Lymphomas are cancers that develop in the lymphatic system -- the tissues and organs that produce, store, and carry white blood cells. The lymphatic system includes the bone marrow, spleen, thymus, lymph nodes, and a network of thin tubes that carry lymph and white blood cells to all the tissues of the body. Types of lymphoma include non-Hodgkin's, Hodgkin's, and cutaneous T-cell lymphoma.
In non-Hodgkin's lymphoma, the most common form of the disease, cells in the lymphatic system become abnormal. They divide and grow without any order or control, or old cells that should die, don't. Non-Hodgkin's lymphoma can begin or spread to almost any part of the body.
In Hodgkin's disease, cells in the lymphatic system also become abnormal, but the cancer tends to spread in an orderly way from one group of lymph nodes to the next. Eventually, it can spread almost anywhere.
In cutaneous T-cell lymphoma, T-lymphocytes (infection fighting white blood cells) become cancerous, causing skin problems.
Signs and Symptoms:
Lymphoma is accompanied by the following signs and symptoms, by type:
Non-Hodgkin's and Hodgkin's:
- Painless swelling in lymph nodes in neck, underarm, or groin
- Unexplained fever
- Drenching night sweats
- Unexplained weight loss
- Itchy skin
- Persistent, nonproductive cough
- Dark patches on skin
- Tumors on skin (mycosis fungoides)
- Skin infections
Who's Most At Risk?:
People with the following conditions or characteristics are at risk of developing lymphoma, by type:
- Congenital immunodeficiency
- Infections: Epstein-Barr virus (EBV), Helicobacter pylori, Kaposi's sarcoma herpes virus (HIV related lymphoma), human T-cell leukemia virus type 1
- Immunosuppressive therapy following organ transplant
- Autoimmune diseases
- Prior chemotherapy or radiation exposure or therapy
- Exposure to certain chemicals or solvents
- Viruses: EBV, mononucleosis, HIV
- Genetic predisposition
- Caucasians more likely than African-Americans
- Men more likely than women
- Same sex siblings: 10 times greater risk
- Human T-cell leukemia virus type 1
- Exposure to certain chemicals or solvents
What to Expect at Your Provider's Office:
If you are having symptoms of lymphoma, your health care provider will carefully check for swelling or lumps in the neck, underarms, and groin. If the lymph nodes don't feel normal, your doctor will perform a biopsy. The doctor will remove a small piece of the lymph node -- or, in the case of cutaneous T-cell lymphoma, a growth from the skin -- and a pathologist will examine the tissue under a microscope to check for cancer cells.
If you have cancer, your doctor will do more tests to find out if the cancer has spread to other parts of the body (staging). This may involve blood and bone marrow tests, computed tomography (CT) scans, positron emission tomography scans (PET), cobmination PET/CT scans, and, possibly, a laparotomy, in which the doctor cuts into the abdomen and checks the organs for cancer.
Your doctor will develop a treatment plan based on the diagnosis, the stage of the disease, the size of the tumor, and your general health and age.
Your health care provider may prescribe the following drug therapies:
Hodgkin's and Non-Hodgkin's:
- Radiation therapy
- Chemotherapy, possibly with alpha interferon
- Emollients, moisturizers, topical steroids
- Electron beam therapy
- Retinoids and interferon
Surgical and Other Procedures
Patients sometimes receive bone marrow transplantation and peripheral blood stem cell transplantation. Researchers are testing the effectiveness of radioimmunotherapy, a treatment with a radioactive substance linked to an antibody that will attach to the tumor when injected into the body. A surgeon may also remove the tumor.
Complementary and Alternative Therapies
Lymphoma requires conventional medical management. A comprehensive treatment plan for lymphoma may include a range of complementary and alternative (CAM) therapies. Be sure to ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Some CAM therapies may interact negatively with conventional medical Lymphoma interventions. Always tell your health care providers about any supplements you are taking.
Improved relaxation and decreased stress, through activities such as guided imagery, tai chi, yoga, and meditation are helpful in promoting a sense of well being. Intimacy and support from others helps promote a positive and empowering attitude.
Nutrition and Supplements
These nutritional tips may help reduce symptoms. Many herbs and supplements can interact negatively with conventional cancer medications and new research about such reactions is ongoing. While supplements may be helpful, it's important to work with knowledgeable provider and inform your doctors about any supplements you're using or considering using.
- Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
- Eat antioxidant rich foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as kale, spinach, and peppers).
- Avoid refined foods, such as white breads, pastas, and sugar.
- Eat cruciferous vegetables (such as broccoli, cabbage, and cauliflower). Studies show that a higher intake of green leafy vegetables and cruciferous vegetables is associated with a lower risk of non-Hodgkin's lymphoma.
- Use healthy oils in foods, such as olive oil or vegetable oil.
- Reduce or eliminate trans fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
- Avoid coffee and other stimulants, alcohol, and tobacco.
- Drink 6 - 8 glasses of filtered water daily.
- Exercise lightly, if possible. Speak to your doctor about what regimen is right for you.
You may address nutritional deficiencies with the following supplements:
- Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration - check the label carefully.
- Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbsp. oil 2 - 3 times daily, to help decrease inflammation. Fish oils may increase bleeding in sensitive individuals, such as those taking blood thinning mediations (including aspirin).
