FAQ's on Cancer

Lymphoma

Lymphoma is a type of cancer that can occur when an error occurs in the way a lymphocyte is produced, resulting in an abnormal cell. These abnormal cells can accumulate by two mechanisms: (a) they can duplicate faster than normal cells, or (b) they can live longer than normal lymphocytes. Like normal lymphocytes, the cancerous lymphocytes can grow in many parts of the body, including the lymph nodes, spleen, bone marrow, blood, or other organs. There are two main types of cancer of the lymphatic system. One is called Hodgkin's disease, while the other is called non-Hodgkin's lymphoma.

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Cancers that originate in the lymphatic system (also called the body's immune system) are called lymphomas. In part, the lymphatic system is composed of lymph nodes, which are small, spherical clusters of lymphocytes, or white blood cells. In a healthy immune system, lymphocytes have a normal cycle of life-they are produced regularly, and they die off regularly. In cases of lymphoma, the lymphatic system becomes abnormal, producing functionless or defective cells at an alarming rate. Lymphomas are classified as either Hodgkin's or Non-Hodgkin's, and both affect adults and children equally. Prognosis and treatment are dependent upon the type of cancer and at which stage it is caught.

What are the different types of lymphoma?

The two types of lymphoma are Hodgkin's lymphoma (Hodgkin's disease) and non-Hodgkin's lymphoma.

What is Hodgkins lymphoma?

An extremely rare form of cancer, Hodgkin's lymphoma accounts for just 1 percent of all cancer cases in the United States. It is triggered by the random, uncontrollable growth of cells in the lymphatic system. These cells amass, forming unhealthy tumors. Because lymphatic tissue can be found throughout the body, Hodgkin's disease can originate anywhere. It usually begins in one lymph node or a group of lymph nodes and then spreads throughout the body, but its causes are not known.

What is non-Hodgkins lymphoma?

Non-Hodgkins lymphoma is cancer of the lymphatic system, the body's immune system. In the immune systems of people with non-Hodgkins lymphoma, abnormal lymphocytes emerge and divide uncontrollably and at an alarming rate, overcrowding the lymph nodes and impairing their functions. This type of cancer accounts for about 5 percent of all cancer cases in the United States and can spread to anywhere in the body, including the bone marrow, liver, spleen, or other organs.

What is aplastic anemia?

Aplastic anemia is a very serious and rare condition in which the bone marrow stops producing enough red and white blood cells to keep the body healthy, resulting in an increased risk of infection and uncontrollable bleeding. The disease can develop in patients of any age and is treatable by medication, bone marrow transplants, and blood transfusions. Another form of the disease, called secondary aplastic anemia, may develop when bone marrow is injured by chemotherapy, cancer, toxic exposure, or in some cases, pregnancy.

What is myelodysplastic syndrome?

Myelodysplastic syndrome is a disease in which the bone marrow produces new blood cells, but those cells are dysfunctional and insufficiently developed. Several or all types of cells are affected in cases of myelodysplastic syndrome, whereas only one type is affected in instances of leukemia. It is important to note that while myelodysplastic syndromes are not cancer, in rare cases, they may lead to it. Treatment options include platelet or red blood cell transfusions, bone marrow transplants, and various medications.

What is acute myeloid leukemia?

Acute Myeloid Leukemia (AML), one of the four major types of leukemia is a malignant cancer caused by damage to the DNA of developing cells in the bone marrow. The disease is marked by: 1)the overabundant, uncontrolled growth of dysfunctional cells in the bone marrow and 2)the deficiency of red blood cells, platelets, and white blood cells, caused by ceased production of normal bone marrow cells. The decrease in healthy red blood cells often also causes anemia in many patients, while the drop in functional white blood cells and platelets impairs the body's ability to fight infection.

What are the causes of acute myeloid leukemia?

