Non-hodgkin's Lymphoma

INTRODUCTION

Non-Hodgkin’s lymphoma (NHL) is one of the two most common types of lymphoma. It affects the immune system, and it starts with the proliferation of white blood cells in the immune system by mutating. However, the exact cause is unknown. 

What Is the Lymphatic System? 

The lymphatic system or lymph system is an essential part of our immune system. It is a network of tubes and tissues that runs throughout the body. Working similarly to blood, it has an extensive network of vessels that run through nearly all of our tissues to allow the movement of lymph fluid. It maintains fluid balance in the body. It plays a role in absorbing fats and fat-soluble nutrients. And it also protects the body from disease by removing germs (bacteria, viruses, and parasites) toxins.  

The lymphatic system contains lymph that carries white blood cells called lymphocytes.  

These lymph types consist of:  

• B cells that produce antibodies that fight bacteria and other infections. 
• T cells that destroy viruses and foreign cells and trigger B cells to produce antibodies.  
• Natural killer (NK) cells destroy specific invaders such as viruses, virus-infected cells, and cancer cells. 

About Non-Hodgking’s Lymphoma 

Non-Hodgking’s lymphoma is much more common than the other types. It can include many different types of lymphoma that all share some of the same characteristics. Generally, it develops in lymph nodes, stomach, small intestine, bone marrow, lymph tissue, lymph nodes, and skin. Lymphoma cells can be seen in all body parts or a single area. 

NHL occurs when mature B, T, and NK lymph cells in the lymphatic system mutate and grow uncontrollably. However, the most common type of NHL is B-cell lymphoma. If NHL is not treated, cancerous cells replace normal white cells, and the immune system cannot provide adequate protection against infection. 

There are many different subtypes of NHL, either indolent (slow-growing) or aggressive (fast-growing). Two of the most frequently asked questions regarding lymphoma are “Is lymphoma a type of blood cancer?” and “Is lymphoma contagious?”. Lymphoma is a type of blood cancer and is not contagious. NHL is primarily seen in people aged 60-74 years. 

The signs and symptoms of non-Hodgking’s lymphoma can be listed as follows; 

• Painless swelling of lymph nodes in neck, armpits, or groin 
• Persistent fatigue 
• Fever 
• Night sweats 
• Shortness of breath 
• Unexplained weight loss 
• Itchy skin or debris 

Although most people diagnosed with NHL do not have obvious risk factors, some factors that can increase the risk of NHL include: 

• Use of drugs that suppress your immune system. 
• Infections from certain viruses and bacteria. 
• Chemicals. 
• Older age. 

Types of Lymphoma 

There are over 60 different types of lymphoma, which are sorted into groups or sub-types. The most common types are listed as follows: 

• Lymphoma in children and young people: Some types of lymphoma are more common in children and young people than in adults, and they can be treated differently. 
• Hodgking’s lymphoma (HL): Hodgking’s lymphoma (Hodgkin’s disease) is a cancer that starts in white blood cells called lymphocytes. Lymphocytes are part of the body’s immune system. 
• Non-Hodgkin’s lymphoma: Non-Hodgkin’s lymphoma (sometimes called NHL, or just lymphoma) is cancer that starts in cells called lymphocytes, part of the body’s immune system.  
• Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL): CLL and SLL are different forms of the same disease and are often classified as types of B-cell non-Hodgkin’s lymphoma. They are treated in the same way.  

• Skin lymphoma: Lymphoma only in the skin is not treated the same as lymphoma that affects the whole body. Are lymphomas that start in the skin are called skin lymphomas (or cutaneous lymphomas). 
• Central nervous system lymphoma (CNS): This type of lymphoma affects the central nervous system (brain, spinal cord, and eyes). 

Differences and Similarities Between Hodgkin’s & Non-Hodgkin’s Lymphoma 

• Both types of lymphoma are cancers that begin in a subset of white blood cells called lymphocytes. 
• Both have similar symptoms. 
• Non-Hodgkin’s lymphoma is more common than Hodgkin’s lymphoma.  
• The main difference between HL and NHL is in the specific lymphocytes each contains. If there are Reed-Sternberg cells in the cells examined under the microscope, it is classified as HL, and if there is no Reed-Sternberg cell, it is classified as NHL. 
• HL can be seen in the 40s and NHL over 55. 
• Non-Hodgkin’s lymphoma may arise in lymph nodes anywhere in the body, whereas Hodgkin’s lymphoma typically begins in the upper body, such as the neck, chest, or armpits. 

Sources: 

Cancer.org

Lls.org

Lymphoma-action.org.uk

Cancer.net

Moffitt.org

SYMPTOMS AND SIGNS OF NON-HODGKIN’S LYMPHOMA

The signs and symptoms for non-Hodgkin’s lymphoma (NHL) vary based on the type and location of the disease. Most of the symptoms associated with NHL can be caused by other conditions, such as influenza, mononucleosis, or infection as well, so the fact that you present them does not necessarily mean that you have lymphoma. But if the symptoms do not go away and instead make you feel more uncomfortable day by day, you should see a doctor. 

Here are the common symptoms: 

• Swollen lymph nodes: Lymphoma can start anywhere in the body if there is lymph tissue. This means that you might feel swollen tissue on the surface areas of the groin, neck, underarms, or you might have discomfort in your internal organs such as the spleen and liver. The swelling is usually painless, so it is easy to ignore. However, persistent swellings should be taken seriously, and medically investigated by a doctor. 
• Frequent infections: The low blood cell count may cause your immune system not to work properly, and you might find yourself having infections more frequently or longer than usual. If you experience these symptoms, you are advised to see a doctor rather than self-diagnosing. 

• Coughing or shortness of breath: Although the cause of these problems might be something else, such as asthma, a chest infection, panic attack, smoking, being overweight or any other lung-related disease, it might also be a sign of lymphoma in the chest. When the lymphoma is in the lymph nodes in the chest or the thymus, it may cause pressure on the windpipe (trachea), leading to chest pain or pressure as well as shortness of breath or coughing. The swelling in lymph nodes here may cause pressure on the large vein carrying blood from head to arms back to the heart (superior vena cava or SVC) and block the veins. The blocking should be taken seriously as it might have a chain result on the brain causing change in consciousness as well as breathing problems, or coughs.  
• Continuous fatigue: Although the fatigue might be a different cause, it might also be a sign of lymphoma. The biological cause of it might be the low red blood cell count or anemia. People with lymphoma often describe their physical state as exhausted, weak, or constantly tired. Fatigue is extreme tiredness even after a decent rest, or sleep. If you observe yourself needing more energy doing your routine tasks, not feeling energetic after a good rest, sleeping more than usual, or being confused, you are advised to see a medical professional. Mental fatigue, such as having difficulty focusing on your thoughts, or even talking might be a symptom of lymphoma in the brain, so you should visit your doctor immediately.  
• Continuous itches: The itches and lumps (red to purple) might be symptoms of lymphoma in the skin. The lumps are easy to see or feel. There might be many other reasons such as high alcohol consumption for the itching. But the itches related to lymphoma are considered to be caused by the body’s reaction to the chemicals the patient’s immune system produces in reaction to the disease. So, to clearly identify the reason you have persistent itches, you are advised to see a doctor. 
• Bruises and bleedings: The low platelet counts might cause the patient to get easily bruised or bleed. Platelets are the cells that circulate in the blood, and when the blood vessels are damaged, they bind together and form a blood clot to prevent bleeding. The bleeding might take place in the gums, nose, or gastrointestinal (GI) tract. The reason for low platelets might be something else such as a hereditary condition, high alcohol consumption, medication, or kidney-related problems. 
• Chills: Seen after a heavy night sweat or because of an infection, chills might be a symptom of non-Hodgkin’s lymphoma. 

