The Wellness Community

Frankly Speaking About Lymphoma

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Non-Hodgkin's lymphoma (NHL) is one of two types of cancer of the lymph system. The other type is Hodgkin's lymphoma. (See the section titled Hodgkin's Lymphoma.) NHL can be either Indolent or Aggressive. Indolent NHL, or low-grade lymphoma, usually grows slowly and requires treatment less urgently than aggressive or very agressive forms of the disease.

Understanding Lymphoma:
NON-HODGKIN'S LYMPHOMA

Non-Hodgkin's lymphoma (NHL) is much more prevalent than Hodgkin's lymphoma. It is the sixth most common malignancy in the United States and is the fifth leading cause of cancer deaths in men and the sixth in women. NHL is diagnosed nearly six times more frequently than Hodgkin's lymphoma in the United States.

Risks

As with other lymphomas, many factors may contribute to NHL. These factors include heredity, viruses and other infectious organisms, and immune system deficiencies. Exposures to herbicides and perhaps other chemicals are also risk factors, but the exact causes remain unknown. There is most likely nothing you could have done to avoid developing NHL.

Incidence

An estimated 66,100 cases of NHL will be diagnosed in 2008. NHL has the second fastest rising cancer rate in the United States today. Since the 1970s, incidence rates for NHL have almost doubled, although that rate began to slow in the 1990s. Caucasian males are at highest risk of developing the disease. In terms of age, there may be a preadolescent peak of the disease rate, which decreases in the late teens. The disease rate also begins to rise again in the early 60s and continues to rise sharply until the 80s. The median age of individuals with NHL is in the late 50s.

Survival

Important advances have been made in the diagnosis and treatment of NHL. Survival will depend on the type, grade and stage of NHL. The one-year survival rate for all forms of NHL is 73%, meaning that is the percentage of people who live at least one year after their cancer is diagnosed. The five-year survival rate is 55%, and the 15-year survival rate is 38%. (American Cancer Society Facts and Figures, 2003). Please keep in mind that statistics are gathered from information from many patients who have the disease. It is important to remember that no two patients are alike, and statistics do not always accurately predict what will happen to a specific person. It is important that you speak with your doctor to obtain the most accurate information about your disease.

Types and Stages of NHL

There are many subtypes of NHL. Currently, each subtype of NHL is determined by the appearance of the cells and the structure of the lymph node under the microscope (e.g. small or large cells, diffuse or follicular pattern), the presence of certain markers (antigens) on the surface of the cell, and at times specific chromosome abnormalities. The main classification system is the World Health Organization, whichsubdivides lymphomas into groups based on their appearance under the microscope, immunologic and genetic features, and similar clinical behavior, i.e. likelihood of survival of cure. In general, non- Hodgkin's lymphoma may be divided into three groups:

Indolent (low grade)

Aggressive
Very agressive

To accurately diagnosis NHL, a biopsy must be performed. Your doctor will run some, or all, of the following tests to determine what type and stage of the disease you have:

Blood tests - Complete blood cell count (CBC), LDH (a blood test that shows if there is any cancer activity going on in your body), and any other blood tests your physician may need to assist in making an accurate diagnosis.

X-ray-uses radiation to take images of areas inside your body.

CT scan (or CAT [computerized axial tomography] scan)-takes x-rays from many different angles, usually of the neck, chest, abdomen, and pelvis in patients with suspected NHL.

MRI (magnetic resonance imaging)-similar to a CT scan but uses magnets and radio frequency waves. MRI can provide information about tissue that other techniques cannot.

PET (positron emission tomography) scan-evaluates metabolic activity by using a special camera that detects a radioactive tracer substance injected into the body. PET scan may be used in addition to the above tests to identify areas of the body affected by non-Hodgkin's lymphoma.

Staging of NHL

There are four stages of NHL. Each of the four stages can be divided into "A," "B," "E," and "S" categories. In stage "A" patients are without symptoms; in stage "B," patients have symptoms. "E" means the disease has spread directly from a lymph node to a nearby organ. "S" means the spleen is involved.

Stage I (early disease) means the cancer is in a single area or region, often a single lymph node, and perhaps the area surrounding it. There are typically no symptoms.

Stage II (locally advanced disease) involves more than one lymph node area on one side of the diaphragm (the breathing muscle separating the abdomen from the chest).

Stage III (advanced disease) involves lymph node regions above and below the diaphragm.

Stage IV (widespread disease) involves one or more organs.

Prognosis or Outcome

Keep in mind that prognosis is based upon information gathered from many other patients who have had the disease. The prognosis gives the doctors and patients a general idea about what to expect and helps guide the treatment. Different types and stages of lymphoma respond to treatments differently. It is important to remember that no two patients are alike, and statistics do not always accurately predict what will happen to a specific person. It is important to understand your disease and discuss with your doctor how you can actively participate in your treatment to achieve the best possible outcome.

For more information about Hodgkin's lymphoma or non-Hodgkin's lymphoma, please contact the Lymphoma Research Foundation for its patient education booklets, Understanding Hodgkin's Disease: An Introductory Guide for Patients and Understanding Non-Hodgkin's Lymphoma: An Introductory Guide for Patients.

The Wellness Community provides this information as a service. Publication of this information is not intended to take the place of medical care or the advice of your doctor. The Wellness Community strongly suggests consulting your doctor or other health care professional about the information presented.

Updated June 23, 2008

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