Non-Hodgkin's Lymphoma

Non-Hodgkin's Lymphoma: Overview

Lymphoma is a general term for cancers that develop in the lymphatic systemHodgkin's disease is one type of lymphoma, and all other lymphomas are grouped together and called non-Hodgkin's lymphoma.  Lymphomas account for about 5% of all cases of cancer in the U.S.

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In non-Hodgkin's lymphoma, cells in the lymphatic system become abnormal.  They divide and grow without any order or control, or old cells do not die as cells normally do.  Because lymphatic tissue is present in many parts of the body, non-Hodgkin's lymphoma can start almost anywhere in the body.  Non-Hodgkin's lymphoma may occur in a single lymph node, a group of lymph nodes, or in another organ.  This type of cancer can spread to almost any part of the body, including the liver, bone marrow, and spleen.

Over the years, doctors have used a variety of terms to classify the many different types of non-Hodgkin's lymphoma.  Most often, they are grouped by how the cancer cells look under a microscope and how quickly they are likely to grow and spread.  Aggressive lymphomas, also known as intermediate and high-grade lymphomas, tend to grow and spread quickly and cause severe symptoms.  Indolent lymphomas, also referred to as low-grade lymphomas, tend to grow quite slowly and cause fewer symptoms.

Incidence; Causes and Development; Contributing Risk Factors

The incidence of non-Hodgkin's lymphoma has increased dramatically over the last couple of decades.  This disease has gone from being relatively rare to being the fifth most common cancer in the United States.  At the time of writing, little is known about the reasons for this increase or about exactly what causes non-Hodgkin's lymphoma.

Doctors can seldom explain why one person gets non-Hodgkin's lymphoma and another does not.  It is clear, however, that cancer is not caused by an injury, and is not contagious; no one can "catch" non-Hodgkin's lymphoma from another person.

By studying patterns of cancer in the population, researchers have found certain risk factors that are more common in people who get non-Hodgkin's lymphoma than in those who do not.  However, most people with these risk factors do not get non-Hodgkin's lymphoma, and many who do get this disease have none of the known risk factors.

Signs and Symptoms

Symptoms of non-Hodgkin's lymphoma may also be caused by other, less serious conditions, such as the flu or other infections.

Diagnosis and Tests

If non-Hodgkin's lymphoma is suspected, a doctor asks about the patient's medical history and performs a physical exam.  The exam includes feeling to see if the lymph nodes in the neck, underarm, or groin are enlarged.  In addition to checking general signs of health, the doctor may perform blood tests.  The doctor may also order tests that produce pictures of the inside of the body, including:

  • X-rays
  • CT (or CAT) scan
  • MRI (magnetic resonance imaging)
  • Lymphangiogram: Pictures of the lymphatic system taken with X-rays after a special dye is injected to outline the lymph nodes and vessels.

A biopsy is needed to make a final diagnosis.  A biopsy for non-Hodgkin's lymphoma is usually taken from a lymph node, but other tissues may be sampled as well.  In some cases, an operation called a laparotomy may be performed.  During this operation, a surgeon cuts into the abdomen and removes samples of tissue to be checked under a microscope.

If non-Hodgkin's lymphoma is diagnosed, the doctor needs to learn the stage, or extent, of the disease.  Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected.  Treatment decisions depend on these findings.

The doctor considers the following to determine the stage of non-Hodgkin's lymphoma:

  • The number and location of affected lymph nodes
  • Whether the affected lymph nodes are above, below, or on both sides of the diaphragm
  • Whether the disease has spread to the bone marrow, spleen, or to organs outside the lymphatic system, such as the liver.

Treatment and Prevention

Eating well during cancer treatment means getting enough calories and protein to help prevent weight loss and regain strength.  Good nutrition often helps people feel better and have more energy.  Some people with cancer find it hard to eat a balanced diet because they may lose their appetite.  In addition, common side-effects of treatment, such as nausea, vomiting, or mouth sores, can make eating difficult.  Often, foods taste different.  Also, people being treated for cancer may not feel like eating when they are uncomfortable or tired.

Treatment for non-Hodgkin's lymphoma depends on the stage of the disease, the type of cells involved, whether they are indolent or aggressive, and the age and general health of the patient.  Non-Hodgkin's lymphoma is usually treated with chemotherapy, radiation therapy, or a combination of these treatments.  In some cases, bone marrow transplantation, biological therapies, or surgery may be options.  For indolent lymphomas, the doctor may decide to wait until the disease causes symptoms before starting treatment.  Often, this approach is called "watchful waiting".

