Together Newsletter - Issue 3 2008 - MC1604-0908

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Fall 2008: Volume 8 Number 3
Learning About Lymphoma
Lymphoma is cancer of the lymphatic system. The lymphatic system includes the lymph nodes
(lymph glands), spleen, thymus gland, and bone marrow. Lymph nodes are small, bean-shaped
structures, with 300 to 500 found throughout the body. They produce and store white blood cells,
called lymphocytes, which are involved in fighting infection and inflammation.

When lymphocytes grow abnormally and become cancer cells, they accumulate in lymph nodes
Healthy Holiday
and almost any other organs. Lymphomas are categorized as either non-Hodgkin lymphoma
(NHL) or Hodgkin lymphoma.
Non-Hodgkin Lymphoma (NHL)
Non-Hodgkin lymphoma is the most common of the lymphomas and begins in either B cells or
T cells. At least 30 different forms of non-Hodgkin lymphoma have been identified. About 95
percent of non-Hodgkin lymphomas are diagnosed in adults and about 5 percent in children.
There are many forms of non-Hodgkin lymphoma, but the most common type is diffuse large
Margaret Adams
B-cell lymphoma. Other forms may include:
• Chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL)
• Follicular lymphoma
• Marginal zone lymphoma
• Peripheral T-cell lymphomas
Less common types of NHL include:
• Mantle-cell lymphoma
• Primary mediastinal B-cell lymphoma
• Burkitt lymphoma
• Lymphoplasmocytic lymphoma
Cancer Terms &
Hodgkin Lymphoma
Hodgkin lymphoma is an uncommon cancer of the
lymphatic system that most often affects people
between the ages of 15 and 34 and those older
than 55.
The lymphatic system
In individuals with this cancer, cells in the lymphatic system also grow abnormally and may
accumulate in the lymphatic system and in other organs. Many initial symptoms (fever, fatigue,
night sweats, and weight loss) are similar to influenza symptoms. As the disease progresses, it
reduces the body’s ability to fight infection and tumors develop.
Navigator Notes:
Life During the

Signs, Symptoms and Diagnosis of Lymphomas
Many of the first lymphoma symptoms can also be symptoms of other diseases. Often individuals may
think they have a cold that won’t go away. Symptoms may include:
NHL Hodgkin lymphoma
• Painless swelling of lymph nodes,
• Painless swelling of lymph nodes, especially in
especially in the neck or under the arms
the neck, under the arms or groin
• Fever
• Fever
• Night sweats
• Night sweats
• Unexplained weight loss
• Unexplained weight loss
• Unexplained tiredness and lack of energy
• Itching
• Unexplained fatigue
• Cough
• Abnormal blood counts
• Reed-Sternberg cells in lymph node biopsy
If lymphoma is suspected, a physician will conduct a complete physical examination, paying special
attention to the lymph nodes. Many other tests may be needed to confirm a diagnosis, including:
• Blood tests for different blood cells
• Bone marrow examination of tissue inside the bones
• Biopsy of lymph node or other organs
• Chest X-ray
• CT (computerized tomography) scan of internal organs
• MRI (magnetic resonance imaging) of the brain and spinal cord
• PET (positron emission tomography) scan of areas affected and for response to treatment
Staging and Treatment of Lymphomas
Treatment depends on the specific kind of lymphoma, the stage of the disease, the symptoms and the
individual’s overall health. Four stages are used to describe all lymphomas:
Stage 1: when lymphoma is found in only one lymph node or one organ; early disease
Stage 2: disease that is confined to two or more lymph nodes on one side of the diaphragm
Stage 3: advanced disease with involvement of lymph nodes both above and below the diaphragm
Stage 4: disease that has spread beyond the lymph nodes and spleen to one or more organs
While many treatment strategies are similar for lymphomas, some treatment options are unique to
NHL. For individuals who have no obvious symptoms and the disease is discovered at an early stage,
watchful waiting may be the initial treatment option. This means that no treatment is needed right away
except for periodic exams and close observation for any changes.
NHL Hodgkin lymphoma
• Watchful waiting
• Chemotherapy
• Chemotherapy
• Radiation therapy
• Radiation therapy
• Combined chemotherapy and radiation therapy
• Peripheral blood stem cell transplantation
• Peripheral blood stem cell transplantation
• Clinical research studies
• Clinical research studies
• Immunotherapy

Today, more than 75 percent of people who receive initial treatment for lymphoma experience a
complete remission. The success rate for treatment of early-stage Hodgkin lymphoma, when the disease
has not advanced beyond a single lymph node area, is 80 to 90 percent.
A variety of treatment options are available, including new treatments available to those who participate
in clinical research studies. It is important for individuals to talk with their doctor about treatment
options and goals.

