NON- HODGKIN LYMPHOMA non - Hodgkin lymphoma This medical guide is designed for educational purposes to help patients understand. Please consult your doctor on specific questions and details about your symptoms.
02 03 NON- HODGKIN LYMPHOMA How does the lymphatic system work? The lymphatic system is part of the immune system. It includes the lymph nodes and related organs that are part of s immune and blood-forming systems, such as the spleen and bone marrow. There are about 600 lymph nodes throughout. 1,2 Lymph nodes: Contents How does the lymphatic system work? What is (NHL)? What causes NHL? What are the symptoms of NHL? How is NHL diagnosed? How is NHL treated? Living with NHL Frequently asked questions Lymph nodes are located throughout Lymph nodes are located throughout Thymus Spleen Bone marrow small, bean-shaped glands throughout carrying fluid (lymph fluid), nutrients, and waste material between tissues and the bloodstream Thymus: an organ that produces a specific type of white blood cells Spleen: an organ found in the upper left part of the abdomen that filters the blood and helps the immune system fight infection Bone marrow: a spongy tissue comprising the center of large bones that contains stem cells that produce blood cells
04 05 What is? What causes NHL? Within the lymph nodes, spleen, and bone marrow are white blood cells called lymphocytes. The exact cause of NHL is unknown. However, NHL is associated with some risk factors including: 1,4 Non-Hodgkin lymphoma (NHL)* is a type of cancer that occurs when these lymphocytes start growing in an uncontrolled manner to form tumours. 1,2 There are at least 61 different types of NHL, depending on the type of lymphocyte involved, where the tumour is, whether the tumour is fast-growing or slow-growing, and how the tumour affects. 3 1 Age Getting older is a strong risk factor for lymphoma overall, with most cases occurring in people in their 60s or older. Lymphocytes in the lymph node 2 Gender Overall, the risk of NHL is higher in men than in women. Normal cells Cells with damaged DNA 3 Weakened or abnormal immune system If you have a weakened immune system for certain reasons (organ transplants, HIV, genetic syndromes, or immune disorders), your risk of NHL may increase. 4 Exposure to certain chemicals or radiation Exposure to radiation and some chemicals such as weed-and insect-killing substances may be linked with an increased risk of NHL. In normal cells, cell division eventually stops * Also known as non-hodgkin s lymphoma, NHL, or sometimes just lymphoma Cancer cell division 5 Viral or bacterial infections Exposure to certain viruses and bacteria, including the Epstein-Barr virus (EBV) and human herpes virus 8 (HHV-8), may increase the risk of NHL. HIV, Human Immunodeficiency Virus
06 07 What are the symptoms of NHL? How is NHL diagnosed? NHL can cause many different signs and symptoms, depending on where it is in. In some cases, it might not cause any symptoms until it grows quite large. 1,2 Confirming the diagnosis may require a combination of physical examinations, blood tests, imaging tests (CT, MRI, and PET scans) and biopsies. 5 Common signs and symptoms include: 1,2 Diagnosis of NHL 5 Swollen lymph nodes Night sweats Shortness of breath Physical exam To check for symptoms and signs of NHL Blood test To check general health and white and red blood cell levels Biopsy: the removal of a small amount of tissue from to examine under a microscope CT (computerized tomography) scan: a type of scan that uses a series of X-rays to build up a 3D picture of inside MRI (magnetic resonance imaging) scan: a type of scan that uses strong magnetic fields and radio waves to produce detailed images of inside Unexplained weight loss Chest pain or pressure Fever Imaging tests To check the spread of cancer through detailed images of with CT, MRI, or PET scans Biopsy To examine parts of affected lymph nodes or bone marrow samples for cancerous cells PET (positron emission tomography) scan: a type of scan that uses a radioactive drug (tracer) to produce detailed 3D images of
08 09 How is NHL treated? The main goal of treatment is to improve your quality of life by helping you become cancer-free. 3 Once you develop symptoms that are severe enough for treatment, your options may include: 7 The form of treatment chosen depends on the type and stage of lymphoma, as well as other factors including your age, prior therapies received, and overall health. 3 Staging of NHL Diaphragm level Chemotherapy Chemotherapy is a drug treatment, given orally or by injection, that kills cancer cells. Radiation therapy During radiation therapy, you are positioned on a table and a large machine directs radiation at precise points on your body to kill cancerous cells and shrink tumours. STAGE I STAGE II STAGE III STAGE IV The cancer is found only in a single lymph node or in one organ. The cancer is found in two or more lymph node regions on one side of the diaphragm. The cancer involves lymph nodes both above and below the diaphragm. The cancer is found in several parts of one or more organs or tissues. Biological therapy Stem cell transplant WAIT If your symptoms are mild and thought to be low-grade, starting immediate treatment may not be necessary. In this case, your doctors may decide to wait and see until you develop troublesome symptoms. 6 Biological drugs help your body s immune system fight cancer. For example, a biological drug called rituximab attacks the cancerous cells in so that s immune system can destroy them. After cancer cells are killed with high dose chemotherapy, healthy stem cells (your own or from a donor) are injected into your body, where they can form new healthy blood cells.
