Non-Hodgkin’s disease causes the lymphatic system to abnormally produce an increased number of white blood cells (lymphocytes) which can then cause tumors to develop and grow. In addition to causing tumors to develop, Non-Hodgkin’s lymphoma cells can also spread and affect other lymphatic system elements including: lymphatic vessels, tonsils, adenoids, spleen, thymus, and bone marrow.
There are 30 other types of Non-Hodgkin’s lymphoma. The criteria used in classifying Non-Hodgkin’s disease are: microscopic appearance, cellular genetic changes, the cell size, the cells’ growth rate, staining pattern with specific antibody stains.
Dr. Navneet Sharda provides this information as an educational source. It is not intended as a substitute for a consultation with a qualified healthcare provider.
The non-Hodgkin’s lymphoma classifications recognized by the International Lymphoma Study Group describes 4 types of lymphoma:
• Indolent (slow to develop) lymphomas and lymphoid leukemias.
• Moderately aggressive lymphomas and lymphoid leukemias.
• Aggressive lymphomas.
• Highly aggressive lymphomas and lymphoid leukemias
Although medical research of NHL has advanced, the true causes of non-Hodgkin’s lymphoma are not yet clear. Some scientists believe that this type of cancer is possibly caused by the activation of certain abnormal genes.
Signs and Symptoms
One of the major symptoms of NHL is the presence of one or more swollen lymph nodes in the neck, collarbone, armpit, or groin region. If NHL spreads to the lymphatic tissues within the abdominal area, this region can become “swollen.” This phenomenon occurs because fluid starts to be build up in the abdomen cavity. The swollen node can also press against the intestines causing intestinal blockages. These blockages can be felt as an internal abdominal pressure and even pain.
Symptoms may include:
Excessive sweating, especially while sleeping at night Fever Severe itchiness Swollen lymph nodes in the neck, underarms, groin, or other areas Unintentional weight loss Coughing or shortness of breath may occur if the cancer affects the thymus gland or lymph nodes in the chest, which puts pressure on the windpipe (trachea) or other airways.
Some patients may have abdominal pain or swelling, which may lead to a loss of appetite, constipation, nausea, and vomiting.
If the cancer affects cells in the brain, the person may have a headache, concentration problems, personality changes, or seizures.
DIAGNOSIS AND MEDICAL TESTS
Physical Examination and Anamnesis One of the first steps in the screening process is an anamnesis where past health problems are discussed, all risk factors are covered and the present health state is investigated.
Blood and urine tests Another step in the diagnosis procedure is blood and urine tests. When a lymphatic node swells, it is a sign that your body is fighting an infection. Therefore, the doctor will take a sample of blood and urine to establish the infection parameters and determine the causes of the infection.
X-Ray, Computer Tomography (CT) and Positron Emission Tomography (PET) If the inflammated lymph nodes are in the chest area, they can be seen in a plain chest x-ray. If a tumor is visible on the x-ray, the doctor will follow with a CT scan in order to obtain a better image of the tumor. The CT scan is an advanced x-ray procedure that produces a more detailed cross-sectional image of the body. Positron Emission Tomography, or PET scan is a new type of radioactive scan. A special glucose substance that contains a radioactive atom is administered to the patient and a special camera will detect radioactivity. Lymphoma cells have a high rate of metabolism that absorbs a high amount of radioactive sugar. This procedure is effectively used in detecting non-Hodgkin’s lymphoma.
Biopsies There are several types of biopsies available in order to determine the stage of the cancer. When the doctor recommends a biopsy, the diagnosis procedure passes into the second phase of this process.
The first two steps (anamnesis, physical examination, and then x-ray, CT scan and PET scan) are decisive in establishing if there is a form of cancer or not. The role of the next procedure is to determine the cancer type, the cancer stage and other indicators necessary to establish a treatment plan.
Fine needle aspiration (FNA) biopsy: This procedure involves taking a sample of cells from the swollen lymphatic node using a thin needle attached to a syringe. When the swollen lymph node is right under the skin and palpable, the needle is then inserted directly into the node. If the lump is deep within the body, this procedure is performed with the help of a CT scan, ultrasound or other imagining techniques. This biopsy can determine noncancerous conditions from different forms of cancer and establish the cancer staging or monitor recurrence or return of cancer.
Large needle/core biopsy: This procedure involves taking a sample of tissue from the tumor. It is not a commonly diagnosed procedure and it is used just for those patients that cannot tolerate invasive surgical procedures. Like FNA, core biopsy is performed under a CT scan, ultrasound and other imagine techniques.
Surgical biopsy:There are two types of surgical biopsies: incisional biopsies, when a small piece of a large tumor is removed for examination and excisional biopsies, when the small size tumor is removed completely. Both types of surgical biopsies procedures are performed under local or total anesthesia. Biopsy procedures can be used to remove tissue from a lymph node or from the bone marrow. The lymph node biopsy provides important information about the progressive rate of the cancer.
Bone Marrow Tests A bone marrow biopsy is necessary if there are concerns that the disease spread. The bone marrow is drawn up through a thin needle that is inserted into the pelvic bone. Once the bone marrow is extracted, it will be examined by different specialists (pathologist – the disease diagnosis specialist, hematologist – the blood specialist) and oncologist – the cancer specialist). These tests are used to establish the cancer staging.
Lumbar Puncture A lumbar puncture or spinal tap procedure can tell doctors if the cancer has spread to the central nervous system. The puncture is made with a thin needle inserted in the lumbar backbone below the level of spinal cord and a sample of cerebrospinal fluid is withdrawn. This sample then is analyzed for the number of the lymphocytes cells.
Chemotherapy This treatment option involves the use of different cancer-killing drugs administered: intravenously, orally, subcutaneously, intramuscularly, or intrathecally (injected into the cerebrospinal fluid).
Radiotherapy This treatment option is used when lymphoma is in an early to low-grade stage. Radiotherapy or radiation therapy uses high-energy, ionizing radiation to kill malignant cells. This treatment can be administered 3 different ways: (1) through a short exposure to a radiation device similar with the x-ray exposure, (2) by an injectable short-lived radioactive chemical, (3) implantation, when a radioactive material is inserted near the tumor.
Stem-Cell Transplantation This procedure is used to treat intermediate or high-grade lymphoma that has relapsed after a successful treatment. Stem cells have to be withdrawn from the blood and bone marrow long before the patient is starting chemotherapy since chemotherapy will damage them. After they are taken out of the body, these cells are then frozen. After the chemotherapy treatment ends, these healthy stem cells are defrosted and reintroduced into the body.
Biologic Therapy Rituximab or Rituxan, a type of monoclonal antibody that helps the immune system to fight against cancer cells is the only biological therapy form approved by Food and Drug Administration for the treatment of B-cells lymphoma. Usually Rituxan is administrated in combination with chemotherapy or radioimmunotherapy.
Radioimmunotherapy This therapy is the latest form of treatment used for Non-Hodgkin’s lymphoma. It uses monoclonal antibodies combined with radioactive isotopes. The role of monoclonal antibodies is to attach themselves to the malignant cells, while the radioactive isotopes kill them. Radioimmunotherapy is often used as a last resort when other treatment options mentioned above have failed to work.