After Adult Nhl

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After adult non-Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells

have spread within the lymph system or to other parts of the body.

The process used to find out the type of cancerand if cancer cellshave spread within thelymphsystemor to other parts of the body is called staging. The information gathered from the staging

process determines the stageof the disease. It is important to know the stage of the disease inorder to plan treatment. The following tests and procedures may be used in the staging process:

Complete blood count (CBC) with differential: A procedure in which a sample ofbloodis drawn and checked for the following:

o The number of red blood cellsandplatelets.

o The number and type of white blood cells.

o The amount of hemoglobintheproteinthat carrieso!ygen" in the red blood cells.

o The portion of the blood sample made up of red blood cells.

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$omplete blood count $%$". %lood is collected by inserting a needle into a vein andallowing the blood to flow into a tube. The blood sample is sent to the laboratory and the

red blood cells, white blood cells, and platelets are counted. The $%$ is used to test for,

diagnose, and monitor many different conditions.

Blood chemistry studies: A procedure in which a blood sample is checked to measure

the amounts of certain substances released into the blood by organsand tissuesin thebody. An unusual higher or lower than normal" amount of a substance can be asignof

disease in the organ or tissue that makes it.

CT scan(CAT scan): A procedure that makes a series of detailed pictures of areas inside

the body, such as thelung, lymph nodes, and liver, taken from different angles. The

pictures are made by a computer linked to an !-raymachine. A dyemay bein&ectedinto aveinor swallowed to help the organs or tissues show up more clearly. This procedure is

also called computed tomography, computeri'ed tomography, or computeri'ed a!ial

tomography.

PET scan(positron emission tomography scan): A procedure to find malignanttumor

cells in the body. A small amount ofradioactiveglucosesugar" is in&ected into a vein.

The (#T scannerrotates around the body and makes a picture of where glucose is beingused in the body. )alignant tumor cells show up brighter in the picture because they are

more active and take up more glucose than normal cells do.

MR(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a

computer to make a series of detailed pictures of areas inside the body. This procedure is

also called nuclear magnetic resonance imaging *)+I".

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Bone marrow aspirationandbiopsy: The removal ofbone marrow, blood, and a small

piece of bone by inserting a needle into the hipbone orbreastbone.Apathologistviews

the bone marrow, blood, and bone under a microscopeto look for signs of cancer.

orpregnantwomen with non-Hodgkin lymphoma, staging tests that protect the fetusfrom the

harms of radiationare used. These include )+I, bone marrow aspiration and biopsy,lumbarpuncture, and ultrasound, which do not use radiation. An ultrasound e!am is a procedure in

which high-energy sound waves ultrasound" are bounced off internal tissues or organs and makeechoes. The echoes form a picture of body tissues called a sonogram.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

Through tissue. $ancer invadesthe surrounding normal tissue.

Through the lymph system. $ancer invades the lymph system and travels through the

lymph vesselsto other places in the body.

Through theblood. $ancer invades the veinsand capillariesand travels through the bloodto other places in the body.

hen cancer cellsbreak away from theprimaryoriginal" tumorand travel through thelymphor

blood to other places in the body, another secondary" tumor may form. This process is called

metastasis.The secondary metastatic" tumor is the same type of cancer as the primary tumor.or e!ample, ifbreast cancerspreads to the bones, the cancer cells in the bones are actually

breast cancer cells. The disease is metastatic breast cancer, notbone cancer.

tages of adult non-Hodgkin lymphoma may include # and .

Adult non-Hodgkin lymphomamay be described as follows:

#: /#/ stands for e!tranodaland means the cancer is found in an area or organ other thanthe lymph nodesor has spread to tissues beyond, but near, the ma&or lymphaticareas.

: // stands forspleenand means the cancer is found in the spleen.

