Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Cancer Care

Fremont and San Leandro Medical Centers

Overview

Non-Hodgkin lymphoma (NHL) is cancer that forms in the lymph system. It affects white blood cells (lymphocytes) found in the immune system. 

Some types of lymphoma:

  • May not require treatment for years. We’ll monitor you for signs the disease is progressing (called active surveillance or watchful waiting).
  • Can be cured. Even when not curable, NHL is treatable. You can live for many years with treatment. 

When needed, treatment options usually include chemotherapy, radiation therapy, and other methods. Surgery is usually not considered. 

We know a cancer diagnosis is overwhelming. Once we identify the type of NHL, we’ll work with you to create the best treatment plan.

Types

Depending on how fast it grows, NHL may be: 

  • Low grade, growing slowly and not aggressively. 
  • Intermediate grade, growing fast. 
  • High grade, growing extremely fast (aggressive). 

Types of NHL are:

  • Follicular lymphoma (low grade). It grows slowly. You may not need any treatment right away, only monitoring. While it’s not curable, you can live for many years with treatment.
  • Diffuse large B-cell lymphoma (intermediate grade). It grows fast and must be treated right away. It may be curable with chemotherapy. 
  • Burkitt’s lymphoma (BL) and acute lymphoblastic lymphoma (ALL) (high grade). They are both rare and require urgent treatment.

Treatment

The treatment for non-Hodgkin lymphoma depends on the type. 

Diffuse large B-cell lymphoma

This type is curable. It’s treated with R-CHOP, which is a combination of 4 chemotherapy drugs plus rituximab.  

Follicular lymphoma

This type may be controlled with treatment, giving you a long life expectancy of 10 years or more. 

Mucosa-associated lymphoid tissue (MALT) lymphoma

MALT lymphoma frequently develops in the stomach. It’s caused by the H. pylori bacteria. It can be cured by antibiotics or radiation to the stomach. MALT lymphoma can also develop in other organs, such as the lungs, spleen, and skin. It’s often associated with other infections. Treatment depends on where the lymphoma appears.

Mantle-cell lymphoma (MCL)

MCL isn’t curable. It may be slow or aggressive. Treatment can be challenging. You may be considered for a stem cell transplant. 

High-grade lymphomas

This type (such as Burkitt’s’ lymphoma and acute lymphoblastic lymphoma) are uncommon but curable with urgent and intensive chemotherapy.

Anaplastic T-cell lymphoma

This type isn’t common. It’s aggressive but can be cured with CHOP (a combination of 4 chemotherapy drugs).

Cutaneous T-cell lymphoma

This type (mycosis fungoides) is less common and slow-growing. Treatment includes topical chemotherapy, phototherapy, biologic drugs, systemic chemotherapy, and radiation.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. You may receive a combination of different types of chemotherapy drugs. 

Most chemotherapy is given through intravenous (IV) infusion, although sometimes it’s a pill. 

Chemotherapy is treatment that:

  • Circulates throughout your entire body (systemic).
  • Can destroy cancer cells that travel outside the lymphatic system. 

Chemotherapy is given in cycles. The number of cycles you have depends on the type and stage of your NHL. You’ll receive treatment and then have a rest period so your body has time to recover. 

Lymphoma usually responds well to chemotherapy.

Side effects

Chemotherapy works by killing rapidly dividing cancer cells. It can also affect normal cells. Side effects may include:   

  • Hair loss
  • Nausea and vomiting
  • Loss of appetite
  • Mouth sores
  • Fatigue
  • Diarrhea
  • Low blood cell count

We can help you manage all side effects. Most side effects typically go away when treatment ends. However, some may continue years after treatment ends (late side effects), such as:

  • Fertility problems (difficulty getting pregnant or having children).
  • Heart and lung damage, especially after radiation therapy to the chest.
  • Secondary cancers from treatment (such as acute myelogenous leukemia).

Before treatment, we’ll talk about possible side effects. After treatment, we’ll watch you for signs of late side effects. 

Seek urgent care if you develop signs of infection, including fever, chills, and cough.

Radiation Therapy

We may recommend radiation for certain types and stages of NHL. Radiation may also be used: 

  • After you have several cycles of chemotherapy, or along with chemotherapy.
  • To control cancer pain when NHL is not curable.  

Radiation therapy uses high-energy beams to kill tumor cells. The most common type is external-beam radiation therapy. 

A machine outside the body delivers radiation directly to the tumor and nearby tissue.

We use a CT scan to identify the precise location first. The radiation beam is aimed at the lymph node areas affected by NHL. 

You may have radiation: 

  • 5 days a week for up to 5 weeks. 
  • After chemotherapy ends to remove any remaining cancer cells.
Side effects

Radiation side effects depend on the area treated. These include:

  • Hair loss
  • Skin changes, such as redness
  • Fatigue
  • Nausea or vomiting
  • Bowel discomfort or diarrhea
  • Dry, sore throat and mouth, loss of taste, and difficulty swallowing
  • Tooth decay

We can treat your side effects, so be sure to let us know.

Depending on the area receiving radiation, you may also have side effects years after treatment ends (late effects), such as:

  • Fertility problems (difficulty becoming or getting a woman pregnant)
  • Heart disease and stroke
  • Thyroid problems
  • Secondary cancer (such as lung or breast cancer) 

We take special care to limit exposure of radiation to the surrounding healthy tissue and organs. We’ll monitor you for signs of late effects during your follow-up care.

Stem Cell Transplant

When standard treatment doesn’t kill the cancer, or if it returns, we may recommend stem cell transplantation.

Stem cells are usually obtained from circulating blood or a newborn’s umbilical cord and placenta. 

First, you’re given high doses of chemotherapy or whole-body radiation therapy. This destroys cancer cells throughout the body. It also destroys healthy cells in bone marrow. 

Next, we’ll replace stem cells in bone marrow to help with blood cell production.

The type of transplant you have depends on the source of the stem cells. These include:

  • Autologous transplant. Stem cells from your own blood are frozen and stored. After high-dose chemotherapy, we’ll put them back into your bloodstream. This type causes fewer side effects.
  • Allogeneic transplant. Blood stem cells come from a donor with a matching tissue type. The closer the match, the better. This is rarely used for non-Hodgkin lymphoma.
Side effects

To prepare for stem cell transplantation, your bone marrow is treated with high-dose chemotherapy or radiation. This can temporarily leave your body without its natural defenses. 

It can take several months for the bone marrow to recover. During this time, you’re at an increased risk of infection and bleeding. We may recommend: 

  • Antibiotics to prevent infections.
  • Platelet transfusions to reduce bleeding risk.
  • Other treatments to boost blood cell counts.

A possible complication of donor (allogeneic) stem cell transplantation is graft-versus-host disease (GVHD). This happens when donor stem cells start attacking tissues of your skin, digestive tract, and liver. 

Symptoms of GVHD include:

  • Skin rash
  • Yellowing of the skin and eyes
  • Nausea
  • Diarrhea
  • Fatigue and weakness

We’ll talk about possible side effects and how we plan to prevent or manage them.

Clinical Trials

We’re always looking for new and better ways to treat non-Hodgkin lymphoma. Clinical trials are research studies that test new treatments or procedures. We can talk about any clinical trials that may be right for you.

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