Lymphoma is a broad term for cancer that begins in cells of the lymph system.

The two main types are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). Hodgkin lymphoma can often be cured.

Hodgkin lymphoma (the only allopathically curable form of cancer) has characteristics that distinguish it from other diseases classified as lymphoma, including the presence of Reed-Sternberg cells. These are large, cancerous cells found in Hodgkin lymphoma tissues. Hodgkin lymphoma results from a change to the DNA of a lymphocyte, if untreated, results in the uncontrolled growth of cancerous lymphocytes. These cancerous cells crowd out normal white cells, and the immune system can’t guard against infection effectively.

Lymphoma cells grow and form masses, usually in the lymph nodes, located throughout our bodies in the lymphatic system. Lymphoma cells can also gather in other areas of the body where lymphoid tissue is found.

Hodgkin lymphoma is distinguished from other types of lymphoma by the presence of Reed-Sternberg cells (named for the scientists who first identified them). Other cells associated with the disease are called Hodgkin cells.

Hodgkin cells are larger than normal lymphocytes but smaller than Reed-Sternberg cells. (These differences can be observed under a microscope and further identified by special pathology tests).

Hodgkin lymphoma has further two main subtypes:

• Classical Hodgkin lymphoma
• Nodular lymphocyte-predominant Hodgkin lymphoma

Classical Hodgkin lymphoma is characterized by the presence of both Hodgkin and Reed-Sternberg cells. Nodular lymphocyte-predominant Hodgkin lymphoma is characterized by the presence of lymphocyte-predominant cells, sometimes termed “popcorn cells,” which are a variant of Reed-Sternberg cells.

Classical Hodgkin Lymphoma

About 95 percent of patients with Hodgkin lymphoma have classical Hodgkin lymphoma. This subtype is further divided into four distinct subtypes shown in the table below.

Classical Hodgkin Lymphoma Subtypes

Nodular Lymphocyte-Predominant Hodgkin Lymphoma

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) affects about 5 percent of Hodgkin lymphoma patients. The following are some characteristics of NLPHL:

• Most common in the 30- 50-year-old age group.
• More common in males.
• Slow growing and can relapse many years later.
• Highly curable.
• Small risk of transformation to aggressive non-Hodgkin lymphoma (7 percent of cases).

Use physical examinations, imaging tests, blood tests and, sometimes, bone marrow tests to determine the extent of the disease.  This determination is called “staging.”  Staging provides important information for treatment planning.

Staging for Hodgkin lymphoma is based on the Lugano classification, which is derived from the Ann Arbor staging system.

Hodgkin Lymphoma Stages

Categories

In addition to the stage number, the letters A, B, E or S may be used to further classify the stage of HL.

• Category A: The patient does not have B symptoms (fever, weight loss or night sweats).
• Category B: The patient has B symptoms.
• Category E: The patient has HL cells in organs or tissues outside the lymphatic system.
• Category S: The patient has HL cells in the spleen.

For example, stage IIB would indicate that the patient has

• Involvement of two lymph node sites near each other (for example, enlarged lymph nodes in the neck and collarbone area or in the neck and the armpit)
• Fever, excessive sweating and/or weight loss

Patients in the B category sometimes require more aggressive treatments. It is important to note that even patients with stage IV (advanced stage) Hodgkin lymphoma are frequently cured with treatment, despite having lymphoma in many areas of the body.

Risk Factors

For most people who have Hodgkin lymphoma, the exact cause is different types of fungal infections, said Dr Qaisar Ahmed; the following risk factors may increase a person’s likelihood of developing Hodgkin lymphoma:

• Past Epstein-Barr virus infection: The Epstein-Barr virus (EBV), known for causing mononucleosis, is associated with the development of some types of cancer, including Hodgkin lymphoma. Infection with EBV in early childhood or having “mono” in the teenage years increases the risk of developing Hodgkin lymphoma. But while many people are infected with EBV, very few actually develop Hodgkin lymphoma.
• Age: Hodgkin lymphoma is most common in adolescents and young adults (15-29) and older adults (75-79).
• Sex: Hodgkin lymphoma is slightly more common in males.
• Family history: Having a parent or sibling with Hodgkin lymphoma may increase the risk of Hodgkin lymphoma.
• Weakened immune system: People infected with HIV have an increased risk of developing Hodgkin lymphoma. People who take allopathic medicines to suppress the immune system and people with autoimmune disease are also at a higher risk.

Hodgkin lymphoma is not contagious.

Symptoms of Hodgkin lymphoma

The most common symptom of Hodgkin lymphoma is one or more enlarged (swollen) lymph nodes. The enlarged lymph node may be in the neck, upper chest, armpit, abdomen or groin. The swollen lymph node is usually painless.

Other signs and symptoms of Hodgkin lymphoma may include: –

• Drenching night sweats.
• Unexplained weight loss.
• Unexplained fever.
• Persistent fatigue.
• Persistent cough and shortness of breath (due to enlarged lymph nodes in the chest).
• Itchy skin, especially after bathing or drinking alcohol.
• Decreased appetite.
• Abdominal pain or swelling and feeling of fullness (due to an enlarged spleen).
• Occasional pain in lymph nodes after drinking carbonated drinks and alcohol.

B- symptoms – Fever, drenching night sweats and loss of more than 10 percent of body weight over six months are sometimes termed “B symptoms.”  These symptoms are significant to the prognosis and staging of the disease.

Diagnosis Hodgkin lymphoma

A good doctor will take a comprehensive medical history and ask questions regarding patient’s symptoms. Physical examination will include measurement of all accessible lymph node groups (neck, underarms and groin) as well as the size of palpable organs such as the spleen and liver.

Lymph Node Biopsy

A biopsy of an enlarged lymph node is needed to diagnose Hodgkin lymphoma. The preferred and most common type of biopsy is called an “excisional biopsy,” in which the whole lymph node is typically removed (excised). If the lymph node is just under the skin, the biopsy procedure is usually simple and can sometimes be done with local anesthesia. If the lymph node is inside the chest or abdomen (stomach area), give your patient general anesthesia.

The biopsy samples will be sent to a hematopathologist, who’ll examine the samples for cancer cells. (The lymph node biopsy’s purpose is to confirm a diagnosis and identify Hodgkin lymphoma subtype).

