Dr. M.J. Bazos, MD. Patient Handout

LYMPHOMA, NON-HODGKIN’S

About Your Diagnosis
Lymphoma or non-Hodgkin’s lymphoma is cancer of the white blood cells called lymphocytes. Lymphocytes are produced in the bone marrow, lymph nodes, and spleen. Lymphocytes are part of the immune system, which fights off infections. The cause of lymphoma is unknown. Some persons are at higher risk for lymphoma than are others. Weakened of the immune system by viruses such as the human immunodeficiency virus (HIV) and Epstein- Barr virus (EBV), use of medications connected with organ transplantation, and excessive amounts of radiation all increase the risk for lymphoma. More than 50,000 new cases of lymphoma were diagnosed last year. The only sure way to detect lymphoma is by obtaining tissue, usually from a swollen lymph node, and examining it with a microscope (biopsy). Non- Hodgkin’s lymphoma is usually classified as low grade, intermediate grade, or high grade. There is no cure for low-grade lymphomas, but the usual survival time is more than 10 years. With aggressive treatment, some intermediate and high-grade lymphomas can be cured.

Living With Your Diagnosis
The symptoms of lymphoma are swollen lymph glands in the neck, groin, or armpits. Some patients notice a lump in the abdomen. Non-Hodgkin’s lymphoma, unlike Hodgkin’s disease, does not spread in an orderly way. Therefore other organs can be involved even if a few lymph glands are swollen. Non-Hodgkin’s lymphoma can involve the abdomen, liver, bone, brain, testis, thyroid, skin, sinus, tonsils, and gastrointestinal tract. Other symptoms include weight loss, nausea, vomiting, abdominal pain, fever, night sweats, loss of appetite, headache, double vision, and itching.

Treatment
When a biopsy of the tissue is performed, the pathologist tells the physician the specific type of cell causing the lymphoma. Once the diagnosis is confirmed, the physician determines the extent (stage) of the cancer. The stages are classified I through IV depending on how many areas of lymph nodes are involved, whether the involvement is above or below the diaphragm (muscle that separates the chest from the abdomen), and whether one or more organs are involved. To determine the stage of lymphoma, the physician
orders blood tests; radiographs (x-rays) of the chest; computed tomographic (CT) scans of the abdomen, pelvis, and possibly the head; and a bone marrow biopsy (drawing the blood-forming substance from the center of the pelvis or sternum). The physician also may order a lymphangiogram (injection of dye into the lymph vessels in the foot to look for abnormal lymph glands in the abdomen and pelvis). In some situations, a laparotomy (exploratory abdominal operation) is performed to remove the spleen (splenectomy) and lymph nodes and to obtain a biopsy specimen of the liver. Non-Hodgkin’s lymphoma is usually managed with chemotherapy, radiation therapy, or combined radiation and chemotherapy. Unlike Hodgkin’s disease, non-Hodgkin’s lymphoma spreads early and not in an orderly way. Therefore chemotherapy is usually used first. Radiation therapy plays a role in the management of local disease in its early stage, radiation therapy is used to assist the chemotherapy. Different combinations of chemotherapy drugs are used. An oncologist (physician specializing in cancer) decides which combination to use. The management of lymphoma is complex and depends on the stage of disease (I to IV) and the grade of disease (low, intermediate, or high). Side effects of radiation therapy depends on which part of the body is being irradiated. An underactive thyroid, dry mouth, and sore throat can occur if the neck is being irradiated. Inflammation of the lining of the heart (pericarditis) or lungs (pleurisy) can occur if the chest is being irradiated. Nausea, vomiting, diarrhea, sterility, and suppression of the bone marrow can occur if the abdomen and pelvis are being irradiated. Side effects of chemotherapy are nausea, vomiting, loss of appetite, easy bruising and bleeding, numbness, hair loss, and infections.

The DOs
• Remember that management of non-Hodgkin’s lymphoma is complex and involves a team of physicians and healthcare providers. An oncologist, radiation oncologist (physician specializing in radiation therapy), surgeon, nutritionist, social worker, rehabilitation physician, and psychiatrist all can help with difficult decisions.
• Continue with daily exercise and activities before, during, and after treatment.
• Ask for emotional support if needed.
• Discuss the option of bone marrow transplantation and investigational studies if treatment has not been successful.

The DON’Ts
• Do not ignore any swollen lymph nodes.
• Do not miss follow-up appointments during and after treatments. It is important to monitor side effects of treatment and to see whether the cancer returns after treatment.
• Do not be afraid to ask questions about infertility, stress, fear, life insurance, job discrimination, and limitations.

When to Call Your Doctor
• If you feel a swollen lymph node.
• If you have cough, nausea, vomiting, shortness of breath, diarrhea, bloody stools, fever, or bruising after radiation.
• If you have fevers after chemotherapy.
• If you have low back pain with numbness or pain shooting down your legs.
• If you feel depressed.