Radiation Therapy for Hodgkins and
Non-Hodgkins Lymphoma
Understanding Your Treatment
Options
Facts
About Hodgkins and Non-Hodgkins Lymphoma
The lymphatic system is a
network of thin tubular vessels that branches out to almost all
parts of the body. Scattered in between these vessels are lymph
nodes. The job of the lymphatic system is to fight infection and
disease. Cancer of the lymphatic system is called lymphoma. Hodgkins
is one of two main types of lymphoma with non-Hodgkins being the
other.
- Hodgkins lymphoma (Hodgkins disease) commonly affects lymph
nodes in the neck or in the area between the lungs behind the
breastbone. It can also begin in groups of lymph nodes under the
arms, in the abdomen or in the groin.
- It's named after the British doctor Thomas Hodgkin who first
described the disease in 1832.
- According to the American Cancer Society, nearly 64,000 new
cases of lymphoma will be diagnosed this year. This includes 7,350
cases of Hodgkins lymphoma.
- Hodgkins lymphoma is very treatable and often curable. Eighty-five
percent of patients with Hodgkins live longer than five years
after diagnosis.
- Non-Hodgkins lymphoma (or NHL) refers to a variety of cancers
involving the lymph system. Non-Hodgkins lymphoma can begin in
any part of the body, not just the lymph nodes.
- According to the American Cancer Society, nearly 64,000 new
cases of lymphoma will be diagnosed this year.
- Survival rates vary widely by cell type and stage of disease.
More than 75 percent of patients with NHL live longer than a year
after diagnosis; nearly 60 percent of patients live longer than
five years.
Risk
Factors for Hodgkins and Non-Hodgkins Lymphoma
The cause of Hodgkins lymphoma
is unknown. However, doctors believe immune system problems as well
as age may increase a person's chance of developing this disease.
- Hodgkins lymphoma has two peak time frames: between the ages
of 15 and 40 and in people over age 55. However, the disease can
affect anyone.
- Males are typically more at risk of developing Hodgkins lymphoma.
- Those who have been infected with the Epstein-Barr virus are
more likely to develop Hodgkins lymphoma.
- Having a parent or sibling with Hodgkins lymphoma also increases
risk of the disease.
- Non-Hodgkins is most commonly found in people in their 60s and
70s. However, the disease can affect anyone.
- People with auto-immune disorders, including HIV and AIDS, are
more likely to develop non-Hodgkins lymphoma.
- People who have received an organ transplant have a high risk
of developing non-Hodgkins. This is because they must take drugs
that suppress the immune system.
Signs
and Symptoms of Hodgkins and Non-Hodgkins Lymphoma
The signs and symptoms of
lymphoma are not specific and may also be associated with other,
noncancerous conditions. Talk to your doctor if you have any of
these problems.
Signs and Symptoms of
Hodgkins Lymphoma
- Swollen lymph nodes in the neck, underarm or groin.
- Unexplained fevers.
- Drenching night sweats.
- Unexplained weight loss.
- Constant fatigue.
- Skin rash or itchy skin.
Signs and Symptoms of
Non-Hodgkins Lymphoma
- Swollen lymph nodes in your neck, underarm or groin.
- Unexplained fevers.
- Unexplained weight loss.
- Constant fatigue.
- Skin rash or itchy skin.
- Unexplained pain in the chest, abdomen, pelvis or bones.
- Drenching night sweats.
Unexplained fevers, night
sweats and weight loss are known as “B” symptoms. Ask your doctor
about their significance in your case.
Diagnosing
Hodgkins and Non-Hodgkins Lymphoma
Lymphoma is not just one
disease. Rather, it is more than 30 types of cancer that act differently
and may need special treatment. To see if you have lymphoma and
what kind it is, your doctor may order some or all of the following
tests.
To see if you have Hodgkins
lymphoma, your doctor will first examine you to assess your overall
health and look for anything unusual. He or she may also perform
some or all of the following tests.