Immunophenotyping

This laboratory test can detect specific cancer cells based on the types of antigens or proteins on the surface of the cells. Immunophenotyping is used to help diagnose specific types of leukemia and lymphoma.

Some of these tests may be repeated both during and after therapy to measure the effects of treatment.

Next Generation Sequencing and Liquid Biopsies

Next generation sequencing (NGS) tests can rapidly examine stretches of DNA or RNA. This technology can detect mutations and other genetic abnormalities in DNA extracted from blood or bone marrow samples. Due to the low abundance of Reed-Sternberg cells, performing genetic analysis from tumor samples in Hodgkin lymphoma can be difficult.

This method is currently under investigation in clinical trials, and it could become a complementary method to tissue biopsy in the near future. It could be particularly useful in cases where a tumor mass is difficult to biopsy or when there is very little tissue removed through biopsy.

Staging Tests

Once hematologist-oncologist confirms a Hodgkin lymphoma diagnosis, doctor orders more tests to stage the disease. Staging identifies the extent and location in the body.

Staging tests include:

• Imaging tests.
• Blood tests.
• Bone marrow tests.

Some of these tests may be repeated, both during and after therapy, to measure the response to treatment.

Imaging Tests

Imaging tests help the doctor evaluate:

• The location and distribution of enlarged lymph nodes.
• Whether organs other than lymph nodes are involved.
• Whether there are very large masses of tumors in one site or another.

Imaging tests may include:

• Chest X-ray (I – Dr Qaisar Ahmed strictly not recommends).
• CT (computed tomography) scan of the neck, chest, pelvis and abdomen (stomach area) {I – Dr Qaisar Ahmed strictly not recommends}.
• PET-CT scan (positron emission tomography-computed tomography) scan, a combination PET and CT scan, of the entire body with a radioactive tracer. This is also referred to as an “FDG-PET scan” (fluorodeoxyglucose [FDG] positron emission tomography [PET]) {I – Dr Qaisar Ahmed strictly not recommends}.
• MRI (magnetic resonance imaging), in select cases. (I – Dr Qaisar Ahmed strictly not recommends).

Blood Tests

Blood tests may include: –

• Complete blood count (CBC). This test measures the number of blood cells in a sample, including red blood cells, white blood cells, and platelets. A low level of red blood cells, white blood cells or platelets may indicate that the lymphoma is present in the bone marrow and/or blood.
• Erythrocyte sedimentation rate (ESR). To determine the rate at which the red blood cells settle to the bottom of a tube. The “sedimentation” rate is a measure of how much inflammation is in the body. Inflammation is the body’s attempt to heal itself. The ESR may be higher than normal for some people with Hodgkin lymphoma.
• Lactate dehydrogenase (LDH). This protein is released into the blood when a cell is damaged. A high level of LDH in the blood is a sign of cell damage. The level of LDH can be higher than normal in patients with Hodgkin lymphoma when the cancer is more active and does more damage to cells.
• Liver and kidney function tests. These tests can help determine if cancer has affected these organs.
• Human immunodeficiency virus (HIV) and hepatitis B testing. Tests for both HIV and hepatitis B should be part of the pretreatment workup for patients with Hodgkin lymphoma, since these diseases can affect cancer treatment.

Heart and Lung Tests

Some Hodgkin lymphoma allopathic treatments may weaken or damage the heart and lungs. The healthcare team may decide to test how well these organs work before treatment, in order to plan appropriate treatment.

Pregnancy Test

All allopathic cancer treatments can harm fetus, so a pregnancy test may be required for women of reproductive age before you can start certain treatments. Treatment options will be dependent on the results.

Bone Marrow Tests

Some patients who have been diagnosed with Hodgkin lymphoma may need to undergo a bone marrow aspiration and biopsy, to see if there are lymphoma cells in the bone marrow, bone marrow biopsy may be eliminated by the use of a PET scan to assess the disease.

Non-Hodgkin lymphoma (NHL)

Non-Hodgkin lymphoma is a type of cancer that generally develops in the lymph nodes and lymphatic tissue found in organs such as the stomach, intestines or skin. In some cases, NHL involves bone marrow and blood.

Non-Hodgkin lymphoma represents a diverse group (group of blood cancers that all arise from lymphocytes – white blood cells that are part of the immune system) of diseases distinguished by the characteristics of the cancer cells associated with each disease type. Lymphoma cells may develop in just one place or in many sites in the body. Non-Hodgkin lymphoma has many different subtypes which are either indolent (slow-growing) or aggressive (fast-growing).

Most patients with non-Hodgkin lymphoma have a B-cell type of NHL (about 85 percent). The others have a T-cell type or an NK-cell type of lymphoma. Some patients with fast-growing non-Hodgkin lymphoma can be cured. For patients with slow-growing non-Hodgkin lymphoma, treatment may keep the disease in check for many years.

How Does NHL Develop?

A cell mutates in a lymph node or in some other lymphatic structure. It can start in one of three major types of lymphocytes:

• B lymphocytes (B cells), which produce antibodies to help combat infections.
• T lymphocytes (T cells), which have several functions, including helping B lymphocytes make antibodies.
• Natural killer (NK) cells, which attack virus-infected cells or tumor cells.

About 85-90 percent of NHL cases start in the B cells.

The abnormal lymphocyte grows out of control and produces more abnormal cells like it. These abnormal lymphocytes (lymphoma cells) accumulate and form tumors. If NHL isn’t treated, the cancerous cells crowd out normal white cells, and the immune system can’t guard against infection effectively.

Non-Hodgkin lymphoma that develops in or spreads to other areas of the body where lymphoid tissue is found, such as the spleen, digestive tract and bone marrow, is called primary extranidal lymphoma.

Non-Hodgkin lymphoma is classified into more than 60 different subtypes. Doctors classify the non-Hodgkin lymphoma subtypes into categories that describe how rapidly or slowly the disease is progressing:

• • Aggressive (fast-growing) NHL
  • Indolent (slow-growing) NHL

Risk Factors

There are risk factors that may increase the likelihood of developing the disease. Factors affecting people’s risk of developing non-Hodgkin lymphoma have been studied extensively. Some of these factors are immune disorders, allopathic medicines, infections, lifestyle, genetics race, family history and occupational factors. Some risk factors differ by subtype.

