Leukemia and Lymphoma

If you've recently been diagnosed with one of the blood cancers (leukemia or lymphoma), you and your family might be overwhelmed with questions and concerns. Your first decision is where to get treatment.

You want a place where you can get the most advanced treatment options available. A place where you are supported by a team of compassionate experts. A place where you are treated as a whole person.

MultiCare Regional Cancer Center is that place. We have the region’s best health care providers in the field of oncology. Our world-class treatment facility offers cutting-edge technology in a welcoming and positive healing environment.

Learn about our cancer care team or more about one of the blood cancers (leukemia or lymphoma) in the tabs below.

Leukemia

Overview

Leukemia is cancer of the blood cells. It starts in the bone marrow, the soft tissue inside most bones. Bone marrow is where blood cells are made.

When you are healthy, your bone marrow makes:

• White blood cells, which help your body fight infection
• Red blood cells, which carry oxygen to all parts of your body
• Platelets, which help your blood clot

When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. They don't do the work of normal white blood cells, they grow faster than normal cells and they don't stop growing when they should.

Over time, leukemia cells can crowd out the normal blood cells. This can lead to serious problems such as anemia, bleeding, and infections. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain.

Causes

Experts don't know what causes leukemia. But some things are known to increase the risk of some kinds of leukemia. These things are called risk factors. You are more likely to get leukemia if you:

• Were exposed to large amounts of radiation
• Were exposed to certain chemicals at work, such as benzene
• Had some types of chemotherapy to treat another cancer
• Have Down syndrome or some other genetic problems
• Smoke

Symptoms

Symptoms may depend on what type of leukemia you have, but common symptoms include:

• Fever and night sweats
• Headaches
• Bruising or bleeding easily
• Bone or joint pain
• A swollen or painful belly from an enlarged spleen
• Swollen lymph nodes in the armpit, neck or groin
• Getting a lot of infections
• Feeling very tired or weak
• Losing weight and not feeling hungry

Diagnosis

To find out if you have leukemia, a doctor will:

• Ask questions about your past health and symptoms
• Do a physical exam. The doctor will look for swollen lymph nodes and check to see if your spleen or liver is enlarged.
• Order blood tests. Leukemia causes a high level of white blood cells and low levels of other types of blood cells.

If your blood tests are not normal, the doctor may want to do a bone marrow biopsy. This test lets the doctor look at cells from inside your bone. This can give key information about what type of leukemia it is so you can get the right treatment.

Treatment

What type of treatment you need will depend on many things, including what kind of leukemia you have, how far along it is and your age and overall health.

• If you have acute leukemia, you will need quick treatment to stop the rapid growth of leukemia cells. In many cases, treatment makes acute leukemia go into remission.
• Chronic leukemia can rarely be cured, but treatment can help control the disease. If you have chronic lymphocytic leukemia, you may not need to be treated until you have symptoms. But chronic myelogenous leukemia will probably be treated right away.

Treatments for leukemia include:

• Chemotherapy, which uses powerful medicines to kill cancer cells. This is the main treatment for most types of leukemia.
• Radiation treatments. Radiation therapy uses high-dose X-rays to destroy cancer cells and shrink swollen lymph nodes or an enlarged spleen. It may also be used before a stem cell transplant.
• Stem cell transplant. Stem cells can rebuild your supply of normal blood cells and boost your immune system. Before the transplant, radiation or chemotherapy may be given to destroy cells in the bone marrow and make room for the new stem cells. Or it may be given to weaken your immune system so the new stem cells can get established.
• Biological therapy. This is the use of special medicines that improve your body's natural defenses against cancer.

For some people, clinical trials are a treatment option. Clinical trials are research projects to test new medicines and other treatments. Often people with leukemia take part in these studies.

Non-Hodgkin's Lymphoma

Overview

Non-Hodgkin's lymphoma (NHL) is cancer of the lymphatic system, which is part of the immune system. The lymphatic system is found throughout the body. When you have this disease, cells in the lymphatic system either grow without control or do not die as cells normally do.
There are many types of NHL. Sometimes they are grouped as:

• Aggressive Lymphomas, which are also called intermediate-grade and high-grade lymphomas. These cancers tend to grow and spread quickly and cause severe symptoms.
• Non-aggressive Lymphomas, which are also called indolent or low-grade lymphomas. These tend to grow and spread quite slowly and cause few symptoms.

Non-Hodgkin's lymphoma is different from Hodgkin's lymphoma. NHL can start almost anywhere in the body. It may start in a single lymph node, a group of lymph nodes, or an organ such as the spleen. NHL can spread to almost any part of the body, including the liver and bone marrow.

Treatment can cure some people and may allow others to live for years. How long you live depends on the type of NHL you have and how early it’s diagnosed.

Causes

The cause of non-Hodgkin's lymphoma (NHL) is unknown. The incidence of NHL has continued to increase over the years. When a person has non-Hodgkin's lymphoma, abnormal rapid cell growth occurs. This abnormal growth may need a "trigger" to start, such as an infection or exposure to something in your environment. There is also a link between NHL and problems with the immune system.

Symptoms

Symptoms of non-Hodgkin's lymphoma (NHL) depend on the area of the body affected by the disease. The most common symptom is a painless swelling of the lymph nodes in the neck, underarm or groin. Other symptoms may include:

• Unexplained fever
• Night sweats
• Extreme fatigue
• Unexplained weight loss
• Itchy skin
• Reddened patches on the skin
• A cough or shortness of breath
• Pain in the abdomen or back

Diagnosis

If non-Hodgkin's lymphoma (NHL) is suspected, your doctor will ask about your medical history and perform a physical exam. This exam includes checking for enlarged lymph nodes in your neck, underarm and groin.