The following stages are used for adult non-Hodgkin lymphoma:

tage I

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#nlarge

tage I adult non-Hodgkin lymphoma. $ancer is found in one lymphatic area lymph nodes,

tonsils, thymus, or spleen". In stage I# not shown", cancer is found in one organ or area outside

the lymph nodes.

tage Iadult non-Hodgkin lymphomais divided into stage I and stage I#.

tage I: $anceris found in one lymphaticarea lymph nodegroup, tonsilsand nearby

tissue,thymus, or spleen".

tage I#: $ancer is found in one organor area outside the lymph nodes.

tage II

tage IIadult non-Hodgkin lymphomais divided into stage II and stage II#.

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tage II: $anceris found in two or more lymph nodegroups either above or below the

diaphragmthe thin muscle below thelungsthat helps breathing and separates the chest

from the abdomen".

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tage II adult non-Hodgkin lymphoma. $ancer is found in two or more lymph nodegroups, and both are either above a" or below b" the diaphragm.

tage II#: $ancer is found in one or more lymph nodegroups either above or below the

diaphragm.$ancer is also found outside the lymph nodes in one organor area on the

same side of the diaphragm as the affected lymph nodes.

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#nlarge

tage II# adult non-Hodgkin lymphoma. $ancer is found in one or more lymph node

groups either above or below the diaphragm and outside the lymph nodes in an organ or

area on the same side of the diaphragm as the lymph nodes with cancer a".

tage III

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#nlarge

tage III adult non-Hodgkin lymphoma. $ancer is found in one or more lymph node groups

above and below the diaphragm a". In stage III#, cancer is found in lymph node groups above

and below the diaphragm and outside the lymph nodes in a nearby organ or area b". In stageIII, cancer is found in lymph node groups above and below the diaphragm a" and in the spleen

c". In stage III# plus , cancer is found in lymph node groups above and below the diaphragm,

outside the lymph nodes in a nearby organ or area b", and in the spleen c".

tage IIIadult non-Hodgkin lymphomais divided into stage III, stage III#, stage III, and stageIII#0.

tage III: $anceris found in lymph nodegroups above and below the diaphragmthe thin

muscle below the lungsthat helps breathing and separates the chest from the abdomen".

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tage III#: $ancer is found in lymph nodegroups above and below the diaphragmand

outside the lymph nodes in a nearby organor area.

tage III: $ancer is found in lymph nodegroups above and below the diaphragm, and in

the spleen.

tage III#0: $ancer is found in lymph nodegroups above and below the diaphragm,outside the lymph nodes in a nearby organor area, and in the spleen.

tage I1

#nlarge

tage I1 adult non-Hodgkin lymphoma. $ancer is found throughout one or more organs that are

not part of a lymphatic area lymph nodes, tonsils, thymus, or spleen" a"2 or in one organ that isnot part of a lymphatic area and has spread to lymph nodes far away from that organ b"2 or

cerebrospinal fluid not shown", the liver, bone marrow, or lungs.

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In stage I1adult non-Hodgkin lymphoma, the cancer:

is found throughout one or more organsthat are not part of a lymphaticarea lymph node

group, tonsilsand nearby tissue, thymus, or spleen", and may be in lymph nodes nearthose organs2 or

is found in one organ that is not part of a lymphatic area and has spread to organs orlymph nodes far away from that organ2 or

is found in the liver,bone marrow, cerebrospinal fluid$", or lungsother than cancer

that has spread to the lungs from nearby areas".

Adult non-Hodgkin lymphomas are also described based on how fast they grow and where theaffected lymph nodes are in the body.

Indolentor aggressive:

Indolent lymphomas: These tend to grow and spread slowly and have few symptoms.

Aggressive lymphomas: These grow and spread 3uickly and have severe symptoms.

4ymphoblastic lymphoma, diffusesmall noncleaved cell lymphoma5%urkitt lymphoma,and mantle cell lymphomaare three types of aggressive adult non-Hodgkin lymphoma.

Aggressive lymphomas are seen more often in patients who are HI1-positive AI6

-related lymphoma".