Symptoms of Non-Hodgkin lymphoma

The signs and symptoms of non-Hodgkin lymphoma are also associated with a number of other, less serious diseases.

There are about 600 lymph nodes in the body. The most common early sign of NHL is painless swelling of one or more lymph node(s).

Most patients with non-Hodgkin lymphoma have one or more enlarged lymph nodes in the neck, armpit or groin. Less often, a swollen node appears near the ears, the elbow or in the throat near the tonsils.

Occasionally, the disease starts in a site other than the lymph nodes, such as a bone, a lung, the gastrointestinal tract or the skin. In these circumstances, patients may experience symptoms that are associated with that specific site.

Common symptoms of non-Hodgkin lymphoma include:

• Painless swelling in one or more lymph node(s).
• Unexplained fever.
• Drenching night sweats.
• Persistent fatigue.
• Loss of appetite.
• Unexplained weight loss.
• Cough or chest pain.
• Abdominal pain.
• Sensation of bloating or fullness (due to an enlarged spleen).
• Itchy skin.
• Rashes or skin lumps.
• Enlargement of the spleen or liver.

Some patients have no symptoms and the disease may only be discovered during a routine medical examination or while the patient is under care for an unrelated condition.

B Symptoms

The term “B symptoms” is used to refer to fever, drenching night sweats and loss of more than 10 percent of body weight over 6 months. B symptoms are significant to the prognosis and staging of the disease. Other NHL symptoms, such as itching and fatigue, do not have the same prognostic importance as B symptoms and are not considered to be B symptoms.

Physical Evaluation

The doctor should take a comprehensive medical history and ask questions regarding either the absence or the presence of B symptoms. Physical examination will include measurement of all accessible lymph node groups, as well as the size of organs, such as the spleen and liver.

Lymph Node Biopsy

A biopsy of an involved lymph node or other tumor site is needed to confirm the non-Hodgkin lymphoma diagnosis and subtype.  A needle biopsy may be done, but a needle usually cannot obtain a large enough specimen of lymph node tissue for the hematopathologist to make a firm diagnosis. To ensure that there is enough tissue to make an accurate diagnosis, either a small area of tissue is taken (an incisional biopsy) or an entire lymph node is removed (an excisional biopsy). The decision which types of biopsies to use is based on the location of the tumor. The patient is usually given a local anesthetic.

The purpose of a lymph node biopsy is to:

• Confirm a diagnosis.
• Identify your non-Hodgkin lymphoma subtype.
• Develop a treatment plan.

Non-Hodgkin lymphoma can develop in parts of the body that do not involve lymph nodes, such as the lung or bone. When lymphoma is detected exclusively outside of the lymph nodes, it is called “primary extra nodal lymphoma,” and the biopsy specimen is taken from that involved tissue.

Additional Tests

Additional tests that may be necessary include:

• Immunophenotyping
• Flow cytometry
• Cytogenetic analysis
• Gene expression profiling and microarray analysis

Getting a Second Opinion

Non-Hodgkin lymphoma is a difficult disease to diagnose, therefore you may want to get a second opinion from an experienced hematopathologist before you begin treating your patient. The appropriate treatment depends on having the correct diagnosis.

Staging Tests

Imaging Tests

Also called diagnostic radiology, along with a physical exam, to evaluate:

• The location and distribution of lymph node enlargement.
• Whether organs other than the lymph nodes are involved.
• If there are very large masses of tumors in one site or another.

Imaging tests include:

• Chest x-rays.
• CT (computed tomography) scan.
• Magnetic resonance imaging (MRI).
• Positron emission tomography-computed tomography (PET-CT) scans.

Blood Tests

Blood tests are used to determine whether lymphoma cells are present in the blood; check for indicators of disease severity by examining blood protein levels; assess kidney and liver functions; and measure important biological markers, which are helpful prognostic indicators for several NHL subtypes. Blood tests include:

• Complete blood count (CBC) – This test measures different components of the blood, including counts of red blood cells, white blood cells and platelets.
• Comprehensive metabolic panel – This test often includes tests for up to 14 chemicals that come from the liver, bone and other organs. Abnormal levels can be caused by cancer or other health problems.
• Beta₂ microglobulin – Beta2 microglobulin is a small protein made by many types of cells, including lymphoma cells. High levels of this protein may be an indication for urgent treatment.
• Lactate dehydrogenase (LDH) – LDH is a protein that is found in most cells. When a cell is damaged, LDH is released into the bloodstream. Thus, when associated with cancer, a high LDH level may be a sign that treatment is needed soon.
• Hepatitis testing – The presence of hepatitis B or hepatitis C can be important considerations when treating certain types of lymphoma. Hepatitis B can become active again due to cancer or some of its treatments. Hepatitis C may diminish the effectiveness of therapy.
• Uric acid testing – This test measures the amount of uric acid in the body. When cancer cells breakdown and die, they release substances into the blood. If the cancer cells breakdown too quickly, the kidneys cannot remove these substances from the blood. An increased level of uric acid can lead to tumor lysis syndrome (TLS).
• Antibody testing – Depending on the type of NHL, patients may have either low levels of antibodies or very high amounts of tumor-specific antibodies.

Bone Marrow Biopsy

Most patients diagnosed with NHL undergo a bone marrow biopsy to make sure there is no spread of the disease to the bone marrow and to evaluate the use of specific therapies including radioimmunotherapy (a combination of radiation therapy and immunotherapy). A bone marrow biopsy may not always be required for patients with early-stage disease who also have low-risk features.

Heart Tests

All cancer treatments can damage the heart. So, members of the treatment team may want to determine how well a patient’s heart functions before he or she starts a specific treatment. Tests include

• An echocardiogram.
• A mitigated acquisition (MUGA) scan—This scan measures how well the heart pumps blood. A radiotracer substance is injected into a vein. Pictures of the heart are taken with a special camera that detects the radiation released by the tracer.