AML is an acquired disease, not a genetic or contagious one. Although not all of its causes not known the following are believed to cause AML:

• Exposure to high levels of radiation
• Benzene - if you have transported benzene, gasoline, or worked in the petroleum or petro-chemical industries
• Chemotherapy (in cases wherein patients are battling other cancers, such as ovarian cancer)
• People with Down Syndrome, Fanconi anemia, and other genetic disorders face a higher risk of developing this type of leukemia, which accounts for approximately 15 percent of all childhood leukemia cases.

What are the treatments for acute myeloid leukemia?

For optimal results, it is recommended that those diagnosed with AML seek treatment as soon after diagnosis as possible. Because there is no cure for leukemia or any other type of cancer, emphasis is instead placed on bringing about remission, in which there is no evidence of cell overproduction in the marrow.

Patients are usually initially treated with chemotherapy an individualized combination and sequence of at least two drugs. Chemotherapy essentially poisons cancerous cells, but it often damages healthy cells in the process. As a result, many patients find that they are further weakened, lose their hair, and are much more susceptible to infection. In some cases, radiation therapy is used to kill localized leukemia cells. On other occasions, a spinal tap is performed; spinal fluid is removed through a needle and replaced with a fluid containing cancer-fighting drugs.

What is chronic lymphocytic leukemia?

Chronic lymphocytic leukemia, or CLL, is a type of cancer that affects the bone marrow and lymph system. It is most common among adults over age 60. Leukemia patients have an excessive number of white blood cells called lymphocytes-cells usually responsible for fighting infections. However, the abnormal lymphocytes of a leukemia patient cannot prevent infection as effectively as healthy white blood cells can. In addition, because they appear in large numbers in the blood, the abnormal white blood cells lower production of red blood cells, which are responsible for delivering oxygen to the body, and platelets, which are responsible for blood clotting. In chronic lymphocytic leukemia, the excess number of white blood cells is not usually due to overproduction but to the fact that the affected lymphocytes have an abnormally long life span.

What are the causes of chronic lymphocytic leukemia?

Chronic lymphocytic leukemia does appear to have a hereditary component, because family members of leukemia patients are three times more likely to develop the disease. Also, CLL is far more common in people over sixty, so age appears to be a factor in its development. In addition, many types of leukemia have been linked to benzene exposure. If you have transported benzene, gasoline, or worked in the petrolium or petro-chemical industries, click here to learn your legal rights.

What are the symptoms of chronic lymphocytic leukemia?

In its early stages, CLL may not present recognizable symptoms. As the disease progresses, the lymph nodes, spleen, or liver may swell. In addition, people with leukemia may experience persistent fatigue and small cuts or injuries may bleed excessively. During later stages of the disease, the number of red blood cells and platelets in the body drops. Other symptoms include: fever, headache, bruising easily, frequent infection, pain, and weight loss.

What are the treatments for chronic lymphocytic leukemia?

Unlike acute forms of leukemia, chronic lymphocytic leukemia is not usually curable. Patients may not need treatment until symptoms appear. The goals of treatment then are to bring about a period of remission and keep the disease in check. Treatment for CLL may include:

• Chemotherapy -- Chemotherapy uses one or more drugs to kill leukemia cells in the body. Chemotherapy for CLL may be administered orally, intravenously, through a catheter, or by injection directly into the cerebrospinal fluid.
• Biological therapy/ Immunotherapy - uses antibodies known as biological response modifiers (most often interferon) to boost the body's natural immune system. Interferon can inhibit cancer cell division, thereby slowing the growth of tumors.
• Radiation therapy - may be used to destroy leukemia cells or to shrink enlarged lymph nodes. Powerful rays of energy may be directed at specific areas of the body where many leukemia cells are or radiation may be used over the whole body. The latter is often used prior to bone marrow transplantation.
• Bone marrow transplantation/ Stem cell transplantation - Bone marrow transplantation replaces the marrow damaged by treatment with healthy marrow. The donor marrow may come from the patient's own body (autologous transplantation) if it is extracted and saved prior to treatment. It may also come from a donor (allogeneic transplantation).

