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V Care Foundation is a voluntary support group dedicated providing free help, hope, awareness & education to cancer patients & their families through outreach programs & services that improve the quality of their lives. V-Care has prepared this booklet to help patients & their families understand & deal with cancer &its related conditions. We believe this will help the patient & the family faces the disease together to get in touch with us for any help. What is cancer? Normal, healthy cells, which are responsible for the growth of the tissue of the body, divide and replace themselves constantly. Sometimes they lose the ability to regulate and limit their growth and divide too fast, resulting in too much tissue being produced, thereby forming a tumor. A tumor can be benign or malignant. Benign tumors do not spread to the other parts of the body are seldom dangerous to life. They can be removed surgically and do not usually recur. Malignant tumors can attack and destroy neighboring tissues and organs. Cancer cells can spread to other parts of the body and form secondary tumors. Cancers are classified according to the cells or organs in which they start. Every illness should be diagnosed and treated as early as possible. This is particularly important in the case of cancer, as it can spread to other other parts of the body. The sooner cancer is detected and treated, the better the chances of a complete recovery. What is lymphoma? Lymphomas are cancer which arises in the lymphatic system. They are classified as Hodgkin’s lymphomas. The latter is a group of at least ten different lymphomas. The lymphatic system is a part of the immune system, the body’s natural defense mechanism which help fight against disease & infection. It is made up of small bean like glands called lymph nodes, tonsils, spleen, thymus & very lymphatic vessels which connect the lymph nodes throughout the body. Cluster of lymph nodes are found in the groin, under arm, neck, chest & abdomen. Lymph is a clear fluid arising from body tissue which contains infection fighting cells called lymphocytes & special proteins called anybodies. It flows through the network of vessels, circulating throughout the body. As the lymph, and cause the lymph nodes to swell. This can happens due to many infections. Many types of cancer may spread into the lymph nodes when cancer cells are trapped and grow in the nodes, but most lymphomas start here. In lymphomas, cells of any part of the lymphatic system grow abnormally and can spread to neighboring groups of nodes through the lymphatic vessels and to the other organs if untreated. Large numbers of abnormal lymphocytes, disrupting the immune system. As the disease progresses, the body loses its ability to fight infection. What are the symptoms? The most common symptom of non-Hodgkin’s Lymphoma is a painless swelling in the lymph nodes of the neck, underarm, abdomen or groin. Several groups of nodes in different parts of the body may be enlarged simultaneously. They can cause problems in digesting food, fluid buildup and swelling of the ankles. Other symptoms may include fever, night sweats, and loss of appetite, tiredness, weight loss and persistent itch all over the body. Occasionally the patients may have pain or lump in the abdomen, cough or suffer from breathlessness. All these may be caused by many other common illnesses, but it is important to see a doctor if the symptoms last longer than a fortnight. Non-Hodgkin’s lymphomas can occur at any age. Cause Through effective treatment is available for non- Hodgkin’s lymphoma, the cause is still not known. It is not contagious. Diagnosis After a through physical examination, a series of test such as blood test and x-rays are carried out. The disease is confirmed only after tissue from the enlarged lymph node is removed and examined. This is known as a biopsy and tells the doctor if cancer is present and if so what type of lymphoma it is. The different types of non-Hodgkin’s lymphomas are often groped according to how fast they grow: low grade, intermediate and high grade. They may be further categorized according to cell type. When non-Hodgkin’s lymphoma is confirmed, it is staged or us extent determined. Staging indicated where the disease has spread and how much tissue