Negating Non-Hodgkin’s Lymphoma

You feel a small lump on your neck. It’s been there for a while and it feels like a small marble. You have night sweats and a fever. You may have non-Hodgkin’s lymphoma.

Non-Hodgkin’s lymphoma (NHL) is a type of cancer that usually begins in the lymphatic system. The lymphatic system is part of the body’s immune system. It is one of the fastest increasing malignancies. Lymphomas are cancers of the lymph system which sends thin branching tubes throughout the body carrying a clear, watery fluid called lymph. Lymph contains white blood cells (lymphocytes) that fight infection. Small, bean shaped organs called lymph nodes or glands are positioned along the tubes and these nodes make and store a range of infection fighting cells.

About 80,470 people (44,120 males and 36,350 females) will be diagnosed with NHL, according to the American Cancer Society. About 20,250 will die from this disease (11,700 males and 8,550 females). NHL can occur at any age. It is one of the more common cancers among children, teens, and young adults.

A family history of NHL increases risk by three to four times. Older adults are more at risk of developing the cancer and its uncommon below age 30, although children can develop a rare form of it.

Lymphomas come in two types, Hodgkin’s and non-Hodgkin’s, based on the way the cancer cells look under a microscope. Initially NHL can be a disease that is hard to diagnose because the symptoms can be attributed to general tiredness, viral infection or even menopause. Symptoms may include painless swelling of the lymph nodes of the neck, underarms or groin, unexplained fever, drenching night sweats, tiredness, unexplained weight loss, or itchy skin.

NHL is the cancer of the lymphocytes—cells that make antibodies to disease and are essential to immune function. The cells undergo a malignant change and spread through lymph nodes or bone marrow and can even extend to the liver, brain, kidney or heart, thus impairing their functions. Besides damaging immune response, the cells, like any cancer, also tend to replace healthy cells.

People whose immune systems are weakened by AIDS or drugs used to prevent rejection of transplanted organs are especially susceptible to forms of the disease triggered by Epstein-Barr virus, the same virus that causes infectious mononucleosis.

NHL often begins in the B and T cells. B cells are a type of lymphocyte that fights infection by producing antibodies to neutralize foreign invaders. Most NHL arises from B cells. Subtypes of NHL that involve B cells are diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma and Burkitt lymphoma.

T cells are a type of lymphocyte that’s involved in killing foreign invaders directly. NHL occurs much less often in the T cells. Subtypes of NHL that involve T cells are peripheral T-cell lymphoma and cutaneous T-cell lymphoma.

Although NHL is actually many diseases, it is broadly divided into three main categories, depending on how aggressively it spreads throughout the body.

Low grade or indolent disease make up roughly half of all cases. It spreads slowly and responds well to chemotherapy. Those with this category may live 10 or 20 years. However, this form eventually comes back and is considered to be generally incurable.

Intermediate and high-grade cancer, which are usually lumped together as aggressive NHL are much faster spreading. In fact, high grade can be fatal in a matter of weeks. However, these cancers are also potentially curable.

There is speculation on what may cause NHL such as a viral infection, exposure to chemicals in the environment, high meat-high protein diet, sunlight exposure, black hair dyes, physical activity levels, and a host of lesser possibilities.

In order to be diagnosed with NHL, you will have to undergo a battery of tests including a physical exam, where your doctor will check for swollen lymph nodes in your neck, underarms and groin as well as any other affected areas like a swollen spleen or liver. Then there are blood and urine tests. Imaging tests may include a computerized tomography (CT) scan, a magnetic resonance imaging exam (MRI), and a positron emission tomography (PET) scan. Your doctor may recommend a lymph node biopsy procedure for laboratory testing of the sample tissue. Bone marrow biopsy might also be recommended as well as a lumbar puncture (spinal tap).

There are several treatment options available. Chemotherapy is a drug treatment that kills cancer cells. Chemotherapy is a common initial treatment for an NHL and if the cancer returns. Chemotherapy can also be used as part of a bone marrow transplant.

Radiation therapy uses high-powered energy beams, such as X-rays and protons, to kill cancer cells. During radiation therapy, you lie on a table as a large machine moves around you, directing the energy beams to specific points on your body. For certain types of NHL, radiation therapy may be all the therapy you need. Radiation is usually used after chemotherapy to kill any lymphoma cells that might remain.

Targeted drug therapy focuses on specific abnormalities present in the cancer cells. By blocking these abnormalities, targeted drug treatments may cause cancer cells to die. For NHL, targeted drug therapy can be used alone or with chemotherapy.

A treatment called chimeric antigen receptor cell therapy (CAR)-T takes your body’s T cells, engineers them to fight cancer and infuses them in the body.

Bone marrow transplant also known as stem cell transplant involves high doses of chemotherapy and radiation to suppress your bone marrow and immune system. Healthy bone marrow stem cells from your body or a donor are infused into your blood where they travel to your bones and rebuild your bone marrow.

Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interrupting that process.

Having NHL can be jarring. But there are some suggestions that may make it easier to cope. You should learn all you can about this disease. Maintain strong supportive relationships by surrounding yourself with family and friends who will be in your corner no matter what. Also consider joining a support group of likeminded individuals who are going through the same experience.