People with non-Hodgkin’s lymphoma might also present symptoms called B symptoms, including: 

• Unintentional weight loss: Losing weight even though you do not change your daily level of activity and diet is called unintentional weight loss. If you have unintentionally lost more than 10 percent of your body weight over 6 months, you should consider seeing a doctor.  

The root cause of weight loss might be classified into 3 categories: mental health conditions, digestion-related problems, and other physical health problems. Mental health-related problems can be listed as eating disorders, depression, and anxiety. Reducing or taking control of stress might be a good start to overcome if the problem is related to mental health. Problems such as coeliac disease and irritable bowel syndrome are categorized as digestion-related problems. The third category includes a wider range of physical problems varying from thyroid irregularity, heart problems, diabetes, and an enlarged spleen. The patient might be feeling full even after eating a small portion of food. It might be a sign of lymphoma in the abdomen. If the abdominal pain is accompanied by vomiting and nausea, it might be a sign of lymphoma in the stomach or intestines. Since it is not possible to identify the right cause of unintentional weight loss, lack of appetite, or swelling in the abdomen, people experiencing it are advised to have themselves checked by a medical professional. 

• Night sweats: Apart from other causes such as alcohol or drug use, medication, anxiety, or low blood sugar night sweats might indicate the presence of lymphoma. The patients usually describe the level of sweating they experience as soaking wet or needing to change the sheets and night clothes. The reason for intense sweating might be the fever during sleep. If you regularly wake up sweating, losing weight simultaneously and having fever and/or chills, please see a doctor immediately. 
• Fever without infection: Fever is the body’s reaction to infections. So, if you experience a fever that comes and goes for two or more weeks without any apparent infection, it might be a symptom of non-Hodgkin’s lymphoma. 

Sources: 

cancer.org 

nhs.uk 

hopkinsmedicine.org 

lymphoma-action.org.uk 

NON-HODGKIN’S LYMPHOMA STATISTICS

Non-Hodgkin’s lymphoma (NHL) is one of the most frequent cancers in the US, accounting for approximately 4 percent of all cancers. The following are the projections for non-Hodgkin’s lymphoma in 2022: 

• NHL will be diagnosed in around 80,470 people (44,120 men and 36,350 women). Adults and children are also included. 
• This cancer will kill approximately 20,250 people (11,700 males and 8,550 females). 

Overall, a man’s lifetime risk of developing NHL is about 1 in 42, while a woman’s risk is about 1 in 52. However, a variety of risk factors can influence everyone’s risk. NHL may strike at any age. It is, in fact, one of the most frequent cancers among children, adolescents, and young people.  

Still, the risk of developing NHL increases throughout life, and more than half of patients are 65 or older at the time of diagnosis. The aging of the American population is likely to lead to an increase in NHL cases during the coming years. 

Non-Hodgkin’s Lymphoma in Numbers 

It is estimated that 20,720 deaths (12,170 men and 8,550 women) from this disease will occur this year. It is the ninth leading cause of death from cancer in both men and women. Thanks to the advancements in treatment, the survival rate has been improving since 1997. From 2009 through 2018, the death rate fell by 2 percent every year. 

The 5-year survival rate indicates the percentage of people who live for at least 5 years after being diagnosed with cancer. Percentage denotes how many out of a total of 100. The overall 5-year survival rate for NHL patients is 73 percent. 

For stage I NHL, the 5-year survival rate is more than 83 percent. For stage II the 5-year survival rate is close to 76 percent and for stage III it is more than 70 percent. For stage IV NHL, the 5-year survival rate is around 63 percent. These survival rates vary depending on the cancer’s stage and subtype. 

The rate of new cases of non-Hodgkin’s lymphoma was 19.6 per 100,000 men and women per year. The death rate was 5.3 per 100,000 men and women per year. These rates are age-adjusted and based on 2014–2018 cases and 2015–2019 deaths. 

Approximately 2.1 percent of men and women will be diagnosed with non-Hodgkin’s lymphoma at some point during their lifetime. 

It is important to remember that statistics on NHL survival rates are only estimates. The estimate is based on annual data on the number of people diagnosed with this cancer in the United States. Experts also assess survival rates every five years. As a result, the estimate may not reflect the results of improved diagnosis or therapy accessible in fewer than 5 years. 

Sources:  

https://www.cancer.org. 

https://seer.cancer.gov 

NON-HODGKIN’S LYMPHOMA TREATMENT OPTIONS

Lymphoma is a type of blood cancer that forms from malignant cells in the lymphatic system, which is a part of the immune system and helps the body fight diseases and infection. Non-Hodgkin’s Lymphoma (NHL) consists of 85 percent of all lymphoma cases. The remaining lymphomas are considered Hodgkin’s lymphoma, which has a slightly more favorable prognosis than other lymphomas. There are many different NHL treatment options available due to the numerous subtypes, and is one of the most common cancer types. These treatment options include: 

• Surgery 
• Watchful waiting 
• Chemotherapy
• Radiation therapy 
• Immunotherapy 
• Targeted therapy 
• Stem cell transplant 

Non-Hodgkin’s Lymphoma surgery options are typically only available to patients who are diagnosed in the early stages of disease when the cancer has not spread beyond the original tumor site. The tumor is either removed during a local excision or a splenectomy for patients with marginal zone lymphoma of the spleen. 

Watchful Waiting or Active Surveillance 

When a patient receives a Non-Hodgkin’s Lymphoma diagnosis, they may or may not have symptoms. Some treatments have harmful side effects, meaning they would cause more harm than good in a patient in the early stages of lymphoma. Watchful waiting, also known as active surveillance, is when doctors monitor a patient’s condition until signs or symptoms appear or get worse before starting treatment. This is common in patients with an indolent type of lymphoma or cancer diagnosed in the  early stages. 

Chemotherapy 

Chemotherapy is one of the most used treatment options for all cancer types. Chemotherapy drugs kill cancer cells or prevent cancer cell division and can either be injected or taken orally. Chemotherapy drugs are often combined with other treatments in cancers, including lymphoma, which is called combination chemotherapy. Chemotherapy in lymphoma is also systemic, meaning it enters the bloodstream to reach cancer cells throughout the entire body, opposed to intrathecal chemotherapy, which only affects cancer cells near the injection site. For most subtypes, stages, aggressive, and indolent types of lymphoma, chemotherapy is almost always used or combined with another treatment. 

Radiation Therapy 

Radiation treatment for Non-Hodgkin’s Lymphoma uses high-energy x-rays or other types of radiation to kill cancer cells by keeping them from growing. There are several types of radiation that can be used in lymphoma. External radiation therapy uses a machine to send radiation near the tumor site from outside the body. This method of radiation therapy is often used in adults with NHL or as palliative care to relieve symptoms in patients. 

Proton beam radiation therapy uses streams of protons, which are particles with a positive charge, to kill tumor cells. The advantage of this method is the radiation damage is typically less to organs such as the heart or breast than other methods of radiation therapy. 

