
                 CancerNet from the National Cancer Institute 


                       Information from PDQ for Patients


AIDS-related lymphoma
208/03779

** OVERVIEW OF PDQ ** 

-- What is PDQ? --

PDQ is a computer system that gives up-to-date information on cancer treatment. 
It is a service of the National Cancer Institute (NCI) for people with cancer
and their families, and for doctors, nurses, and other health care
professionals.

PDQ tells about the current treatments for most cancers.  The information in
PDQ is reviewed each month by cancer experts.  It is updated when there is new
information.  The patient information in PDQ also tells about warning signs and
how the cancer is found.  PDQ also lists information about research on new
treatments (clinical trials), doctors who treat cancer, and hospitals with
cancer programs.  The treatment information in this summary is based on
information in the PDQ treatment summary for health professionals on this
cancer.

-- How to use PDQ --

You can use PDQ to learn more about current treatment for your kind of cancer. 
Bring this material from PDQ with you when you see your doctor.  You can talk
with your doctor, who knows you and has the facts about your disease, about
which treatment would be best for you.  Before you start your treatment, you
might also want to seek a second opinion from a doctor who treats cancer.

Before you start treatment, you also may want to think about taking part in a
clinical trial.  A clinical trial is a study that uses new treatments to care
for patients.  Each study is based on past studies and what has been learned in
the laboratory.  Each trial answers certain scientific questions in order to
find new and better ways to help cancer patients.  During clinical trials, more
and more information is collected about new treatments, their risks, and how
well they do or do not work.  If clinical trials show that the new treatment is
better than the treatment currently being used, the new treatment may become
the "standard" treatment.  Listings of clinical trials are a part of PDQ.  Many
cancer doctors who take part in clinical trials are listed in PDQ.

If you want to know more about cancer and how it is treated, or if you wish to
learn about clinical trials for your kind of cancer, you can call the National
Cancer Institute's Cancer Information Service.  The number is 1-800-4-CANCER
(1-800-422-6237).  The call is free and a trained information specialist will
talk with you and answer your questions.

PDQ may change when there is new information.  Check with the Cancer
Information Service to be sure that you have the most up-to-date information.

** DESCRIPTION ** 

-- What is AIDS-related lymphoma? --

Acquired Immunodeficiency Syndrome (AIDS) is caused by a virus called the Human
Immunodeficiency Virus (HIV), which attacks and weakens the immune system. 
Infections and other diseases can then invade the body, and the immune system
cannot fight against them.  AIDS-related lymphoma is a disease in which cancer
(malignant) cells are found in the lymph system in patients who have AIDS.

The lymph system is made up of thin tubes that branch, like blood vessels, into
all parts of the body.  Lymph vessels carry lymph, a colorless, watery fluid
that contains white blood cells called lymphocytes.  Along the network of
vessels are groups of small, bean-shaped organs called lymph nodes.  Clusters
of lymph nodes make and store infection-fighting cells.  The spleen (an organ
in the upper abdomen that makes lymphocytes and filters old blood cells from
the blood), the thymus (a small organ beneath the breastbone), and the tonsils
(an organ in your throat) are also part of the lymph system.

Since there is lymph tissue in many parts of your body, the cancer can start in
almost any part of your body and spread to almost any organ or tissue.  This
includes your liver, bone marrow (the spongy tissue inside the large bones of
your body that makes blood cells), your spleen, or your brain.

Lymphomas are divided into two general types: Hodgkin's disease and
non-Hodgkin's lymphomas.  Either type may occur in AIDS patients.  The cancer
cells in Hodgkin's disease look a certain way under a microscope. 
Non-Hodgkin's lymphoma is treated differently than Hodgkin's disease, and both
can occur in adults or children.  Information on both types of lymphomas in
persons without AIDS can be found in the PDQ patient information statements on
Hodgkin's and non-Hodgkin's lymphomas (adult or childhood).