Living with NHL Frequently Asked Questions A diagnosis of cancer can be overwhelming. At first, you are likely to feel very upset, frightened and confused. 8 When you are having treatment, or when you are recovering, you might not be able to do all the things you used to. But as you begin to feel better it might be helpful to stay positive and active by: 9 planning a healthy, well balanced diet learning relaxation techniques exercising regularly People who are well informed about their illness and treatment are more able to cope with what happens. So, it is very important to get the right information about your type of NHL by frequently communicating with your doctor. 8 1. Can I get another type of cancer after having NHL? 10 Unfortunately, being treated for cancer does not mean you cannot get another cancer. Survivors of NHL have a 15% increased chance of getting new cancers compared to the general population. The risk of getting a second cancer is higher in those who were diagnosed and treated at younger ages (20 years old and younger). 2. Can I lower my risk of NHL progressing or coming back? 11 Currently, there is little evidence to support that specific lifestyle changes can reduce the risk of NHL progressing or coming back. Adopting healthy behaviors such as not smoking, eating well, and staying at a healthy weight may help, but more studies are required in this area. However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of NHL or other cancers. 3. Will treatment affect my appearance and physical image? 12 Treatments including chemotherapy and radiotherapy can change the way your body looks, works or feels. The effects may vary depending on the treatment, but it is common for patients to experience hair loss, dry skin, rashes, brittle nails during treatment. However, most symptoms will disappear once treatment is completed. Questions
NON- HODGKIN LYMPHOMA REFERENCES 1. Leukemia & Lymphoma Society. Non-Hodgkin Lymphoma. 2013. Available at: https://www.lls.org/sites/ default/files/file_assets/nhl.pdf 2. American Cancer Society. What is Non-Hodgkin Lymphoma? Available at: https://www.cancer.org/ cancer/non-hodgkin-lymphoma/about/what-is-non-hodgkin-lymphoma.html 3. Lymphoma Research Foundation. Non-Hodgkin Lymphoma (NHL). Available at: http://www.lymphoma. org/site/pp.asp?c=bkltkaoqlmk8e&b=6300139&gclid=cj0keqjwhpngbrdkpy-my9rdutabeiqa- WNcslEXEF2BsyiHBn5qC5FRMo-h6OklA9TRi-4xYgT9OL7saAoee8P8HAQ# 4. American Cancer Society. What Are the Risk Factors for Non-Hodgkin Lymphoma? Available at: https:// www.cancer.org/cancer/non-hodgkin-lymphoma/causes-risks-prevention/risk-factors.html Accessed March 2017. 5. NHS Choices. Non-Hodgkin Lymphoma Diagnosis. Available at: http://www.nhs.uk/conditions/ non-hodgkins-lymphoma/pages/diagnosis.aspx 6. NHS Choices. Non-Hodgkin Lymphoma Treatment. Available at: http://www.nhs.uk/conditions/ non-hodgkins-lymphoma/pages/treatment.aspx 7. Mayo Clinic. Non-Hodgkin Lymphoma. Treatment and drugs. Available at: http://www.mayoclinic.org diseases-conditions/non-hodgkins-lymphoma/basics/treatment/con-20027792 8. Cancer Research UK. Coping with Non-Hodgkin Lymphoma. Available at: http://www.cancerresearchuk. org/about-cancer/type/non-hodgkins-lymphoma/living/coping-with-non-hodgkins-lymphoma 9. Cancer Research UK. Coping with Cancer- What you can do. Available at: http://www.cancerresearchuk. org/about-cancer/coping/practically/what-you-can-do 10. American Cancer Society. Can I Get Another Cancer After Having Non-Hodgkin Lymphoma? Available at: https://www.cancer.org/cancer/non-hodgkin-lymphoma/after-treatment/second-cancers.html 11. American Cancer Society. Lifestyle Changes After Treatment for Non-Hodgkin Lymphoma. Available at: https://www.cancer.org/cancer/non-hodgkin-lymphoma/after-treatment/lifestyle-changes.html 12. Macmillan cancer support. What might happen. Available at: http://www.macmillan.org.uk/information-and-support/lymphoma/lymphoma-non-hodgkin/coping/changes-to-appearance-and-body-image/changes-during-treatment/what-might-happen.html Celltrion Healthcare Co., Ltd. 2017 HCTRU-00 PB-0317/01