Lymphoma (cont.)

Medical Treatment

Standard first-line therapy (primary therapy) for lymphoma includes radiation therapy for most early-stage lymphomas, or a combination of chemotherapy and radiation. For later-stage lymphomas, chemotherapy is primarily used, with radiation therapy added for control of bulky disease. Biological therapy, or immunotherapy, is increasingly being used in addition to or as an alternative to these standard therapies.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. It is considered a local therapy, meaning that it should be used to target areas of the body involved by tumor masses. A radiation oncologist will plan and supervise therapy.

• The radiation is targeted at the affected lymph node region or organ. Occasionally, nearby areas are also irradiated to kill any cells that might have spread there undetected.
  
  
• Depending on how and where the radiation is administered, it may cause certain side effects such as fatigue, loss of appetite, nausea, diarrhea, and skin problems. Radiation of lymph node areas may result in suppression of the immune system to varying degrees. Irradiation of the underlying bone and the marrow within the bone may result in suppression of the blood counts.
  
  
• The radiation is usually administered in short bursts on 5 days a week over the course of several weeks. This keeps the dose of each treatment low and helps prevent or lessen side effects.

Chemotherapy

Chemotherapy is the use of powerful drugs to kill cancer cells. Chemotherapy is a systemic therapy, meaning that it circulates through the bloodstream and affects all parts of the body. Ideally, chemotherapy can find and kill cancer cells anywhere in the body.

Unfortunately, chemotherapy also affects healthy cells; this accounts for its well-known side effects.

• The side effects of chemotherapy depend partly on the drugs used and the doses.
  
  
• Some people, because of variability in metabolism of chemotherapy drugs, tolerate chemotherapy better than other people.
  
  
• The most common side effects of chemotherapy include suppression of blood counts, which could result in increased susceptibility to infection (low white blood cell count), anemia (low red blood cell count), or blood clotting problems (low platelet). Other side effects may include nausea and vomiting, loss of appetite, hair loss, sores in the mouth and digestive tract, fatigue, muscle aches, and changes in fingernails and toenails. Specific drugs may confer other, specific side effects. 
  
  
• Medications and other treatments are available to help people tolerate these side effects, which can be severe.
  
  
• It is very important to discuss and review the potential side effects of each chemotherapy drug in the treatment with the oncologist, pharmacist, or oncology nurse. Medications to lessen the side effects should also be reviewed.

Chemotherapy may be given in pill form, but it is typically a liquid infused directly into the bloodstream through a vein (intravenous).

• Most people who receive intravenous chemotherapy will have a semi-permanent device placed in a large vein, usually in the chest or arm.
  
  
• This device allows the medical team quick and easy access to the blood vessels, both for administering medications and for collecting blood samples.
  
  
• These devices come in several types, usually referred to as a "catheter," "port," or "central line."

Experience has shown that combinations of drugs are more efficient than monotherapy.

• Combinations of different drugs both increase the chance that the drugs will work and lower the dose of each individual drug, reducing the chance of intolerable side effects.
  
  
• Several different standard combinations are used in lymphoma. Which combination one receives depends on the type of lymphoma and the experiences of the oncologist and the medical center where a person is receiving treatment.
  
  
• The combinations of drugs are usually given according to a set schedule that must be followed very strictly.
  
  
• In some situations, chemotherapy can be given in the oncologist's office. In other situations, one must stay in the hospital.

Chemotherapy is given in cycles.

• One cycle includes the period of actual treatment, usually several days, followed by a period of rest for several weeks to allow recovery from side effects caused by the chemotherapy, particularly anemia and low white blood cells.
  
  
• Standard treatment typically includes a set number of cycles, such as 4 or 6.
  
  
• Spreading the chemotherapy out this way allows a higher cumulative dose to be given, while improving the person's ability to tolerate the side effects.

Biological therapy

Biological therapies are sometimes referred to as immunotherapy because they take advantage of the body's natural immunity against pathogens. These therapies are attractive because they offer anticancer effects without many of the undesirable side effects of standard therapies. There are many different types of biological therapies. The following are some of the most promising for treating lymphoma:

• Monoclonal antibodies: Antibodies are substances produced by lymphocytes to fight pathogens. Every cell, organism, or pathogen within our body carries markers on its surface that antibodies may recognize. These surface markers are called antigens. A monoclonal antibody is an antibody that is made in a laboratory to find and attach itself to a specific antigen. Monoclonal antibodies can be used to help one's own immune systems kill tumor cells and other pathogens directly, or they can deliver cancer-killing therapies (such as radiation or chemotherapy) directly to a specific antigen found on cancer cells.
  
  
• Cytokines: These naturally occurring chemicals are produced by the body to stimulate the cells in the immune system and other organs. They can also be produced artificially and administered in large doses to patients with greater effect. Examples include interferons and interleukins, which stimulate the immune system, and colony-stimulating factors, which stimulate the growth of blood cells.
  
  
• Vaccines: Unlike the more familiar vaccines for infectious diseases such as polio and flu, cancer vaccines do not prevent the disease. Rather, they are designed to stimulate the immune system to mount a specific response against the cancer. They also create a "memory" of the cancer so that the immune system activates very early in cases of recurrence, thus preventing the development of a new tumor.

The subtype and classification of a lymphoma may determine whether biologic therapy will be used to treat an individual patient's lymphoma. Monoclonal antibodies are being increasingly used in the treatment of B cell NHLs, usually in combination with chemotherapy. Monoclonal antibodies may also be given as maintenance therapy following chemotherapy, particularly in low-grade disease. 

Interferon may be used in indolent, low-grade lymphomas, or as adjunctive therapy in patients with hepatitis associated lymphomas. Colony-stimulating factors, such as growth factors for white blood cells, may be used to stimulate recovery of the white cells following chemotherapy. 

Other therapies under continuing development include drugs that target cancer cells on a molecular level, various new monoclonal antibodies, and other biologic therapies.

Next: Medications »

Printer-Friendly Format

|

Email to a Friend