is affected. Test like bone marrow aspiration, ultrasound and CT scans, X rays of gastrointestinal tract, lumbar puncture, or lymph angiograms are carried out to do this. All this may two to three weeks. Stage 1: Cancer is limited to one group of lymph nodes. Stage 2: Two or more groups of lymph nodes are affected on the same side of the diaphragm, the thin muscle separating the chest and abdomen. Stage3: lymph nodes on both sides of the diaphragm are affected. Stage 4: Disease has spread beyond the nodes to organs such as the spleen, bone marrow or liver. Depending on the type of lymphoma and the extent of spread, the specific treatment is planned. Treatment: Chemotherapy is the main form of treatment and is planned depending on symptoms, general health, and age of patient, stage & type of lymphoma. Treatment also depends on whether it is a low or high grade lymphoma. Some adults with low grade lymphoma, which is growing very slowly and with low grade lymphoma, which is growing very slowly, and with no symptoms, may not need treatment for a longtime, if at all, and regular checkups are all that are required. When they do require treatment it is usually mild chemotherapy, sometimes tablets which can be taken at home. Radiotherapy alone may be used for adults with very early or localized disease. Treatment for intermediate and high grade lymphomas is usually chemotherapy And, in the case of adults, radiotherapy may also be given as adjuvant therapy In addition, large tumors may be removed surgically. Children with non-Hodgkin’s lymphomas usually have high grade tumors which need intensive chemotherapy. Combination of drugs are usually given, some of which may be injections and some tablets. Chemotherapy is usually given in cycles: treatment period followed by a rest period. The duration of the treatment and rest periods. The duration of the treatment and rest periods varies. Sometimes steroids are given for a short time to help the patient feel better quickly. Treatment is planned by the doctor according to the specific need of each patient. Chemotherapy drugs do have side effects so the dosage is adjusted so as to damage as few normal cells. The fall in the normal blood cell level can cause the patients to feel tired, bleed easily and suffer from infections. Other side effects may be nausea, vomiting, mouth sores, and hair loss and stomach disorders. All these re temporary and it are important for the patient to drink a lot of fluids and eat as well as possible so as to tolerate the treatment better and recover quickly. Some of the drugs that may be used to treat non-Hodgkin’s Lymphoma may cause fertility problems. Women’s menstrual periods may stop, but are likely to return in younger women. In men both the disease and the treatment can affects fertility. Sperm banking before treatment is an option that men may consider. Side effects can vary from person to person and also differ according to treatment. There are many couples who have had normal, healthy babies after one of the partners has been treated for lymphoma. Regular follow up checks are very important and the doctor continues to watch the patient every few months for several years. Blood tests and x-rays are taken periodically. Thus should any problems arise, prompt treatment can be started. For many patients the treatment will completely cure the disease. For most patients, then risk of recurrence diminishes after two years. Should the disease flare up or relapse, further treatment is required. It is important to continue seeing the doctors for as long as he thinks it is necessary because lymphomas can be cured or controlled for very long periods and the patients can live a normal life. V care information resources: V care provides helping booklet about cancer their treatments and coping with these include chemotherapy radiation therapy and diet for cancer patients. At any stage of disease, supportive care is available to relieve the side effects of treatment, and to ease emotional concerns. Further information you can meet with one our volunteers or call out troll free help line-
