Lymphoma

What is Non – Hodgkin Lymphoma?

Non-Hodgkin's lymphoma (also called NHL) is Cancer that begins in the lymphatic system. The lymphatic system is part of the body's immune system. The immune system fights infection and other diseases.

What Causes It?

Doctors cannot always explain why one person develops lymphoma and another does not. However, we do know that a person with certain risk factors may be more likely than others to develop lymphoma.

Studies reveal that individuals who have a weak immune system (such as autoimmune disorder), or suffering from certain types of infections (such as Human immunodeficiency virus, HIV) are at higher risk of developing non-Hodgkin's lymphoma. Although non-Hodgkin's lymphoma can occur in young people, the chances of developing this disease go up with age. Most people with non-Hodgkin's lymphoma are older than 60 years of age.

Symptoms

Non-Hodgkin’s lymphoma can cause many symptoms:

• Swollen, painless lymph nodes in the neck, armpits, or groin
• Unexplained weight loss
• Fever
• Soaking night sweats
• Coughing, trouble breathing, or chest pain
• Weakness and tiredness that don’t go away
• Pain, swelling, or a feeling of fullness in the abdomen

Most often, these symptoms are not due to cancer. Other health problems can cause some of these symptoms. Anyone with such symptoms should see a doctor to be diagnosed and treated as early as possible.

Diagnosis

If you have swollen lymph nodes or other symptoms that suggest non- Hodgkin’s lymphoma, your doctor must find out whether it originates from cancer or other conditions. You may be required to do some blood tests and diagnostic procedures:

Physical examination: Your doctor checks for swollen lymph nodes in your neck, underarms, and groin. Your doctor also checks your spleen and liver to see if they are swollen.

Blood tests: The lab does a complete blood count to check the number of blood cells. The lab also checks for other substances, such as Lactate dehydrogenase (LDH). Lymphoma may cause a high level of LDH.

Chest x-rays: You may have x-rays to check for swollen lymph nodes or other signs of disease in your chest.

Biopsy: Your doctor removes tissue to look for lymphoma cells. A biopsy is the only sure way to diagnose lymphoma. Your doctor may remove an entire lymph node (excision biopsy) or only part of a lymph node (incisional biopsy). A pathologist checks the tissue for lymphoma cells under a microscope.

How is Lymphoma Assessed?

Your doctor needs to know the extent (stage) of non-Hodgkin’s lymphoma to plan the best treatment. The stage is based on where lymphoma cells are found (in the lymph nodes or in other organs or tissues) and the extent of the areas affected. The stages of non- Hodgkin’s lymphoma are as follow:

• Stage I: The lymphoma cells are in a single lymph node group (such as in the neck or underarm). Or, if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone-marrow).
• Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.
• Stage III: The lymphoma is in groups of lymph nodes above and below the diaphragm. It also may be found in an organ or tissue near these lymph node groups.
• Stage IV: The lymphoma is throughout at least one organ or tissue (in addition to the lymph nodes). Or, it is in the liver, blood, or bone-marrow.

What Treatment is offered?

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach cancer cells in almost all parts of the body.

You may receive chemotherapy by mouth, through a vein, or in the space around the spinal cord. Treatment is usually as an outpatient in the hospital/clinic or at home. Some patients need to stay in the hospital during treatment for close observation.

If a patient has lymphoma in the stomach caused by Helicobactor infection, the doctor may treat this lymphoma with antibiotics. When the infection is cured, the cancer may resolve.

Biological Therapy

People with certain types of non-Hodgkin's lymphoma may have biological therapy to boost the immune system to fight cancer effectively.

Monoclonal antibodies are used for lymphoma. They are proteins that can bind to cancer cells to help the immune system kill lymphoma cells. Patients receive this treatment through a vein at the doctor's clinic or hospital.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill non-Hodgkin's lymphoma cells. It can shrink tumors and help control pain.

Two types of radiation therapy are used for people with lymphoma:

• External radiation: A large machine aims the rays at the part of the body where lymphoma cells have collected. This is local therapy because it affects cells in the treated area only. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.
• Systemic radiation: Some people with lymphoma receive an injection of radioactive material that travels throughout the body. The radioactive material is bound to antibodies that target and destroy lymphoma cells.

Stem Cell Transplantation

A person with recurrent lymphoma may receive stem cell transplantation. A transplant of blood-forming stem cell allows a person to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in the bone marrow. Later, the patient receives healthy blood-forming stem cells through a flexible tube placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells.

Stem cell transplants take place in the hospital. The stem cells may come from the patient or from a donor.

What kind of support is available?

CanHOPE, a ParkwayHealth initiative together with the multi-disciplinary team of doctors tries to bring about a holistic approach to cancer care at no extra cost. Counsellors manned its cancer counselling service through a hotline and email to provide emotional and psychosocial support to all patients and caregivers to assist them to cope effectively with cancer. A ‘meet and greet’ service with face-to-face counselling can also be arranged.

Patients, health care professionals & the general public can also receive up-to-date cancer information, its related screening tests, treatment and referral to appropriate cancer services, resources for further rehabilitation and support services, advice on side-effects of cancer treatment, coping strategies, diet and nutrition.

CALL our CanHOPE counsellors: +65 67389333 or e-mail: enquiry@canhope.org