$ontiguousor noncontiguous:

$ontiguous lymphomas: 4ymphomasin which the lymph nodeswith cancerare ne!t to

each other.

*oncontiguous lymphomas: 4ymphomasin which the lymph nodeswith cancerare not

ne!t to each other, but are on the same side of the diaphragm.

There is no standard staging system for aldenstr7m macroglobulinemia.

$heck for 8.. clinical trials from *$I9s list of cancer clinical trials that are now accepting

patients with aldenstr7m macroglobulinemia. or more specific results, refine the search by

using other search features, such as the location of the trial, the type of treatment, or the name ofthe drug. Talk with your doctor about clinical trials that may be right for you. eneral

information about clinical trials is available from the*$I eb site.

There are different types of treatment for patients with non-Hodgkin lymphoma.

6ifferent types of treatment are available for patients with non-Hodgkin lymphoma. ometreatments are standardthe currently used treatment", and some are being tested in clinical trials.

A treatment clinical trial is a research studymeant to help improve current treatments or obtain

information on new treatments for patients with cancer. hen clinical trials show that a new

treatment is better than the standard treatment, the new treatment may become the standardtreatment. (atients may want to think about taking part in a clinical trial. ome clinical trials are

open only to patients who have not started treatment.

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orpregnantwomen with non-Hodgkin lymphoma, treatment is carefully chosen to protect the

fetus. Treatment decisions are based on the mother;s wishes, the stageof the non-Hodgkin

lymphoma, and the age of the fetus. The treatment plan may change as the symptoms, cancer,and pregnancy change. $hoosing the most appropriate cancer treatment is a decision that ideally

involves the patient, family, and health care team.

i! types of standard treatment are used:

+adiation therapy

+adiation therapy is a cancer treatment that uses high-energy !-raysor other types of radiationtokill cancer cellsand keep them from growing. There are two types of radiation therapy. #!ternal

radiationtherapy uses a machine outside the body to send radiation toward the cancer. Internal

radiationtherapy uses aradioactivesubstance sealed in needles, seeds, wires, or cathetersthatare placed directly into or near the cancer. The way the radiation therapy is given depends on the

type and stage of the cancer being treated.

or pregnant women with non-Hodgkin lymphoma, radiation therapy should be given after

delivery, if possible, to avoid any risk to the fetus. If treatment is needed right away, pregnantwomen may decide to continue the pregnancy and receive radiation therapy. However, lead used

to shield the fetus may not protect it from scattered radiation that could possibly cause cancer in

the future.

$hemotherapy

$hemotherapy is a cancer treatment that uses drugsto stop the growth of cancer cells, either by

killing the cells or by stopping them from dividing. hen chemotherapy is taken by mouth or

in&ectedinto a veinor muscle, the drugs enter the bloodstream and can reach cancer cellsthroughout the body systemic chemotherapy". hen chemotherapy is placed directly into thecerebrospinal fluid,an organ, or a body cavitysuch as the abdomen, the drugs mainly affect

cancer cells in those areas regional chemotherapy". To treat certain types of adult non-Hodgkin

lymphoma that spread to the brain, $* prophyla!ischemotherapy given to kill cancer cells inthe brain or spinal cord" may be used. The way the chemotherapy is given depends on the type

and stage of the cancer being treated.

$ombination chemotherapyis treatment using two or more anticancer drugs.teroid drugsmay

be added, to relieve swelling and inflammation.

In pregnant women, the fetus is e!posed to chemotherapy when the mother is treated, and someanticancer drugs cause birth defects. %ecause anticancer drugs are passed to the fetus through the

mother, both must be watched closely when chemotherapy is given.

ee 6rugs Approved for *on-Hodgkin 4ymphomafor more information.

Targeted therapy

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Targeted therapyis a type of treatment that uses drugs or other substances to identify and attack

specific cancer cells without harming normal cells. )onoclonal antibodytherapyandproteasome

inhibitortherapy are two types of targeted therapy used to treat adult non-Hodgkin lymphoma.