Healthy Holiday Foods
This year use the holiday season to improve your health
by incorporating more “cancer-blocking” foods into
festivities. The below foods are good sources of antioxidants,
phytonutrients, omega 3 fatty acids,
fiber and/or other
nutrients that have been known to fight cancer.
• Sweet potatoes
• Pumpkin
• Winter squash
• Cranberries
• Dried fruit
• Dark chocolate
• Salmon
• Shrimp
• Nuts
• Wild rice
• Popcorn
• Clementines and other citrus fruits
Healthy Eating Suggestions
• Serve sweet potatoes or winter squash as a side dish.
Deep orange vegetables are loaded with beta carotene.
• Make pumpkin or cranberry tea bread. Pumpkin contains
more beta carotene than any other food, and cranberries
contain antioxidants.
• Serve cranberry relish or sauce as a condiment or side
dish; use cranberry juice in the holiday party punch.
• Give a box of clementines as a gift.
• Snack on popcorn. Did you know that popcorn is a
whole grain?
• Wild rice is also a whole grain. Use it for soups, stuffing
or as a side dish.
• Make a dip out of smoked salmon.
• Serve shrimp along with raw vegetables. Don’t forget
the cocktail sauce and salsa. Tomatoes are an excellent
source of lycopene, vitamin C and potassium.
• Add dried fruits and nuts to salads.
• Consider making dips made from legumes, such as
hummus, which are good sources of fiber and other
• Make a snack mix out of dried cranberries, almonds and
dark chocolate bits. All nuts are high in antioxidants,
protein, fiber, healthy fats, vitamins and minerals.
• Use dark chocolate and walnuts in baked goods. Dark
chocolate has more antioxidants than milk chocolate.
These are known as flavonols or phenols.
And, it is okay to eat sugar in moderation. Contrary to
popular belief, sugar does not feed cancer. However, if you
are overweight, too much sugar can contribute to unwanted
and unnecessary calories.


Margaret Adams
Radioimmunotherapy as a treatment option for
non-Hodgkin lymphoma
By Carol Chaffin
As a former high school math instructor,
solving problems is something that has
always come naturally to Margaret Adams.
Having taught geometric formulas and
algebraic equations to high school students
for nearly 40 years, she knows a thing or two
about finding answers.
So when in the spring of 1996 she was
told that she had stage IV non-Hodgkin
lymphoma, the process of solving a tough
problem suddenly became very personal.
“I started not being able to breathe well, so I
went to my doctor,” says Adams. “I certainly
didn’t expect that diagnosis, but I have the
will of a person who accepts things and I
dealt with it.”
Adams underwent treatments for seven
months — intensive chemotherapy for the
first four months; chest and upper abdominal
radiation therapy for the next three. Adams
continued to teach school at the beginning
of her treatment and even took a college
course after the school year ended, but it
was a bounty of willpower that kept her
going. After teaching in Massachusetts for
25 years and in Ft. Lauderdale another 11,
she decided it was time to retire to focus on
her health. Adams and her husband moved
to the Jacksonville area to make it easier to
receive ongoing treatments at Mayo Clinic
in Florida.
“Not teaching was difficult,” says Adams.
“It was who I was, and I did it for so
many years.”
The treatment worked, though, and Adams’
cancer was dormant for nearly a decade. The
Adamses moved back to Lauderdale-by-the-
Sea and had been there for about two years
With the twelfth anniversary of her original diagnosis
when she felt two enlarged lymph nodes on
approaching, Adams is feeling healthy and positive.
her neck under her left ear. On Valentine’s
Day 2005, a biopsy was taken; the cancer
had recurred. This time her Mayo Clinic