There are about ten different types of non-Hodgkin's lymphomas.  Some types
spread more quickly than others.  The type is determined by how the cancer
cells look under a microscope, which is called the histology.  The histologies
are grouped together, based on how quickly they spread, into low-grade,
intermediate-grade, or high-grade lymphomas.  The most common AIDS-related
lymphomas are intermediate- or high-grade lymphomas.  These lymphomas grow and
spread faster than low-grade lymphomas.

Like most cancers, non-Hodgkin's lymphoma and Hodgkin's disease are best
treated when found (diagnosed) early.  You should see your doctor if you have
any of the following for more than two weeks:  painless swelling in the lymph
nodes in the neck, underarm, or groin; fever that doesn't go away; night
sweats; feeling tired all the time; weight loss without dieting; or itchy skin.

If you have AIDS and symptoms of lymphoma, your doctor will examine you
carefully and check for swelling or lumps in your neck, underarms, and groin. 
If the lymph nodes don't feel normal, your doctor may need to cut out a
small piece and look at it under the microscope to see if there are any cancer
cells.  This is called a biopsy.

In general, patients with AIDS-related lymphoma respond to treatment
differently from patients with lymphoma who do not have AIDS.  AIDS-related
lymphoma usually grows faster and spreads outside of the lymph nodes and to
other parts of the body more often than lymphoma not related to AIDS.  Patients
with AIDS-related lymphoma are generally treated with lower drug doses than
patients without AIDS because therapy can damage their weak immune systems even
further.

** STAGE EXPLANATION ** 

-- Stages of AIDS-related lymphoma --

Once AIDS-related lymphoma is found, more tests will be done to find out if the
cancer has spread from where it started to other parts of the body.  This is
called staging.  The stage of a disease, ranging from stage I to stage IV,
gives an indication of how far the disease has spread.  Your doctor needs to
know the stage of your disease to plan treatment.

Your doctor may determine the stage of your disease by examining you and doing
blood tests and different kinds of x-rays.  This is called clinical staging. 
In some cases, your doctor may need to do an operation called a laparotomy to
determine the stage of your cancer.  During this operation, your doctor cuts
into your abdomen and carefully looks at the organs inside to see if they
contain cancer.  Your doctor will cut out (biopsy) small pieces of tissue
during the operation and look at them under a microscope to see whether they
contain cancer.  This type of staging is called pathological staging. 
Pathological staging is usually done only when it is needed to help your doctor
plan treatment.

For treatment, AIDS-related lymphomas are grouped based on where they started,
as follows:

-- Systemic/peripheral lymphoma --
Lymphoma has started in lymph nodes or other organs of the lymph system.  The
lymphoma may have spread from where it started throughout the body, including
to the brain or bone marrow.

-- Primary CNS lymphoma --
Lymphoma has started in the brain or spinal cord, both of which are part of the
central nervous system (CNS).  This type of lymphoma is called a "primary CNS
lymphoma" because it starts in the CNS rather than starting somewhere else in
the body and spreading to the CNS.

** TREATMENT OPTION OVERVIEW ** 

-- How AIDS-related lymphoma is treated --

The treatment of AIDS-related lymphoma is difficult because of the problems
caused by HIV infection, which weakens the immune system.  The doses used are
often lower than doses given to patients without AIDS.  Two types of treatment
are used:
  chemotherapy (using drugs to kill cancer cells and shrink tumors).
  radiation therapy (using high-dose x-rays or other high-energy rays to kill
    cancer cells and shrink tumors).

Additionally, clinical trials are testing the effect of giving drugs to kill
the AIDS virus (antiviral therapy) in addition to treatment for lymphoma.

