Non-Hodgkin Lymphoma

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After completing a thorough lab analysis of your recent biopsy, a specialized doctor called a pathologist reported a diagnosis of non-Hodgkin lymphoma (NHL), which is a type of cancer that develops in certain lymphatic system cells called lymphocytes. The average age at the time of diagnosis is 60; about half of all cases occur in patients age 65 and older.

About the Condition

The lymphatic system is comprised of lymph nodes, vessels and fluid, as well as related organs. Part of the immune system, it helps the body fight infections, delivers oxygen, nutrients and hormones to the cells, and filters harmful substances such as bacteria and waste from the lymph fluid.

More than 600 bean-shaped lymph node glands are connected by a vast network of lymphatic vessels that transport the colorless lymph fluid, which originates in the blood as plasma and returns to the bloodstream after traveling through the lymph system. The lymph nodes and organs such as the tonsils, thymus and spleen are made of lymphoid tissue that contains a large amount of lymphocytes, a type of white blood cell that fights infection and includes B- and T-cells and natural killer cells.

Lymphoma is a type of cancer that occurs when lymphocytes in lymph nodes or lymphatic organs do not develop and die in their normal manner. The extra cells that result can form a growth, or tumor, and spread to adjacent lymph nodes, invade and damage other nearby lymph nodes or organs, or spread further to other locations in the body.

Non-Hodgkin lymphoma is classified by the pace of the disease and the subtype, which is based on specific features of the cancer cells. Indolent (low-grade) NHL grows slowly while aggressive (high-grade) NHL grows more rapidly. B-cell NHL subtypes are the most common — up to 85–90% of cases — and include mucosa-associated lymphatic tissue (MALT) lymphoma and diffuse large B-cell lymphoma, the most common NHL accounting for nearly a third of all cases. T-cell and natural killer cell subtypes account for 10–15% of cases and include peripheral T-cell lymphoma and anaplastic large cell lymphoma.

There are four general stages of non-Hodgkin lymphoma (I, II, III, IV) based on whether and how much the cancer has spread. In addition, each stage can be characterized with a “B” to denote if certain symptoms (such as weight loss, night sweats and fever) are present or an “A” to denote the absence of such B symptoms. Your doctor can tell you more about your particular cancer subtype and stage.

Treatment Options

Deciding on a treatment plan for non-Hodgkin lymphoma can be complex and depend upon a variety of factors such as the disease pace, subtype and stage, and your age, general health condition and personal preferences. The following treatment possibilities are available:

Watchful Waiting – Some patients with indolent NHL decide not to pursue active therapy for their cancer but rather adopt a “watch and wait” tactic, avoiding the side effects of standard treatments.

Chemotherapy – The use of anti-cancer drugs, or chemotherapy, provides a way to kill lymphoma cells systemically (throughout the body) via the bloodstream. Often a combination of several drugs is given, which varies based on the stage of cancer.

Radiation Therapy – Radiation therapy provides a way to shrink or destroy masses of cancer cells as well as to reduce pain. For non-Hodgkin lymphoma, external beam radiation is used, in which a high energy X-ray machine directs radiation at the affected lymph nodes or other areas.

(Hematopoietic) Stem Cell Transplant – Stem cell transplant involves the transfer of specific blood-forming (hematopoietic) cells after high-dose chemotherapy (and at times added radiation therapy). Cancer cells in the body and healthy blood-forming cells in the bone marrow are destroyed by the chemotherapy, which is given following the harvest of transplant cells from the bone marrow or blood of the patient (autologous transplant). This usual method has lower risks than allogeneic transplant, when cells come from a matched donor. The harvested cells are frozen and later thawed for infusion into the body to help grow new bone marrow. Stem cell transplant is used for patients whose cancer has come back (recurred) or not fully responded to previous treatments.

Biologic Therapy – In certain cases, therapy that employs man-made biologics (i.e., synthetic proteins) such as rituximab or alemtuzumab is used to treat non-Hodgkin lymphoma. These biologics are called monoclonal antibodies and work by targeting specific proteins found on cancerous cells.

Targeted Therapy – This newer form of anti-cancer therapy targets specific abnormalities within just the cancer cells to slow or stop their growth using drugs such as bortezomib and temsirolimus.

You may also consider participating in clinical trials. These investigative studies help doctors learn about new treatments and better ways to use established treatments. Talk with your doctor about the possibility of taking part in a clinical trial in your area.

What You Can Do

You can choose to take an active role in your health and well-being. Learn as much as you can about your condition and have a list of questions ready each time you meet with your doctor. Join a cancer support group, and talk with your family, friends, clergyperson or counselor as you feel comfortable. Also, be sure to get enough sleep every night, keep all of your doctor’s appointments and promptly report any new symptoms or treatment side effects that develop.

Additional Resources

American Cancer Society, 800.227.2345, www.cancer.org
Leukemia & Lymphoma Society, 800.955.4572, www.leukemia-lymphoma.org
Lymphoma Research Foundation, 800.500.9976, www.lymphoma.org

This patient resource sheet is provided to you as a service of CBLPath® and is intended for information purposes only. It may not fully describe all aspects of your diagnosis and is not meant to serve as medical advice or a substitute for professional medical care. Your physician can provide you with a thorough explanation of your diagnosis and appropriate treatment options, which may vary. Only you and your physician can determine your best treatment plan.

Updated 1.12