Non-Hodgkin's Lymphomas: Treatment Options

How are they treated?

Non-Hodgkin's Lymphomas (NHLs) are normally treated with chemotherapy, radiation therapy, or a combination of both. Other treatments such as bone marrow transplants and biological therapy (immunotherapy) are sometimes used. Minor surgery may be used to obtain a tissue sample for diagnosis, but surgery is rarely a part of the actual treatment of the disease. The different stages of NHL develop at very different speeds. For this reason, treatment choices are often determined by the stage and location of the cancer.

Radiation Therapy

In some cases X-rays can be used to destroy or shrink cancer cells at the site of the tumor. External beam radiation is the type of radiation normally used in the treatment of Hodgkin's Disease. External beam radiation therapy uses radiation from outside the body to focus on the cancer and is, therefore, not the primary treatment for cancer that may have spread. A machine such as a linear accelerator or cobalt apparatus may administer this type of radiation. Radiation therapy is a type of localized treatment, which means that it affects only a specific area of the body. The radiation can be focused just on the site of the tumor (involved field radiation) or it can also be directed to the surrounding lymph nodes (extended field radiation).

Chemotherapy

Chemotherapy drugs are administered by mouth or injection to destroy the cancer cells. The drugs enter the blood stream and can, therefore, reach areas of the body where the cancer may have spread. Chemotherapy for NHL almost always involves the use of a number of different drugs. This allows several different types of cancer cells to be destroyed at the same time. Chemotherapy is a type of systemic treatment, which means that it affects all areas of the body.

Other Treatments

• Bone Marrow Transplant - This type of treatment is sometimes used if the cancer becomes resistant to regular chemotherapy or radiation therapy. Bone marrow contains stem cells, which develop into disease fighting cells. Healthy stem cells can provide an NHL patient with the ability to fight off the cancer cells and other diseases. If the bone marrow comes from a close relative it is called an allogenic transplant. If the bone marrow comes from the same person it is being given to, then it is called an autologous transplant. In an autologous transplant, the bone marrow is often treated in the lab to ensure that all the cancer cells have been removed before it is reintroduced to the body.
  
  
• Biological therapy - This treatment uses substances naturally produced by the body to either slow the growth of or kill cancer cells. Interferons are hormone-like proteins that have been shown to shrink some tumors. It is still unclear whether this treatment is appropriate for everyone. Monoclonal antibodies are substances similar to natural antibodies that are produced in a lab to specifically target certain diseases or infections. Monoclonal antibodies that are specific for the cancer cells can be used to destroy the cancer cells while not harming the healthy cells.
  
  
• Clinical Trials - There are always new experimental treatments being tested that often have promising results. The effectiveness and side effects of clinical trials are not always known, but they can sometimes offer hope of survival especially for end-stage cancer patients. Consult your physician or the Rhode Island Cancer Council to find out what clinical trials are going on near you and if you are eligible.
  

Treatment By Stages

Treatment plans are different for each patient, but the different stages often have general treatment plans. This is only a general description of common treatment plans for each stage. You and your healthcare team must determine what treatment is right for you.

• LOW GRADE - Extremely slow growing Low Grade NHLs can be treated with the "watch and wait" method. This simply means that the cancer is closely watched, but no treatment is started until symptoms develop. This can be more effective on the cancer and easier on the patient. Faster growing Low Grade NHLs are treated primarily with external beam radiation and sometimes with a combination of chemotherapy and radiation.
  
  
• INTERMEDIATE GRADE - A combination of chemotherapy and radiation therapy is almost always used. If the patient can't tolerate the combination therapy, then radiation therapy alone is used. Bone marrow transplants can also be added to the treatment plan if the cancer is not responding to the chemotherapy and radiation.
  
  
• HIGH GRADE - Intensive chemotherapy is the primary treatment. Radiation therapy, bone marrow transplants, and biological therapy are also sometimes combined with the chemotherapy depending on the specific type of NHL. Patients with very advanced High Grade NHLs may find hope through clinical trials.
  

What are the side effects of the treatments?

Certain side effects have been associated with different types of treatments. Each patient's response to treatment will be different but there are some common effects that have been reported by patients. Most side effects are temporary and can often be relieved with medication.

• Radiation Therapy (Side effects depend on area of the body being treated.)
  
  • Nausea, vomiting, diarrhea
    
  • Sexual dysfunction
    
  • Irritation to the skin near the radiation site
    
    
• Chemotherapy
  
  • Nausea and vomiting - loss of appetite
    
  • Loss of hair
    
  • Mouth sores
    
  • Increased susceptibility to infection
    
  • Premature menopause (permanent)
    
  • Infertility (permanent)
    
    
• Bone Marrow Transplant
  
  • Higher risk of infection
    
  • Possible toxicity to heart, lungs, liver, kidney, and other organs
    
    
• Biological Therapy
  
  • Moderate to severe fatigue
    
  • Fever
    
  • Chills
    
  • Headaches
    
  • Muscle and joint aches
    
  • Mood changes
    
  • Nausea
    
  • Rashes
    

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