)onoclonal antibody therapy is a cancer treatment that usesantibodiesmade in the laboratory

from a single type of immune systemcell. These antibodies can identify substances on cancercells or normal substances that may help cancer cells grow. The antibodies attach to the

substances and kill the cancer cells, block their growth, or keep them from spreading.)onoclonal antibodies are given byinfusion. They may be used alone or to carry drugs, to!ins,

or radioactive material directly to cancer cells. )onoclonal antibodies that have been &oined to

radioactive material are called radiolabeledmonoclonal antibodies.

(roteasome inhibitor therapy blocks the action of proteasomes in cancer cells and may prevent

the growth of tumors.

ee 6rugs Approved for *on-Hodgkin 4ymphomafor more information.

(lasmapheresis

If the blood becomes thick with e!tra antibodyproteinsand affects circulation,plasmapheresisisdone to remove e!traplasmaand antibody proteins from the blood. In this procedure, blood is

removed from the patient and sent through a machine that separates the plasma the li3uid part of

the blood" from the blood cells. The patient9s plasma contains the unneeded antibodies and is not

returned to the patient. The normal blood cells are returned to the bloodstream along withdonatedplasma or a plasma replacement. (lasmapheresis does not keep new antibodies from

forming.

%iologic therapy

%iologic therapyis a treatment that uses the patient9s immune system to fight cancer. ubstancesmade by the body or made in a laboratory are used to boost, direct, or restore the body9s natural

defenses against cancer. This type of cancer treatment is also called biotherapy or

immunotherapy.

Interferonis a type of biologic therapy. It affects the division of cancer cells and can slow tumorgrowth.

atchful waiting

atchful waitingis closely monitoringa patient;s conditionwithout giving any treatment until

symptoms appear or change.

*ew types of treatment are being tested in clinical trials.

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This summary section describes treatments that are being studied in clinical trials. It may not

mention every new treatment being studied. Information about clinical trials is available from the

*$I eb site.

1accine therapy

1accine therapyis a type ofbiologic therapy.%iologic therapy is a treatment that uses the

patient;s immune system to fight cancer. ubstances made by the body or made in a laboratory

are used to boost, direct, or restore the body;s natural defenses against cancer. This type of cancertreatment is also called biotherapy or immunotherapy. 1accine therapy can also be a type of

targeted therapy.

High-dose chemotherapy with stem cell transplant

High-dose chemotherapywith stem cell transplantis a method of giving high dosesof

chemotherapy and replacingblood-forming cells destroyed by the cancer treatment. tem cells

immature blood cells" are removed from the blood orbone marrowof the patient or adonorandare fro'en and stored. After the chemotherapy is completed, the stored stem cells are thawed and

given back to the patient through an infusion. These reinfused stem cells grow into and restore"the body;s blood cells.

(atients may want to think about taking part in a clinical trial.

or some patients, taking part in a clinical trialmay be the best treatment choice. $linical trials

are part of the cancer research process. $linical trials are done to find out if new cancertreatments are safe and effective or better than the standard treatment.

)any of today9s standard treatments for cancer are based on earlier clinical trials. (atients whotake part in a clinical trial may receive the standard treatment or be among the first to receive a

new treatment.

(atients who take part in clinical trials also help improve the way cancer will be treated in thefuture. #ven when clinical trials do not lead to effective new treatments, they often answer

important 3uestions and help move research forward.

(atients can enter clinical trials before, during, or after starting their cancer treatment.

ome clinical trials only include patients who have not yet received treatment.

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ollow-up tests may be needed.

ome of the tests that were done to diagnosethe cancer or to find out thestageof the cancer may

be repeated. ome tests will be repeated in order to see how well the treatment is working.6ecisions about whether to continue, change, or stop treatment may be based on the results of

these tests. This is sometimes called re-staging.

ome of the tests will continue to be done from time to time after treatment has ended. The

results of these tests can show if yourconditionhas changed or if the cancer has recurredcomeback". These tests are sometimes called follow-uptests or check-ups.

