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Lymphoma There are two main types of lymphomas: Hodgkin's lymphoma or Hodgkin's disease, identified in 1832 by Dr. Thomas Hodgkin. All other types of lymphoma are called non-Hodgkin's lymphomas (NHL). Because lymph tissue is found in many parts of the body, lymphoma can start nearly anywhere. The lymph nodes become enlarged and the cancer can spread through the lymph system. In 2005, there will be about 7,350 new cases of Hodgkin's disease and about 56,390 cases of NHL diagnosed, according to the American Cancer Society. It is the fifth most common cancer in this country, excluding nonmelanoma skin cancers, and the most common malignant tumors of adults between the ages of 20-40 years. Hodgkin's disease and NHL are different diseases that both arise from the lymph node tissues in the body. In fact, there are many, many types of NHL. The different types can be distinguished from one another by looking at the cells under a microscope. Regardless of the type of cell, early diagnosis and appropriate treatment is key to a patient's long term well-being - which is how PET scanning can help. DiagnosisThere are no screening tests to find Hodgkin's disease or NHL early, and some people with the disease have no symptoms at all. The signs and symptoms of lymphomas may highly vary depending on the location of the lymph tissue that is involved with the disease. Since enlarged lymph nodes are the primary sign, the diagnosis of lymphoma may be delayed because enlarged lymph nodes commonly occur with infections. Doctors often observe swollen nodes over a period of weeks to look for changes or reductions in size. Some of the most common early symptoms of lymphoma may be:
In addition to the local signs related directly to the enlarged lymph nodes, patients may also experience:
If the lymph node does not resolve on its own, either a small piece of the node or, more commonly, the entire node will be removed for examination under the microscope (biopsy). If a lymphoma is found, prompt treatment could save your life. Call a doctor at the PET center nearest you if you have any of these symptoms. If your doctor suspects that you might have lymphoma, he/she will most likely talk to you about your medical history, do a physical exam, and biopsy the enlarged lymph node. PET can help doctors select a site for biopsy when the first suspected site is not easily accessible. If you have lymphoma, your doctor might want to do additional tests. PET (positron emission tomography) scanning is one of the most accurate ways to characterize the extent of lymphoma spread. Top of this Page | Back to Cancer Information TreatmentPhysicians diagnose the cancer and determine what kind it is by looking at a sample of the tumor under a microscope. This alone does not determine what treatment you should have. Before treatment, your doctors must determine how much lymphoma you have. This is called staging the cancer. Treatment options, as well as the outlook for your recovery, depend on both the exact type and the stage of the lymphoma. Once identified, a suspected lesion is biopsied. If it is found to be lymphoma, it will be surgically removed, often with the surrounding lymph nodes. A number of diagnostic tests may be performed, including a PET scan and a sentinel node biopsy. Tests used to gather information for staging may include:
PET is the most useful test that you can have when doctors are staging or re-staging lymphoma because it accurately shows the extent of the cancer. How does PET come into play? In cancer, cells begin to grow at a much faster rate, feeding on sugars like glucose. PET works by using a small amount of a radioactive drug called a tracer in combination with a compound such as glucose. Once you are injected with the tracer and glucose, the tracer travels through your body. It emits signals as it travels and eventually collects in the organs targeted for examination. If an area in an organ is cancerous, the signals will be stronger since more glucose will be absorbed in those areas. In tissues or organs affected by lymphoma, more of the radioactive glucose will be taken up as compared to normal lymph nodes and tissues. This helps the doctors understand exactly where the lymphoma is. Proper staging of the location and extent of the tumor is the first step in appropriate treatment. Moreover, once treated, patients are often re-staged to determine the effectiveness of the treatment. In addition to providing basic staging information, the initial PET scan provides a baseline for subsequent evaluation of whether the therapy was effective or not. Whole Body PET may be particularly useful in detecting extra nodal sites of disease such as bone marrow, liver and spleen. The treatment of lymphoma has been one of the true cancer success stories of the last 20-30 years. Continued improvements in chemotherapy and radiotherapy have resulted in better survival rates. After first showing the doctors where the cancer cells are, PET can also see if the therapy has been effective at killing them. Top of this Page | Back to Cancer Information Follow-UpAfter treatment, it is important to know if any active cancer cells remain in the body. In the past, the amount and type of therapy that was used were set according to standard rules. PET allows the type and amount of therapy to be directed specifically to you, the patient, and based on the location and extent of your type of cancer. Imaging with PET is a critical test in order to look for the return of the cancer. Before PET, it was extremely difficult to monitor patients to see if the lymphoma had returned. Multiple CT scans would have to be done to capture images of the whole body and it still could not see the recurrent cancer as sensitively as PET. Delay in finding recurrence could result in a delay of further surgical removal. PET can be used to image lymphoma tumor response to therapy and to detect recurrence in successfully treated lesions. Post treatment, PET plays an extremely important role in monitoring to see if the cancer cells have returned. Early studies have shown that PET may also identify patients who are more likely to achieve remission and less likely to relapse by showing a characteristic pattern of reduction in glucose uptake in the abnormal lymph nodes during chemotherapy. If the cancer cells have been killed by the treatment, they will not absorb any of the radioactive glucose given in the PET scan. After treatment, although the tumor masses may still be present and seen on CT scans, the cells may no longer be alive, which can be shown by PET. Conversely, if the cancer cells have come back, PET can see the accumulation of the radioactive glucose much sooner than a CT scan. Treatment can be re-started sooner, improving the possibility of a better outcome. Top of this Page | Back to Cancer Information Case Study
Top of this Page | Back to Cancer Information More InformationFind the support you need:The stress of illness can often be helped by joining a support group where members share common experiences and problems. Support programs exist in a variety of formats, including counseling, support groups, and self-help programs. For those who cannot attend meetings, there are also on-line mechanisms that may allow a patient to "chat" with other people facing similar situations. These types of programs can provide a way for you to relate your experience firsthand with others and may provide treatment-related tips about drug side-effects that will be helpful to you. Online Resources: |
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