Lymphoma

Lymphomas are cancers that develop in the lymphatic system—the tissues and organs that produce, store, and carry white blood cells. The lymphatic system includes the bone marrow, spleen, thymus, and lymph nodes and a network of thin tubes that carry lymph and white blood cells into all the tissues of the body. Types of lymphoma include non-Hodgkin's, Hodgkin's, and cutaneous T-cell lymphoma.

In non-Hodgkin's lymphoma, the most common form of the disease, cells in the lymphatic system become abnormal. They divide and grow without any order or control, or old cells that should die, don't. Non-Hodgkin's can begin and/or spread to almost any part of the body.

In Hodgkin's disease, cells in the lymphatic system also become abnormal, but the cancer tends to spread in a fairly orderly way from one group of lymph nodes to the next. Eventually, it can spread almost anywhere.

In cutaneous T-cell lymphoma, T-lymphocytes (infection-fighting white blood cells) become cancerous, causing skin problems.

Signs and Symptoms

Lymphoma is accompanied by the following signs and symptoms, by type.

Non-Hodgkin's and Hodgkin's:

• Painless swelling in lymph nodes in neck, underarm, or groin
• Unexplained fever
• Drenching night sweats
• Tiredness
• Unexplained weight loss
• Itchy skin

Cutaneous T-Cell:

• Itchiness
• Dark patches on skin
• Tumors on skin (mycosis fungoides)
• Skin infections

Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing lymphoma, by type.

Non-Hodgkin's:

• Congenital immunodeficiency
• Infections—Epstein-Barr virus (EBV), Helicobacter pylori, Kaposi's sarcoma herpes virus (HIV-related lymphoma), human T-cell leukemia virus type 1
• Immunosuppressive therapy following organ transplant
• Autoimmune diseases
• Prior chemotherapy or radiation exposure or therapy
• Exposure to certain chemicals or solvents

Hodgkin's:

• Viruses—EBV, mononucleosis, HIV
• Tonsillectomy
• Genetic predisposition
• Whites more likely than blacks
• Men more likely than women
• Same-sex siblings—10 times greater risk

Cutaneous T-Cell:

• Human T-cell leukemia virus type 1
• Exposure to certain chemicals or solvents

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with lymphoma, you should see your health care provider. He or she will carefully check for swelling or lumps in the neck, underarms, and groin. If the lymph nodes don't feel normal, a biopsy will be performed. The doctor will remove a small piece of the lymph node—or, in the case of cutaneous T-cell lymphoma, a growth from the skin—and a pathologist will examine the tissue under a microscope to check for cancer cells.

If cancer is present, more tests will be done to find out if the cancer has spread to other parts of the body (staging). This may involve blood and bone marrow tests, CT scans, and, possibly, a laparotomy, in which the doctor cuts into the abdomen and checks the organs for cancer.

Treatment Options

Treatment Plan

A treatment plan will be based on the diagnosis, the stage of the disease, the size of the tumor, and your general health and age.

Drug Therapies

Your provider may prescribe the following drug therapies.

Hodgkin's and Non-Hodgkin's:

• Radiation therapy
• Chemotherapy, possibly with alpha interferon

Cutaneous T-Cell:

• Emollients, moisturizers, topical steroids
• Chemotherapy
• Electron beam therapy
• Retinoids and interferon

Surgical and Other Procedures

Bone marrow transplantation and peripheral blood stem cell transplantation are sometimes performed. Radioimmunotherapy, which is treatment with a radioactive substance that is linked to an antibody that will attach to the tumor when injected into the body, is being tested in clinical trials. Surgical removal of the tumor may also be performed.

Complementary and Alternative Therapies

A comprehensive treatment plan for lymphoma may include a range of complementary and alternative therapies. Be sure to ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan.

Improved relaxation and decreased stress, through such activities as guided imagery, tai chi, yoga, and meditation are helpful in promoting a sense of well-being. Intimacy and support from others helps promote a positive and empowering attitude.

Nutrition
Eat only organically-raised foods and foods that support detoxification, immunity, and are high in antioxidant nutrients, such as beets, carrots, artichokes, yams, onions, garlic, dark leafy greens, yellow and orange vegetables, shiitake mushrooms, green tea, and filtered water. Avoid refined foods, sugar, alcohol, caffeine, and saturated fats (animal products).

Potentially beneficial nutrient supplements include the following.

• Vitamin C (250 to 500 mg twice per day), vitamin E (400 IU twice per day), beta carotene (50,000 IU one to two times per day), coenzyme Q10 (100 mg three times per day), and zinc (30 mg per day)
• Coenzyme Q10 and L-carnitine (600 mg three times per day) may reduce toxicity from chemotherapy
• Selenium (200 mcg twice per day) and glutathione (500 mg twice per day) may reduce toxicity from chemotherapy
• B-complex (50 to 100 mg) for stress
• Juicing: In a juicer, combine equal parts romaine lettuce, green pepper, celery, parsley, cucumber, and apple or pear (for flavor). Use organic fruits and vegetables. Drink one glass per day.

Herbs
Herbal remedies may aid detoxification, tumor inhibition, and immune support. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).

Choose one or more of the following.

• Commercial Hoxsey-like formulas or trifolium compounds (60 drops two to three times per day for six months or longer)
• Scudder's Alterative Compound: combine equal parts of corydalis tubers (Dicentra Canadensis), black tag alder (Alnus serrulata), mayapple root (Podophyllum peltatum), figwort (Scrophularia nodosa), and yellowdock (Rumex crispus). Take 30 to 40 drops tincture three to four times per day for six months.
• Essiac or Flor-Essence (drink one cup tea twice per day or take 2 tbs. formula twice per day for six months)

Homeopathy
Homeopathy may help reduce symptoms and strengthen overall constitution and may help decrease the side effects of chemotherapy.

Physical Medicine
Contrast hydrotherapy may help enhance immune function and facilitate the transport of nutrients and waste products. End hot showers with one to two minutes of cold-water spray.

Acupuncture
Acupuncture may help strengthen immunity and detoxification. It may also reduce the side effects of chemotherapy.

Prognosis/Possible Complications

Prognosis varies depending on the type and stage of lymphoma. Survival rates for Stage I and II non-Hodgkin's lymphoma and Hodgkin's lymphoma are very high. Potential complications include the following: Hodgkin's sometimes develops into non-Hodgkin's lymphoma; radiation and chemotherapy can cause secondary cancers; infections and pulmonary fibrosis (thickening and scarring of the air sacs of the lungs) may occur.

Following Up

Once you are in remission, it is essential that you be checked for signs of relapse on a regular basis.

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