Military Officer - December 2008 - (Page 46) askthedoctor Other Lymphomas More than 60,000 people are diagnosed each year with nonHodgkin’s lymphomas. Rear Adm. Joyce Johnson, D.O., reviews diagnosis and treatment options. L Look Online for More Information I The National Cancer In- stitute publishes a booklet, “What You Need to Know About Non-Hodgkin Lymphoma,” www.cancer .gov/cancertopics/wyntk/ non-hodgkin-lymphoma. ymphoma is a general term encompassing a variety of cancers of the lymphatic system. Unlike Hodgkin’s lymphoma, which is characterized by a specific abnormal cell (the Reed-Sternberg cell, as described in the November 2008 “Ask the Doctor” column), non-Hodgkin’s lymphomas are a diverse group of more than 20 lymphatic cancers. To make a diagnosis of non-Hodgkin’s lymphoma requires a biopsy. If the tissue to be biopsied is difficult to reach, a needle biopsy (in which fluid is aspirated for microscopic examination) is possible, but generally biopsy of an entire lymph node is recommended for lymphoma patients. Non-Hodgkin’s lymphomas are divided into two main groups according to the rate of cell growth visible in a biopsy. Lowgrade disease grows slowly and is called indolent lymphoma; high- or intermediategrade disease is called aggressive lymphoma. The aggressive form actually is more often cured, because treatments affect cells while they are in the growth stage. Once a diagnosis of non-Hodgkin’s lymphoma has been confirmed, additional tests such as blood tests, X-rays, and scans (MRI, CT, or PET) can help stage the disease. A bone marrow biopsy can determine whether the lymphoma has spread to the bone marrow. In conjunction with a physical examination and patient history, other test results — cluster differentiation markers, tumor markers, and other special markers — also can help clarify a patient’s condition. A health care provider will develop a treat- ment plan based on the specific diagnosis (from the biopsy results), the staging (from other parts of the evaluation), consideration of various markers, and an understanding of a patient’s overall health. For indolent disease patients with no real symptoms, “watchful waiting” for a year or two might be an initial approach. This involves a reevaluation about every three months, with the option to begin aggressive treatment if the disease progresses. This approach delays the side effects of treatment as long as possible. Treatment of indolent disease also could include an intravenous infusion of monoclonal antibodies, which attach to the cancer cell. This complex stimulates the body’s immune system to inactivate tumor cells. Chemotherapy and radiation commonly are used to treat both indolent and aggressive lymphomas. Indolent disease tends to go into periods of remission lasting several years, which often are followed by relapses that are responsive to chemotherapy and other treatments. However, over time, tumor cells might become resistant to these agents. A cell transplant (with treated cells from the patient or a close relative or other donor) might be the next step for patients with either indolent or aggressive nonHodgkin’s lymphoma. MO — Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. Find more health and wellness resources at www .moaa.org/wellness. For submission information, see page 18. PHOTO: STEVE BARRETT 46 MILITARY OFFICER DECEMBER 2008 http://www.cancer.gov/cancertopics/wyntk/non-hodgkin-lymphoma http://www.cancer.gov/cancertopics/wyntk/non-hodgkin-lymphoma http://www.cancer.gov/cancertopics/wyntk/non-hodgkin-lymphoma http://www.moaa.org/wellness http://www.moaa.org/wellness
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