oncologist, Dr. Gerardo Colon-Otero, told her
was located and how much of the solution Adams
about a new radioactive iodine treatment called
would need to fight it. On her final visit, Buskirk
gave her the major infusion, which lasted about
90 minutes, and discharged her home.
BEXXAR was approved by the Food and Drug
Administration in 2003 for patients with CD 20
“The anxiety was the most difficult part,” says
positive, B-cell, follicular non-Hodgkin lymphoma
Adams. “I felt no extreme nausea, fatigue or
who have relapsed following chemotherapy.
illness during treatment. The isolation was lonely,
but I got through it.”
Instead of months of treatment, she could have a
single course of radioimmunotherapy over one to
Her enlarged lymph nodes shrunk within two
two weeks. She would not lose her hair, but she
weeks. Follow-up tests three and six months later
would have to live with a new side effect — being
showed no sign of cancer.
radioactive for a few weeks.
“She has responded very well,” says Buskirk.
“BEXXAR is an intravenous monoclonal antibody
“These targeted therapies are being developed
that’s directed against the proteins located
because they make more sense and are very
in lymphoma cells,” says Colon-Otero. “The
effective. The idea is to get a high dose of
antibodies are coupled with a radioactive iodine
radiation to the cancer and a low dose to the
substance. Monoclonal antibodies identify the
surrounding healthy cells. Targeting the cancer
bad cancer cells and attach to them; then the
cells directly with the ‘smart bomb’ approach
radioactive iodine gives off radiation and kills
versus treating large areas with radiation and
them. It’s a double-whammy approach against
using different types of chemotherapy is the new
non-Hodgkin lymphoma.”
way of thinking.”
Adams’ body could emit low levels of radioactivity
Buskirk says that the BEXXAR treatment can only
for about seven to 12 days. She would have to
be used once in a patient’s lifetime. Two-thirds of
be in isolation. That meant being in separate
patients respond to it — one third have a long-
rooms when her husband was at home, frequently
term, multiyear remission and the other third
washing her hands, using gloves while cooking,
respond with about a two year remission.
doing separate laundry and avoiding being in
“Hopefully she’ll get another long-lasting
remission,” says Colon-Otero.
“I was apprehensive at first because of the possible
side effects, and it was a long process for me to
With the twelfth anniversary of her original
decide that this was the right treatment,” says
diagnosis approaching, Adams is feeling healthy
Adams. “But I did a lot of research and learned as
and positive. She spends time reading, walking
much as I could about it.”
on the beach, riding her bicycle, and exercising
three times a week at a fitness center. She even
In the end, the equation was simple. One
keeps the old No. 2 pencil sharpened for when
treatment plus a therapy that showed early signs
her teenage grandson needs a little help with
of success in patients who had a recurrence
added up to a solution she wanted to try. Mayo
Clinic radiation oncologist Dr. Steven Buskirk
She keeps her sense of humor sharpened, too.
administered a small dose of BEXXAR through an
“Instead of being radioactive, now I’m just
IV in her arm and then took a series of body scans
active!” jokes Adams. “I say ‘Hey, hey, let’s go’!”
over a few days to determine where the cancer

Cancer Terms
A type of protein made by plasma cells (a type of white blood cell) in response to an antigen
(foreign substance). Each antibody can bind to only one specific antigen. The purpose of this
binding is to help destroy the antigen.
A substance that protects cells from damage. Antioxidants include beta-carotene, lycopene,
vitamins A, C, and E, and other natural and manufactured substances.
The thin muscle below the lungs and heart that separates the chest from the abdomen.
Lymphatic system The tissues and organs that produce, store, and carry white blood cells that fight infections and
other diseases. Lymphatic vessels branch, like blood vessels, into all the tissues of the body.
A type of protein made in the laboratory that can locate and bind to substances in the body,
including tumor cells. They can be used alone or to carry drugs, toxins, or radioactive materials
directly to a tumor.
Omega 3 fatty acid A type of fat obtained in the diet and involved in immunity.
Plant-derived compound associated with positive health effects.
A type of systemic radiation therapy in which a radioactive substance is linked to an antibody that

locates and kills tumor cells when injected into the body.
Cancer that has recurred (come back), usually after a period of time during which the cancer could
not be detected. The cancer may come back to the same place as the original (primary) tumor or to
another place in the body.
A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but
not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and
symptoms of cancer have disappeared, although cancer still may be in the body.
Definitions obtained from Defined terms are in italics in newsletter.
100 Questions & Answers about Lymphoma by Peter Holman, M.D.,
Jodi Garrett, R.N. and William Jensen, 2004.
Living with Lymphoma: A Patient’s Guide by Elizabeth M. Adler, Ph.D., 2005.
Web Sites
Leukemia & Lymphoma Society —
Lymphoma Information Network —
Lymphoma Research Foundation — Tools for Healthier Lives —

