What Lymphoma Is, How it’s Treated and How to Cope

Lymphoma is the name given to a group of cancers affecting the lymphoid or ‘lymphatic’ tissue in the body and in particular the lymph nodes and spleen. There are two main kinds of lymphoma that affect people and these are Hodgkin’s and non-Hodgkin’s lymphoma. Doctors tell the two kinds apart by looking for the presence of certain cells called Reed-Steenberg cells.

These abnormal cells are not present in non-Hodgkin’s lymphoma but will be found in patients with Hodgkin’s lymphoma, so it is these cells which determine which diagnosis is given.

Non-Hodgkin’s Lymphoma (NHL)

Any cancer which affects the lymphoid tissue other than Hodgkin’s lymphoma is called non-Hodgkin’s lymphoma. Any lymphoid tissue in the body may be affected by this kind of cancer. There are cancers that start in the lung or colon and spread to lymphoid tissue but these are not called lymphomas.

Lymphoma is characterized by the fact that it begins in the lymphocytes in the lymphoid tissue or lymphoid organs and can spread from these areas to the rest of the body.

What is the Lymphatic System and How Does it Work?

To understand lymphoma, it is helpful to understand just how the lymphatic system and its cells work. The lymphatic system is made up of lymph nodes that grow and store white blood cells. The function of these cells is to protect the body against infection. They are also known as lymphocytes.

Our bodies have a network through which these lymphocytes flow throughout the body known as lymph vessels. The watery or milky fluid that flows through these vessels is called lymphatic fluid and this fluid is eventually emptied into a main vein in the chest.

There are two kinds of lymphocytes in the body, the B lymphocytes (‘B cells’) and T lymphocytes (‘T cells’). B lymphocytes are cells that protect the body against infection by fighting off germs like viruses and bacteria by attaching to them and kick-starting our immune system into action.

The many T lymphocytes have unique and specialized functions such as protecting us against viruses, fungi, and bacteria or releasing cytokines that attach to white blood cells whose role is to digest dangerous cells. T cells can also fight some kinds of cancer or boost or lower levels of other cells in our immune system.

The different kinds of lymphoma will relate to a certain sub-type of normal, healthy lymphocyte functions and is used to diagnose which kind is affecting the body and how it should be treated.

What are the Symptoms of Lymphoma?

Non-Hodgkin’s lymphoma usually presents with widespread, firm but painless swelling of the lymph nodes with tiredness, weight loss and sometimes fever. As the disease progresses pressure may be placed on the spinal cord, esophagus or bowel or even the lymph vessels themselves.

Hodgkin’s lymphoma usually begins in adolescence or early adult life but can affect people of any age.

It is thought that it may be caused by certain cancer-causing viruses. Symptoms are painless enlargement of the lymph nodes all over the body and these nodes are rubbery and may be a little tender to pressure.

The spleen and liver may enlarge as the illness progresses and the abnormal cells spread to these organs. There may be persistent fever and anemia and secondary effects due to the pressure of the large lymph nodes on veins and other organs. Late in the disease, the bone marrow may be affected.

What are the Risk Factors for Lymphoma?

Being over the age of sixty (when the disease becomes more commonly seen) may be considered a risk factor and being obese may also contribute to the development of non-Hodgkin’s lymphoma. Unless you developed your lymphoma from a genetic tendency towards a compromised immune system you won’t pass the risk of lymphoma on to your children.

Those who have been exposed to any form of radiation even in the course of treating another cancer may be at risk for developing lymphoma and chemicals like benzene or weed killer and insecticides may be implicated, but this has not been conclusively proven.

Chemotherapy treatments have also been implicated in the development of the disease, but again this has not been proven.

Any drug or illness that interferes with the immune system such as those used to prevent rejection after an organ transplant or the HIV virus may contribute to being at higher risk for lymphoma.

The T cell virus or HTLV-1 can make you more likely to get lymphoma. This virus is common in areas of Japan and the Caribbean but it causes less than 1 percent of cases in the United States. This virus is spread through contaminated blood or sexual fluid and breast milk.

Helicobacter pylori, a bacteria that causes stomach ulcers, can cause lymphomas of the stomach so these can be treated by antibiotic therapy.