- Melatonin, 2 - 5 mg before bed, when needed for sleep. Some alternative health care providers recommend higher dosages. Melatonin may interact with a variety of medications, including sedatives, antidepressants, hormonal medications, and others.
Herbs can potentially be an important part of an integrated cancer plan, but they should only be prescribed by a knowledgeable health care provider who is in communication with all of your other doctors.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (such as nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you individually.
Homeopathy may help reduce symptoms and strengthen overall constitution and may help decrease the side effects of chemotherapy.
Radium bromatum is specific for radiation poisoning, especially followed by arthritic complaints. Acute dose is 3 - 5 pellets of 12X to 30C every 1 - 4 hours until symptoms are relieved.
Contrast hydrotherapy may help enhance immune function and facilitate the transport of nutrients and waste products. End hot showers with 1 - 2 minutes of cold water spray. Since hydrotherapy stimulates lymphatic flow, talk to your physician first before beginning and hydrotherapy regimen.
Acupuncture may help strengthen immunity and detoxification. It may also reduce the side effects of chemotherapy. For many patients and physicians, acupuncture has become one of the most widely used alternative interventions in cancer treatment. Unlike botanicals and nutrients, acupuncture works without ingesting substances so possible interactions with cancer treatments is unlikely.
Prognosis varies depending on the type and stage of lymphoma. Survival rates for Stage I and II non-Hodgkin's lymphoma and Hodgkin's lymphoma are very high. Cure rates as high as 75 -80% are now possible with appropriate initial therapy.
Potential complications include the following:
- Hodgkin's sometimes develops into non-Hodgkin's lymphoma.
- Radiation and chemotherapy can cause secondary cancers.
- Infections and pulmonary fibrosis (thickening and scarring of the air sacs of the lungs) may occur.
Once you are in remission, it is essential that you be checked for signs of relapse on a regular basis.
Basu S, Li G, Bural G, Alavi A. Fluorodeoxyglucose positron emission tomography (FDG-PET) and PET/computed tomography imaging characteristics of thyroid lymphoma and their potential utility. Acta Radiol. 2009;50(2):201-4.
Bellizzi S, Cocco P, Zucca M, D'Andrea I, Sesler S, Monne M, et al. Household contact with pets and birds and risk of lymphoma. Cancer Causes Control. 2011;22(2):159-65.
Chiu BC, Kwon S, Evens AM, Surawicz T, Smith SM, Weisenburger DD. Dietary intake of fruit and vegetables and risk of non-Hodgkin's lymphoma. Cancer Causes Control. 2011;22(8):1183-95.
Drake MT, Maurer MJ, Link BK, Habermann TM, Ansell SM, Micallef IN, et al. Vitamin D insufficiency and prognosis in non-Hodgkin's lymphoma. J Clin Oncol. 2010;28(27):4191-8.
Ferri: Ferri's Clinical Advisor 2012. 1st ed. Philadelphia, PA: Mosby, Elsevier. 2011.
Goldman: Cecil Medicine. 24th ed. Philadelphia, PA: Saunsers, Elsevier. 2011. Ch. 196.
Hollender A, Bjoro T, Otto Karlsen K, et al. Vitamin D deficiency in patients operated on for gastric lymphoma. Scand J Gastroenterol. 2006;41(6):673-81.
Jiang J, Slivova V, Sliva D. Ganoderma lucidum inhibits proliferation of human breast cancer cells by down-regulation of estrogen receptor and NF-kappaB signaling. Int J Oncol. 2006;29(3):695-703.
Kelemen LE, Cerhan JR, Lim U, et al. Vegetables, fruit, and antioxidant-related nutrients and risk of non-Hodgkin lymphoma: a National Cancer Institute-Surveillance, Epidemiology, and End Results population-based case-control study. Am J Clin Nutr. 2006;83(6):1401-10.
Kelly JL, Friedberg JW, Calvi LM, van Wijngaarden E, Fisher SG. A case-control study of ultraviolet radiation exposure, vitamin D, and lymphoma risk in adults. Cancer Causes Control. 2010;21(8):1265-75.
Kormosh N, Laktionov K, Antoshechkina M. Effect of a combination of extract from several plants on cell-mediated and humoral immunity of patients with advanced ovarian cancer. Phytother Res. 2006;20(5):424-5.
McCarty MF, Block KI. Toward a core nutraceutical program for cancer management. Integr Cancer Ther. 2006;5(2):150-71.
MacLean CH, Newberry SJ, Mojica WA, et al. Effects of omega-3 fatty acids on cancer risk: a systematic review. JAMA. 2006;295(4):403-15.
Miller MF, Bellizzi KM, Sufian M, et al. Dietary supplement use in individuals living with cancer and other chronic conditions: a population-based study. J Am Diet Assoc. 2008;108(3):483-94.
Polesel J, Talamini R, Montella M, et al. Linoleic acid, vitamin D and other nutrient intakes in the risk of non-Hodgkin lymphoma: an Italian case-control study. Ann Oncol. 2006;17(4):713-8.
Wan XS, Ware JH, Zhou Z, Donahe JJ, et al. Protection against radiation-induced oxidative stress in cultured human epithelial cells by treatment with antioxidant agents. Int J Radiat Oncol Biol Phys. 2006;64(5):1475-81.
Velicer CM, Ulrich CM. Vitamin and mineral supplement use among US adults after cancer diagnosis: a systematic review. J Clin Oncol. 2008 1;26(4):665-73.