What is Non-Hodgkin's Lymphoma?

ANNOUNCER: While many people are familiar with the topics of breast and lung cancer, not quite so well known is non-Hodgkin's lymphoma, a cancer of the immune system. Yet this disease is the sixth most common cause of cancer deaths.JOHN LEO...

ANNOUNCER: While many people are familiar with the topics of breast and lung cancer, not quite so well known is non-Hodgkin's lymphoma, a cancer of the immune system. Yet this disease is the sixth most common cause of cancer deaths.

JOHN LEONARD, MD: In lymphoma, there are at least 20 different types of lymphomas. Non-Hodgkin's lymphoma is a tumor of the lymph cells, and the lymph cells make up the immune system. The cells of the immune system typically have a job to do to fight infections, and in lymphoma the switches that regulate the cell's growth are broken, and the cells accumulate. They may make a lump, or they may involve or infiltrate one of the organs and cause a problem that leads to the diagnosis of lymphoma.

ANNOUNCER: Simply put, NHL is a cancer of the very system that is supposed to protect us against disease.

RONALD LEVY, MD: The normal immune system is built on a collection of special cells in the body that stay in the lymph nodes or in the spleen or in the bone marrow or in the blood. And each one of them has a slightly different way of recognizing foreign invaders, and so they make a response by making things that kill the foreign invader. NHL is coming from one of these cells. This one cell goes haywire and develops a problem and doesn't know how to stop growing. And it grows into what we call a clone of cells, making many more of the same from that original one cell that grows too far and too fast and spreads around the body and crowds out the other cells in the body.

ANNOUNCER: It's important that patients recognize the symptoms.

JOHN LEONARD, MD: One of the sites that lymphoma can involve are the lymph nodes or the glands, typically felt in the neck, under the arms and in the groin. And so often lymphomas will present to the patient with a lump in one of those areas. And if that lump is causing pain or at a large size, that may be a reason to treat the patient. Other symptoms can include fever, weight loss, fatigue.

ANNOUNCER: The nature of each person's non-Hodgkin's lymphoma is a key issue in its outlook.

JOHN LEONARD, MD: We have two very broad categories, one being the indolent type of lymphomas, another being the aggressive type of lymphomas. And the aggressive lymphomas, the name sounds worse, and in some ways scarier to patients. And the bad parts about aggressive lymphomas are that they do grow more quickly in some ways, and patients do require treatment at the time of diagnosis, in the vast majority of cases.

The good part about the aggressive lymphomas are that we can cure them with chemotherapy a percentage of the time. Even if it does come back in that situation, it can be cured.

RONALD LEVY, MD: The medicines we use, called chemotherapy, work by killing cells that are growing fast, dividing and replicating and making more of themselves. And so the fast-growing lymphomas are doing that more, and they're more susceptible, more affected by this chemotherapy than the slow-growing lymphomas.

ANNOUNCER: Ironically, the indolent or slower growing lymphomas pose a tougher challenge.

DAVID FISHER, MD: Slow-growing lymphomas tend to grow over months to years, can respond to chemotherapy, but have a tendency to recur. And so, we treat them multiple times, whenever they start to cause trouble again. People can live with them a very long time, but it's very hard to eradicate them. You'll find median survivals for follicular lymphoma, the most common type of slow-growing lymphoma, to be somewhere in the five to eight or nine year range.

ANNOUNCER: Sometime doctors take a wait and see attitude with slow-growing lymphoma.

JOHN LEONARD, MD: If patients are asymptomatic, and the disease is at a relatively low level, the disease isn't bothering them, isn't causing symptoms, often the patient isn't treated. There is no clear advantage for the patient to begin treatment early in the course of their disease if the disease isn't bothering them. And that's something that's hard for patients sometimes to understand, that you can diagnose a cancer but decide not to do any treatment for it.

ANNOUNCER: However, when treatment is needed, either for indolent or aggressive lymphomas, science offers several options.

RONALD LEVY, MD: The traditional treatments are mostly chemotherapy treatments. We also have radiation treatments, so-called radiotherapy, and combinations of radiotherapy and chemotherapy.

DAVID FISHER, MD: The more recent therapies that have come along are immune therapies, which are basically therapies to use the immune system to help attack the disease. Lymphoma cells seem to be more receptive to immune therapies, because they're part of the immune system. And so, the immune system is used to sort of working with those type of cells and can cause immune reactions to be effective against these cells.

ANNOUNCER: In the future the immune system, the very source of the problem in NHL, may be the key to unlocking a way to defeat it.

JOHN LEONARD, MD: If we can teach the immune system to go after those cells wherever they are, and that that immune effect can be longstanding, that is a potential way to have an effect against the tumor cells, and that's really one of the goals to give a longer-lasting effect that the patient can benefit from, potentially, without being on a treatment that they have to receive constantly.