- The doctor will order blood tests to evaluate a variety of factors,
including the number of blood cells in your blood and how well
your liver and kidneys are working.
- During a lymph node biopsy, your doctor will perform surgery
to take out a lymph node. It will then be examined under a microscope
to look for cancer.
- Several imaging tests will be performed to see if lymphoma has
spread to other organs. These tests may include CT, PET or gallium
scans.
To see if you have Non-Hodgkins
lymphoma, your doctor will first examine you to assess your overall
health and look for anything unusual. He or she may also perform
some or all of the following tests.
- The doctor may order blood tests to evaluate a variety of factors,
including the number of blood cells in your blood and how well
your liver and kidneys are working.
- During a lymph node biopsy, your doctor will perform surgery
to take out a lymph node. It will then be examined under a microscope
to look for cancer.
- A bone marrow biopsy may help determine if lymphoma has spread
to that part of the body.
- Your doctor may order imaging tests to see if lymphoma has spread
to other organs. These tests may include X-rays or CT, PET or
MRI scans.
Staging
of Hodgkins and Non-Hodgkins Lymphoma
The stage of cancer is a
term used to describe its size and whether it has spread.
Knowing this helps doctors
plan the best treatment.
Staging of Hodgkins Lymphoma
- Stage I: Single lymph node or non-lymph node region is affected.
- Stage II: Two or more lymph node or non-lymph node regions are
affected on the same side of the diaphragm (the muscle under the
lungs).
- Stage III: Lymph node or non-lymph node regions above and below
the diaphragm are affected.
- Stage IV: The cancer has spread outside the lymph nodes to organs
such as the liver, bones or lungs. Stage IV can also refer to
a tumor in another organ and/or tumors in distant lymph nodes.
Staging of Non-Hodgkins Lymphoma
The stage of cancer is
a term used to describe its size and whether it has spread. Knowing
this helps doctors plan the best treatment.
- Stage I: Single lymph node or non-lymph node region is affected.
- Stage II: Two or more lymph node or non-lymph node regions are
affected on the same side of the diaphragm (the muscle under the
lungs).
- Stage III: Lymph node or non-lymph node regions above and below
the diaphragm are affected.
- Stage IV: The cancer has spread outside the lymph nodes to organs
such as the liver, bones or lungs. Stage IV can also refer to
a tumor in another organ and/or tumor in distant lymph nodes.
Treatment
Options for Hodgkins and Non-Hodgkins Lymphoma
Treatment options depend
on the type of lymphoma, its stage and your overall health. Treatment
may include chemotherapy or radiation therapy, either alone or in
combination. It may help to talk to several cancer specialists before
deciding on the best course of treatment for you, your cancer and
your lifestyle
- A radiation oncologist is a doctor who specializes in destroying
cancer cells with high energy X-rays or other types of radiation.
- A medical oncologist is a doctor who is an expert at prescribing
special drugs (chemotherapy) to treat cancer. Some medical oncologists
are also hematologists, meaning they have experience treating
blood problems.
Understanding
Radiation Therapy
Radiation therapy, also called
radiotherapy, is the careful use of radiation to safely and effectively
kill cancer cells while avoiding nearby healthy tissue.
- Radiation oncologists use radiation therapy to cure cancer,
to control cancer growth or to relieve symptoms, such as pain.
- Radiation therapy works within cancer cells by damaging their
ability to multiply. When these cells are destroyed by the radiation,
the body naturally eliminates them.
- Healthy tissues can also be affected by radiation, but they
are usually able to repair themselves in a way cancer cells cannot.
External
Beam Radiation Therapy
External beam radiation therapy
is a series of outpatient treatments to accurately deliver radiation
to the cancer cells. Radiation therapy has been proven to be very
successful at treating and curing Hodgkins lymphoma.
External Beam Radiation
Therapy of Hodgkins lymphoma
- Radiation oncologists deliver external beam radiation therapy
to the lymphoma from a machine called a linear accelerator.
- Each treatment is painless and is similar to getting an X-ray.