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LIMFOMI Kada stanice iz limfoidne obitelji počnu odrastati, premještaju se u druge organe tijela, uključujući u prsnu žlijezdu, limfne žlijezde i u druga tkiva. Zloćudnom promjenom takvih zrelih stanica i njihovim nekontroliranim umnažanjem nastaje bolest, srodna leukemiji, zloćudni limfom (malignant lymphoma). Limfomi, za razliku od leukemije, pripadaju kategoriji solidnih tumora, tj. ograničeni su na tkivo. Limfom se može razvijati polako ili može biti agresivan. Dijelimo ga u dvije osnovne, i vrlo različite skupine: Posebna vrsta limfoidne zloćudnosti odnosi se na najzreliji oblik B limfocita, stanice koje proizvode protutijela, a zovu se plazma stanice. Ta bolest se zove multipli mijelom (multiple myeloma). Dijagnoza Hogdkinove bolesti Obavezno posjetite liječnika ukoliko se neki od sljedećih simptoma javljaju duže od dva tjedna: bezbolno oteknuće limfnih čvorova u vratu, preponama ili ispod pazuha, povišena temperatura, umor, gubitak težine i svrbež kože. Ukoliko postoje simptomi, liječnik će oprezno provjeriti postojanje oteknuća na vratu, preponama i ispod pazuha. Ako je kod osobe došlo do patoloških promjena limfnih čvorova, jedan od čvorova se kirurški odstranjuje kako bi se potvrdila dijagnoza. Limfni čvor šalje se u laboratorij na analizu, gdje se utvrđuje oblik limfoma i daje dijagnoza. Provode se i drugi testovi –CT prsnog koša, abdomena i zdjelice, punkcija koštane srži, biopsija kosti i krvni testovi - kako bi se utvrdilo u kojem se stupnju bolest nalazi. Prognoze za oporavak i način liječenja ovise o stupnju proširenosti limfoma (da li je lokaliziran ili metastaziran), veličini nateknutog područja, rezultatima pretraga krvi, vrsti simtpoma i pacijentovoj dobi, spolu i općenitom zdravstvenom stanju. Koji su mogući načini liječenja? Liječenje je opcija za sve osobe oboljele od Hodgkinove bolesti. Pritom su moguća dva oblika liječenja: ne-Hodgkinove Limfom Ne-Hodgkinov limfom (non-Hodgkin, NHL) predstavlja tumor koji nastaje zloćudnom preobrazbom stanica limfocitnog reda. Razumijevanje NHL-a posljednjih je desetljeća bitno unaprijeđeno što uz nove, sve uspješnije načine liječenja mijenja prognozu oboljelih od ove bolesti. Pod nazivom ne-Hodgkinov limfom, podrazumijeva se više od 30-tak vrsta limfoma, koji se međusobno razlikuju po tipu stanica iz kojih su nastali, brzini rasta, osjetljivosti na liječenje i prognozi. Prema zloćudnosti tj. brzini rasta mogu se podijeliti na ne-Hodgkinove limfome niskog, srednjeg i visokog stupnja malignosti. Limfomi niskog stupnja malignosti Limfome niskog stupnja malignosti karakteriziraju sporiji rast i napredovanje, zbog čega bolesnik simptome primjećuje obično kada je bolest već uznapredovala. Limfomi niskog stupnja malignosti još se nazivaju indolentnim limfomima. Najpoznatiji predstavnici te skupine su folikularni limfom i mali limfocitni limfom (ili kronična limfocitna leukemija). Kod nekih spororastućih oblika indolentnih limfoma, ovisno o procjeni liječnika, s liječenjem se ne mora započeti odmah nakon dijagnoze. Umjesto toga bolesnik se redovito kontrolira, a s liječenjem se započne kada se uoče znaci napredovanja (progresije) bolesti. Međutim, izlječenje kod indolentnog NHL-a uglavnom nije moguće. Umjesto toga, liječenjem se bolesnik uvodi u remisiju, stanje koje karakterizira nestanak simptoma i znakova tumora u krvi ili koštanoj srži. Remisija može biti potpuna, kada je dostupnim dijagnostičkim metodama nemoguće detektirati znakove bolesti ili djelomična (parcijalna) kada postoje znaci bolesti, no bolesnik je bez simptoma i živi gotovo normalnim životom. Nakon remisije koja može trajati i po nekoliko godina, bolest se obično vraća, što se uočava dijagnostičkim metodama ili ponovnom pojavom simptoma. Takvo stanje nazivamo relaps i ono uvijek zahtijeva terapiju. Limfomi visokog stupnja malignosti Limfomi visokog stupnja malignosti rastu vrlo brzo, zbog čega vrlo brzo stvaraju simptome. To je razlog zašto se češće otkriju u ranim fazama, kada bolest još nije uznapredovala. Limfomi visokog stupnja malignosti još se nazivaju i agresivnim limfomima. Najpoznatiji predstavnici ove skupine su difuzni i anaplastični B-velikostanični limfom, Burkittov limfom te limfoblastični limfom. Bez terapije, agresivni bi limfomi vrlo brzo doveli do smrtnog ishoda, pa se s liječenjem mora započeti odmah nakon potvrde dijagnoze. Budući da ovi limfomi najčešće vrlo dobro reagiraju na terapiju, liječenjem je moguće postići ne samo dugotrajnu remisiju, već i izlječenje. Limfomi srednjeg stupnja malignosti Limfomi