Immunotherapy  

Immunotherapies boost the patient’s natural immune system to fight cancer. Substances from a laboratory or naturally made in the body are injected to enhance the body’s defenses. The two most common types of immunotherapies for NHL are: 

• CAR T-cell Therapy: The patient’s T-cells are collected from the blood and are then altered using special receptors. Once injected back into the patient, these T-cells will attack proteins on the surface of cancer cells. 

• Immunomodulatory drugs: These drugs stimulate the immune system to fight diseases such as cancer. Lenalidomide is a common immunomodulator for lymphoma that helps the immune system kill abnormal blood cells and cancer cells.  

Targeted Therapy 

Targeted therapies in cancer treatment use drugs or other substances to identify and kill cancer cells. These therapies often cause less harmful side effects to healthy cells than chemotherapy and radiation therapy. 

There are several different types of targeted therapies being developed in clinical trials that patients can access. The types of targeted therapies are listed below: 

• Monoclonal Antibodies: Proteins in the immune system that are artificially made in a laboratory to treat diseases including cancer. The monoclonal antibody binds to specific alterations in cancer cells and attacks the cell. These antibodies are injected into patients and can be used to carry other toxins, drugs, or radioactive materials to the cancer cells. Common monoclonal antibodies used in lymphoma treatment are Rituximab, Obinutuzumab, and Tafasitamab. 

• Kinase inhibitors: These drugs prevent proteins in cancer cells from growing to kill them. Common kinase inhibitors used in lymphoma treatment are Copanlisib, Idelalisib, Ibrutinib, and Acalabrutinib. 
• EZH2 inhibitor: Tazemetostat is used in recurrent NHL patients who test positive for the EZH2 gene present in their cancer cells. This drug blocks enzymes involved in gene expression and cell division to prevent cancer cells from growing. 
• BCL2 inhibitor: In patients with mantle cell lymphoma, Venetoclax blocks the BCL-2 protein from performing vital cell functions leading to the cancer cells dying. 

Bone Marrow Stem Cell Transplantation 

In stage 4 or metastatic non-Hodgkin’s lymphoma, treatment may include a bone marrow transplant, also known as a stem cell transplantation. Bone marrow transplant involves specialized cells called hematopoietic stem cells added to bone marrow or peripheral blood cells, then injected into the patient. 

This treatment presents more risks than other standard treatments such as chemotherapy or radiation therapy. Before moving forward with a bone marrow transplant several factors, such as the patient’s age, overall health, and previous treatments are considered. There are two main types of bone marrow transplants: 

• Allogenic (ALLO) stem cell transplantation: Stem cells are donated from a healthy individual such as a family member or an unrelated donor who matches. Graft versus lymphoma allows the donor cells to identify and target the lymphoma cells. This is often combined with chemotherapy, radiation therapy, or immunotherapy. 
• Autologous (AUTO) stem cell transplantation: The patient’s stem cells are collected, then a combination of chemotherapy, radiation therapy, or immunotherapy is used to destroy all of the cancer cells in the blood and bone marrow. The stem cells are then injected back into the patient to regenerate the bone marrow and healthy blood cell production. 

Clinical Trials  

Lymphoma clinical trials test the latest scientific advancements in cancer treatment for lymphoma and other cancers. Patients who choose to enroll in trials can receive cutting-edge treatment and high-quality care under the direction of scientists, doctors, and researchers. Cancer patients might gain access to promising drugs and innovative treatments long before they’re made available to the public.   

Massive Bio specializes in finding advanced clinical treatments for every lymphoma type. If you’ve been diagnosed with any lymphoma subtypes, we’re here to help. If you don’t know which type of lymphoma you have, that’s okay. Additional testing can help you determine your exact diagnosis. 

Sources: 

https://www.cancer.gov 

https://www.cancer.net 

LIVING AND MANAGING NON-HODGKIN’S LYMPHOMA

Being diagnosed with any type of cancer is a stressful situation on its own. The patients might find themselves under the pressure of keeping up with the new medical terms they are hearing and lost while trying to find the best treatment option. To manage the changes in your life, one of the most effective solutions is to create a support system and delegate some of the responsibilities. 

Based on the stage of your disease the treatment options and their success rate change. The overall five-year survival rate of non-Hodgkin’s lymphoma (NHL) is 73 percent. Depending on the type and stage of your cancer as well as conditions such as age, physical wellbeing, this rate might go up or down. The cancer might be completely treated, but you might still have concerns about having it back, which is called recurrence. Know that you are not alone, many cancer survivors share the same feelings. How they manage it is paying attention to their doctor’s appointments, keeping a close eye on their changing values, and making lifestyle adjustments to prevent a recurrence. 

The other scenario is not having a fully successful treatment and trying to live a life with cancer. Again, many patients go through this. They keep having regular treatments, going under procedures, and taking medications. Managing the side effects of ongoing NHL treatment can be stressful as any type of cancer. Developing a close relationship with your medical team, having examined, and discussing the side effects might help you overcome or manage those life-changing effects with their help. 

What is Normal During and After Treatment? 

The definition of normal changes for each person physically, environmentally, and mentally. Each patient has a particular case defined by their specifics, so your normal might not be the same as someone else’s. Just like your normal was different from others even before diagnosis. 

Starting from the diagnosis, a medical team is added to the group of people surrounding you. You develop a close relationship with the team and get used to seeing them regularly. Not having them around after the treatment might create a sense of emptiness and their absence might feel like you are out of your comfort zone, cemented by the presence of professionals. This is normal for many patients. Remember that the medical team is still there to support you. 

Even when your treatment was successful and you are cancer-free, the medical team treating you will want to be in contact and want you regularly check you to see if the results are in line with their plans, and to be alert when there is a possibility of recurrence. When you go on an appointment, feel free to discuss any mental, emotional, and physical changes so that they can detect any important developments as soon as possible. You can also ask your doctor about the schedule of upcoming appointments, what kind of side effects or changes they consider normal or acceptable and so on, so that you can have a general idea of what you will go through. 

When your doctor asks questions about your life after treatment, any side effects, orders some blood tests or scans, you might develop concerns about having the cancer back. The reason your doctor requests these regular visits and tests, or questions your condition is to make sure they have your situation under control. Different therapies such as radiation and chemotherapy, targeted therapy or immunotherapy create different side effects, and the side effects might go on for different periods of time. Sometimes, the medications patients use for treating a disease might cause other diseases or complications. That is why keeping up with your scheduled appointments and cooperating with your doctor is essential. 

