Frequently Asked Questions
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The origins of lymphoma are complicated and not completely understood. Part of the problem is that there are many different subtypes of lymphoma, each one with different risk factors. Another issue is that studies that examine these risk factors, called epidemiologic studies, are very complicated and prone to bias and confounding.
The short answer for most subtypes is that we don’t know why one person may get lymphoma and another person does not. Generally, we can divide risk factors into two categories: those that are specific to the person, and those that are related to an exposure.
Some people are more likely to develop lymphoma. The biggest risk factors are probably related to problems with the immune system. Since lymphoma is a cancer of the immune system, this may not be surprising. Interestingly, both an underactive immune system (e.g. immunodeficiency related to hereditary conditions, infections, or medications) and an overactive immune system (e.g. autoimmune disorders such as rheumatoid arthritis) are associated with the development of lymphoma. However, the majority of people with these risk factors never develop lymphoma, suggesting that additional factors play an important role. There may also be some genetic risk factors, but it unlikely a specific genetic mutation would be sufficient to cause lymphoma in the absence of other events.
Some exposures are definitely associated with increased risk of lymphoma. For example, exposure to ionizing radiation (e.g. atomic bomb survivors) results in an increased risk of lymphoma. Similarly, exposure to dark hair dyes used before 1980 is also associated with risk of lymphoma. The bacteria Helicobacter pylori, which can cause gastric ulcers, is also associated with a specific subtype of lymphoma called gastric mucosa-associated lymphoid tissue (MALT) lymphoma.
However, not all people exposed to radiation or old hair dyes or H.pylori will develop lymphoma. Proving a link between a given exposure and the subsequent development of lymphoma is very challenging and is the subject of ongoing study. back to top
Some cancers are definitely associated with hereditary risk factors (e.g. breast cancer and inheritance of specific BRCA gene mutations). Whether or not lymphoma may have a hereditary component is unclear. For the most part, the answer appears to be that there is no significant increase in risk among family members. A small percentage of people with lymphoma however, may have an inherited risk factor that other family members may share. It is important to remember that the absolute risk of developing lymphoma is very low, so a small increase in relative risk still results in a fairly low absolute risk that a family member will develop lymphoma. back to top
Hair loss, also called alopecia, is a common side effect of many chemotherapy drugs. Whether or not a person experiences hair loss depends in part on the drugs that they receive and in part on personal factors (i.e. luck). Many new, “targeted” drugs do not cause hair loss. Your doctor can tell you what drugs you are receiving and can discuss the likelihood of hair loss.
Hair loss is an emotionally charged issue that can serve as a visible reminder of the challenges that cancer patients face. Although hair loss cannot always be avoided, there are a number of ways to deal with it. This may be the time to explore the world of hats or fashionable scarves. Wigs are available at many specialty stores and are often paid for by insurance. It can also be helpful to remember that chemotherapy-related hair loss is not permanent. back to top
Nutritional supplements range from over-the-counter vitamins to various natural or naturopathic compounds prescribed by alternative health care practitioners. Many people take supplements during their regular life and want to know whether they can continue during chemotherapy. Other people want to start new supplements during chemotherapy to make the cancer go away faster or avoid treatment-related side effects.
Unfortunately, there is very little published data regarding the safety or effectiveness of combining supplements with more conventional chemotherapy regimens. It is important to remember that natural or not, all supplements may contain active ingredients with the potential to interact with other medications. Although some of these interactions may be beneficial in theory, they may also be harmful. An excellent example is the case of ECGC. Epigallocatechin-3-gallate (ECGC) is a naturally occurring compound found in green tea. Laboratory data suggests that ECGC can kill some cancer cells. Bortezomib is an anti-cancer drug that is approved for treatment of patients with multiple myeloma and mantle cell lymphoma. Interestingly, one laboratory study found that ECGC could antagonize the anti-cancer effects of bortezomib. So, although it would be reasonable to assume that two drugs are better than one, it may not always be the case.
More recently an investigation by the New York State Attorney General found that not all nutritional supplements contain the active ingredients listed on the labels, and some supplements may contain ingredients not listed on the labels.
Regardless of the drugs or supplements you are considering taking, it is important to have an open discussion with your doctor. Most of us will readily admit that the world of medicine is not so sophisticated as to have all of the answers. If there is any doubt, it is probably best to stop all supplements until after the chemotherapy is over and then consider restarting in consultation with your care providers. back to top
The decision to exercise during chemotherapy is a personal one. There is no evidence that exercise is likely to improve or worsen response to treatment. However, regular aerobic exercise can improve physical functioning and quality of life in patients undergoing chemotherapy for lymphoma. If you are interested in beginning and exercise program, ask your doctor if he or she has any concerns. back to top