                   AIDS INFORMATION NEWSLETTER
                   Michael Howe, MSLS, Editor
                     AIDS Information Center
                VA Medical Center, San Francisco
                     (415) 221-4810 ext 3305
                          June 14, 1996

              Opportunistic Infections (Part XXVI)
           AIDS-Related Lymphoma - Patient Information
          CancerNet from the National Cancer Institute
                Information from PDQ for Patients
                  Last Modified February, 1996

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
essels, 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
     Office of Cancer Communications
     31 Center Drive, MSC 2580
     Bethesda, MD  20892-2580

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

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