srednjeg stupnja malignosti po brzini su rasta i zloćudnosti između dvije gore opisane skupine. Ne-Hodgkinov (Non-Hodgkinov) limfom - važno za zapamtiti: Niski stupanj zloćudnosti: MALI LIMFOCITNI (DIFUZNI, DOBRO DIFERENCIRANI LIMFOCITNI) LIMFOM Niskog je stupnja zloćudnosti. U većine bolesnika nije potrebno liječenje kroz prve 3-4 godine. Srednje je preživljavanje nakon postavljanja dijagnoze: 8-10 godina. FOLIKULARNI, PTRETEŽNO MALIH ZAREZANIH STANICA (NODULARNI SLABO DIFERENCIRANI LIMFOCITNI) LIMFOM Niskog je stupnja zloćudnosti. Ovaj limfom je vrlo učestao u ovoj grupi bolesti i čini polovinu svih slučajeva ne-Hodgkinove bolesti. Bolesnici imaju povećane, bezbolne limfne čvorove koji su prisutni duže vrijeme te se povećavaju i smanjuju. U nekih se bolesnika nađu tumorske mase u trbušnoj šupljini. Iako bolesnici kao znak bolesti navode samo povećanje čvorova, pretragama se obično nađe proširena bolest - u 80% bolesnika zahvaćena je jetra, slezena i koštana srž. Tijek bolesti je vrlo različit. Većina bolesnika ne treba nikakvo liječenje u prve tri godine bolesti. Kod bolesnika s I i ograničenim II stadijem proširenosti, zračenje ograničenih područja tijela neke bolesnike izliječi, a kod nekih dovodi do dugotrajnog perioda bez simptoma. U bolesnika s višim stupnjem proširenosti bolest se nakon nekog vremena izrazito proširi, a prvi je znak ubrzani rast limfnih čvorova. Bolovi uzrokovani naglim rastom zahvaćenih organa smanjuju se nakon primjene kemoterapije (lijekova protiv tumora - citostatici). Potrebno je ponovno napraviti biopsiju čvora jer je u ovoj fazi kod 60% bolesnika moguć prijelaz bolesti u agresivniji tip. Prijelaz u agresivniji tip bolesti povezan je s lošijim ishodom bolesti i slabijim odgovorom na liječenje. Primjenom kemoterapije 40-70% bolesnika se zaliječi i faza bez znakova bolesti može trajati 2-3 godine. Bolesnici s folikularnim limfomom dugotrajno preživljavaju nakon dijagnoze: srednje preživljavanje bolesnika s III ili IV stadijem proširenosti je: 7-9 godina. FOLIKULARNI, MIJEŽANI MALIH ZAREZANIH I VELIKIH STANICA (NODULARNI MIJEŠANI) Ovaj tip limfoma ima zajednička svojstva s ostala dva tipa ne-Hodgkinova limfoma niskog stupnja zloćudnosti. Niskog je stupnja zloćudnosti. Bolesnici uz povećane limfne čvorove često imaju tumorske mase u trbuhu. Dobri uspjesi u liječenju preporuka su za početak liječenja odmah nakon dijagnoze bolesti. Srednji stupanj malignosti: FOLIKULARNI, PRETEŽNO VELIKIH STANICA (NODULARNI HISTIOCITNI) Građa zahvaćenog limfnog čvora je očuvana. Rjeđe zahvaća koštanu srž i jetru, ali se često jave velike tumorske mase u tijelu i širenje izvan limfnih čvorova. U kasnijoj fazi bolesti moguć je prijelaz u agresivniji podtip bolesti i zato je potrebno liječenje početi na vrijeme. Iskustva liječenja kemoterapijom vrlo su ohrabrujuća. DIFUZNI MIJEŠANI VELIKIH STANICA (DIFUZNI MIJEŠANI) Ovaj je podtip limfoma srednjeg stupnja malignosti, a po svom ponašanju sličan je difuznom limfomu velikih stanica. Liječi se agresivnom kemoterapijom. Uspjeh liječenja različit je kod pojedinog bolesnika. Visoki stupanj malignosti: LIMFOBLASTIČNI LIMFOM (DIFUZNI LIMFOBLASTIČNI) Najčešći je podtip ne-Hodgkinove bolesti koji se javlja u dječjoj dobi. Bolesnici su obično muškarci mlađe dobi, a simptomi su povećanje limfnih čvorova i velika tumorska masa u prsištu. Ta je tumorska masa najčešće veća od 10 cm u promjeru i uzrokuje brojne smetnje zbog pritiska na velike krvne žile, srce i dišni sustav. U vrijeme postavljanja dijagnoze većina je bolesnika u III ili IV stadiju proširenosti bolesti, a oko polovina ima simptome. Bolesnici pri dijagnosticiranju bolesti uglavnom nemaju zahvaćenu koštanu srž, ali se kasnije bolest tamo širi u 60% bolesnika što označava tzv. leukemijsku fazu pa je tada teško razlikovati ovaj limfom od akutne leukemije. Zahvaćenost koštane srži obično je uvod u zahvaćanje središnjeg živčanog sustava (mozak, leđna moždina i njihovi živci). Bolest se liječi agresivnom kemoterapijom. BURKITTOV LIMFOM Burkittov se limfom javlja pretežno u djece ili u odraslih do 35. godine života. Dva su glavna oblika bolesti: afrički (endemski) tip je zahvaćanje čeljusti sa širenjem u moždane ovojnice i koštanu srž, a američki (neendemski) tumorskom masom u trbušnoj šupljini i širenjem u kožu, kost i limfne čvorove. Liječi se agresivno kemoterapijom.