Chemotherapy uses drugs to kill cancer cells and shrink tumors.  Chemotherapy
may be taken by pill, or it may be put into the body by a needle in a vein or
muscle.  Chemotherapy is called a systemic treatment because the drugs enter
the bloodstream, travel through the body, and can kill cancer cells throughout
the body.  Chemotherapy may be put into the fluid that surrounds the brain
through a needle in the brain or back (intrathecal chemotherapy) to treat
non-Hodgkin's lymphoma that has spread to the brain.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink
tumors.  Radiation for non-Hodgkin's lymphoma usually comes from a machine
outside the body (external beam radiation therapy).  Radiation given to the
brain is called cranial irradiation.  Radiation therapy may be used alone or in
addition to chemotherapy.

Treatment for AIDS-related lymphomas depends on the stage of your disease, the
histology and grade of the disease, and your general health.  Your doctor must
take into account how low your white blood counts are and the other diseases
caused by AIDS you have had or currently have.

You may receive treatment that is considered standard based on its
effectiveness in a number of patients in past studies, or you may choose to go
into a clinical trial.  Not all patients are cured with standard therapy and
some standard treatments may have more side effects than are desired.  For
these reasons, clinical trials are designed to find better ways to treat cancer
patients and are based on the most up-to-date information.  If you want more
information, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237) or the AIDS Clinical Trials Information Service at
1-800-342-AIDS (1-800-342-2437).

** AIDS-RELATED PERIPHERAL/SYSTEMIC LYMPHOMA ** 

Your treatment may be one of the following:
  1. Standard-dose systemic chemotherapy plus intrathecal chemotherapy.
  2. Low-dose systemic chemotherapy plus intrathecal chemotherapy.
  3. A clinical trial of new types of chemotherapy or new ways of giving
     chemotherapy.

** AIDS-RELATED PRIMARY CNS LYMPHOMA ** 

Your treatment will probably be cranial radiation therapy.  You may want to
consider taking part in a clinical trial of new types of treatment.

** TO LEARN MORE ** 

TO LEARN MORE..... CALL 1-800-4-CANCER and 1-800-342-AIDS

To learn more about AIDS-related lymphomas, call the National Cancer
Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).  By
dialing this toll-free number, you can speak with someone who can answer your
questions.

The Cancer Information Service can also send you free booklets.  The following
booklet about adult non-Hodgkin's lymphoma may be helpful to you:

  What You Need to Know About Non-Hodgkin's Lymphomas

The following general booklets on questions related to cancer may also be
helpful:

  What You Need to Know About Cancer
  Taking Time: Support for People with Cancer and the People Who Care About
    Them
  What Are Clinical Trials All About?
  Chemotherapy and You: A Guide to Self-Help During Treatment
  Radiation Therapy and You: A Guide to Self-Help During Treatment
  Eating Hints for Cancer Patients
  Advanced Cancer: Living Each Day
  When Cancer Recurs: Meeting the Challenge Again

There are many other places where you can get material about cancer treatment
and services to help you.  You can check the social service office at your
hospital for local and national agencies that help with your finances, getting
to and from treatment, care at home, and dealing with your problems.  The
American Cancer Society, for example, has many free services.  Their local
offices are listed in the white pages of the telephone book.

You can also write to the National Cancer Institute at this address:

  National Cancer Institute
  Building 31, Room 10A24
  9000 Rockville Pike
  Bethesda, MD  20892

For more information on services for AIDS patients, you can call the AIDS
hotline at 1-800-342-AIDS (1-800-342-2437).  Additional information on clinical
trials for AIDS patients can be obtained by calling the AIDS Clinical Trials
Information Service at 1-800-TRIALS-A (1-800-874-2572) or by writing to the
service at the following address:

  AIDS Clinical Trials Information Service
  P.O. Box 6421
  Rockville, MD 20850


Date Last Modified: 09/95


 ******************************************************************************
 *  If you want to know more about cancer and how it is treated, or if you    *
 *  if you wish to know about clinical trials for your type of cancer, you    *
 *  can call the NCI's Cancer Information Service at 1-800-422-6237, toll     *
 *  free.  A trained information specialist can talk with you and answer      *
 *  your questions.                                                           *
 ******************************************************************************

