American Medical Association Family Medical Guide - American Medical Association [377]
Your doctor will probably first use an anticancer drug that is usually effective in eliminating or reducing most symptoms of this type of cancer. Your enlarged lymph glands and spleen will probably decrease in size, your blood count will improve, and your symptoms will go away. If this drug does not work, or if it stops working after a while, you will probably be treated with a combination of other anticancer drugs and, perhaps, a corticosteroid (to help reduce inflammation). These drugs are often helpful at this stage.
Many people with CLL live for years without needing treatment. When treatment becomes necessary, it usually keeps a person reasonably healthy for several years. Many people with CLL live a normal life span and die of other causes.
Lymphomas
Lymphomas are cancerous tumors of the lymph glands (organs of the immune system) that result from genetic changes in infection-fighting white blood cells called lymphocytes. Occasionally, lymphomas may develop in people who have a weakened immune system, such as people who are infected with HIV or who have AIDS (see page 909) or who are receiving immune-suppressing drugs to avoid organ rejection after a transplant. In these cases, a virus may be the cause.
Non-Hodgkin′s Lymphoma
Non-Hodgkin’s lymphoma is a very diverse group of cancers. In a slow-growing form, the disease may not require treatment for years and may even go away on its own for a time. In a fast-growing, aggressive form, the disease requires prompt treatment or can quickly be fatal.
Symptoms
The first symptom of non-Hodgkin’s lymphoma is usually a swollen gland. Swollen glands can be anywhere in your body, but they generally appear first in the neck, armpit, or groin. Other possible symptoms include feeling generally ill, loss of appetite, unexplained weight loss, fever, or night sweats. If you have a swelling or lump that persists for no obvious reason for more than 2 weeks, see your doctor.
Diagnosis
If the swelling is an enlarged lymph gland and the doctor sees no sign that the swelling has resulted from a common infection such as a cold, he or she may recommend a blood test and a biopsy of the gland (microscopic examination of a sample of tissue from the gland). Information from the blood test and the biopsy usually can help the doctor determine whether a person has lymphoma and, if so, what type.
Treatment
The treatment for non-Hodgkin’s lymphoma depends on the type of lymphoma and on how many areas of the body are affected. To enable the doctor to determine how widespread your cancer is, you will have imaging procedures such as X-rays, a CT scan (see page 112), an MRI (see page 113), a gallium scan, or a PET scan (see page 114). You will also probably have a bone marrow aspiration and biopsy to determine if the bone marrow has been affected.
The standard treatment for non-Hodgkin’s lymphoma is chemotherapy (see page 23), which is likely to induce a remission (disappearance of symptoms) and can cure a substantial number of people. For people who fail to respond to the standard-dose chemotherapy, high-dose chemotherapy and a stem cell transplant (see page 624) can be lifesaving.
Hodgkin’s Disease
Hodgkin’s disease is a cancer that arises from white blood cells (lymphocytes). The cancer can develop in a single lymph node, a group of lymph nodes, or in other parts of the lymphatic system, such as the bone marrow or spleen. Hodgkin’s disease is most common in adolescents and young adults and in people over age 50.
Symptoms
The main symptom of Hodgkin’s disease is persistent swollen glands, usually in the neck, armpit, or groin. Other possible symptoms include fever, sweating, fatigue, weakness, weight loss, and itching. See your doctor immediately if you have any unexplained swellings—Hodgkin’s disease responds well to early treatment.
Diagnosis
If you have symptoms of Hodgkin’s disease, your doctor will probably take samples of your blood