find a particular type of cancer cell, attach itself to them and destroy them. They can be used alone, or a radioactive molecule can be attached to a monoclonal antibody, which then delivers radiation directly to the cancer cells.
Excerpted from the CancerBACUP booklet series.
|Weak or unproven link|
|Strong or generally accepted link|
|Proven definite or direct link|
|May do some good|
|Likely to help|
|Reasonably likely to cause problems|
AIDS: Acquired Immune Deficiency Syndrome. An immune system deficiency disorder that suddenly alters the body's ability to defend itself. The AIDS virus invades the T4 helper/inducer lymphocytes and multiplies, causing a breakdown in the body's immune system, eventually leading to overwhelming infection and/or cancer, with ultimate death.
Anesthetic: Agent causing loss of sensation by neurological dysfunction or a pharmacological depression of nerve function.
Antibody: A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Biopsy: Excision of tissue from a living being for diagnosis.
Cancer: Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Chemotherapy: A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells.
Diaphragm: The muscle separating the stomach from the chest.
Epstein Barr virus: (EBV): A virus that causes infectious mononucleosis and that is possibly capable of causing other diseases in immunocompromised hosts.
Helicobacter Pylori: H. pylori is a bacterium that is found in the stomach which, along with acid secretion, damages stomach and duodenal tissue, causing inflammation and peptic ulcers. Although most people will never have symptoms or problems related to the infection, they may include: dull, 'gnawing' pain which may occur 2-3 hours after a meal, come and go for several days or weeks, occur in the middle of the night when the stomach is empty and be relieved by eating; loss of weight; loss of appetite; bloating; burping; nausea; vomiting.
HIV: Abbreviation for human immunodeficiency virus, a retrovirus associated with onset of advanced immunodeficiency syndrome (AIDS).
Hodgkin's Disease: Cancer of the lymphatic system and lymph nodes.
Lymph Glands: Located in the lymph vessels of the body, these glands trap foreign material and produce lymphocytes. These glands act as filters in the lymph system, and contain and form lymphocytes and permit lymphatic cells to destroy certain foreign agents.
Lymph Nodes: Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit and groin, but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Children’s nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's.
Lymphatic System: A network of vessels which collect fluid from the tissues of the body and return it to the blood. Lymphatic fluid (also called lymph) is rich in white blood cells that fight infection and an important part of the body's immune system.
Lymphoma: Any tumor of the lymphatic tissues.
MRI: Magnetic Resonance Imaging. A technique used in diagnosis that combines radio waves and magnetic forces to produce detailed images of the internal structures of the body.
Nervous System: A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Protein: Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Sedative: Calming, quieting; drug that quiets nervous excitement.
Steroid: Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Stomach: A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
T-Cell: T cells are lymphocytes that are produced in the bone marrow and mature in the thymus. T cells are responsible for mediating the second branch of the immune system called "cellular immune response." T cells can live for months to years. This lymphocyte population is defined by the presence of a rearranged T-cell receptor.
Virus: Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
White Blood Cell: (WBC): A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. Also known as a leukocyte.