Physicians Get Upper Hand on Cancer of the Lymph Nodes

01/07/99    Portland, Ore.

Twenty-six-year-old Brian Walsh of Portland lived with a small bump on his neck for more than a year before going to see a doctor about it. Then, in August of last year, he was diagnosed with Hodgkin's lymphoma. He'd been healthy his whole life and never thought of himself being at risk for cancer.

Now, after several months of chemotherapy, his cancer is in remission, and his doctors tell him he has an excellent chance to beat the disease. "I had chemotherapy on Friday and was out snowboarding on Saturday. Considering the stories I hear of other people who have cancer, I've gotten off fairly easy," said Walsh. His doctors say precisely targeted radiation therapy should knock the cancer out entirely.

Many people think of a cancer diagnosis as a death sentence. But for lymphoma, that's far from the case. There are more than 60,000 cases of lymphoma a year in the United States. Cure rates Hodgkin's lymphoma, a slower-progressing form that usually strikes younger people, are near 90 percent. For non-HodgkinÕs lymphoma, depending on the stage and type, the cure rate can range from 20 to 80 percent. ÒFor virtually everyone with lymphoma, we have a substantial chance of curing the patient and returning them to a long and full life," said Craig Nichols, M.D., professor of medicine and head of the division of hematology and medical oncology at Oregon Health Sciences University. Nichols is also associate director for clinical research at the Oregon Cancer Center and one of the nation's leading experts on the treatment of lymphoma.

Lymphoma is one of the most common cancers, and it's on the rise," said Nichols. "As with virtually any cancer, the earlier you catch it the better off you are. But an early diagnosis gives us an especially good edge on lymphoma."

The lymph nodes, scattered throughout the upper body, are important components of the human immune system. Normal lymph node cells produce antibodies to fight disease. They are programmed to be able to change their genetic code frequently to help fight new diseases. In lymphoma, the lymph node cells become malignant cells, and then spread to other lymph nodes and in the late stages of disease can spread to organs like the liver, lungs, and brain. As the untreated disease progresses, the patients' immune systems weaken, they lose weight, become susceptible to infections and eventually die.

"We all get swelling of the lymph nodes for a variety of reasons--colds, flu, infection," said Nichols. "But someone with a persistent swelling of the lymph nodes and particularly ones that are quite large and firm should seek a medical evaluation."

While lymphoma can often be accompanied by symptoms such as high fevers and night sweats, often there are no symptoms except the swelling of the nodes themselves. That was the case with Brian Walsh. "Apparently I'd had the disease for more than a year. But I had no symptoms but a lump on my neck," he said.

A lymphoma diagnosis is usually confirmed by removal and pathological examination of a suspect lymph node. The extent of the disease is determined by use of CT scanning and examination of the bone marrow.

The most commonly used treatments for lymphoma are chemotherapy and radiation therapy. But new therapies, such as vaccines and monoclonal antibodies (antibodies targeted specifically at the disease), are becoming more common. Bone marrow transplant is used for some cases. Under Nicholas' guidance, OHSU is currently involved in a number of clinical trials including use of monoclonal antibodies and bone marrow transplant.

"We already have a strong array of weapons against this disease," said Nichols. "And we're coming up with new strategies all the time. This is one of the most hopeful areas of cancer research and treatment."