Treatments last less than 30 minutes each, every day except for
Saturday and Sunday, for three to four weeks.
- Involved field radiation is when your doctor delivers radiation
only to the parts of your body known to have cancer. It is often
combined with chemotherapy. Radiation above the diaphragm to the
neck, chest and/or underarms is called mantle field radiation.
Treatment below the diaphragm to the abdomen, spleen and/or pelvis
is called inverted-Y field radiation.
- Your radiation oncologist may deliver radiation to all the lymph
nodes in the body to destroy cancer cells that may have spread
to other lymph nodes. This is called total nodal irradiation.
- Your radiation oncologist may also deliver radiation to the
entire body. This is called total body irradiation. It is often
done before chemotherapy and a stem cell or bone marrow transplant
to eliminate any remaining cancer cells and create space for the
new stem cells.
External Beam Radiation Therapy
of Non-Hodgkins lymphoma
- Radiation oncologists usually deliver external beam radiation
therapy to the lymphoma from a machine called a linear accelerator.
- Each treatment is painless and is similar to getting an X-ray.
Treatments last less than 30 minutes each and are every day, except
for Saturday and Sunday for three to four weeks.
- Involved field radiation is when your doctor delivers radiation
only to the parts of the body known to have cancer. It is often
combined with chemotherapy.
- Your radiation oncologist may deliver radiation to all the lymph
nodes in the body to destroy cancer cells that may have spread
to other lymph nodes. This is called total nodal irradiation.
- Your radiation oncologist may also deliver radiation to the
entire body. This is called total body irradiation. It is often
done before chemotherapy and a stem cell or bone marrow transplant
to destroy any remaining cancer cells and create a space for the
new stem cells.
Potential
Side Effects
Potential Side Effects
of Hodgkins lymphoma Treatment
The side effects you may
experience will depend on the part of the body being treated, the
dose of radiation given and if you also receive chemotherapy. Ask
your doctor before treatment begins about possible side effects,
and how best to manage them.
- You may experience very few or no side effects and can continue
your normal routine during treatment.
- You may experience mild skin irritation, hair loss, sore throat,
upset stomach, loose bowel movements, nausea and/or fatigue. Most
side effects will go away after treatment ends.
- Tell your doctor or nurse if you experience any discomfort.
They may be able to prescribe medication or change your diet to
help.
- Hodgkins lymphoma is often curable, allowing many people with
the disease to live long lives after treatment. In some very rare
cases, the treatments that cured the cancer may lead to significant
after effects. Talk to your doctor about the risks of your treatment.
Potential Side Effects
of Non-Hodgkins lymphoma Treatment
The side effects you may
experience will depend on the part of the body being treated, the
amount of radiation you are given, and whether or not you have received
chemotherapy. Ask your doctor before treatment begins about possible
side effects and how best to manage them. Most side effects go away
once you finish treatment.
- You may experience very few or no side effects and can continue
your normal routine during treatment.
- You may notice mild skin irritation, upset stomach, hair loss,
sore throat, loose bowel movements, nausea and fatigue.
Tell your doctor or nurse
if you experience any discomfort during treatment. They may be able
to prescribe medication or change your diet to help. Biologic
Therapy of Non-Hodgkins Lymphoma
Also called immunotherapy,
biologic therapy works with your immune system to fight cancer.
Biologic therapy is like chemotherapy. The difference is that chemotherapy
attacks the cancer directly and biologic therapy helps your immune
system better fight the disease
- Monoclonal antibodies work by targeting certain molecules in
the body and attaching themselves to those molecules. This causes
some lymphoma cells to die and makes others more likely to be
destroyed by radiation and chemotherapy.
- Radiolabeled antibodies are monoclonal antibodies with radioactive
particles attached. These antibodies are designed to attach themselves
directly to the cancer cell and damage it with small amounts of
radiation without injuring nearby healthy tissue. Presently, radiolabeled
antibodies are being used to treat non-Hodgkins lymphoma that
has come back after treatment.
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