Harare — Non-Hodgkin's Lymphoma is cancer that begins in cells of the immune system. The immune system fights infections and other diseases.

The lymphatic system is part of the immune system. The lymphatic system includes the following: Lymph vessels: The lymphatic system has a network of lymph vessels. Lymph vessels branch into all the tissues of the body.

Lymph: The lymph vessels carry clear fluid called lymph. Lymph contains white blood cells, especially lymphocytes such as B cells and T cells. Lymph nodes: Lymph vessels are connected to small, round masses of tissue called lymph nodes. Groups of lymph nodes are found in the neck, underarms, chest, abdomen and groin.

Lymph nodes store white blood cells. They trap and remove bacteria or other harmful substances that may be in the lymph. Other Parts of the Lymphatic System

Other parts of the lymphatic system include the tonsils, thymus and spleen. Lymphatic tissue is also found in other parts of the body including the stomach, skin and small intestine.

Because lymphatic tissue is in many parts of the body, Hodgkin lymphoma can start almost anywhere. Usually, it's first found in a lymph node.

Non-Hodgkin Lymphoma Cells:

Non-Hodgkin's Lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell divides to make copies of itself.

The new cells divide again and again, making more and more abnormal cells. The abnormal cells don't die when they should.

They don't protect the body from infections or other diseases. The build-up of extra cells often forms a mass of tissue called a growth or tumor.

Risk Factors

Doctors seldom know why one person develops Non-Hodgkin's Lymphoma and another does not. But research shows that certain risk factors increase the chance that a person will develop this disease.

In general, the risk factors for Non-Hodgkin Lymphoma include the following:

Weakened immune system: The risk of developing lymphoma may be increased by having a weakened immune system (such as from an inherited condition or certain drugs used after an organ transplant).

Certain infections: Having certain types of infections increases the risk of developing lymphoma.

However, lymphoma is not contagious. You cannot catch lymphoma from another person.

The following are the main types of infection that can increase the risk of lymphoma:

Human immunodeficiency virus (HIV): HIV is the virus that causes Aids. People who have HIV infection are at much greater risk of some types of Non-Hodgkin's Lymphoma.

Epstein-Barr virus (EBV): Infection with EBV has been linked to an increased risk of lymphoma. In Africa, EBV infection is linked to Burkitt lymphoma.

Helicobacter pylori: H. pylori are bacteria that can cause stomach ulcers. They also increase a person's risk of lymphoma in the stomach lining.

Human T-cell leukemia/lymphoma virus type 1 (HTLV-1): Infection with HTLV-1 increases a person's risk of lymphoma and leukemia.

Hepatitis C virus: Some studies have found an increased risk of lymphoma in people with hepatitis C virus. More research is needed to understand the role of hepatitis C virus.

Age: Although Non-Hodgkin's Lymphoma can occur in young people, the chance of developing this disease goes up with age.

Most people with Non-Hodgkin's Lymphoma are older than 60.

Researchers are studying obesity and other possible risk factors for Non-Hodgkin's Lymphoma.

People who work with herbicides or certain other chemicals may be at increased risk of this disease.

Researchers are also looking at a possible link between using hair dyes before 1980 and Non-Hodgkin's Lymphoma.

Having one or more risk factors does not mean that a person will develop Non-Hodgkin's Lymphoma. Most people who have risk factors never develop cancer.

Symptoms:

Non-Hodgkin's Lymphoma can cause many symptoms:

Swollen, painless lymph nodes in the neck, armpits or groin.

· Unexplained weight loss

·Fever

· Soaking night sweats

· Coughing, trouble breathing or chest pain

· Weakness and tiredness that don't go away

· Pain, swelling, or a feeling of fullness in the abdomen

Most often, these symptoms are not due to cancer.

Infections or other health problems may also cause these symptoms.

Anyone with symptoms that do not go away within two weeks should see a doctor so that problems can be diagnosed and treated

Diagnosis

Types of Non-Hodgkin's Lymphoma

If you have swollen lymph nodes or another symptom that suggests Non-Hodgkin's Lymphoma, your doctor will try to find out what's causing the problem.

Your doctor may ask about your personal and family medical history.

You may have some of the following exams and tests:

· Physical exam: Your doctor checks for swollen lymph nodes in your neck, underarms and groin. Your doctor also checks for a swollen spleen or liver.

· Blood tests: The lab does a complete blood count to check the number of white blood cells.

· Chest X-rays: You may have X-rays to check for swollen lymph nodes or other signs of disease in your chest.

· Biopsy: A biopsy is the only sure way to diagnose lymphoma. Your doctor may remove an entire lymph node (excisional biopsy) or only part of a lymph node (incisional biopsy). A thin needle (fine needle aspiration) usually cannot remove a large enough sample for the pathologist to diagnose lymphoma. Removing an entire lymph node is best. The pathologist uses a microscope to check the tissue for lymphoma cells.

Types of Non-Hodgkin's Lymphoma

When lymphoma is found, the pathologist reports the type. There are many types of lymphoma. The most common types are diffuse large B-cell lymphoma and follicular lymphoma.

Lymphomas may be grouped by how quickly they are likely to grow:

· Indolent (also called low-grade) lymphomas grow slowly. They tend to cause few symptoms.

· Aggressive (also called intermediate-grade and high-grade) lymphomas grow and spread more quickly. They tend to cause severe symptoms. Over time, many indolent lymphomas become aggressive lymphomas.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat Non-Hodgkin's Lymphoma include hematologists, medical oncologists, and radiation oncologists.

Your doctor may suggest that you choose an oncologist who specialises in the treatment of lymphoma.

Often, such doctors are associated with major academic centres. Your health care team may also include an oncology nurse and a registered dietitian.

The choice of treatment depends mainly on the following:

· The type of Non-Hodgkin's Lymphoma (for example, follicular lymphoma)

· Its stage (where the lymphoma is found)

· How quickly the cancer is growing (whether it is indolent or aggressive lymphoma)

·Your age

· Whether you have other health problems

If you have indolent Non-Hodgkin's Lymphoma without symptoms, you may not need treatment for the cancer right away.

The doctor watches your health closely so that treatment can start when you begin to have symptoms.

If you have indolent lymphoma with symptoms, you will probably receive chemotherapy and biological therapy. Radiation therapy may be used for people with Stage I or Stage II lymphoma.

If you have aggressive lymphoma, the treatment is usually chemotherapy and biological therapy. Radiation therapy also may be used. If Non-Hodgkin's Lymphoma comes back after treatment, doctors call this a relapse or recurrence. People with lymphoma that comes back after treatment may receive high doses of chemotherapy, radiation therapy, or both, followed by stem cell transplantation.

You may want to know about side effects and how treatment may change your normal activities. Because chemotherapy and radiation therapy often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.

At any stage of the disease, you can have supportive care. Supportive care is treatment to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring.

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods.

Chemotherapy

Chemotherapy for lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body.

You may receive chemotherapy by mouth, through a vein, or in the space around the spinal cord. Treatment is usually in an outpatient part of the hospital, at the doctor's office, or at home. Some people need to stay in the hospital during treatment.

Chemotherapy is given in cycles. You have a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and on the anticancer drugs used.