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Lymphoma

• Signs and Symptoms
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis/Possible Complications
• Following Up
• Supporting Research

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 into 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 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 a fairly 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
• Tiredness
• Unexplained weight loss
• Itchy skin

Cutaneous T-Cell:

• Itchiness
• 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 for developing lymphoma, by type:

Non-Hodgkin's:

• 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

Hodgkin's:

• Viruses: EBV, mononucleosis, HIV
• Tonsillectomy
• Genetic predisposition
• Caucasians more likely than African-Americans
• Men more likely than women
• Same-sex siblings: 10 times greater risk

Cutaneous T-Cell:

• Human T-cell leukemia virus type 1
• Exposure to certain chemicals or solvents

What to Expect at Your Provider's Office

If you are experiencing symptoms of lymphoma, you should see your health care provider. 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, a biopsy will be performed. 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, CT scans, and, possibly, a laparotomy, in which the doctor cuts into the abdomen and checks the organs for cancer.

Treatment Options

Treatment Plan

A treatment plan will be based on the diagnosis, the stage of the disease, the size of the tumor, and your general health and age.

Drug Therapies

Your provider may prescribe the following drug therapies:

Hodgkin's and Non-Hodgkin's:

• Radiation therapy
• Chemotherapy, possibly with alpha interferon

Cutaneous T-Cell:

• Emollients, moisturizers, topical steroids
• Chemotherapy
• Electron beam therapy
• Retinoids and interferon

Surgical and Other Procedures

Bone marrow transplantation and peripheral blood stem cell transplantation are sometimes performed. Radioimmunotherapy, which is treatment with a radioactive substance that is linked to an antibody that will attach to the tumor when injected into the body, is being tested in clinical trials. Surgical removal of the tumor may also be performed.

Complementary and Alternative Therapies

A comprehensive treatment plan for lymphoma may include a range of complementary and alternative therapies. Be sure to ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care providers of the supplements you are taking.

Improved relaxation and decreased stress, through such activities 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

Following these nutritional tips may help reduce symptoms:

• 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 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).
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy cooking oils, 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, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc, and selenium.
• Probiotic supplement (containing Lactobacillus acidophilus) , 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your acidophilus products.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbsp.oil two to three times daily, to help decrease inflammation. Cold-water fish, such as salmon or halibut, are good sources.
• Vitamin C, 500 - 1,000 mg two to three times daily, as an antioxidant.
• L-theanine, 200 mg one to three times daily, for nervous system support.
• Melatonin, 2 - 5 mg before bed, when needed for sleep. Some alternative health care providers will use higher dosages.

Herbs

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer).

• Green tea ( Camellia sinensis ) standardized extract, 250 - 500 mg daily, for antioxidant, anticancer and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Reishi mushroom ( Ganoderma lucidum ) standardized extract, 150 - 300 mg two to three times daily, for anticancer and immune effects. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
• Olive leaf ( Olea europaea ) standardized extract, 250 - 500 mg one to three times daily, for anticancer and immune effects.
• Milk thistle ( Silybum marianum ) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
• Fermented wheat germ extract, one packet dissolved in favorite beverage once daily, for anticancer and immune effects.

Homeopathy

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 three to five pellets of 12X to 30C every 1 - 4 hours until symptoms are relieved.

Physical Medicine

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

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 drugs or treatments is unlikely.

Prognosis/Possible Complications

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.

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

Following Up

Once you are in remission, it is essential that you be checked for signs of relapse on a regular basis.

Supporting Research

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Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine . 20 ^th ed. Philadelphia, PA: W.B. Saunders; 1996.

Cheng TO. Can green tea protect against not only sunburn but also melanoma? Chin Med J (Engl). 2006;119(12):1056.

Dambro MR. Griffith's 5-Minute Clinical Consult . 1999 ed. Baltimore, MD: Lippincott Williams & Wilkins, Inc.; 1999.

Das M, Sur P, Gomes A, Vedasiromoni JR, Ganguly DK. Inhibition of tumor growth and inflammation by consumption of tea. Phytother Res . 2002;16 Suppl 1:S40-4.

DeVita VT, ed. Cancer: Principles and Practice of Oncology . 5 ^th ed. Philadelphia, PA: Lippincott-Raven Publishers; 1997.

Eschenauer G, Sweet BV. Pharmacology and therapeutic uses of theanine. Am J Health Syst Pharm . 2006;63(1):26, 28-30.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine . 14 ^th ed. New York, NY: McGraw-Hill; 1998.

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• Review Date: 8/6/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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