Other Tests

Some tests are associated with a specific subtype and are not necessary for all patients with NHL. Examples of specific testing include: –

• Full evaluation of the gastrointestinal (GI) tract, including upper and lower endoscopies for patients who have diseases involving the GI tract, such as mantle cell lymphoma (MCL) and gastric mucosa-associated lymphoid tissue (MALT) lymphoma.
• Colonoscopy for patients with MCL (routine colonoscopy is important for all persons beginning at age 50, or earlier if there is a family history of colon cancer).
• Testicular ultrasound for patients who have a testicular mass.
• Spinal tap (lumbar puncture) and/or MRI of the brain or spinal column may be required for patients with certain subtypes or symptoms that suggest central nervous system involvement.

NHL doesn’t always begin in stage I and spread to more advanced stages. With lymphoma, the stage identifies the location of the disease. It does not reflect how well or how poorly a patient may respond to treatment.

Ann Arbor Staging System for NHL

• Stage I 
  • I: Involvement of one lymph node region (for example, the tonsils).
  • IE: Involvement of one organ or area outside the lymph nodes.
• Stage II 
  • II: Involvement of two or more lymph node regions and both are either above or below the diaphragm.
  • IIE: Involvement of one or more lymph node groups either above or below the diaphragm and outside the lymph nodes in an organ or area on the same side of the diaphragm as the affected lymph nodes.
  • II Bulky: Involvement of multiple lymph node regions on same side of the diaphragm with “bulky disease”.
• Stage III 
  • III: Involvement of lymph node regions above and below the diaphragm (for example, neck, chest and abdomen).
  • IIIE: Involvement of lymph node groups above and below the diaphragm and outside of the lymph nodes in a nearby organ or area.
  • IIIS: Involvement of lymph node groups above and below the diaphragm and in the spleen.
  • IIIE+S: Involvement of lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area, and in the spleen.
• Stage IV
  • Involvement of one of more organs that area not part of a lymphatic area and in lymph nodes near those organs.
    OR
  • Involvement of one organ that is not part of a lymphatic area and of organs or lymph nodes far away from that organ.
    OR
  • Involvement of the liver, bone marrow, cerebrospinal fluid or lungs.

Categories 

• E— “E” stands for extranodal. It means the lymphoma extends to an area or organ beyond the lymphatic system.
• S— “S” stands for spleen and it means the lymphoma is found in this organ.
• X — “X” indicates “bulky disease.” This is a nodal mass whose greatest size is usually more than 10 cm or more than one third of the chest diameter by x-ray.

Lugano Modification of Ann Arbor Staging Sytems (for primary nodal lymphomas)

When all the diagnostic and staging tests are completed, the doctor will evaluate the information, identify the NHL subtype, determine which areas of the body are involved and begin to discuss treatment options with the patient.

More than 60 specific NHL subtypes have been identified and assigned names by the World Health Organization (WHO).  NHL subtypes are categorized by the characteristics of the lymphoma cells, including their appearance, the presence of proteins on the surface of the cells and their genetic features. It’s important to know your subtype since it plays a large part in determining the type of treatment you’ll receive. A hematopathologist, a doctor who specializes in the diagnosis of blood disorders and blood cancers, should review your biopsy specimens.

Specialists further characterize the NHL subtypes according to how the disease progresses:

• Aggressive lymphomas are fast-moving and account for about 60 percent of all NHL cases. Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive NHL subtype.
• Indolent lymphomas are slow-moving and tend to grow more slowly and have fewer signs and symptoms when first diagnosed. Slow-growing or indolent subtypes represent about 40 percent of all NHL cases. Follicular lymphoma (FL) is the most common subtype of indolent NHL.

The treatments for aggressive and indolent lymphomas are different.  When a patient’s rate of disease progression is between indolent and aggressive, he or she is considered to have “intermediate grade” disease. Some cases of indolent NHL can transform into aggressive NHL.

Diagnosis Non-Hodgkin Lymphoma (NHL): Subtypes

This list provides some of the diagnostic designations for NHL subtypes, categorized by cell type (B cell, T cell or NK cell) and rate of progression (aggressive or indolent). The percentages listed reflect the frequency of diagnosed cases of the most common NHL subtypes.

Mature B-cell lymphomas (about 85%-90% of NHL cases)

Aggressive:

• Diffuse large B-cell lymphoma (DLBCL) (30%).
• Mantle cell lymphoma (MCL) (3%)—has features of both indolent and aggressive NHL.
• Lymphoblastic lymphoma (2%).
• Burkitt lymphoma (BL) (2%).
• Primary mediastinal (thymic) large B-cell lymphoma (PMBCL).
• Transformed follicular and transformed mucosa-associated lymphoid tissue (MALT) lymphomas.
• High-grade B-cell lymphoma with double or triple hits (HBL).
• Primary cutaneous DLBCL, leg type.
• Primary DLBCL of the central nervous system.
• Primary central nervous system (CNS) lymphoma.
• Acquired immunodeficiency syndrome (AIDS)-associated lymphoma.

Indolent

• Follicular lymphoma (FL) (22%).
• Marginal zone lymphoma (MZL) (7%).
• Chronic lymphocytic leukemia/small-cell lymphocytic lymphoma (CLL/SLL) (7%).
• Gastric mucosa-associated lymphoid tissue (MALT) lymphoma (8%).
• Lymphoplasmacytic lymphoma (1%).
• Walden Strom macroglobulinemia (WM).
• Nodal marginal zone lymphoma (NMZL) (1%).
• Splenic marginal zone lymphoma (SMZL).

Mature T-cell and natural killer (NK)-cell lymphomas (about 10%-15% of NHL cases)

Systemic:

• Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) (6%).
• Systemic anaplastic large-cell lymphoma (ALCL) (2%).
• Lymphoblastic lymphoma (2%).
• Hepatosplenic T-cell lymphoma.
• Enteropathy-associated intestinal T-cell lymphoma
  • Monomorphic epitheliotropic intestinal T-cell lymphoma.
• Angioimmunoblastic T-cell lymphoma (AITL).
• Adult T-cell leukemia/lymphoma.
• Extranidal natural killer (NK)/T-cell lymphoma (.ENK/TCL), nasal type.

Primary cutaneous

• Cutaneous T-cell lymphoma (CTCL) (4%)
  • Mycosis fungoides (MF).
  • Sezary syndrome (SS).
• Primary cutaneous anaplastic large-cell lymphoma (pcALCL).
• Subcutaneous panniculitis-like T-cell lymphoma (SPTCL)
  • Primary cutaneous gamma delta T-cell lymphoma.

