Non-Hodgkins lymphoma can be cured if caught early

By Maria Endah Hulupi

JAKARTA (JP): If you detect a swelling in one or more of your lymph nodes -- in the throat, armpits or groin -- that is tender though not painful to the touch, you probably need to seek medical consultation.

There is a chance it could be non-Hodgkin's lymphoma, which, if not treated early, could cost you your life.

"If the swelling is also accompanied by inflammation, it usually indicates an infection. If it isn't, it could be a more serious disease," said Djumhana Atmakusuma, an internist at Cipto Mangunkusumo General Hospital in Central Jakarta.

Non-Hodgkin's lymphoma is among the country's top five most common cancers, along with breast, cervical, prostate and liver cancer.

"Non-Hodgkin's Lymphoma is one of the cancers that can be cured if diagnosed early and properly treated," he said, citing data that shows that between 20 percent and 40 percent of sufferers go into remission.

In its advance stages, however, it is often fatal; among its famous victims were Jacqueline Kennedy Onnasis and King Hussein of Jordan. Data shows that, in the United States alone, the disease kills some 25,000 people per year.

NHL is a malignant growth of immunoglobuline-producer lymphocyte B cells. These cells, as well as T cells, are elements of white blood cells that exist in the lymph nodes and bone marrow and organs such as the spleen, liver and lungs. Some of these cells produce antibodies and others ingest bacteria, making them part of the body's line of defense against viruses, bacteria and foreign particles before they enter the bloodstream.

Like other living cells, lymphocyte cells experience several phases when reaching maturity but the process may be disturbed by a virus that manages to integrate with the lymphocyte cells' DNA. The viruses that may cause lymphoma are HTLV-1 (human T-cell leukemia virus type I) and the Epstein-Barr virus.

Other physicians have linked the disturbed growth of lymphocyte B cells with gene translocation. Studies have also pointed to the possibility that obesity, poor diet and environmental factors affect the immune system and increase risk of the cancer.

Non-Hodgkin's lymphoma is marked by the enlargement of the lymph nodes, called the NHL nodal, but it can also develop in other parts of the body, such as the brain, eyes, digestive system, liver, bone marrow, skin and testicles.

Common symptoms that accompany the disease are: unusually high fever, weight loss of up to 10 kilograms within six months and sweating at night.

Djumhana, who is also an internist with state-run Dharmais Cancer hospital, explained that procedures to determine the stage and its spread include biopsy or tissue analysis; CT scan, X-rays and lymphangiography for imaging evaluation, endoscopy of the digestive track and magnetic resolution imaging (MRI).

Doctors use the results to classify whether a person is in stage 1, with only one lymphoma; stage 2, if they have two lymphomas located in one diaphragm; stage 3, if two lymphomas are found in both the upper and lower diaphragms; or stage 4, if the disease has spread to one or more extra lymphatic areas such as the lungs and brain.

The main types of treatment for this cancer are bone marrow transplants, chemotherapy and radiation, with the last two used to kill cancer cells and shrink tumors. Surgery may be required to remove tumors that grow within the digestive system and the brain. Doctors may also prescribe corticosteroid as part of hormone therapy.

Without medication, people with indolent lymphoma can live for years, but aggressive forms can kill people in a matter of months or weeks.

Djumhana stressed the importance of having unusual symptoms checked out.

"Early detection is important because this cancer can be cured with chemotherapy at an early stage," Djumhana said.