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Understanding lymphoma

When Jacqueline Kennedy Onassis abruptly died of non-Hodgkin’s lymphoma in 1994, her passing surprised and saddened millions. At the same time, her death highlighted just how unforgiving this cancer can be when it’s aggressive and goes undetected until a late stage, as hers was—she was only 65 when she died just a few months after being diagnosed.

Fortunately, lymphoma is highly treatable and has distinct symptoms that allow it to be discovered early. The disease comes in two versions: Hodgkin’s, named after Dr. Thomas Hodgkin who discovered it in 1832; and non-Hodgkin’s, which comprises about 10 other variations. Curiously, Hodgkin’s lymphoma usually affects males ages 15 to 34 or those older than 75. Non-Hodgkin’s, by far the more prevalent, generally strikes white men ages 40 and older. In 2008, more than 74,000 new lymphoma cases will be detected, and an estimated 20,000 patients will die.

Immune cells gone bad

Lymphomas attack the body’s lymph system—a network of bean-shaped organs called lymph glands, or nodes, connected by tiny vessels. Clusters of nodes are located in the underarm, pelvis, neck and abdomen. They manufacture and store disease-fighting white blood cells called lymphocytes that help kill germs and mutant cells and rid debris from the blood and tissues.

Lymph, a clear, watery fluid, carries lymphocytes through the glands and is filtered as it passes through the nodes.

Cancer develops when these normally protective lymphocytes turn against the body and begin growing and dividing in a haphazard manner. Because lymph circulates throughout the body, this type of cancer can easily spread. Unfortunately, its actual risk factors remain, for the most part, a mystery.

What are the signs?

It’s normal for glands in the neck, armpits and groin to swell and become tender when they’re fighting infection. But glands that painlessly swell for no apparent reason and stay engorged for more than two weeks should be checked out. Usually there’s no reason to worry, but sometimes swelling is an early symptom of lymphoma.

Other potential warnings include:

  • flu-like symptoms and/or weeks of fever exceeding 100°F
  • itchy skin or rashes
  • pain in the bones, abdomen or chest
  • constant fatigue
  • drenching night sweats
  • unexplained weight loss

Your doctor can examine lumps in your lymph system, take X-rays and perform very sensitive blood and urine analyses to see if your cell counts, hemoglobin or other blood chemistry is abnormal. He or she may also perform a lymph node biopsy to confirm or rule out a lymphoma diagnosis.

Early detection, better odds

Once lymphoma is found, cancer specialists determine its exact type (Hodgkin’s or non-Hodgkin’s), grade (ranging from slow-growing to aggressive) and its stage, or how far it’s spread, to plan a proper course of treatment. You may undergo a computed tomography (CT) scan or positron emission tomography (PET) scan, additional blood tests and lymph node biopsies as well as a lymphangiogram, a special X-ray of the lymph system.

Depending on the illness’s stage, chemotherapy, radiation, surgery and bone marrow transplants are among the treatment options. If caught early enough, nine in 10 cases of Hodgkin’s lymphoma are completely cured—that is, patients stay cancer-free for more than five years.

And while non-Hodgkin’s is not yet curable, it’s very responsive to treatment when found in a nascent stage. In fact, at least 75 percent of patients whose cancer was found early will live at least five years.