Aggressive non-Hodgkin lymphoma (NHL) progresses rapidly. It makes up about 60 percent of all NHL cases in the United States. Aggressive subtypes include:

• AIDS-associated lymphoma
• Burkitt lymphoma
• Central nervous system (CNS) lymphoma
• Diffuse large B-cell lymphoma (DLBCL)
• ​Mantle cell lymphoma (MCL)
• Peripheral T-cell lymphoma (PTCL)
• T-cell lymphoblastic (T-LBL)

Patients with fast-growing NHL are frequently treated with chemotherapy that consists of four or more drugs. In most cases, this is the combination therapy called R-CHOP (rituximab, cyclophosphamide, doxorubicin, and prednisone). This intensive, multidrug chemotherapy can be very effective for aggressive lymphoma, and cures have been achieved. Chemotherapy can be supplemented by radiation therapy in select cases, for instance, when large NHL masses are found during the diagnostic and staging process.

Acquired Immunodeficiency Syndrome (AIDS)-Associated Lymphoma

The types of NHL that are most often seen in patients with acquired immune deficiency syndrome (AIDS) are diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma and primary central nervous system (CNS) lymphoma.

Allopathic treatment outcomes depend on how well the patient with AIDS responds to therapy and manages the effects of chemotherapy on blood counts. Because AIDS already leads to low blood cell counts, chemotherapy must be carefully considered to determine whether the chemotherapy’s additional effects on blood levels can be managed. The number of patients developing AIDS-associated NHL has decreased in the last several years because of improved treatment of HIV (the virus that can lead to AIDS).

Burkitt Lymphoma

This aggressive B-cell subtype grows and spreads very quickly. It may involve the jaw, bones of the face, bowel, kidneys, ovaries, bone marrow, blood, central nervous system (CNS) and other organs. Burkitt lymphoma may spread to the brain and spinal cord; therefore, treatment to prevent CNS spread should be included in any treatment regimen.

Allopathic doctors typically use highly aggressive chemotherapy to treat this subtype of NHL. Commonly used regimens include:

• CODOX-M/IVAC (cyclophosphamide, vincristine, doxorubicin and high-dose methotrexate) alternating with IVAC (ifosfamide, etoposide and high dose cytarabine).
• Hyper-CVAD (hyper fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone) alternating with methotrexate and cytarabine). In small studies, rituximab was used in combination with hyper-CVAD.
• DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin plus rituximab).

Studies report that BL is curable in a significant group of patients when treated with high-dose, multidrug chemotherapy regimens that include central nervous system (CNS) prophylaxis. About 60 to 90 percent of children and young adults with the disease achieve durable remissions if treated timely and appropriately. Older patients with BL have less favorable outcomes than younger patients.

Patients with relapsed or refractory BL are encouraged to participate in clinical trials. Consolidation treatment with a high-dose conditioning therapy and autologous stem cell transplantation (or allogenic transplantation, if a donor is available) may be considered for patients who achieve remission after their second-line treatment.

Central Nervous System (CNS) Lymphoma

Primary CNS lymphoma forms in the brain and/or the spinal cord. It is often a feature of AIDS-associated lymphoma, but most patients in the United States who have primary CNS lymphoma do not have a clear predisposing cause. Secondary CNS lymphoma develops when a lymphoma already presents in other parts of the body spreads to the brain and/or the spinal cord. Patients with highly aggressive lymphomas, such as Burkitt lymphoma and DLBCL, are at a higher risk of disease relapse with CNS involvement. So, first-line treatment for these types of lymphoma may include chemotherapy administered directly into the spinal fluid.

Both primary and secondary CNS lymphomas are uncommon. Standard treatment may include chemotherapy that includes intrathecal methotrexate, corticosteroid drugs and/or radiation therapy. Immunotherapy and high-dose chemotherapy with stem cell transplantation are being studied in clinical trials.

Diffuse Large B-Cell Lymphoma

Diffuse large B-cell lymphoma (DLBCL) is the most common NHL subtype, making up about 31 percent of all NHL cases. It grows rapidly in the lymph nodes and frequently involves the spleen, liver, bone marrow or other organs. Usually, DLBCL development starts in lymph nodes in the neck or abdomen and is characterized by masses of large B cells. In addition, patients with DLBCL often experience B symptoms (fever, night sweats and loss of more than 10 percent of body weight over 6 months).

For some patients, DLBCL may be the initial diagnosis.  For other patients, an indolent lymphoma such as small lymphocytic lymphoma or follicular lymphoma transforms and becomes DLBCL. ​Treatments include

• R-CHOP (rituximab, cyclophosphamide, doxorubicin hydroxy doxorubicin, vincristine and prednisone).
• Dose adjusted EPOCH-RR, (Ose-adjusted etoposide, prednisone, vincristine [Oncovin®], cyclophosphamide, hydroxy doxorubicin [doxorubicin] plus rituximab.
• Rituximab and hyaluronidase human.

Mantle Cell Lymphoma (MCL)

Mantle cell lymphoma (MCL) originates from a lymphocyte in the mantle zone of the lymph node. It begins in the lymph nodes and spreads to the spleen, blood, bone marrow and sometimes the esophagus, stomach and intestines.

The standard treatment is a combination chemotherapy regimen, either with or without an autologous stem cell transplant. Common treatment regimens include bendamustine plus rituximab; a form of CHOP in which bortezomib is used instead of vincristine; and various regimens including high-dose cytarabine. The following agents are indicated for relapsed and refractory MCL: achydroxy doxorubicinenc, given by mouth; bortezomib by IV or subcutaneous injection; ibrutinib (Imbruvica, given by mouth; zanubrutinib given by mouth; lenalidomide (Revlimid®), given by mouth; and brexucabtagene autoleucel, given by IV. Allogeneic transplantation with a standard or reduced-intensity conditioning regimen may be considered for patients with relapsed and refractory MCL who achieve remission following second-line therapy.