Coping with Physical Side Effects 

Knowing the outcome of a successful treatment can motivate you. And having an idea about the side effects might help you feel control over the course of treatment. But knowing what waits ahead is not the same as experiencing them. Therapies such as chemotherapy and radiotherapy might come with possible side effects such as, 

• Fatigue: You might feel less energetic and unwilling to be active, which will lead to burning less calories. Practicing soft exercises such as yoga, having massages and following a diet might help. 
• Lost appetite: Losing the sense of taste or appetite, or mouth and throat problems are common side effects. Having high-calorie snacks instead of large meals, creating moments, such as setting up a table, eating your favorite food more than once during the day might help you reconnect with your appetite. 
• Nausea and vomiting: This might lead to loss of appetite, create distance even with your favorite food, and thus weight loss. That is why patients experiencing nausea are advised to avoid eating their favorite foods, to prevent a negative association with food in general. Instead, eat food that is easily digested, such as yogurt, boiled potatoes, and rice. Avoiding strong smells and warm foods might also help. Ginger and peppermint are known to treat nausea as well. 
• Diarrhea: The loss of bodily fluids and dehydration. Patients experiencing diarrhea are encouraged to drink more water when they can and rest when possible. They are advised to avoid fruit juice and fizzy drinks. 
• Constipation: This might lead you to avoid eating as much as you should, which inevitably leads to feeling less energetic. To overcome constipation, patients are advised to eat more fibers, raw fruits and vegetables, and drink more fluids. If you can find the energy, being physically active also helps. 
• Having infections more frequently: The weakened immune system might create vulnerability to infections. Washing your hands more frequently, avoiding handshakes and hugs, crowded places, and eating freshly cooked foods rather than raw foods might help you face less infections. 
• Bleeding and bruising more easily: Chemotherapy can lower the number of platelets, which help blood clotting and recover bruises. Avoiding certain medicines that thin the blood if possible and being extra careful not to cause bleeding and bruises will help. 
• Hair loss: One of the most common side effects of chemotherapy is hair loss, usually all over the body. Washing your hair less often and with baby shampoo or less chemical-containing products, combing your hair gently, having a short haircut or wearing a cold cap (a hat used during chemotherapy to cool and slow down blood flow, and reduce the amount of chemotherapy drugs reaching the area) might help prevent hair loss. 
• Breathlessness
  

Even when your treatment was successful and you are cancer-free, the medical team treating you will want to be in contact and want you regularly check you to see if the results are in line with their plans, monitor and control the side effects, and to be alert when there is a possibility of recurrence. When you go on an appointment, feel free to discuss any mental, emotional, and physical changes so that they can detect any important developments as soon as possible. You can also ask your doctor about the schedule of upcoming appointments, what kind of side effects or changes they consider normal or acceptable and so on, so that you can have a general idea of what you will go through. 

Coping with Sexual Side Effects 

You might start experiencing some side effects concerning your sex life due to some physical and psychological changes. 

The physical side effects such as nausea or vomiting, fatigue, pain, and problems such as discomfort during intercourse, dysfunctions such as erection or premature ejaculation, vaginal dryness might create a distance towards sex, or prevent you from enjoying it.  

• Fertility: Some drugs used in treating NHL might cause infertility. Some of them are known to cause temporary, and some to permanent fertility, depending on the type and dose of the drugs and your age if you are a female patient. The closer a female patient to the menopause the more likely they will become infertile after treatment. For male patients, the sperm production may lower or completely stop after treatment depending on the dose and type of drugs used. 
• Early menopause: The chemotherapy might lead to the female patient’s periods to stop, meaning an early menopause. This comes with other side effects such as mood swings, feeling low or unable to concentrate, vaginal dryness, hot flushes and sweats, loss of energy and loss of interest in sex. Hormone replacement therapy is a common way to reduce the symptoms of early menopause. 
• Getting or maintaining erection: Chemotherapy might lower your testosterone and cause an erectile dysfunction. The same goes for radiotherapy targeting the pelvic are of male patients. 
• Difficulty reaching an orgasm: Both female and male patients might experience this side effect, not directly related to the treatment but rather to the physical and psychological changes. 
• Sexual pain: Female patients experience vaginal pain where male patients experience penile pain during sex. This might be caused by dryness due to hormonal changes for females, or swellings, inflammations for males. 

Your idea about your physical appearance (body image), sex appeal, sex drive, self-confidence, and even your connection with sex might diminish during and after cancer treatment. The physical changes you go through such as hair loss, weight gain or scars might lead to a disconnect with your body where you feel unattractive or embarrassed. Even the uncertainty you are facing, or the financial aspect of the treatment might put pressure on you and decrease your interest in sex.  

All these, along with the treatment might make you feel depressed or insecure about your sex life. To cope with the sexual side effects of cancer treatment, being prepared for them is a start. Communication among partners as well as your medical team will also be productive. Having your partner present at the doctor’s visit and letting them ask their questions and hear answers from a professional will help. If you are hospitalized, requesting time of privacy to spend time with your partner might also help. Although some might be long-lasting, most of the sexual side effects usually go away. Remember that you can always talk to your medical team in confidentiality as well as psychologists or sex counselors.  

Coping with Emotional and Social Side Effects 

Your relationship with your family and loved ones might have shifted during the treatment. Your health might have been the center of focus for a while. The people who took over the caregiver role might find it hard to adapt to your post-treatment life as well. Although being taken care of gives the patients a sense of safety and confidence, they might not want to be treated as a patient anymore. Or the caregiver/s might want to let go of some of the tasks they overtook but do not know how to put it properly without hurting the patient’s feelings. Keep in mind that open communication will be your best friend to rearrange your relationship with them and to set the ground rules for your new normal. Your feelings about your body, identity, status, roles, or your perspective on certain matters might have been changed. Take your time to identify these according to your new normal. Ups and downs are natural. You are not supposed to feel positive or negative about anything. Be honest to yourself as well as to your loved ones, face your feelings, hear theirs, and be unreserved. Tell them what you are going through, how strong or weak you feel, what you plan or avoid, or what you expect from them so that everyone understands each other. 

Although you receive treatment and know that cancer has left your body, you might have anxiety about having it back. This might put you in an alert state, where you find yourself looking for possible signs and symptoms of cancer constantly. This is where you need to manage the uncertainty. Reminding yourself that you do not have control over cancer, realizing the fears you have and not ignoring them, talking to a professional or a family member and/or a friend, learning to focus on the present and the things you have control over, finding ways to relax and including them in your daily life, learning more about your disease and developing a sense of control might help you cope with uncertainty. 

Coping with the Cost of Cancer Care 

One of the concerns patients have about cancer and treatment is the financial aspect of the process. Whether you are or not the provider of the house, have a backup plan, solid insurance, the cost is a big issue. That is why patients are encouraged to ask for the cost of treatment on each step of the treatment so that they know what to expect and create budgetary solutions. They should be making copies of the expenses, neatly filing them, and having a clear idea about their actual cost. Close communication with the insurance agencies, adjusting and/or looking for suitable plans are also important. Another solution to ease or help overcome the financial side effects of cancer care is learning about the institutions that are specifically founded for this very reason: helping cancer patients. These institutions include non-profit organizations, philanthropic organizations, and disease-specific societies designed to help people manage their cost of care. 

Caring for a Loved One with Cancer 

Assuming the role of a caregiver comes with several serious responsibilities and changes in lifestyle. It imposes an emotional, physical, financial and social burden to the caregiver, which might lead to various complications. 

Caregiver burnout. The caregivers might feel unable to help, and later go full speed on support mode, where they end up drained. They might experience fatigue, hardship to fall asleep or loss of appetite. They might also experience a shift in their emotions towards helplessness, sadness, anxiousness, guilt, anger and frustration. And when they build up, they lead to a burn out, which sometimes manifests as illness, depression, intense anxiety, irritability, resentment, or social withdrawal. 

