Non-Hodgkin’s lymphoma- during pregnancy

Overview

Non-Hodgkin's lymphoma, during pregnancy: A cancer that originates in the lymphatic system and occurs during pregnancy. The greatest problem is the fact that the cancer is usually quite aggressive and delays in delivery often results in delayed treatment and a poor prognosisThere are different types of treatment for pregnant patients with non-Hodgkin lymphoma. Different types of treatment are available for pregnant patients with non-Hodgkin lymphoma. Treatment is carefully chosen to protect the fetus. Treatment decisions are based on the mother’s wishes, the stage of the non-Hodgkin lymphoma, and the age of the fetus. The treatment plan may change as the symptoms, cancer, and pregnancy change. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team. Three types of standard treatment are used: Radiation therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are 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. To avoid any risk to the fetus, radiation therapy should be postponed until after delivery, if possible. If immediate treatment is needed, pregnant women with non-Hodgkin lymphoma 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. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment with more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated. The fetus is exposed to chemotherapy when the mother is treated and some anticancer drugs cause birth defects. Because anticancer drugs are passed to the fetus through the mother, both must be watched closely when chemotherapy is given. Watchful waiting Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. Treatment of Non-Hodgkin Lymphoma During Pregnancy See the PDQ summary on Adult Non-Hodgkin Lymphoma Treatment for more information on the treatment of non-Hodgkin lymphoma. Aggressive Non-Hodgkin Lymphoma During the First Trimester of Pregnancy When aggressive non-Hodgkin lymphoma is diagnosed in the first trimester of pregnancy, medical oncologists may advise the patient to end her pregnancy so that treatment may begin. Treatment is usually chemotherapy with or without radiation therapy. Aggressive Non-Hodgkin Lymphoma During the Second and Third Trimester of Pregnancy When possible, treatment should be postponed until after an early delivery, so that the fetus will not be exposed to anticancer drugs or radiation therapy. However, sometimes the cancer will need to be treated immediately in order to increase the mother's chance of survival. Indolent Non-Hodgkin Lymphoma During Pregnancy Women who have indolent (slow-growing) non-Hodgkin lymphoma can usually delay treatment with watchful waiting.

Symptoms

The list of signs and symptoms mentioned in various sources for Non-Hodgkin's lymphoma, during pregnancy includes the 20 symptoms listed below: * Fever * Night sweats * Fever * Weight loss * Abdominal pain * Abdominal swelling * Lymph node swelling in neck, groin, stomach or underarms * Low red blood cell count * Low white blood cell count * Low platelet counts * Enlarged tonsils * Enlarged spleen * Enlarged tonsils * Bone pain * Chest pain * Abdominal pain * Tiredness * Skin rash * Itchy skin * Chemotherapy, radiation therapy

Causes

Doctors aren't sure what causes non-Hodgkin's lymphoma. Non-Hodgkin's lymphoma occurs when your body produces too many abnormal lymphocytes — a type of white blood cell. Normally, lymphocytes go through a predictable life cycle. Old lymphocytes die, and your body creates new ones to replace them. In non-Hodgkin's lymphoma, your lymphocytes don't die, but continue to grow and divide. This oversupply of lymphocytes crowds into your lymph nodes, causing them to swell.

B cells and T cells

There are two types of lymphocytes, and non-Hodgkin's lymphoma usually involves one or the other.

  • B cells. B cells fight infection by producing antibodies that neutralize foreign invaders. Most non-Hodgkin's lymphoma arises from B cells. Subtypes of non-Hodgkin's lymphoma that involve B cells include diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma and Burkitt lymphoma.
  • T cells. T cells are involved in killing foreign invaders directly. Non-Hodgkin's lymphoma occurs less often in T cells. Subtypes of non-Hodgkin's lymphoma that involve T cells include cutaneous T-cell lymphoma and anaplastic large cell lymphoma.

Whether your non-Hodgkin's lymphoma arises from your B cells or T cells helps to determine your treatment options.

Where non-Hodgkin's lymphoma occurs

Non-Hodgkin's lymphoma generally involves the presence of cancerous lymphocytes in your lymph nodes, but the disease can also spread to other parts of your lymphatic system. These include the lymphatic vessels, tonsils, adenoids, spleen, thymus and bone marrow. Occasionally, non-Hodgkin's lymphoma involves organs outside of your lymphatic system.

Prevention

Because no one knows exactly what causes Hodgkin's disease, there are no specific steps anyone can take to prevent it. The factors that increase risk are generally not things that can be avoided, making it difficult to decrease risk in people affected by these viruses/bacteria and immune syndromes.

Diagnosis

These home medical tests may be relevant to Non-Hodgkin's lymphoma, during pregnancy: * Colon & Rectal Cancer: Home Testing o Home Colorectal Cancer Tests o Home Fecal Occult Bleeding Tests * Home Pregnancy Tests o Home Early Pregnancy Tests o Home Ovulation Tests o Home Fertility Tests o Home Rhesus/RH Blood Type Tests o Home Fetal Tests * Fertility-related Home Testing: o Home Ovulation Tests o Home Fertility Tests * Male Fertility Tests o Home Sperm Tests o Sperm Count Tests o Sperm Motility Tests * Cold & Flu: Home Testing: o Home Fever Tests o Home Ear Infection Tests o Home Flu Tests

Prognosis

After non-Hodgkin's lymphoma during pregnancy 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 if cancer has spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

To protect the fetus from the harms of radiation, tests that do not use radiation are used in the staging process. These include the following:

  • MRI (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 (NMRI).
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Bone marrow aspiration and biopsy: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views both the bone and bone marrow samples under a microscope to look for signs of cancer.
  • Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.

 

Treatment

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

Different types of treatment are available for pregnant patients with non-Hodgkin’s lymphoma. Treatment is carefully chosen to protect the fetus. Treatment decisions are based on the mother’s wishes, the stage of the non-Hodgkin’s lymphoma, and the age of the fetus. The treatment plan may change as the symptoms, cancer, and pregnancy change. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are 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.

To avoid any risk to the fetus, radiation therapy should be postponed until after delivery, if possible. If immediate treatment is needed, pregnant women with non-Hodgkin’s lymphoma 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.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment with more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

The fetus is exposed to chemotherapy when the mother is treated and some anticancer drugs cause birth defects. Because anticancer drugs are passed to the fetus through the mother, both must be watched closely when chemotherapy is given.

Watchful waiting

Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.

Aggressive Non-Hodgkin’s Lymphoma During the First Trimester of Pregnancy

When aggressive non-Hodgkin’s lymphoma is diagnosed in the first trimester of pregnancy, medical oncologists may advise the patient to end her pregnancy so that treatment may begin. Treatment is usually chemotherapy with or without radiation therapy.

Aggressive Non-Hodgkin’s Lymphoma During the Second and Third Trimester of Pregnancy

When possible, treatment should be postponed until after an early delivery, so that the fetus will not be exposed to anticancer drugs or radiation therapy. However, sometimes the cancer will need to be treated immediately in order to increase the mother's chance of survival.

Indolent Non-Hodgkin's Lymphoma During Pregnancy

Women who have indolent (slow-growing) non-Hodgkin’s lymphoma can usually delay treatment with watchful waiting.

 

Resources

These and other symptoms may be caused by non-Hodgkin's lymphoma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

  • Painless swelling of the lymph nodes in the neck, underarm, groin, or stomach.
  • Fever for no known reason.
  • Drenching night sweats.
  • Feeling very tired.
  • Weight loss for no known reason in the past 6 months.
  • Skin rash or itchy skin.
  • Pain in the chest, abdomen, or bones for no known reason.