Non-Hodgkin's lymphoma cancer (NHL) is a malignant tumor that arises in the lymphatic system. There are several subtypes of this type of cancer. These range from slow growing chronic diseases (indolent) to rapidly progressive, acute diseases (aggressive). These two types of NHL are described below.
Indolent
Indolent lymphomas, which are non-Hodgkin's lymphoma cancers, tend to grow slowly (sometimes over months) and need treatment less urgently or may have treatment deferred. Indolent lymphomas respond to a wide variety of therapies, but are often widespread at the time of diagnosis and when they are, they are rarely cured with chemotherapy or radiation therapies. The indolent lymphomas are sometimes referred to as "low grade" lymphomas:
- Follicular (small or mixed small and large cleaved cell, grade 1 or 2)
- Small lymphocytic Marginal zone B-cell lymphomas, including mucosa-associated lymphoid tumors (MALT lymphomas), and
- Lymphoplasmacytic
Aggressive
Aggressive lymphomas, which are non-Hodgkin's lymphoma cancers, tend to grow rapidly (sometimes over weeks) and generally need treatment soon after diagnosis. They are often referred to as high-grade or intermediate grade lymphomas. They are generally responsive to chemotherapy and radiation therapy and may be cured.
- Follicular large cell (grade 3)
- Diffuse large B-cell (diffuse large cell)
- Anaplastic large-cell
- Peripheral T-cell
- Mantle cell
- Burkitt’s or Burkitt’s like lymphoma, and
- Precursor T-lymphoblastic
Symptoms
The first noticeable symptoms of non-Hodgkin's lymphoma cancer are often enlarged lymph nodes in a single area, such as the neck or groin, or throughout the body. The lymph nodes enlarge slowly and are usually painless. Occasionally, enlarged lymph nodes in the tonsils cause difficulty in swallowing.
Enlarged lymph nodes deep within the chest or abdomen may press against various organs, causing difficulty in breathing, loss of appetite, severe constipation, abdominal pain, or progressive swelling of the legs. If the lymphoma invades the bloodstream, leukemia may develop.
Non-Hodgkin's lymphomas are more likely to invade the bone marrow, gastrointestinal tract, and skin than Hodgkin's disease.
Therapy
Chemotherapy and Radiation
In the treatment of lymphoma, radiation and chemotherapy may both be recommended. Usually they are given one after the other (often chemotherapy followed by radiation). Chemotherapy is the use of drugs (often called "anticancer drugs") to treat cancer.
Chemotherapy drugs destroy cancer cells by interfering with the cell's ability to grow and multiply. The therapy is considered "systemic" because it affects the whole body, including both normal and cancerous cells. Two or more anticancer drugs are often used to treat cancer, this is called combination therapy. Radiation therapy (or radiotherapy) is the use of high-energy radiation.
This high-energy radiation is used because it concentrates the radiation dose on the tumor while "sparing" the tissues that are not likely to contain lymphoma cells. Radiation works by damaging the DNA in the lymphoma cells making it difficult or impossible to repair radiation-induced injury with the goal that these cancer cells will then die. It is considered "local" therapy as it only affects a small area of the body – the tumor and surrounding area.
Monoclonal antibody therapy
Monoclonal antibodies (MAbs) are one type of biologic therapy that uses the body's own immune system (disease fighting defenses) to treat the disease. An antibody is a part of the body’s normal defenses against bacteria, viruses and other foreign cells.
An antibody works by recognizing "markers" (very specific antigens, another term for the target recognized by an antibody or immune cell) on the surface of cells and attaching itself to these markers. This may either target the cell for destruction by our immune system or, in some cases, act directly to hasten the cell’s death. The goal of this treatment then, is for the monoclonal antibodies to target lymphoma cells specifically, and destroy these cells by activating the body's immune system against them.
Stem cell transplant (SCT)
This involve the use of high dose therapy (chemotherapy) to attack any lymphoma cells in the body. This is followed by a "rescue" of stem cells to replace the old bone marrow that is harmed by the high dose therapy. This replacement will allow the new bone marrow to create new blood cells.