Just like a cancer patient’s, caregiver’s challenges are important and should be addressed. Here are some tips for people to manage their new life as a caregiver: 

• Equipping yourself with knowledge. Having an extensive knowledge about your loved one’s disease, type, stage, treatment option will help you understand the situation and keep track of the information flow you get from the medical team. As you gain experience in this field, you will feel more comfortable and in control aiding to choose the best treatment options as well as the support you provide. It will also help you better monitor the physical or emotional changes, symptoms your loved one experiences, and explain them in a clear way to the medical team. 
• Being organized. As a caregiver, you will also have to schedule appointments, reservations, drives, or fights, keep track of the bills, manage budget and time. To prevent you from getting lost, being organized will help you get a clear picture of needs and musts as well as how to plan. Daily responsibilities, questions for doctors or the patient’s changes, prioritized tasks are better tracked when written down in an agenda. Having a neat filing system of the insurance documents, medical records, and contact information with soft copies will prove useful when needed. 
• Showing your support. You are there for your loved one. You know that. But sometimes, it might be hard for people to express their feelings. Especially when the other party is in pain or in a bad mood. That is why showing support might mean being there and not being there sometimes. Accept that they are doing everything they can but still have bad days and giving them some space is the best way to handle those times. Saying “I’ll be still here when you feel like it” might be the thing they need to hear, to help them feel in control of their emotions and individuality. Supporting them sometimes includes not treating a patient like a patient time to time, meaning creating moments when they can remind there is a version of them that is not ill. 
• Taking time from cancer. Neglecting yourself will steal from the quality of care you provide. That is why you should include a time for yourself in the agenda as well. This might be spending time with your friends and family, or just relaxing on your own. It also includes taking care of your own health and wellbeing, such as being in control of your diet, exercising, practicing your hobbies, or seeing a doctor for your troubles. To overcome isolation and loneliness, socializing is advised to caregivers. Finding a support group might help to fight the loneliness and helplessness. 
• Learning you also need help. There is a limit to what a caregiver can do. That is why learning to say yes to a help offer might lift off some of the stress you experience. Delegating work at home, asking for help with appointments, getting assistance from the social workers are options for you. 

Sources: 

cancer.org 

cancer.net 

hopkinsmedicine.org 

nhs.uk 

cancerresearch.uk 

columbiasurgery.org 

lls.org 

cancercenter.com 

NON-HODGKIN’S LYMPHOMA DIAGNOSIS

There are many tests used for diagnosing Non-Hodgkin’s Lymphoma (NHL). Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test: 

• The type of lymphoma suspected 
• Your signs and symptoms 
• Your age and general health 
• The results of earlier medical tests 

To determine if a person has NHL, the doctor will first acquire a complete medical history. They will also do a physical examination, paying special attention to the lymph nodes, liver, and spleen. The doctor will also look for signs of infection that may cause the lymph nodes to swell and may prescribe an antibiotic. If the swelling in the lymph nodes still does not go down after antibiotic treatment, the swelling may be caused by something other than an infection. If the doctor suspects lymphoma, they will recommend a biopsy, as well as laboratory and imaging tests. 

In addition to a physical examination, the following tests may be used to diagnose and stage NHL: 

Biopsy 

A biopsy is the removal of a small sample of tissue for examination under a microscope. Other tests can indicate the presence of cancer, but only a biopsy can confirm the diagnosis and determine the subtype. A core biopsy needle or surgery can be used to remove this tissue. Tissue is frequently collected from lymph nodes in the neck, under the arm, or in the groin to diagnose lymphoma. Biopsies can also be collected with a thin needle from the chest or abdomen during a computed tomography (CT) or ultrasound, or from the stomach or intestine during an endoscopy. An endoscopy is a test that allows the doctor to see inside the body with a thin, lighted, flexible tube. A biopsy of the skin may also be needed depending on which subtype of lymphoma is suspected. 

In order to make a diagnosis, there must be enough tissue in the biopsy sample. Biopsies may be done by needle, such as a core biopsy or fine-needle aspiration, or by surgical biopsy. A pathologist or a hematopathologist experienced in identifying lymphoma then analyzes the materials.  

Computed tomography (CT or CAT) Scan 

A CT scan uses x-rays captured from various angles to create images of the inside of the body. A computer combines these images into a detailed, three-dimensional image that reveals any irregularities or tumors. A CT scan can be performed to determine the size of the tumor. Before the scan, a specific dye called a contrast medium is sometimes used to improve image detail. This dye can be injected directly into a patient’s vein, taken as a tablet or liquid, or both. CT scans are interpreted by a radiologist, a doctor specializing in performing imaging tests to diagnose disease. CT scans of the chest, abdomen, and pelvis can aid in the detection of cancer that has spread to the lungs, lymph nodes, spleen, and liver. 

Magnetic Resonance Imaging (MRI) 

Magnetic fields, not x-rays, are used in an MRI to provide detailed body images. A magnetic resonance imaging (MRI) scan can be used to determine the tumor’s size. Before the scan, a special dye called contrast medium is administered to provide a crisper image. The scan is then interpreted by a radiologist. 

Positron Emission Tomography or Pet-CT Scan 

A PET scan is frequently paired with a CT scan, referred to as a PET-CT scan. A PET scan is a technique for generating images of organs and tissues within the body. The patient is given a small amount of radioactive sugar material to inject into his or her body. The cells that use the most energy absorb this sugar molecule. Cancer absorbs more of the radioactive substance since it uses energy actively. The amount of radiation in the material, on the other hand, is far too low to be dangerous. The material is then detected by a scanner, which produces images of the inside of the body.  A doctor can use this technique to examine the tumor’s shape as well as how much energy the tumor and healthy tissues utilize. 

Bone Marrow Aspiration and Biopsy 

These two procedures to check the bone marrow are quite similar and are usually done at the same time. There is a solid and a liquid component to bone marrow. A needle is used to take a  fluid sample from the bone marrow. Then, a needle is used to remove a small core of solid tissue from the bone marrow. 

The material is subsequently examined by a pathologist or hematopathologist. The pelvic bone,  positioned in the lower back by the hip, is a common site for bone marrow aspiration and biopsy. To numb the area, doctors usually use a local anesthetic. 

Because lymphoma frequently affects the bone marrow, examining a sample of bone marrow can be helpful in diagnosing lymphoma and defining the stage. The doctor can also look for genetic alterations in the sample taken during aspiration. If a PET scan has been performed, these treatments may not be necessary for some kinds of lymphoma. 

Biomarker Testing  

Your doctor may suggest that laboratory tests be performed on a tumor and/or bone marrow sample to identify specific genes, proteins, and other disease-specific variables. This is often referred to as biomarker testing. The results of these tests can assist you in deciding on your treatment options. There are a variety of genetic tests available: 

• Cytogenetics detects cancer-specific changes in the number and/or structure of chromosomes. 
• Fluorescent in situ hybridization (FISH) uses fluorescent probes under a special microscope to find cancer-specific chromosome changes that cytogenetics may not see. 
• Flow cytometry looks at proteins that are on the surface of or inside a cancer cell. 
• Immunohistochemistry (IHC) is a special staining process to look at proteins on the surface of or inside the cancer cell. 
• Polymerase chain reaction (PCR)-based tests find cancer-specific DNA changes. 
• Molecular profiling/gene sequencing finds cancer-specific changes in the DNA sequence of genes in the cancer cells. Recent advances in sequencing technology, often called next-generation sequencing or NGS, allow testing of many genes from a single sample. 

Your doctor will discuss the results with you after the diagnostic tests are completed. If NHL is the diagnosis, this data also aids the doctor in determining the subtype and stage of the disease. 