Peripheral T-Cell Lymphoma

Peripheral T-cell lymphomas (PTCLs) are a group of rare and often fast-growing non-Hodgkin lymphomas that develop from mature T cells and natural killer (NK) cells. They account for approximately 10 percent of non-Hodgkin’s lymphoma cases. Some subtypes include:

• Peripheral T-cell lymphoma, not otherwise specified (PTCL NOS)—This is the most common subtype of PTCL, accounting for about 30 percent of PTCL cases. It most often appears in the lymph nodes, but it can also affect the liver, bone marrow, gastrointestinal tract and the skin.
• Anaplastic large-cell lymphoma (ALCL)— This accounts for about 12 percent of PTCL cases. It can appear throughout the body (systemic) or a specific variant called primary cutaneous ALCL that mainly or only affects the skin, known as Primary Cutaneous Anaplastic Large Cell Lymphoma (pcALCL).
• Angioimmunoblastic T-cell lymphoma (AITL)—One of the most common types in the US and Europe. It is associated with B cells infected with the Epstein-Barr virus.
• Extranodal natural killer/T-cell lymphoma (ENK/TCL)—This is an uncommon type of lymphoma that can occur in the nasal sinuses or in other parts of the body.
• Adult T-Cell Leukemia/ Lymphoma (ATLL)—This is a rare and aggressive type of PTCL that is associated with the human T-cell lymphotropic virus-1 (HTLV-1).
• Enteropathy-associated T-cell lymphoma (EATL)—This T-cell lymphoma frequently develops in the small bowel of patients with untreated celiac disease.
• Monomorphic Epitheliotropic Intestinal T-cell Lymphoma (MEITL)—This is a lymphoma of the gastrointestinal tract that is NOT associated with celiac disease.
• Hepatosplenic T-cell lymphoma (HSTCL)—This uncommon subtype of PTCL generally affects young men.
• Subcutaneous Panniculitis-like T-cell Lymphoma (SPTCL)— This is a very rare form of skin lymphoma that occurs primarily in the subcutaneous fat tissue, where it causes nodules to form.
• Primary Cutaneous gamma/delta T-cell lymphoma (PCGDTCL)—This is a very rare and aggressive skin lymphoma.

T-Cell Lymphoblastic Lymphoma

Patients with this diagnosis are treated in the same way as patients with acute lymphoblastic leukemia (ALL). To read more about treatment options, download or order LLS’s free fact booklet Acute Lymphoblastic Leukemia (ALL) in adults.

Indolent non-Hodgkin lymphoma (NHL) subtypes progress slowly. They make up about 40 percent of all NHL cases in the United States. Indolent subtypes include:

• Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome).
• Follicular lymphoma (FL).
• Lymphoplasmacytic lymphoma and Wald Enstrom macroglobulinemia.
• Marginal zone lymphoma.
• Small cell lymphocytic lymphoma (SLL) and chronic lymphocytic leukemia (CLL).

Treatment for indolent NHL ranges from observation with careful monitoring (the watch-and-wait approach) to aggressive therapy. Indolent NHL management or treatment is highly individual and depends on factors that include the patient’s

• Prognostic factors.
• Stage of disease.
• Age and other medical conditions.

Cutaneous T-Cell Lymphoma (Mycosis Fungoides and Sezary Syndrome)

Cutaneous T-cell lymphomas (CTCLs) are a group of NHLs that develop primarily in the skin and may grow to involve lymph nodes, blood and other organs. This type of lymphoma originates in a T-cell. Mycosis fungoides is the most common type of CTCL, and is characterized by prominent skin involvement. When the malignant lymphocytes enter and accumulate in the blood, the disease is called Sezary syndrome.

Allopathic therapy for CTCL depends on the nature of the skin lesions and whether disease is present in the lymph nodes.

• Topical therapies are among the approaches used to treat skin lesions. These include drugs applied directly to the skin and two different forms of therapy based on exposing skin lesions to light—ultraviolet light therapy and electron beam therapy. Ultraviolet light is used in conjunction with psoralen (a drug that becomes active when it is exposed to light); the combination therapy is often referred to as “PUVA” (psoralen and ultraviolet A) therapy.
• If there is widespread involvement of lymph nodes and other areas, chemotherapy or extracorporeal photopheresis can be used. Photopheresis is a process in which white blood cells are removed by apheresis, treated with psoralen, exposed to ultraviolet A light and then returned to the patient’s bloodstream.
• Two histone deacetylase (HDAC) inhibitors, romidepsin, given by IV infusion and vorinostat, given by mouth, as well as one monoclonal antibody, mogamulizumab, given by IV, are indicated for the treatment of adult patients with either relapsed or refractory disease who have received previous systemic therapy.

Follicular lymphoma (FL)

Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin lymphoma (NHL), making up about 22 percent of all NHL cases. Most follicular lymphoma cells have a specific chromosomal abnormality (a translocation between parts of chromosomes 14 and 18) that causes the production (overexpression) of the gene, BCL-2, which can make the cells resistant to therapy.

FL is a very slow-growing disease. Some patients may not need treatment for several years, whereas others may have extensive lymph node or organ involvement and need treatment right away. In a small percentage of patients, FL may transform into a more aggressive disease.

Stage I or stage II FL may be treated with:

• Watch-and-wait approach; patients with less advanced disease can be observed with periodic examinations and imaging tests.
• Radiation therapy
• Chemotherapy with rituximab (Rituxan®)

For patients with stage II FL who have large lymph nodes, stage III or stage IV FL or advanced-stage relapsed FL, treatment will be based on symptoms, the patient’s age and health status, the extent of disease and the patient’s choice. Taking part in a clinical trial may also be a good treatment option.  Other treatment options include

• The watch-and-wait approach
• Radiation therapy to lymph nodes that are causing symptoms, or to a large localized mass, if one is present
• Chemotherapy plus immunotherapy (rituximab)
  • Single chemotherapy drugs in combination with rituximab. Examples of drugs used for treatment include cyclophosphamide, chlorambucil or bendamustine hydrochloride.
  • Chemotherapy combinations plus rituximab, such as R-CVP (rituximab plus cyclophosphamide, hydroxydoxorubicin [doxorubicin], vincristine and prednisone) or R-CHOP (rituximab plus cyclophosphamide, doxorubicin [hydroxydoxorubicin], [vincristine] and prednisone)
  • Maintenance rituximab after completion of initial therapy with either rituximab alone or rituximab in combination with chemotherapy. This involves a single dose of rituximab administered on a prescribed schedule (generally every 2 to 3 months). The Rituximab maintenance may be continued for 2 years.
• Autologous and allogeneic stem cell transplantation for selected patients
• Targeted therapy, using kinase inhibitors
  • Copanlisib.
  • Duvelisib.
• Lenalidomide.
  • Yttrium-90+ibritumomab tiuxetan.
  • Obinutuzumab.
  • Rituximab and the endoglycosidase hyaluronidase human.
• Tazemetostat.

