Lymphoma .... We are targeting cure
 

*What is lymphoma?
A term used to describe certain types of cancer. It is cancer of the lymphatic system which is one of the most important parts of the immune system. The lymphatic system is composed mainly of lymph nodes connected to each other by lymph vessels. Thousand and thousands of nodes are found all over the body.

*What are the types of lymphoma?
There are two main types of lymphoma:
1) Hodgkin's lymphoma or Hodgkin’s disease (HD): commonly affects young adults
2) Non-Hodgkin’s lymphoma (NHL): more common and more often affect older adults.

*What are the symptoms of lymphoma?
Painless swelling of a lymph node: It is worth mentioning that lymph node swelling could be for other more common problems as sore throat. This may be in the neck, axilla (armpits), elbow or groin.
Fever, night sweats & weight loss: These are called the B symptoms of lymphoma. The fever is usually low grade not exceeding 38.5^c
Fatigue and weakness

*How can we confirm diagnosis?
Physical examination: This includes medical history and checking on the lymph nodes. In case of suspicion, a biopsy has to be done
Biopsy: In cases of lymph node enlargement, the lymph node is removed or part of it to be examined under the microscope. Confirmation of diagnosis cannot be done without biopsy.
Images and X-ray: Is done to determine whether other organs are affected or not. Sometimes lymphoma can affect liver, spleen or lungs.
Bone marrow examination: It is the material found inside our bones containing the stem cells or in other words the mother cells which are immature cells. These immature cells develop over certain period of time into three types of mature cells which are the red blood cells, white blood cells and platelets. These cells are normally found in our circulation and have vital functions to perform. In certain cancers as blood malignancies, abnormal cancerous cells can be detected in the bone marrow. Simply a needle is inserted in the hip bone and small sample is withdrawn. The procedure is sometimes painful during bone marrow withdrawal. Local anesthesia is applied, however in some settings, general anesthesia is required. The sample is examined by a pathologist under the microscope and provides the oncologist with a detailed report. For details about bone marrow examination, go to detection & diagnosis of cancer  

*How can we treat lymphoma?
Chemotherapy is the main line of treatment for both main types of lymphoma. It is given in the form of a cycle. This is a process in which chemotherapy is given followed by a period of rest during which the body is allowed to recover. To a lesser extent, radiotherapy plays a role in management of lymphoma. In aggressive lymphoma, a bone marrow transplant is done.

*Do people with lymphoma have to receive steroids (cortisone)?
Steroids are widely used in the management of lymphoma. Classically they are used in combination with chemotherapy. They are highly effective and administrated either in the form of injections or in tablets form.

*What is Bone Marrow Transplant?
The so called Bone Marrow Transplant (BMT) is a process in which the stem cells are removed from the body followed by administration of very high doses of chemotherapy & radiotherapy. The reason why the stem cells are removed is to avoid being destroyed by the high dose of chemotherapy. There are two types of bone marrow transplant. The first is called AUTOLOGOUS TRANSPLANT in which the patient own stem cells are re-injected after administration of high dose chemotherapy. The other one is called ALLOGENIC TRANSPLANT in which the stem cells of a healthy MATCHING donor are injected instead.

*What are the side effects of treatment?
Chemotherapy side effects are classified into two big items:
First: Blood related side effects: which is in-fact the most serious.
Chemotherapy slows the production of blood cells in the bone marrow.
Consequently, it will lower the red blood cell which carries hemoglobin that supplies the body cells with oxygen resulting in what we call anemia. Anemia will result in fatigue and tiredness. It will lower the white blood cells as well which are the bacteria fighting cells. This will lead to easy catching of infection.
Platlets will be affected as well causing bleeding.
Accordingly, we have to put a close eye on the blood picture before giving chemotherapy to monitor such side effects.
Second: Non blood related side effects: Which include hair loss, nausea,
vomiting, mouth infection, tingling, numbness and abdominal troubles.
These side effects are not permanent. They subside as soon as treatment
finishes.  

*How can we deal with anemia caused by chemotherapy?
As mentioned earlier, chemotherapy may cause decrease in the red blood cells and consequently anemia. This may necessitate blood transfusion. Blood transfusion is a simple procedure but require highly professional, properly supervised blood banks to avoid serious side effects. Another alternative for blood transfusion is receiving erthropoetin which encourages the bone marrow to make more red blood cells. They are not classically used as they are significantly expensive in comparison to blood transfusion.

*How can we deal with decreased white blood cells?
In order to increase the white cell count, subcutaneous injections are commonly used to increase the count. They stimulate the bone marrow to increase the production of the white blood cells. They are called GCSF.

*Are there any possibilities for cure?
YES. Lymphoma is one of the most curable malignant tumors. Probabilities of cure are higher in earlier stages reaching up to 90% in stage I disease. However, possibilities of recurrence are always possible especially in high risk patients.

*Who have higher risk for recurrence?
Five factors have been identified to detect at risk patients. At risk patients are those having more than 2 of the following factors and this is what we call IPI score.

1) Age: more than 60
2) Poor performance status = poor general condition
3) Elevated LDH: LDH is an enzyme produced by the liver and it is usually elevated in lymphoma. It is used as well as a tumor marker to detect response to therapy and in follow up
4) Extra-nodal involvement > 1: This means involvement of more than one organ other than the lymph nodes.
5) Late stage: stage III, IV

*How can we prevent lymphoma?
Lymphoma is not preventable. There are no screening programs available for lymphoma. Even risk factors for developing lymphoma are not yet clear. 

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Chemotherapy ..... A monster No more   

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How can we detect and diagnose cancer :
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Early detection & screening  programs:  
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Revised: 07/28/05.