Sources:  

https://www.cancer.net 

https://www.mayoclinic.org 

NON-HODGKIN’S LYMPHOMA STAGING

To stage non-Hodgkin’s lymphoma, doctors perform several tests to determine the extent of the disease. This helps determine the best option for treatment. The stages of lymphoma are based on the Lugano classification, which is defined as I, II, III, and IV: 

• Stage I Non-Hodgkin’s lymphoma: The cancer is either found in no more than 1 lymph node or lymphoid organ (thymus) or is only found in 1 organ outside the lymph system. 
• Stage II Non-Hodgkin’s lymphoma: The cancer is either found in 2 or more lymph nodes on 1 side of the diaphragm or extends locally to an organ. 
• Stage III Non-Hodgkin’s lymphoma: The cancer is found on both sides of the diaphragm and in the spleen. 

• Stage IV Non-Hodgkin’s lymphoma: The cancer has spread to a distant organ including the bone marrow, lungs, or liver. The stage 4 (metastatic) NHL, the 5-year survival rate is roughly 63 percent but varies depending on the subtype of disease. 

The final stage of non-Hodgkin’s lymphoma is considered stage IV. Despite many people assuming this is the NHL clinical trial stage, lymphoma clinical trials are available to patients of all stages. 

One of the main factors in determining the treatment options for lymphoma is the stage. However, in some aggressive subtypes of NHL, the stage is not as much a factor. Patients are considered early-stage non-Hodgkin’s lymphoma if the disease is “limited (I or II non-bulky). Lymphoma that reaches “advanced stages” (III or IV) is often given different treatment options than patients with limited disease.  

Other factors for NHL treatment include: 

• Patient’s age and overall health 
• Subtype of lymphoma 
• Present symptoms 
• Amount of lactase dehydrogenase (LDH) in the blood 
• Is the cancer recurrent or newly diagnosed? 
• What Biomarkers are present? 

International Prognostic Index 

The International Prognostic Index (IPI) is a score that helps doctors for prognosis in addition to stages. The IPI is used for lymphoma subtypes that are aggressive and are classified as low or high-risk. Factors that determine a patient’s IPI score are: 

• Older than 60 years of age 
• Lower ECOG performance score (How fit someone is to walk and take care of themselves) 
• Cancer has spread to 1 organ or structure outside the lymph node 
• Cancer is stage III or IV 
• Blood tests indicate high levels of lactate dehydrogenase (LDH), which is an enzyme found in the blood associated with lymphoma 

Bulky Disease 

Bulky disease is used to classify lymphomas that consist of 1 or more large tumors in the chest. These cases of lymphoma require more aggressive treatments than indolent lymphomas. For bulky disease, other prognostic factors are used in determining the right treatment option compared to other types of NHL. 

Progressive/refractory 

NHL that continues to progress or grow larger during treatment  is labeled as a progressive disease or refractory lymphoma. There are several drugs used specifically for refractory lymphomas such as Mogamulizumab, Tafasitamab, and Polatumab vedotin. 

Recurrent/relapsed 

After completing treatment and there is no sign of lymphoma in the body, the patients are in remission. If the lymphoma comes back, it is called recurrent lymphoma. In most cases, this occurs within a few years of being in remission but can also happen years later. Lymphoma can return to the original site or somewhere new, where further testing needs to be done to restage the disease. 

Signs and Symptoms of Non-Hodgkin’s Lymphoma 

In most cases, patients will have a painless lump around the armpit, groin, or neck. Non-Hodgkin’s lymphoma causes the lymph nodes to swell up and grow over time. 

In many patients, other non-Hodgkin’s lymphoma signs and symptoms include: 

• Night sweats 
• Persistent fatigue 
• Weight loss from loss of appetite 
• Itchy skin 
• On and off fever over several weeks 

In stage I, NHL symptoms may not be present at all. Some patients are diagnosed when in advanced stages due to a lack of signs and symptoms in early stages. The earlier patients are diagnosed, the higher the NHL curable rate will be. 

Sources: 

https://www.cancer.net 

https://www.cancer.org 

NON-HODGKIN’S LYMPHOMA SUB-TYPES

There are more than 60 different known sub-types of non-Hodgkin’s lymphoma. It is essential to know the sub-type, as it plays a significant role in determining the treatment of non-Hodgkin’s lymphoma.   

Sub-types of NHL  

Different types of NHL are often grouped based on how they develop (by lymphocyte cell types) or how they behave (growth rate). As a result of non-Hodgkin’s lymphoma screening studies, doctors divide NHL sub-types into two categories based on the disease’s progress rate: Aggressive (fast-growing) NHL and Indolent (slow-growing) NHL. 

Indolent (Slow-growing) NHL  

They grow and spread slowly. In cases where NHL is not widespread in the body, does not progress, or develops gradually, the patient’s condition is closely followed; however, drug therapy or radiotherapy is not administered. Treatment is started when signs of NHL present themselves. The most common sub-type of indolent NHL in the United States is follicular lymphoma (FL).  

Aggressive (fast-growing) NHL  

They grow and spread quickly and have signs and symptoms that can be severe. This category accounts for about 60 percent of all NHL cases. Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive NHL sub-type.   

The treatments for aggressive and indolent lymphomas are different. Regardless of how quickly they grow, all non-Hodgkin’s lymphomas can spread to other parts of the lymph system if not treated. Eventually, they can also reach other body parts, such as the brain, bone marrow, or liver.  

Cell-types of NHL  

Specialists further characterize the NHL sub-types according to cell type. The cell types of lymphoma are classified into three main groups:  

• B-cell lymphoma: B cells that fight bacteria and other infections help protect the body by producing proteins called antibodies. About 90 percent of lymphoma patients in Western countries have B-cell lymphoma.  
• T-cell lymphoma: T cells are several cell types that destroy viruses and foreign cells and trigger B cells to produce antibodies. Some T cells destroy pathogens or unusual cells in the body. Others help increase the activity of other immune system cells. About 10 percent of lymphoma patients have T-cell lymphoma. This type of lymphoma is more common in Asian countries.  
• NK-cell lymphoma: The natural killer destroys specific invaders such as NK cells, viruses, virus-infected cells, and some cancer cells. Less than 1 percent of lymphoma patients have NK cell lymphoma.  

Sub-types of B-cell Lymphoma   

Mature B-cell lymphomas (about 85-90 percent of NHL cases)   