Bone marrow transplantation (BMT) may be a treatment option, especially for patients whose non-Hodgkin's lymphoma has recurred (come back).  BMT provides the patient with healthy stem cells (very immature cells that produce blood cells) to replace cells damaged or destroyed by treatment with very high doses of chemotherapy and/or radiation therapy.  The healthy bone marrow may come from a donor, or it may be marrow that was removed from the patient, treated to destroy cancer cells, stored, and then given back to the person following the high-dose treatment.  Until the transplanted bone marrow begins to produce enough white blood cells, patients have to be carefully protected from infection.  They usually stay in the hospital for several weeks.

Patients who have a bone marrow transplant face an increased risk of infection, bleeding, and other side-effects from the large doses of chemotherapy and radiation they receive.  In addition, graft-versus-host disease (GVHD) may occur in patients who receive bone marrow from a donor.  In GVHD, the donated marrow attacks the patient's tissues (most often the liver, the skin, and the digestive tract).  GVHD can range from mild to very severe.  It can occur any time after the transplant (even years later).  Drugs may be given to reduce the risk of GVHD and to treat the problem if it occurs.

Biological therapy (also called immunotherapy) is a form of treatment that uses the body's immune system, either directly or indirectly, to fight cancer or to lessen the side effects that can be caused by some cancer treatments.  It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease.  Biological therapy is sometimes also called biological response modifier therapy.

The side-effects caused by biological therapy vary with the specific type of treatment.  These treatments may cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea.  Patients also may bleed or bruise easily, get a skin rash, or retain fluid.  These problems can be severe, but they usually go away after treatment stops.

Surgery may be performed to remove a tumor.  Tissue around the tumor and nearby lymph nodes may also be removed during the operation.

Signs, symptoms & indicators of Non-Hodgkin's Lymphoma:

Lab Values - Cells

Slightly elevated eosinophil count

As with Hodgkin's lymphoma, non-Hodgkin's lymphoma causes eosinophilia (elevated eosinophil levels), but to a lesser degree.

Symptoms - Abdomen

Symptoms - Gas-Int - General

Symptoms - Glandular

(Frequent/multiple) swollen axillary nodes

The most common symptom of non-Hodgkin's lymphoma is a painless swelling of the lymph nodes in the neck, underarm, or groin.

(Frequent) swollen cervical nodes

The most common symptom of non-Hodgkin's lymphoma is a painless swelling of the lymph nodes in the neck, underarm, or groin.

Back-of-neck lymph node problems

The most common symptom of non-Hodgkin's lymphoma is a painless swelling of the lymph nodes in the neck, underarm, or groin.

Symptoms - Metabolic

Symptoms - Skin - General

Conditions that suggest Non-Hodgkin's Lymphoma:

General

Skin-Hair-Nails

Symptoms - Cancer

Risk factors for Non-Hodgkin's Lymphoma:

Addictions

Cigarette Smoke Damage

One study has found that, compared to men who had never smoked, men who had smoked had an elevated mortality rate for non-Hodgkin's, with a risk almost four-fold greater among the heaviest smokers.

Immunity

Weakened Immune System

Non-Hodgkin's lymphoma is more common among people with inherited immune deficiencies, autoimmune diseases, or HIV/AIDS, and among people taking immunosuppressant drugs following organ transplants.

HIV/AIDS

People with HIV have a weakened immune system and, as a result, are more likely to develop certain cancers.  Non-Hodgkin's Lymphomas are the second-most common type of malignancy after Kaposi's Sarcoma in HIV patients.

Infections

Epstein-Barr Virus (EBV)

Human T-lymphotropic virus type I (HTLV-1) and Epstein-Barr virus are two infectious agents that increase the chance of developing non-Hodgkin's lymphoma.

Personal Background

Caucasian ethnicity

Non-Hodgkin's lymphoma occurs more frequently in whites than in African-Americans.

Symptoms - Cancer

Symptoms - Environment

(High) current exposure to solvents or history of solvent exposure

People who work extensively with or are otherwise exposed to certain chemicals, such as pesticides, solvents, or fertilizers, have a greater chance of developing non-Hodgkin's lymphoma.

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Non-Hodgkin's Lymphoma suggests the following may be present:

Addictions

Cigarette Smoke Damage

One study has found that, compared to men who had never smoked, men who had smoked had an elevated mortality rate for non-Hodgkin's, with a risk almost four-fold greater among the heaviest smokers.

Autoimmune

Gluten Sensitivity / Celiac Disease

Gluten sensitivity predisposes patients to the eventual development of lymphoma.  If this relationship is re-stated as "cereal grains cause cancer" the implications are more easily understood.  In addition, the incidence of undiagnosed celiac disease is higher among those with small-bowel lymphoma [Eur J Gastroenterol Hepatol 2000;12: pp.645-8].  There is evidence that strict adherence to a gluten-free diet will reduce the incidence of lymphoma.

