Recently, a friend of mine was diagnosed with lymphoma. This seems to me to represent an “up and coming disease,” as a couple of my other friends have also developed lymphoma. Could you write about it in your column?



First, we want to address the perception of a “cluster” or a “new” pattern. As humans, we think like this: if we see a few more cases, it must mean the problem is occurring more often. To identify an outbreak takes careful surveillance. We are not aware of any recognized “outbreak” of lymphoma.

The lymphatic system is part of the immune system. The cells called lymphocytes have different jobs they perform. All are beautifully coordinated to protect us against disease. If they themselves become ill, they can become cancerous. Cancers start with a defect, starting in the genes that regulate cell division. Genes are segments of DNA (deoxyribonucleic acid) in the nucleus that can be damaged during the stresses of living. 

Lymphocytes circulate in blood, or cluster in lymph nodes. B cells are those which make antibody and T cells that work directly, cell to cell, on invaders or defective cells. A lymphoma is a tumor mass of lymphocytes. (“Oma” at the end of a word means tumor.) Because there are different types of lymphocytes that may have gone wrong, we find that more than one kind of lymphoma exists.

Lymphomas usually occur as lumps of lymph-node-like tissue. Lymphomas can be confusing, because there is a blurred edge between lymphomas and lymphatic leukemias, in which the cancerous lymphocytes are circulating in the blood. Both lymphomas and leukemias respond best to chemotherapy. Sometimes the response is dramatic. Great advances in treatment have occurred over the past 30 years. Because all lymphoid cancer cells in an individual will be the result of a single cell that went wrong, they will be genetically identical. Most lymphomas—about 80 percent—come from the B cell type of lymphocytes.

Treatments include irradiation of affected nodes and chemotherapy to mop up circulating cancer cells.  



Are Hodgkin’s disease and multiple myeloma related?



Both these diseases are related to lymphomas. Hodgkin’s disease (named after its original describing physician) is actually a group of diseases, but—unlike general lymphoma or non-Hodgkin’s lymphomas—it tends to keep strictly to lymph nodes. Unlike the situation with other lymphomas, the malignant lymphoid cells in Hodgkin’s make up only about 1 to 5 percent of the lump. Because it stays close to lymph nodes, it is often easy to irradiate Hodgkin’s tumors. The person with Hodgkin’s has few symptoms, other than enlarging lymph nodes.

Fortunately, the response to treatment with chemotherapy and radiation is excellent. There is a five-year cure of some 90 percent for stage I and II, and even 70 percent for later stages. Persons can reasonably expect to look for a cure. In fact, some people are living so long that late side effects of the radiation may be seen some 20 or 30 years later. 

Multiple myeloma is not the same disease. It starts in plasma cells. These cells are transformed lymphocytes that are actively making antibodies. When such cells become malignant, they once again are all derived from a single defective cell, and make an identical antibody. This antibody can be measured in the blood, and can be used as a measure of how much tumor is present. These “myeloma” cells often grow as clumps in bone, where they make “holes.” These show up as clear little circles in the X-ray of the bone where there is a lack of the usual calcium. They cause “multiple holes”—hence the name “multiple” myeloma.

Once again, response to chemotherapy is much better than it used to be.

These are very complex diseases, and require careful management by well-trained physicians in order for a person to have an optimal outcome.

We have given but a very simple glimpse of a few of what is a large group of diseases. The key message here is that there is a lot of room for hope—even if a diagnosis of lymphoma or myeloma is made. Please apply principles of healthful living, but do not avoid the remarkable advances made over the past few decades that, indeed, can add years of great life. 
 



I’m going to have a hysterectomy for prolapse. Because I’m 50 years old, the doctor has asked me if I want my ovaries removed to reduce the risk of ovarian cancer. What do you advise?



We advise that you discuss it with your own doctor. However, some interesting points you might consider are as follows:

First, if you are still premenopausal, a surgical menopause is often quite difficult. Hormonal replacement can help symptoms, but a study suggested that women keeping their ovaries at the time of hysterectomy had a 62 percent chance of living to 80 years, versus a 54 percent chance if their ovaries were removed. Osteoporosis may pose a higher risk as well.

The risk of ovarian cancer is only marginally greater in those keeping their ovaries, perhaps 1 percent. 

The study on hormonal replacement in 65-year-old at-risk women (HERS study) showed that estrogen was not a good treatment for heart disease. But prevention and treatment are different, and where there is no heart disease, the hormone estrogen may well exert a protective effect.

Personally, I tended to conserve ovaries unless some contraindication existed, such as malignancy or endometriosis.

_____________________________
Allan R. Handysides, M.B., Ch.B., FRCPC, FRCSC, FACOG, is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA executive director and associate director of Health Ministries.

Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or you may send your questions via e-mail to: letters@adventistreview.org. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.


 
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