Aggressive   

• Diffuse large B-cell lymphoma (DLBCL) (31 percent): DLBCL is the most common form of lymphoma. Recent research shows different types of DLBCL, including germinal centers and non-germinal centers.   
• Mantle cell lymphoma (MCL) (6 percent): Can present as aggressive or indolent. It most often appears in people older than 60 and is much more common in males than females. It usually involves the bone marrow, lymph nodes, spleen, and gastrointestinal system, including the esophagus, stomach, and intestines. If there are no symptoms in patients with a slow-growing form, a watchful waiting approach can be followed.   
• Lymphoblastic lymphoma (2 percent): In lymphoblastic lymphoma is very rare in adults, most commonly affecting under 35. It starts in the thymus and can grow very quickly. It may present symptoms with breathing difficulty, cough swelling of the head and neck, cause of tumor pressing on the windpipe or large veins above the heart.    
• Burkitt lymphoma (BL) (2 percent): There are three types of Burkitt; Endemic, Sporadic, Immunodeficiency-related lymphoma. The endemic sub-type occurs most commonly in Africa, appears most often in the jawbones of children, and is usually associated with infection with Epstein Barr Virus (EBV). It can also be associated with HIV. In the United States, Burkitt lymphoma sometimes appears with a mass in the abdomen, but it can affect many other parts of the body. It requires immediate treatment.   
• Primary mediastinal (thymic) large B-cell lymphoma (PMBCL) (2 percent): It appears as a large mass in the central chest. The assembly may cause breathing problems or the superior vena cava (SVC) syndrome, the central vein that carries blood from the head, neck, upper chest, and arms to the heart.   
• Transformed follicular and transformed mucosa-associated lymphoid tissue (MALT) lymphomas: MALT lymphoma develops in lymphoid tissue, the mucous membrane lining body organs, or the gastrointestinal tract, lungs, eyes, skin, salivary glands, thyroid gland, and breasts. It can occur at any age, but it mostly affects people in their 60s. It is more common in women and tailored to the type, stage, and degree of treatment. Most slow-growing, localized MALT lymphomas respond well to treatment.  
• Extranodal marginal zone B-cell lymphoma of MALT: It most commonly occurs in the stomach. However, it may also occur in the lung, skin, thyroid, salivary gland, the orbit, adjacent to the eye, or in the bowel. If the MALT occurs in the stomach, it may be caused by a type of bacteria called Helicobacter pylori.   
• High-grade B-cell lymphoma with double or triple hits (HBL): This is a highly aggressive sub-type of DLBCL, accounting for about 5 percent of these cases. Rarely, low-grade follicular lymphoma may also transform into double-hit lymphoma. Double hit lymphoma is often diagnosed in older adults.   
• Primary cutaneous DLBCL, leg type: Tumors are usually located on a lag and are generally seen in elderly patients.    
• Primary central nervous system (CNS) lymphoma: It occurs when cancer cells form in the lymphatic tissue of the brain and/or spinal cord. Tests that examine the eyes, brain, and spinal cord are used to diagnose it. Because the eye is so close to the brain, primary CNS lymphoma can also start in the eye.  
• Acquired immunodeficiency syndrome (AIDS)-associated lymphoma: AIDS-related lymphoma occurs when cancer develops in the lymphatic system of patients with acquired immunodeficiency syndrome (AIDS). Symptoms include weight loss, fever, and drenching night sweats. 

Indolent   

• Follicular lymphoma (FL) (22 percent): Follicular lymphoma is the second most common lymphoma in the United States and Europe. It usually begins in the lymph nodes and grows very slowly. Over time, follicular lymphoma may turn into DLBCL. Non-Hodgkin’s lymphoma screening suggests that people with follicular lymphoma have lived longer over the last few decades due to advancements in treatments.   
• Marginal zone lymphoma (MZL) (8 percent): MZL is the second most common indolent type of non-Hodgkin’s lymphoma. The average age of diagnosis is 60 and is seen more common in females. There are three types of marginal zone lymphomas: the extranodal MZL (EMZL) of mucosa-associated lymphoid tissue (MALT or gastric GALT), the splenic MZL, and the nodal MLZ. EMZL arises in organs that normally lack lymphoid tissue, and the most frequently affected organ in EMZL is the stomach.   
• Chronic lymphocytic leukemia/small-cell lymphocytic lymphoma (CLL/SLL) (6 percent): This type of lymphoma is without a significant disease circulating in the blood.   
• Gastric mucosa-associated lymphoid tissue (MALT) lymphoma (5 percent): It is a rare gastric tumor. It is associated with Helicobacter pylori infection.   
• Lymphoplasmacytic lymphoma (1 percent): Often involves the bone marrow, sometimes lymph nodes, and spleen.   
• Waldenström macroglobulinemia (WM): It is a rare type of cancer that starts in the white blood cells. Abnormal white blood cells produce a protein that builds up in the blood, impairing circulation and causing complications. It is not clear what causes WM.  
• Nodal marginal zone lymphoma (NMZL) (1 percent): It is rare and involves the lymph nodes.   
• Splenic marginal zone lymphoma (SMZL): Begins in the spleen and usually involves the bone marrow and the blood. It is typically slow-growing.   

Sub-types of T-cell and NK-cell Lymphoma   

 Aggressive   

• Peripheral T-cell lymphoma (PTCL), not otherwise specified (6 percent): It is most common among people older than 60 and makes up about 6 percent of all lymphomas in the United States and Europe.   
• Systemic anaplastic large-cell lymphoma (ALCL) (2 percent): Makes up about 2 percent of all lymphomas and about 10 percent of all childhood lymphomas.   
• Lymphoblastic lymphoma (2 percent): Lymphoblastic lymphoma usually develops from T lymphocytes and sometimes from B lymphocytes. It is generally associated with painless swelling in the neck, armpit, or groin. Fatigue, loss of appetite, fever, night sweats, and weight loss are common. It is very rare in adults and most commonly affects people under 35. Intensive chemotherapy is used in the treatment.   
• Hepatosplenic gamma/delta T-cell lymphoma: This is an aggressive form of peripheral T-cell lymphoma that involves the liver and spleen. It is more common in males with a median age of 35 years.   
• Subcutaneous panniculitis-like T-cell lymphoma (SPTCL): The disease involves the tissue under the skin and is often first diagnosed as panniculitis, inflammation of fatty tissues.   
• Enteropathy-type intestinal T-cell lymphoma: Is more common in Europe. It involves the intestines. Some people with this sub-type have celiac disease or a history of gluten intolerance.   
• Primary cutaneous anaplastic large-cell lymphoma: Only involves the skin. It is often indolent, although aggressive sub-types of the disease are possible.   
• Angioimmunoblastic T-cell lymphoma (AITL): This is an aggressive form of lymphoma with specific symptoms: Enlarged, often tender lymph nodes, fever, weight loss, rash, high levels of immunoglobulins in the blood. People with AITL have a lower immune system, so infections are also common.   

Indolent   

• Cutaneous T-cell lymphoma (CTCL) (4 percent): It occurs in your body’s white blood cells called germ-fighting T cells (T lymphocytes). It can cause a rash-like skin rash, slightly raised or scaly round patches on the skin, and sometimes skin tumors. Treatments may include systemic medications such as skin creams, light therapy, radiation therapy, and chemotherapy.  
• Mycosis fungoides (MF): This rare T-cell lymphoma primarily involves the skin, either in patches or with diffuse redness of the skin. It often has a long and indolent course but may become more aggressive and spread to lymph nodes or internal organs.   
• Sézary syndrome (SS): It is a less common type of CTCL that causes skin redness all over the body.  
• Adult T-cell leukemia/lymphoma: A disease often involves the bone and skin and is caused by a virus called the human T-cell lymphotropic virus type I. Usually, lymphoma cells are found in the blood, so this condition is sometimes also called leukemia.   
• Extranodal NK/T-cell lymphoma (ENK/TCL), nasal type: More common in Asian and Hispanic communities. It can occur in children or adults, most often involving the nasal area and sinuses. It can also affect the gastrointestinal tract, skin, testicles, or other body regions.  

Sources:  

Cancer.Net 

Lls.org 

Cancer.gov 

Leukaemia.org.au 

Mayoclinic.org 

NON-HODGKIN’S LYMPHOMA RISK FACTORS AND PREVENTION

Anything that raises a person’s chances of acquiring cancer is a risk factor. Although risk factors have a role in the development of cancer, many of them do not cause cancer. Some people who have one or more risk factors never get cancer, whereas others with none do. Knowing your risk factors and discussing them with your doctor may assist you in making better lifestyle and health-care decisions. 

