Malignant Lymphoma Health Article

Diagnosis

Like all cancers, lymphomas are best treated when found early. However, they are often difficult to diagnose. There are no screening tests available, and, since the symptoms are nonspecific, lymphomas are rarely recognized in their early stages. Detection often occurs by chance during a routine physical examination.

When the doctor suspects lymphoma, a thorough physical examination is performed and a complete medical history taken. Enlarged liver, spleen, or lymph nodes may suggest lymphomas. Blood tests will determine the cell counts and obtain information on how well the organs, such as the kidney and liver, are functioning.

A biopsy (microscopic tissue analysis) of the enlarged lymph node is the most definitive way to diagnose a lymphoma. Once the exact form of lymphoma is known, it is then staged to determine how aggressive it is, and how far it has spread. This information helps determine the appropriate treatment. The doctor may also perform a bone marrow biopsy. During this procedure, a cylindrical piece of bone—generally from the hip—and marrow fluid are removed. These samples are sent to the laboratory for examination. Biopsies may also be repeated during treatment to see how the lymphoma is responding to therapy.

Conventional imaging tests, such as x rays, computed tomography scans (CT scans), magnetic resonance imaging, and abdominal sonograms, are used to determine the extent of spread of the disease. Lymphangiograms are x rays of the lymphatic system. In this procedure, a special dye, called contrast medium, is injected into the lymphatic channels through a small incision (cut) made in each foot. The dye is injected slowly over a period of three to four hours. This dye clearly outlines the lymphatic system and allows it to stand out. Multiple x rays are then taken and any abnormality, if present, is revealed.

In rare cases a lumbar puncture (spinal tap) is performed to see if malignant cells are in the fluid that surrounds the brain. In this test, the physician inserts a needle into the epidural space at the base of the spine and collects a small amount of spinal fluid for microscopic examination.

Treatment

Non-Hodgkin's lymphoma is a life-threatening disease, and a correct diagnosis and appropriate treatment with surgery, chemotherapy, and/or radiation are critical to controlling the illness.

Acupuncture, hypnotherapy, and guided imagery may be useful tools in treating the pain of lymphomas. Acupuncture uses a series of thin needles placed in the skin at targeted locations known as acupoints; in theory, this harmonizes the energy flow within the body, and may help improve immune system function.

In guided imagery, patients create pleasant and soothing mental images that promote relaxation and improve their ability to cope with discomfort and pain. Another guided-imagery technique involves creating a mental picture of pain. Once the pain is visualized, patients can adjust the image to make it more pleasing, and thus more manageable.

Herbal remedies, such as Chinese herbs and mushroom extracts, may also lessen pain and promote relaxation and healing. Some herbs, such as ginger, are effective in the treatment of nausea caused by chemotherapy, and others, such as astragalus, help build the immune system. Check with an herbal practitioner before deciding on treatment. Depending on the preparation and the type of herb, the remedies may interfere with other prescribed medications. Naturally, any other activities that promote well-being, such as exercise, stress reduction, meditation, yoga, t'ai chi, and qigong will also benefit the patient. Proper nutrition and some specialized diets may help in recovering from lymphomas.

Allopathic treatment

Treatment options for lymphomas depend on the type of lymphoma and its stage. In most cases, treatment consists of chemotherapy, radiation therapy, or a combination of the two.

Chemotherapy uses anticancer drugs to kill cancer cells. In non-Hodgkin's lymphomas, combination therapy, which uses several drugs, has been found more effective than single-drug use. Treatment usually lasts about six months, but in some cases may be as long as a year. The drugs are administered intravenously (through a vein) or given orally. If cancer cells have invaded the central nervous system, then chemotherapeutic drugs may be instilled, through a needle in the brain or back, into the fluid that surrounds the brain. This procedure is known as intrathecal chemotherapy.

Radiation therapy, where high-energy ionizing rays are directed at specific portions of the body, such as the upper chest, abdomen, pelvis, or neck, is often used for treatment of lymphomas. External radiation therapy, where the rays are directed from a source outside the body, is the most common mode of radiation treatment.

Bone marrow transplantation is being tested as a treatment option when lymphomas do not respond to conventional therapy, or when the patient has had a relapse or suffers from recurrent lymphomas. There are two ways of doing bone marrow transplantation. In a procedure called allogeneic bone marrow transplant, the donor's marrow must match that of the patient. The donor can be a twin (best match), sibling, or not related at all. High-dose chemotherapy or radiation therapy is given to eradicate the lymphoma. The donor marrow is then given to replace the marrow destroyed by the therapy. In autologous bone marrow transplantation some of the patient's own marrow is harvested, chemically purged, and frozen. High-dose chemotherapy and radiation therapy are administered. The marrow that was harvested, purged, and frozen is then thawed and put back into the patient's body to replace the destroyed marrow.

A new option for lymphoma patients is peripheral stem cell transplantation. In this treatment, stem cells (immature cells from which all blood cells develop), that normally circulate in the blood are collected, treated to remove cancer cells, then returned to the patient in a process called leukapheresis. Researchers are exploring whether these cells can be used to restore the normal function and development of blood cells, rather than using a bone marrow transplant.