American Cancer Society Navigator Notes
Celebrating Life During the Holidays
By Angela Young, American Cancer Society patient navigator
People often view the holidays as a time to
Live in the Moment
celebrate, give and receive gifts, reunite with
• Understand your limitations and be gentle on
family and friends, and celebrate religious
traditions. However, the season can be a stressful
time if you or a loved one is faced with cancer.
• Don’t feel obligated to live up to others’
Cancer survivors and their families often ask
themselves questions such as:
• Express your love in more direct ways
• How do I take care of the holiday rush and
than gifts
myself at the same time?
• Rededicate yourself to your spiritual growth
• How can I celebrate when I have so many
other things on my mind?
Share the Hope
• Volunteer your time at a local nursing home
• What will my life be like next year during
or soup kitchen
this time?
• Instead of gifts, donate to a local charity or
This year, take time to enjoy yourself and those
adopt a needy family
you love. Consider trying these tips:
• Invite someone to your holiday celebration
Simplify the Holidays
who you know is alone
• Create a new holiday tradition that makes
the most of your energy, such as planning
Remember to try and find comfort, peace and
potluck dinners or dining at a favorite
joy in those areas of your life that mean the
most to you.
• Buy your holiday treats to reduce the amount
For more information about making the most
of time you spend baking and decorating
of the holidays, visit the American Cancer
Society at or Cancer Care
• Shop online or via catalogues
at, or contact your
American Cancer Society patient navigator
• Send seasonal cards, such as New Year’s
at 800-227-2345.
or Valentine’s Day
Celeste “CC”
Jeri Lensing
Kelly McGuire
Angela Young
Mayo Clinic
Mayo Clinic
Mayo Clinic
Mayo Clinic

Calendar of Events

Medical Editor:

Timothy G. Call, M.D.
February 2009
National Colon Cancer Awareness Month
Prevent Cancer Foundation
Managing Editors:
15 26.2 with Donna: The National
Nicole Bennett Engler
Marathon to Fight Breast Cancer
Cancer Education Program
Communications Consultant
Jacksonville Beach, Fla.
904-355-PINK (7465)
Sarah Christensen
May 2009
Patient Education Specialist
Kelli Fee-Schroeder
15 Stay Out of the Sun Run
Cancer Education Program Educator
March 2009
Rochester, Minn.
Sheryl Ness
Cancer Education Program Manager
14 2009 Silent No More Marathon Swim to
Editorial Review Board:
benefit the MN Ovarian Cancer Alliance
Melanoma Public Education Symposium
Carol Ann Attwood
Rochester Area Family Y
Mayo Clinic
Medical Librarian
Rochester, Minn.
Rochester, Minn.
Carol Brueggen
Certified Oncology Clinical
Nurse Specialist
Julie Earle
Radiation Oncology Nurse
Wayland Eppard
Patient Advocate
Deborah A. Johnson
Cancer Education Program
together Spotlight
Administrative Assistant
Mary E. Johnson
In January 2000, a small group of staff from Mayo Clinic
Kelly McGuire
American Cancer Society Navigator
Cancer Center sat down to talk about how to provide patients
Nancy Pick
improved access to cancer education and resources — no
Oncology Supervisor, Clinical Operations
matter where they lived. Dr. Timothy Call, from the Division
Robin Peck
of Hematology, volunteered to lead the group’s efforts. Nearly
Hematology/Oncology Outpatient
nine years later, we are pleased to report that we now publish
Nursing Supervisor
Dr. Timothy Call
Jacalyn See
three newsletters annually for more than 5,000 subscribers
Registered Dietitian
across the nation.
The mission of Mayo Clinic Cancer
Center is to provide compassionate,
Dr. Call has faithfully served as medical editor for each issue of together. He has
state-of-the-art care for the patient
guided our growth and ensured that the newsletter’s mission hasn’t wavered. His
with cancer today and continued
vision and steadfast support have brought the newsletter to the forefront of one of
advancements in the prevention,
the nation’s leading medical institutions. It is with mixed emotions that we share
diagnosis, treatment and cure of
that Dr. Call is finishing his term as medical editor of together with this issue.
cancer in the future. The programs
and services of the Cancer Center
span the three Mayo Clinic campuses
With gratitude and respect, the together editorial board recognizes Dr. Timothy
in Arizona, Florida and Minnesota.
Call for his leadership and support, and thank him for his compassionate vision in
together newsletter provides
developing this valued resource. We wish him the best as he continues focusing his
educational information for cancer
clinical expertise in education, practice and research with the Division of Hematology
patients, their family, caregivers and
at Mayo Clinic in Rochester.
friends. Physicians, staff and cancer
patients write the articles. To view the
together newsletter online, visit www.
To submit story ideas, provide
feedback or unsubscribe, call
(507) 266-9288 or e-mail
[email protected]