Some patients may also need to have their spleen removed if it is enlarged. Patients may also need help with pain and side effects of treatment. Treatment for symptoms and side effects of CLL and other cancers is sometimes referred to as system management or palliative care.

What is non-Hodgkin's lymphoma?

Non-Hodgkin's lymphoma is cancer of the lymphatic system, the body's immune system. In part, the lymphatic system is composed of lymph nodes, which are small, spherical clusters of lymphocytes, or white blood cells. In a healthy immune system, lymphocytes have a normal cycle of life-they are produced regularly and die off regularly. But in the immune systems of people with non-Hodgkin's lymphoma, abnormal lymphocytes emerge and divide uncontrollably and at an alarming rate, overcrowding the lymph nodes and impairing their functions. This type of cancer accounts for about 5 percent of all cancer cases in the United States and can spread to anywhere in the body, including the bone marrow, liver, spleen, or other organs.

What are the causes of non-Hodgkin's lymphoma?

Researchers are not sure what causes Non-Hodgkin's lymphoma, but many believe that it is fueled by the activation of faulty (or injured) DNA found in the body's B lymphocytes. Lymphocytes are classified as either B or T cells, depending on their origins. Those produced in the bone marrow are called B cells; those derived from the thymus are labeled T cells. B cells cultivate plasma cells, which produce antibodies intended to abrogate foreign attackers, while T cells kill invaders directly. Roughly 85 percent of non-Hodgkin's cancers originate in B lymphocytes; T cells are to blame for the remaining 15 percent.

What are the symptoms of non-Hodgkin's lymphoma?

Non-Hodgkin's lymphoma is usually signaled by tender, swollen lymph nodes in the groin, neck, or armpit and less frequently, in the elbow, throat, and ears. A person with the disease may also experience fevers, excessive sweating (usually at night), weight loss or gain, fatigue, loss of appetite, or an enlarged spleen. Less often, non-Hodgkin's lymphoma originates somewhere other than the lymph nodes, such as in the skin, a bone, or a lung. In such cases, symptoms may be localized-chest pain, skin masses, coughs, bone pain, or rashes are the norm. But typically, swollen lymph nodes are the only sign of the disease. It is important to note that most enlarged lymph nodes are attributed to infection, not cancer. Further testing-such as a biopsy-for cancer may be performed only if no signs of infection are present.

What are the treatments for non-Hodgkin's lymphoma?

The way in which lymphoma is treated depends on the patient's age, health, and stage of disease. More than one type of treatment is often administered. Options include:

• Chemotherapy - In chemotherapy, a personalized combination of drugs is either injected or swallowed to fight rapid cancer cell growth. The amount of drugs or doses is determined by the grade of lymphoma-usually one drug is used to treat low-grade lymphoma, and multiple drugs are used for intermediate- or high-grade lymphoma.
• Radiation - High doses of radiation are administered to shrink cancerous cells and tumors. This type of treatment is usually reserved for low-grade, early-stage lymphoma and is sometimes used in conjunction with chemotherapy.
• Stem Cell Transplantation - With stem-cell transplantation, healthy stem cells are drawn from the patient's blood or marrow and frozen; after chemotherapy is administered, the healthy stem cells are injected back into the patient's body. Such treatment is typically used to treat patients who have relapsed after successful treatment of intermediate- to high-grade lymphomas.
• Observation - In cases of slow-progressing lymphoma, doctors sometimes observe the patient and patterns of cancer growth for up to or longer than a year before choosing a treatment option
• Ibritumomab (Zevalin) - This drug, recently approved by the Food and Drug Administration (FDA) is used in conjunction with another approved drug, rituximab (Rituxan), to help the immune system identify and destroy cancer cells. Because of its radioactive format and serious side effects, Zevalin is administered only to patients for whom all other options have failed.

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