February is Lymphoma Month
LYMPHOMA — by Denis Hammond
The term lymphoma refers to a group of cancers that arise from the cells of the immune system – the lymphocytes. These cells are involved in fighting infection, allergic reactions, and rejecting foreign proteins.
Lymph nodes are the organs in which many of the lymphocytes reside. Lymph nodes are strategically placed to guard our blood stream against infections or cancers.
Lymphomas are an especially varied group of diseases. Some are very slow growing and would barely be recognized as cancers. Others are so aggressive that a person might die without treatment within a few weeks of diagnosis. Overall the lymphomas are divided into two big families: Hodgkin’s Disease and the Non-Hodgkin’s Lymphomas.
Hodgkin's Disease
Hodgkin’s Disease usually arises in the lymph nodes of the neck or chest. Hodgkin’s Disease usually spreads sequentially from the more central lymph nodes to the more peripheral lymph nodes.
In more advanced cases, Hodgkin’s Disease can involve other organs such as the spleen, liver or bone marrow. Hodgkin’s Disease is usually treated with a combination of chemotherapy and radiation therapy. It is highly responsive to both of these types of treatment and is usually cured as a result of treatment.
In some cases, where the disease is resistant to standard treatment or relapses, intensive chemotherapy and autologous transplantation is used. Autologous transplantation involves removing a patient’s own bone marrow or marrow-like cells in the blood, and storing them. A super-high does of chemotherapy is given, which hopefully cures the cancer, but which also kills off the patient’s own bone marrow. The stored marrow is then given back to the patient to rescue them from the effects of the high-dose chemotherapy.
Non-Hodgkin's Lymphomas
The Non-Hodgkin’s Lymphomas (NHL) are a much more varied group of diseases. These lymphomas usually start in the lymph nodes under the arms or in the groin, and spread to the more central lymph nodes. In more advanced cases the bone marrow, liver or spleen can be involved. The NHLs are further divided into B cell and T cell lymphomas. Most are in the B cell group. B lymphocytes make the infection fighting proteins called immunoglobulin.
The less common types are the T cell lymphomas. T cells largely reside in the skin and are involved in allergic reactions and some specialized infection fighting processes.
The way lymphomas are likely to behave is classified by both their grade and their stage. Grade is described by what type of lymph cell makes up the lymphoma. It is determined by what the lymphoma looks like under the microscope, and by special chemical and molecular tests, which are done on the lymphoma tissue. Stage describes where the lymphoma is, and gives a rough idea of how much lymphoma there is; it is determined by radiologic studies such as CAT scans and possibly PET scans, as well as by bone marrow biopsies.
Bboth the T cell lymphomas and theand B cell lymphomas there are diseasescan be of low grade, intermediate grade and high grade. The low-grade lymphomas tend to grow slowly and may exist for months or years before they become a threat to someone’s health. The intermediate- and high-grade lymphomas are faster growing and usually require treatment as soon as they are diagnosedmore urgent treatment than the low-grade lymphomas.
Treatment for the NHLs almost always involves chemotherapy. Radiation therapy is used less commonly. If the disease is localized to one or two groups of lymph nodes, it is said to be of low stage. Low-stage lymphomas may be treated with both chemotherapy and radiation. The higher-stage and/or high-grade lymphomas are treated with chemotherapy alone. Low-grade lymphomas generally receive gentler chemotherapy, whereas the higher-grade lymphomas are treated with stronger, more aggressive chemotherapy.
The low-grade lymphomas are not usually cured by our current treatments, but people may live for many years with these diseases. Frequently, low-grade lymphomas are not fatal even when not cured.
Intermediate- and high-grade lymphomas are often cured with chemotherapy, but if cure cannot be achieved, these diseases are often fatal. However, even in some cases of treatment-resistant, intermediate- and high-grade lymphoma, cure can be achieved with autologous transplantation, as descibed above for Hodgkin’s disease.
It is obviously impossible in this brief article to convey enough information to relate to any individual’s case. If you or a loved one has been diagnosed with lymphoma, it is essential that you get as much information as possible from your physician about your specific case. Literature is also available in our offices. Information can be gained from the web at http://www.plwc.org/ or by calling 1-800-4-Cancer.
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