The specific cause of NHL is unknown, and most people diagnosed with the disease will never find out why. The following factors, on the other hand, may increase a person’s chances of developing NHL: 

Age/Gender 

The risk of NHL grows as a person ages. People in their 60s and 70s are more likely to develop the most common subtypes. 

Men are slightly more likely than women to develop NHL. 

Bacterial Infections 

Specific infections are linked to certain forms of NHL. For example, an infection with the bacteria Helicobacter pylori is suspected of causing mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach. If this lymphoma is detected early enough, it can be treated with antibiotics and help it disappear. Other kinds of MALT lymphoma, such as those affecting the lungs, tear glands, and skin, can be caused by infections. 

Viruses  

Some kinds of NHL are caused by viruses. Mononucleosis, popularly known as “mono,” is caused by the Epstein-Barr virus (EBV), which is linked to several forms of NHL. Burkitt lymphoma, lymphomas that develop after an organ transplant, and, in rare cases, other lymphomas in apparently healthy patients are among them. However, because practically everyone carries EBV, the virus is unlikely to be the sole determinant of cancer risk. NHL caused by EBV is most likely due to the body’s inability to control the infection. As a result, those who have experienced mononucleosis are not necessarily more likely to have NHL in the future. In addition, hepatitis C infection has been linked to a higher risk of splenic marginal zone lymphomas.  

Immune Deficiency Disorders 

NHL is more common in people with immune system illnesses like HIV/AIDS, especially severe B-cell lymphomas. 

Autoimmune Disorders 

Certain kinds of NHL are more likely to develop in people with autoimmune diseases such as rheumatoid arthritis and Sjögren syndrome. Some medications used to treat autoimmune illnesses have been linked to an increased risk of NHL. 

Organ Transplantation 

NHL is more common in organ transplant recipients. This is due to the medicines that patients must take to suppress their immune systems to prevent the donated organ from being rejected. 

Previous Cancer Treatment 

NHL may be aggravated by previous treatment with specific medications for other cancers. 

Chemical Exposure 

Certain substances have been linked to an increased risk of NHL. Pesticides, herbicides, and petrochemicals are examples. 

Genetic Factors 

Currently, there are no generally acknowledged genetic tests that can accurately detect hereditary risk factors for NHL or forecast a person’s likelihood of acquiring the disease. Clinical trials are currently being conducted to investigate these potential dangers. 

Vaccines 

The link between vaccines and lymphoma is still unknown and debatable. Vaccination with Bacillus Calmette–Guerin (BCG) has been linked to an increased risk of NHL in several studies. BCG is a tuberculosis vaccine that is used to treat bladder cancer in some circumstances. Other vaccinations, such as those for smallpox, cholera, yellow fever, influenza, measles, tetanus, and polio, have also been linked to a lower incidence of NHL. 

Diet/Weight 

Obesity and a diet high in fatty foods or red meat may modestly raise the risk of lymphoma, according to some inconclusive research. 

Prevention: Ways to Reduce Risk 

Many risk factors for NHL are beyond the control of an individual. The following factors, on the other hand, can be managed: 

• Avoiding activities that weaken the immune system, such as those that raise the risk of AIDS and hepatitis C infections.  
• Keeping radiation exposure to a minimum. 
• Maintaining healthy weight and eating habits. 

Some women get lymphoma in the scar tissue around breast implants on a rare occasion. Breast augmentation should be a well-considered decision. 

Sources:  

https://www.cancer.net 

https://my.clevelandclinic.org 

Non-Hodgkin’s Lymphoma Clinical Trials 

Clinical trials focusing on Non-Hodgkin’s Lymphoma are aiming to find safe and effective new treatments, drugs or approaches to better care for the patients suffering from the disease. For these new methods to be widely available, they first need to be tested and approved. Non-Hodgkin’s lymphoma (NHL) is one of the most frequent cancers in the US, accounting for approximately 4 percent of all cancers. According to the American Cancer Society, the overall 5-year survival rate for Non-Hodgkin’s Lymphoma is 73 percent. These numbers are possible because medical science puts an enormous effort into advancement. That is why joining a clinical trial is valuable not only for the patients themselves but also anyone who is suffering from NHL. 

According to the information provided by the clinicaltrials.gov, there are currently 469 clinical trials (either active, recruiting or enrolling by invitation) on Non-Hodgkin’s Lymphoma in the United States as of March 2022. There are various methods scientists are working on to improve: 

Immunotherapy: The research evolving around the CAR (Chimeric antigen receptor) T-cell therapy is included under the immunotherapy studies. The patient’s healthy T-cells (a type of immune cells) are collected and engineered in the laboratory to recognize, bind to and defeat the cancer cells. In addition to four approved CAR T-cell therapies that are currently available as treatment, more is expected to be approved soon. Among the ongoing studies, several are targeting CD19, and assessing the competence of the CAR T-cell therapies for treating refectory and relapsed Non-Hodgkin’s Lymphoma. 

Chemotherapy: A common treatment for all cancer patients, chemotherapy has positive results for Non-Hodgkin’s Lymphoma as well. Researchers are focusing on combining different chemotherapies and treatment methods such as immunotherapy and radiation. They are looking for ways to improve the current drugs and develop or combine new ones. 

Genetic testing: Genetics is an important element in classification and diagnosis of Non-Hodgkin’s Lymphoma subtypes. Researchers are trying to find out more about the mutations (gene changes) in the development of cancer. The expectation with these studies is to identify the specific mutations to design the best treatment for each patient. 

Vaccines: Especially for Non-Hodgkin’s Lymphoma in indolent nature, therapeutic vaccines are a wide area of study. Main goal is preventing or diminishing the chance of relapse of the disease after chemotherapy or targeted therapy, rather than prevention. 

Targeted therapies: Targeted therapy is the most prominent and promising area of clinical trials for the Non-Hodgkin’s Lymphoma studies. The targeted drugs such as proteasome inhibitors, Histone Deacetylase (HDAC) inhibitor, Bruton Tyrosine Kinase (BTK) inhibitors, Phosphoinositide 3-kinase (PI3K) inhibitors, EZH2 inhibitor, mTOR inhibitor, nuclear export inhibitor and other agents are being carefully studied to provide new options for patients. 

Bone Marrow Transplantation/Reduced-Intensity Stem Cell Transplantation (Nonmyeloablative Allogeneic Transplantation): This method is being tested both for patients that re newly diagnosed and for those already received a treatment but experienced a relapse.  Current studies are looking into the procedure to determine its effectiveness for different types of lymphoma, including some subtypes of Non-Hodgkin’s Lymphoma. For preparation, the patients first receive a low dose of chemotherapy drug/s and/or radiation therapy for a while before the reduced-intensity transplant. 

Supportive care/palliative care: The clinical trials also focus on diminishing the symptoms and side effects of Non-Hodgkin’s Lymphoma treatments that are already available, as improving the patients’ comfort and quality of life is one of the main concerns. 

How to find clinical trials for Non-Hodgkin’s Lymphoma? 

This is a question that needs to be answered in guidance of a medical team who know your medical history, your current stage and condition along with the match your case has with the requirements of a given clinical trial. Here at Massive Bio our patient relations coordinators consist of oncology nurses, and our artificial intelligence-based clinical trial matching system can assist you to choose the best option and enroll as soon as possible. You can get a free consultation, or directly start your journey to advanced treatment options. 

Sources: 

cancer.org 

lls.org 

cancer.net