Central Nervous System Lympho... Health Article

Clinical staging, treatments, and prognosis

All treatment is palliative (designed to provide relief from symptoms and make a patient comfortable). Surgery is sometimes used to eliminate well-defined masses that are causing pressure in the brain and spinal cord. This pressure causes the symptoms, such as headache and numbness, because it contributes to swelling and dislocation. However, because CNS lymphoma generally spreads throughout the brain and spinal cord, surgery is usually not a treatment choice.

Medication in the form of steroids and radiation treatment both give good results over the short term by causing clusters of malignant cells to shrink briefly. However, neither treatment is effective for much more than six months. A great deal of interest surrounds research aimed at finding chemotherapy that works effectively for this type of cancer. Chemotherapy for CNS lymphoma is sometimes given by putting drugs directly into the brain or spinal cord.

The prognosis (outlook for recovery) for a patient with CNS lymphoma is poor. Untreated, the disease usually results in death in just a few weeks. If it is treated, life can be extended by perhaps six months to one year, and occasionally longer.

Ulrich Herrlinger, M.D., and colleagues in Tuebingen, Germany, have reported that the combination of radiation therapy and chemotherapy gives patients a much better chance of extended survival, prolonging life for more than six years in one individual. Eleven of the 21 patients in their study lived for 33 months or longer.

Alternative and complementary therapies

Any relaxation program, such as biofeedback or yoga, often help a patient deal with the poor prognosis, pain, and symptoms of CNS lymphoma.

Coping with cancer treatment

Radiation therapy, particularly of the entire brain that is required to treat most CNS lymphoma, can greatly alter memory and thought processes. Being prepared for the effects of radiation before the treatment begins is important. For example, a patient can write out a daily schedule of things to do—the essentials of an ordinary day such as brushing teeth and combing hair. This schedule can then be used as a memory aid after treatment.

Having a patient taking an active part in planning the course of treatment can be helpful, such as participating in meetings with the treatment team. Premier cancer treatment centers encourage patients to be an integral member of the team. Because some individuals beat the odds and live much longer than expected, an optimistic attitude is important.

Clinical trials

The National Cancer Institute at the National Institutes of Health, Bethesda, MD, offers a Cancer Information Service that can connect people with clinical trials. The toll free number for the Service is 1-800-4-CANCER(1-800-422-6237).

Prevention

No prevention is known; however, any effort that reduces the number of people infected with the virus that causes AIDS will indirectly reduce the number of people with CNS lymphoma. Three percent of all AIDS patients exhibit CNS lymphoma.

Special concerns

Because CNS lymphoma is a fatal disease, patients must make decisions about end-of-life care. How will it be arranged: at home, in a hospice, in some other setting? Who will make decisions if the patient is no longer able to state his or her desires? Advance directives, or written instructions for how a person wishes the medical team to respond at each juncture of the illness, should be completed as soon as possible after a diagnosis is made.

Resources

BOOKS

Canellos, George P., et al. The Lymphomas. Philadelphia: W.B.Saunders Co., 1997.

PERIODICALS

Herrlinger, Ulrich, et al. "Primary Central Nervous System Lymphoma" Cancer 91 (Jan.1, 2001): 131-135.

OTHER

Lymphoma Information Network. Mike Barela, host. 1 July 2001 <http://www.lymphomainfo.net>

Diane M. Calabrese

B lymphocyte

—Cell in the lymph system that produces antibodies, which protect against foreign substances.

Biopsy

—Tissue sample taken from the body for microscopic examination.

Computed tomography (CT)

—X rays are aimed at sections of the body (by rotating equipment) and images appear as slices. Results are assembled with a computer to give a three-dimensional picture of a structure within the body.

Herbicide

—A chemical compound used to kill plants.

Lymphatic system

—The nodes of tissue and the fluid that moves among them. This system works to protect the body from invading substances and organisms, and to return fluid that collects outside cells to the blood vessels.

Magnetic resonance imaging (MRI)

—Magnetic fields and radio frequency waves take pictures (images) of the inside of the body.

Ultrasound

—Sound waves are bounced off structures in the body to produce an image of those structures.

QUESTIONS TO ASK THE DOCTOR

• Will my quality of life be better with or without radiation treatment? How much of the time that I gain from radiation treatment will be time that I can function and do some of the things I enjoy?
• Is there a clinical trial in which I could participate?
• Is there a support group for CNS lymphoma at this institution or in this town?