Immunity

Weakened Immune System

Non-Hodgkin's lymphoma is more common among people with inherited immune deficiencies, autoimmune diseases, or HIV/AIDS, and among people taking immunosuppressant drugs following organ transplants.

Tumors, Malignant

Non-Hodgkin's Lymphoma can lead to:

General

Skin-Hair-Nails

Recommendations for Non-Hodgkin's Lymphoma:

Botanical

Diet

Drug

Hydrazine Sulfate

See the link between Cancer (General) and Hydrazine Sulfate.

Habits

Tobacco Avoidance

The following study suggests a link between cigarette smoking and non-Hodgkin's lymphoma.  In 17,633 U.S.  male insurance policy holders, 49 deaths from Hodgkin's lymphoma and 21 from multiple myeloma occurred during a 20 year follow-up.  Men who had ever smoked cigarettes had an elevated mortality for non-Hodgkin's, with a risk almost fourfold greater among the heaviest smokers compared with those who used no tobacco.

Immunotherapy

Mineral

Selenium

In evaluating 59 patients with lymphoid malignancies such as Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma and chronic lymphocytic leukemia, it was found that serum selenium concentrations were significantly lower in patients than in controls.  The lower the selenium levels were, the worse the cancer turned out to be.

As deficient selenium levels are associated with an increased risk of cancers in general, ensuring adequate selenium intake and maximizing selenium status in the presence of an elevated cancer risk is appropriate.

Nutrient

Oxygen / Oxidative Therapies

Ozone / Oxidative Therapy

Ozone assists in reversing opportunist malignancies such as non-Hogkins lymphoma (especially if pulmonary) and lymphadenopathy-associated virii.

Vitamins

Vitamin D

Administration of activated vitamin D (1,25 dihydroxycholecalciferol) may be beneficial in non-Hodgkin's lymphoma.  Experimental Study: In a small trial, patients with non-Hodgkin's lymphoma who were found to have high levels of vitamin D receptors responded to activated vitamin D.  [Cunningham D, Gilcrist NL, Cowan RA, et al.  Vitamin D as a modulator of tumour growth in low grade lymphomas.  Abstract.  Scot Med J 30: p.193, 1985]

Vitamin K

Many patients on high dose chemotherapy for lymphoma or myeloma test positive for prothrombin precursor PIVKA II.  These are proteins induced by vitamin K absence or antagonism.

Preventive measures against Non-Hodgkin's Lymphoma:

Detoxification

Sauna Detoxification Program

Programs using low temperature environments (like special saunas) have clearly demonstrated the ability to reduce or remove chemicals commonly stored in the fatty tissues of modern man.  Such chemicals include recreational drugs, pesticides, herbicides, and many solvents.  These chemicals are often carcinogenic, and non-Hodgkin's lymphoma, in particular, has been linked to herbicide and pesticide exposure.  By avoiding contact with these agents or removing them from a body already burdened with them, the risk of health consequences including non-Hodgkin's lymphoma should be reduced.

Diet

Plant-Based Nutrition

A high red meat and animal fat intake is associated with an increased risk of non-Hodgkin lymphoma in older women.

Caffeine/Coffee Avoidance

The consumption of coffee, tea and cola were all positively correlated with a higher risk of NHL.

Mineral

Zinc

It was found that the copper to zinc ratio was significantly higher in patients with lymphoma or acute and chronic leukemias compared to control subjects.  A person at increased risk of one of these cancers should check blood levels of copper and zinc to rule out abnormalities and make adjustments accordingly.  Since zinc and copper are antagonistic, and zinc deficiency is relatively common, supplemental zinc is often used to improve this ratio.  Zinc helps block the absorption of copper and acts to remove accumulated copper from the body as well as prevent its accumulation.  [Rev.  Invest.  Clin, Nov-Dec.  1995;47(6): pp.447-52]

Nutrient

Beta-Carotene

The diets of 358 white men and women with NHL and 1432 controls living in Nebraska were compared.  Dietary carotene intake was inversely related to NHL risk in men but not in women.  [Ward MH, Hoar ZS, Weisenburger DD, et al.  Dietary factors and non-Hodgkin's lymphoma in Nebraska]

Vitamins

Vitamin E

Observational Study: Serum vitamin E concentrations were significantly lower in leukemia and lymphoma patients than in normal controls.

Vitamin C (Ascorbic Acid)

The diets of 358 white men and women with non-Hodgkin's lymphoma and 1,432 controls living in Nebraska were compared.  When dietary vitamin C levels were low, the risk of non-Hodgkin's lymphoma in men increased.  This correlation was not found in women.  [Ward MH, Hoar ZS, Weisenburger DD, et al.  Dietary factors and non-Hodgkin's lymphoma]

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