Transformed B-Cell Follicular Lymphoma (FL). Follicular lymphoma has a small risk of transforming into an aggressive large B-cell lymphoma, such as DLBCL. Patients with transformed B-cell FL appear to benefit from rituximab therapy, either alone or in combination with chemotherapy. Other options include

• Axicabtagene ciloleucel
• Tisagenlecleucel

Reduced-intensity transplantation, within a clinical trial, may also be considered in cases of FL transformation. Several novel drug combinations are being studied for the treatment of refractory/relapsed FL.

The Follicular Lymphoma International Prognostic Index (FLIPI)

The FLIPI is a scoring system used to predict which patients with follicular lymphoma may be at higher risk for disease recurrence. One point is assigned for each of the following risk factors (known by the acronym NoLASH):

• Nodes involved—5 or more
• Lactate dehydrogenase (LDH) level—higher than the upper limit of normal
• Age older than 60 years
• Stage III or stage IV disease
• Hemoglobin concentration—less than 12 g/dL

Low risk:  0 to 1 point
Intermediate risk: 2 points
High risk: 3 to 5 points

Lymphoplasmacytic Lymphoma and Wald Enstrom Macroglobulinemia

Lymphoplasmacytic lymphoma and Walden Strom macroglobulinemia are both slow-growing types of lymphoma that originate in a B-lymphocyte precursor. Walden Strom macroglobulinemia is a type of lymphoplasmacytic lymphoma.

In lymphoplasmacytic lymphoma, the lymph nodes are more involved than they are in WM. Both disorders show malignant lymphoplasmacytic cells in the marrow and spleen.

Patients may experience increased blood viscosity (thickening of the blood), inadequate blood flow, and symptoms and signs of limited blood flow (eg, headache, visual blurring, mental confusion). This is referred to as hyper viscosity syndrome” which may require urgent intervention. Hyper viscosity syndrome can be treated by plasmapheresis (a process in which plasma is separated from whole blood and the rest is returned to the patient). Plasmapheresis can reverse acute symptoms and signs, but long-term control requires a reduction in the mass of lymphoma cells that make the protein.

One option for patients without symptoms of WM is to take a watch-and-wait approach. Active treatment begins for these patients only if symptoms develop. Progressive disease may also involve the lungs, the gastrointestinal (GI) tract and other organs.

Several different therapies are effective against WM, but no single or combination standard treatment is used for all patients. Patients are advised to discuss with their doctors the most appropriate treatment for their situation. Specific treatments include drug therapy, combinations of drugs, stem cell transplantation, and involvement in clinical trials.

Marginal Zone Lymphoma (MZL)

This indolent B-cell lymphoma subtype may be extranodal (disease outside of the lymph nodes) or nodal (disease within the lymph nodes). It begins in B lymphocytes in a part of the lymph tissue called the “marginal zone.” The disease tends to remain localized.

There are several subtypes of MZL, each categorized by the type of tissue where the lymphoma forms.

• Gastric mucosa-associated lymphoid tissue (MALT) lymphoma usually develops in the stomach. Patients with MALT lymphoma may have a history of an autoimmune disease such as Hashimoto thyroiditis or Sjögren syndrome. A higher incidence of MALT lymphoma involving the stomach is seen in patients who have been infected with the bacterium H. pylori. Bacteria have also been implicated in other forms of MALT lymphoma. Treatment often includes potent combinations of antibiotics, which both eradicate the H. pylori infection and cause the lymphoma to regress. Many patients with H. pylori have been cured of MALT lymphoma without radiation or chemotherapy. If remission is not achieved following antibiotic treatment, radiotherapy can be a curative option. For a small subset of patients, MALT lymphoma can transform into diffuse large B-cell lymphoma (DLBCL), and if this happens, patients can benefit from treatments used for DLBCL.
• Monocytoid B-cell lymphoma, also known as “nodal marginal zone B-cell lymphoma” (nodal MZL), may be found in the spleen and blood. This form of NHL is generally treated like follicular lymphoma.
• Splenic marginal zone lymphoma (SMZL) begins in the spleen and may spread to the peripheral blood and bone marrow. One of the first signs of SMZL is an enlarged spleen; however, symptoms can be slow to develop. SMZL has been associated with hepatitis C infection. Treatment for hepatitis C with interferon (either alone or in combination with ribavirin) may result in a remission of the patient’s lymphoma.

For patients with SMZL who do not have hepatitis C or any symptoms of lymphoma, the first allopathic treatment may be the watch-and-wait approach. Allopathic treatment is generally started when an enlarged spleen starts to cause symptoms or produces low white blood cell counts. For symptomatic patients who are hepatitis-C negative, treatment may include

• Splenectomy.
• Single-agent chemotherapy.
• Combination chemotherapy plus rituximab (Rituxan).
  • R-CVP (rituximab, cyclophosphamide, vincristine and prednisone).
  • R-CHOP (rituximab plus cyclophosphamide, doxorubicin [hydroxydoxorubicin], Oncovin and prednisone).
  • BR (bendamustine hydrochloride (Bendeka), rituximab).

For relapsed or refractory cases, allopathic treatment may include

• Ibrutinib, a Bruton tyrosine kinase (BTK) inhibitor given by mouth, is indicated for the treatment of patients with MZL who require systemic therapy and have received at least one prior anti-CD20-based therapy.
• Lenalidomide, given by mouth is indicated in combination with a rituximab product for MZL patients who have been previously treated.

Allopathic researchers are evaluating new treatment approaches for MZL.

Small Cell Lymphocytic Lymphoma (SLL) and Chronic Lymphocytic Leukemia (CLL)

Chronic lymphocytic leukemia (CLL) and SLL are different manifestations of the same disease and their treatment is very similar.