Indolent, tage I and $ontiguous tage II Adult *on-Hodgkin 4ymphoma

Treatment of indolent,stage Iand contiguousstage IIadultnon-Hodgkin lymphomamay include

the following:

+adiation therapydirected at the area where canceris found. atchful waiting.

$hemotherapywith radiation therapy.

+adiation therapy directed at the area where cancer is found and nearby lymph nodes.

)onoclonal antibodytherapywith or without chemotherapy.

Treatments used for more advanced disease, in patients who can;t be treated with

radiation therapy.

$heck for 8.. clinical trials from *$I9s list of cancer clinical trials that are now acceptingpatients with indolent, stage I adult non-Hodgkin lymphomaand indolent, contiguous stage II

adult non-Hodgkin lymphoma.or more specific results, refine the search by using other search

features, such as the location of the trial, the type of treatment, or the name of the drug. Talk withyour doctor about clinical trials that may be right for you. eneral information about clinical

trials is available from the*$I eb site.

Aggressive, tage I and $ontiguous tage II Adult *on-Hodgkin 4ymphoma

Treatment of aggressive,stage Iandcontiguousstage IIadult non-Hodgkin lymphomamayinclude the following:

$ombination chemotherapywith or without radiation therapyto areas wherecanceris

found.

A clinical trialof monoclonal antibody therapy and combination chemotherapy withsteroids. +adiation therapy may also be given.

$heck for 8.. clinical trials from *$I9s list of cancer clinical trials that are now accepting

patients with aggressive, stage I adult non-Hodgkin lymphomaandaggressive, contiguous stage

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II adult non-Hodgkin lymphoma.or more specific results, refine the search by using other

search features, such as the location of the trial, the type of treatment, or the name of the drug.

Talk with your doctor about clinical trials that may be right for you. eneral information aboutclinical trials is available from the*$I eb site.

Indolent, *oncontiguous tage II5III5I1 Adult *on-Hodgkin 4ymphoma

Treatment of indolent,noncontiguousstage II5III5I1adult non-Hodgkin lymphomamay include

the following:

atchful waitingfor patients who do not havesymptoms.

$hemotherapy with or without steroids.

$ombination chemotherapywith steroids.

)onoclonal antibodytherapywith or without chemotherapy.

+adiolabeledmonoclonal antibody therapy.

+adiation therapydirected at the area where canceris found and nearby lymph nodes, for

patients who have stage II and stage III disease.

A clinical trialof chemotherapy with or withouttotal-body irradiationradiation therapy

to the entire body" or radiolabeled monoclonal antibody therapy, followed by autologousor allogeneic stem cell transplant.

A clinical trial of chemotherapy with or withoutvaccine therapy.

$heck for 8.. clinical trials from *$I9s list of cancer clinical trials that are now accepting

patients with indolent, noncontiguous stage II adult non-Hodgkin lymphoma,indolent, stage IIIadult non-Hodgkin lymphomaand indolent, stage I1 adult non-Hodgkin lymphoma. or more

specific results, refine the search by using other search features, such as the location of the trial,the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may

be right for you. eneral information about clinical trials is available from the*$I eb site.

Aggressive, *oncontiguous tage II5III5I1 Adult *on-Hodgkin 4ymphoma

Treatment of aggressive,noncontiguousstage II5III5I1adult non-Hodgkin lymphomamayinclude the following:

$ombination chemotherapywith radiation therapyor monoclonal antibodytherapy. $ombination chemotherapy with $* prophyla!is.

A clinical trialof autologousor allogeneic stem cell transplantfor patients who are likely

to relapse.

$heck for 8.. clinical trials from *$I9s list of cancer clinical trials that are now accepting

patients with aggressive, noncontiguous stage II adult non-Hodgkin lymphoma, aggressive, stage