Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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 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 five 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 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
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
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 count). 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.
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
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 (use of a single medication).
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 four or six.
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.