A tissue sample (biopsy) is needed to make a diagnosis. A biopsy for non-Hodgkin's lymphoma is usually taken from a lymph node, but other tissues may be sampled as well.

A bone marrow aspiration and biopsy is usually done to find out if lymphoma cells are present in the bone marrow.

Treatment

Different types of treatment are used depending on the stage of the disease, the type of non-Hodgkin's lymphoma, the size of the tumor and other factors.

Treatment recommendations for non-Hodgkin's lymphoma include:

• Watchful waiting (surveillance), a period of time after the diagnosis of some types of NHL when you are not receiving treatment but are still being watched closely by your doctor.
• Radiation therapy, which is often the treatment of choice for early-stage, indolent NHL. Radiation therapy may be used alone or combined with other treatment options for more advanced NHL.
• Chemotherapy, which kills cancer cells or stops them from dividing. The way chemotherapy is given depends on the type and stage of cancer. This may include taking it by mouth or having it injected into a vein or muscle. Or chemotherapy may be placed directly into the spine, an organ or into the belly.
• Monoclonal antibody therapy. This is a cancer treatment that uses special antibodies that attach to cancer cells and destroy them without harming normal cells.
• Stem cell transplant is often used to treat recurrent lymphoma. Stem cell transplant may be offered as part of standard treatment or in a clinical trial.

You may use home treatment to help you manage the side effects that may happen with NHL or its treatment.

Hodgkin's Lymphoma

Overview

Hodgkin's lymphoma is cancer of the lymph system, which is the network that carries lymph fluid, nutrients and waste material between the body tissues and the bloodstream.

Along this network are lymph nodes located throughout your body in your neck, underarms and groin, behind your knees and in your chest, abdomen and pelvis. The nodes filter lymph and store cells called lymphocytes that mature into cells of the immune system to defend against infections caused by bacteria, viruses and parasites.

Lymphoma is caused when something goes wrong inside the lymphocytes so they don’t mature to completion and don’t die off like they are supposed to but instead collect in the lymph nodes.

Symptoms

The symptoms of Hodgkin’s lymphoma can be caused by other conditions so your should see a doctor if you have symptoms that concern you, such as:

• Painless swollen lymph nodes in the neck, underarm, groin, chest or abdomen
• Unexplained fever, weight loss or night sweats
• Ongoing fatigue
• Itchy, red patches of skin
• Swelling in the face, neck or upper chest
• Feeling of fullness in the abdomen from an enlarged liver, spleen or lymph nodes
• Abdominal problems, such as nausea, vomiting and indigestion
• Sensitivity to alcohol or pain in the lymph nodes after having alcohol
• Coughing, trouble breathing or chest pain

Compared to non-Hodgkin’s lymphoma, lymph-node symptoms of Hodgkin’s lymphoma usually take longer to occur. For instance, a person may have some swelling for as long as a year before diagnosis.

Causes

Hodgkin's lymphoma affects men more often than women. The cause of Hodgkin's lymphoma is not known, although the following are risk factors associated with the disease:

• Your immune system is weakened by an inherited disease, autoimmune disease, human immunodeficiency virus (HIV) or drugs given because you had an organ transplant
• You have been infected with Epstein-Barr virus (which causes mononucleosis)
• You have a brother or sister who has had Hodgkin’s disease

Diagnosis

Your doctor will do a physical exam first to look for signs of lymphoma. Your doctor will probably perform a tissue sample (biopsy) next to confirm the diagnosis. A biopsy for Hodgkin's lymphoma is usually taken from a lymph node, but may also be taken from bone marrow or the fluid around the lungs (pleural fluid) or in the membrane around the abdominal organs (peritoneal fluid).

Your doctor may also want you to have imaging studies, such as a chest X-ray, magnetic resonance imaging (MRI), computed tomography (CT) scan or positron emission tomography (PET) scan, to see pictures of the inside of your body. This allows the doctor to look for enlarged lymph nodes, tumors or areas of cancer activity.

Doctors may do further tests to detect whether the cancer has spread around the lymph system or to other areas. This helps your doctor determine the stage of your cancer, which will be important when it’s time to make decisions about your treatment.

Treatment

Treatment for Hodgkin's lymphoma depends on the stage of the lymphoma. The most common treatments are radiation or chemotherapy.

Radiation therapy is the use of high-dose X-rays to treat cancer cells and may be used alone or in combination with other treatment options, such as chemotherapy. For lymphoma, radiation therapy may be given from a machine outside the body that directs radiation to the cancer (external radiation). Or it may be given inside the body (internal radiation), with radiation that is sealed inside of needles, seeds, wires or catheters.

Hodgkin’s lymphoma can also be treated with anti-cancer drugs, called chemotherapy. These medicines are usually given intravenously (by IV), though some forms may be taken by mouth. Chemotherapy can help kill cancer cells that are in the lymph system as well as those that may have spread to other areas. This type of treatment is usually given in cycles, with several days in between each dose.

People whose disease is not cured with initial treatment and who get recurrent lymphoma may have a bone marrow transplant in combination with chemotherapy, biologic therapies (used to restore or improve the immune system’s ability to fight disease) or other new treatments being studied.