Non-Hodgkin's Lymphoma: Becomes More Common, More Treatable

By Patlak, Margie | FDA Consumer, December 1996 | Go to article overview

Non-Hodgkin's Lymphoma: Becomes More Common, More Treatable


Patlak, Margie, FDA Consumer


Mary Relles of Philadelphia never neard of non-Hodgkins lymphoma until her father was diagnosed with it in 1990. Since then, three of her friends--and Relles herself, 49--have developed this relatively unknown yet deadly cancer of the immune system.

Non-Hodgkins lymphoma (NHL) has become more common in the last few decades and is now the sixth most common cancer in the United States, according to the National Cancer Institute (NCI). Striking such luminaries as Jacqueline Kennedy Onassis, Senator Paul Tsongas, and the Shah Mohammed Reza Pahlevi of Iran, NHL has increased 75 percent over the last 20 years, making it the most rapidly rising cancer after lung cancer and melanoma, according to NCI. Although recent studies have provided some intriguing clues, the cause of what some experts call the "NHL epidemic" is not known. (See accompanying article.) Fortunately, advances in treatment seem to be keeping pace; the five-year survival rate for NHL rose from 31 percent to 51 percent over the past 30 years, according to NCI.

Cancers of the Immune System

NHL is a collection of more than a dozen different cancers of the lymphatic system, which generates the body's immune defenses. This system includes a network of channels akin to blood vessels through which lymphocytes--important white blood cells of the immune system--patrol the body for invading microbes. Along these lymphatic routes in the neck, armpits, abdomen, and groin are clusters of bean-shaped lymph nodes that house platoons of the infection-fighting lymphocytes. These cells also cluster in areas that serve as gateways to the body, including the mucous membranes lining the respiratory and digestive tracts, and the skin. Lymphocytes travel in the bloodstream, as well. The lymphatic system also includes such organs as the spleen, thymus and tonsils.

Because NHL can develop wherever in the body lymphocytes can be found, the cancer can crop up nearly anywhere. Symptoms can vary widely, depending on the cancer site. The most common symptom is a noticeable, usually painless swelling of a lymph node. NHL in the digestive tract can cause nausea, vomiting, or abdominal pain; in the chest, shortness of breath or cough may develop. If the brain is involved, patients may have headaches, vision changes, or seizures. If the bone marrow is affected, lymphoma cells may crowd out red blood cell precursors, causing anemia. Reddened patches on the skin can occur when lymphoma cells there prompt localized inflammation.

Because NHL can foster a hyperactive immune response, it often causes symptoms that develop when the body is fighting an infection, such as fevers, night sweats, tiredness, and weight loss. Another NHL symptom is widespread itching, apparently triggered by immune cells' release of histamines, the same compounds that cause itchiness in allergic reactions.

NHLs can affect people of all ages, although the incidence of NHL increases with age. About half of all cases are in people aged 60 and older.

The treatments for NHL include drugs and radiation therapy regulated by the Food and Drug Administration.

Diverse Group of Cancers

To diagnose NHL, doctors remove a small sample of the tissue thought to be cancerous. This procedure, known as a biopsy, is usually done with a local anesthetic. A pathologist examines the tissue under a microscope to look for cancer cells. The appearance of these cells and the proteins on their surfaces helps the pathologist determine the type of NHL the cancer is. The various types have distinctive appearances, carry different prognoses (predicted outcomes), and have different treatments. Whereas one type may be extremely deadly, another may be highly curable.

NHLs are classed as low-, intermediate- and high-grade. This classification scheme accurately predicts the survival of untreated patients, but is not as reliable in predicting outcome after treatment. …

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