How is Lymphoma Treated?

This depends on which type of lymphoma you have. Non-Hodgkin’s lymphoma is generally treated by means of chemotherapy (anti-cancer drugs) taken my mouth or via injection into the veins or muscles or in some cases the drugs may be injected directly into the spinal fluid. This is so that it can penetrate abnormal cells in the spinal cord or on the brain’s surface. The drugs can reach all parts of the body through the bloodstream.

You may be given your chemotherapy treatments under the care of doctors in hospital or as an outpatient, depending on what your doctor feels is best in your particular case.

You may be prescribed a course of treatments that includes both chemotherapy and radiation therapy. This depends on the type of lymphoma that you have. Doctors use a variety of drugs in combination to treat lymphoma on different schedules but you will generally be required to take the medicines in cycles that are given three or four weeks apart.

If there is no improvement in your illness and your lymph nodes are still shown to be enlarged on a CT scan you may be given drugs in other combinations until a good result is achieved.

What are the Side Effects of Lymphoma Treatment?

Because the drugs used in chemotherapy kill healthy cells as well as abnormal ones you may develop side effects as a result of treatment. These will not affect every patient and largely depend on the type of drugs you are given and their dosage as well as how long you will be taking them for.

Because the chemotherapy drugs target cells that are rapidly dividing (in order to kill the quickly growing cancer cells) normal healthy cells in your body that divide quickly are also affected. Luckily most of these effects will go away once treatment is stopped and cells re-grow.

Your bone marrow may be affected during treatments as well as your mouth and intestinal linings and hair follicles so you may experience one or more of the following side effects:

• Loss of hair

• Sores in your mouth

• Lowered resistance to infection

• A tendency to bruise or bleed easily after minor cuts or injuries due to low blood platelet levels.

• Tiredness due to low red blood cell levels in the body

• Appetite loss

• Nausea and vomiting

Can Side Effects be Lessened or Avoided?

Luckily, your doctor can prescribe medicine to help lessen the side effects of treatment. You may be prescribed drugs that help with nausea and vomiting along with your chemotherapy treatments or given growth factors like G-CSF or GM-CSF to boost your levels of white blood cells and infection fighting power.

Your doctor may prescribe a course of antibiotics to fend of any possible germs or at the first signs of infection.

A blood platelet transfusion may be given to protect you from bleeding or you may be given a medicine called oprelvekin (Neumega) to help your body make more platelets.

Very low red blood cell counts that cause anemia are often treated with a growth factor like erythropoietin or by means of red blood cell transfusions.

A condition called tumor lysis syndrome is a side effect of the rapid breakdown of cells when bulky lymphomas are successfully treated by chemotherapy. The dying lymphoma cells split open and spill their contents into the bloodstream. This can damage the heart, kidneys or nervous system but if extra fluids and medicines like sodium bicarbonate and Allopurinol are given they can help detoxify the body.

The kidneys, liver, testes, ovaries, brain, heart, and lungs can all be affected by chemotherapy drugs but thankfully such effects are rare as long as treatment is carefully monitored.

Successful chemotherapy may contribute to the development of leukemia and it does occur in a very small percentage of patients.

How to Take Care of Yourself

During treatment you should take extra safety precautions to make sure you don’t become sick from an infection. These may include:

• Making sure you are not exposed to bacteria, fungi, or viruses in the home or garden

• Asking your visitors to wear a mask, a sterile gown, and surgical gloves and wear a mask yourself if you need to

• Washing hands well and asking visitors or those who prepare your food to do the same

• Avoiding eating uncooked fruit and other possibly damaging foods.

• Children should be avoided if possible since they carry infections.

Remember that a positive outlook, healthy habits and dealing with any stressful feelings will help your fight your illness and contribute to the success of your treatment. Making sure you get sufficient rest, moderate exercise and eating nutritious meals are tools to help combat your cancer.

If you have been diagnosed with lymphoma you may be nervous, anxious and have many questions about your illness. This is the time to start developing good, honest open lines of communication with your doctor and other caregivers.

Don’t be afraid to ask all the questions you need to fully understand your illness, treatment options and goals and the way in which these treatments may impact on your lifestyle and family relationships.