NHL.ca: Treatment of Non Hodgkins Lymphoma

NHL.ca: Treatment of Non Hodgkins Lymphoma

The treatment of Non Hodgkins lymphoma depends on many factors including the age of the patient, the stage of the disease, the type of the lymphoma (shape of cells), the general health of the patient, the location of the disease, the grade of the lymphoma, the presence or absence of symptoms, and pregnancy.

There are several options for treating Non Hodgkins lymphoma. These include watchful waiting (not starting any kind of treatment until symptoms emerge), chemotherapy (medications), radiotherapy (radiation), biological therapy (the administration of compounds that are normally secreted by the body), bone marrow transplantation, surgery (to remove the tumor), or a combination of any of the methods above.

Elderly patients are the best candidates for the watchful waiting method. As for children, the treatment decision takes into consideration the child age and development (physical and sexual).

Radiotherapy in Non Hodgkins lymphoma:

Radiotherapy is the application of high energy radiation to kill cancer cells in the affected area. There are three methods of the delivery of radiation to the body. First, the device that delivers the external beam radiation. Second, the injection of radioactive material. Third, the implantation of a radioactive chemical near or in the tumor.

There are two methodes of radiotherapy used in Non Hodgkins Lymphoma, the Total Nodal (Lymphoid) Irradiation (TLI) and the Total Body Irradiation (TBI). TLI is used to irradiate all the lymphatic tissue in the body whereas TBI is mainly used before bone marrow transplantation to prepare the patient for high dose chemotherapy.

The dose of the radiation delivered depends on many factors like the type of the lymphoma, the location, the condition of the patient, the treatment goals, the presence of nearby sensitive organs, and whether it is radiotherapy alone or in combination with chemotherapy.

Side effects of radiotherapy depend on the dose and the part of the body treated and include tiredness, hair loss, red and itchy skin, paresthesia, sore throat, gastrointestinal symptoms, pneumonitis (inflammation of the lung tissue), the emergence of another cancer, inflammation of the spinal cord, pericarditis, and thyroid abnormalities.

Biological Therapy and Non Hodgkins lymphoma

Biological Therapy, also called response modifier treatment, is the use of naturally occuring substances that belong to the immune system to stop the progression of the cancer. Examples in clude Interferons and Monoclonal antibodies.

Interferons are proteins that are secreted by the cells infected by a virus, help uninfected cells to produce antiviral proteins, and help the human body fight the cancer (slow the overall growth of the tumor) by strengthening the immune response.

There are three possible routes of administration of Interferons: Intravenously (A needle is introduced inside the vein), intramuscularly (A needle is introduced inside the muscle), and subcutaneously (A needle is introduced just below the skin). The starting dose should be low and tapered up progressively to decrease side effects that are very disturbing and include fever, chills, flu like symptoms, muscle pain (myalgia), bone pain, gastrointestinal disturbances, headache, and difficulty in concentrating.

Monoclonal antibodies are antibodies that are produced in the laboratory (in vitro) to find and kill cancer cells. Rituximab is an example with FDA approval for the treatment of follicular lymphoma. It is administered intravenously over a three week period. It is usually given to patients with cancer relapse or those unresponsive to treatment. Side effects include nausea, vomiting, fever, chills, and fatigue.

Bone Marrow Transplant and Non Hodgkins Lymphoma

Bone Marrow Transplant is the injection of new healthy stem cells (stem cells are precursors to blood cells) with high doses of chemotherapy to the patient. As a result, the patient's immunity is boosted and the damaged cells are destroyed. The healthy bone marrow can be taken from the patient himself or from a donor (whose blood type is compatible with him).

Chemotherapy and Non Hodgkins lymphoma

Chemotherapy is the administration of high dose high power drugs to the affected areas with the intent to kill involved cells. Side effects depend on the type and on the extent of the treatment. They include loss of appetite, nausea, vomiting, hair loss, anemia, mouth sores, darkening of skin, shorteness of breath, tingling, increased susceptibility to infections, easy bleeding, rapid bruising, and diarrhea.

Occasionally, Tumor Lysis Syndrome may result from chemotherapy. It is characterized by the release of toxic substances into the blood due to the rapid destruction of cancer cells by chemotherapeutic medications. Infertility may result and so sperm banking is usually recommended in young males prior to the initiation of chemotherapy.