Treatments include:

• Ibrutinib.
• Venetoclax.
• Bendamustine hydrochloride.
• Obinutuzumab.
• Acalabrutinib.
• Rituximab.

The following drugs are used for cases of relapsed CLL or SLL:

• Idelalisib, in combination with rituximab or in patients who received at least two prior systemic therapies
• Duvelisib, after at least two prior therapies.

The FCR (fludarabine, cyclophosphamide and rituximab) regimen is a potentially curative option for some patients with CLL/SLL. Recent reports from clinical studies indicate that chimeric antigen receptor (CAR) T-cell therapy can induce durable remissions in patients with refractory disease. This therapy is under investigation in clinical trials.

In general, the goal of allopathic treatment is to destroy as many lymphoma cells as possible and to induce a complete remission. Complete remission means that all evidence of disease is eliminated. Patients who go into remission are sometimes cured of their disease. Allopathic treatment can also keep non-Hodgkin lymphoma (NHL) in check for many years, even though imaging or other studies show remaining sites of disease. This situation may be referred to as a “partial remission.”

Types of Treatment

Doctors use several types of approaches and treatment combinations for NHL, some at different stages.

• Chemotherapy and combination therapy.
• Radiation therapy (usually combined with chemotherapy)
• Stem cell transplantation
• Watch-and-wait
• Some allopathic doctors may suggest participating in a clinical trial (Clinical trials can involve therapy with new drugs and new drug combinations or new approaches to stem cell transplantation).

Homeopathic treatment for Lymphoma

Arsenic Album

A profoundly acting remedy on every organ and tissue. Its clear-cut characteristic symptoms and correspondence to many severe types of disease like different types of cancers, lymphomas etc. Debility, exhaustion, and restlessness. Great exhaustion after the slightest exertion. Peculiar irritability of fiber, irritable weakness. Burning pains. Unquenchable thirst. Gives quiet and ease to the last moments of life when given in high potency. Green discharges. leishmaniasis, Kala-azar. Ovarian pains and burning.

Odor of discharges is putrid; in complaints that return annually. Anemia and chlorosis. Degenerative changes. Gradual loss of weight. Reduced refractive index of blood serum. Malignancy of diseases. Malarial cachexia. Septic infections and low vitality. Liver and spleen enlarged and painful. Ascites and anasarca. Gastralgia from the slightest food or drink. Malignant symptoms. High temperature. Periodicity marked with adynamic. Septic fever. Intermittent.

Face swollen, pale, yellow, cachectic, sunken, cold, and covered with sweat. Tearing needle-like pains; burning. Lips black, livid. Angry, circumscribed flush of cheeks.

Mouth – unhealthy, easily-bleeding gums. Ulceration of mouth with dryness and burning heat. Epithelioma of lips. Tongue dry, clean, and red; stitching and burning pain in tongue, ulcerated with blue color. Bloody saliva. Teeth sensitivity; long feeling and very sore. Metallic taste.

Throat – swollen, edematous, constricted, burning, unable to swallow. The diphtheritic membrane looks dry and wrinkled. Enlargement of esophageal glands.

Arsenic iodide

Is to be preferred for persistently irritating, corrosive discharges. The discharge irritates the membrane from which it flows and over which it flows. The discharge is fetid, watery, and the mucous membrane is always red, angry, swollen; itches and burns. Influenza, hay-fever, old nasal catarrhs, and catarrh of middle ear. Swelling of tissues within the nose. Hypertrophied condition of eustachian tube and deafness. Senile heart, myocarditis and fatty degeneration. Pulse shotty. Chronic aortitis. Epithelioma of the lip. Breast cancer after ulceration has set in.

Early stages of tuberculosis. Profound prostration, rapid, irritable pulse, recurring fever and sweats, emaciation; tendency to diarrhea. Chronic pneumonia, with abscess in lung. Hectic; debility; night sweats.

Phthisis with hoarse, racking cough and profuse expectoration of a purulent nature, and attended with cardiac weakness, emaciation and general debility; in chronic, watery diarrhea in phthisic subjects. Emaciation with good appetite. Amenorrhea, with anemic palpitation and dyspnea. Chronic pneumonia, when abscess is about to form. Great emaciation. Arteriosclerosis, myocardial degeneration and senile heart. Threatened pyemia.

Burning in pharynx. Tonsils swollen. Thick membrane from fauces to lips. Breath fetid, glandular involvement. Diphtheria. Chronic follicular pharyngitis. Scrofulous ophthalmia. Otitis, with fetid, corrosive discharge. Thickening of tympanum. Burning, acrid coryza. Pain and pyrosis. Vomiting for an hour after food. Nausea is distressing. Pain in epigastrium. Intense thirst; Vomits water immediately.

Slight hacking cough, with dry and stopped-up nostrils. Pleuritis exudative. Chronic bronchitis. Pulmonary tuberculosis. Pneumonia that fails to clear up. Broncho-pneumonia after grippe. Cough dry, with little difficult expectoration. Aphonia. Recurrent fever and sweats. Drenching night-sweats. Pulse rapid, feeble, weak, irregular. Chilly, cannot endure cold.

Skin dry, scaly, itching. Marked exfoliation of skin in large scales, leaving a raw exuding surface beneath. Ichthyosis. Enlarged scrofulous glands. Venereal bubo. Debilitating night-sweats. Eczema; watery, oozing, itching; worse, washing. Emaciation. Psoriasis. Acne hard, shotty, indurated base with pustule.

Natrum Arsenicosum

Nasal catarrh, headache, pain at root of nose, dry and painful eyes. Psoriasis. Bronchitis of children over seven years. Facilitates the termination of the cold and conserves strength (immune) and appetite.

Nosal watery discharge; drops into throat. Dry crusts, on removal, leave mucous membrane raw. Post-nasal dropping of thick, bland, yellowish mucus. Crusts in nose. Catarrhal conjunctivitis and blepharitis marginalia. Eyes feel weak, stiffness of balls and the tendency of lids to close. Feel heavy and droop. Lachrymation in wind. Agglutination in morning. Dry, painful, burning; soon tired. Edema of orbital region. Supraorbital pain.

Throat – dark, purplish, swollen, edematous; red and glassy. Racking cough, with profuse greenish expectoration. Oppression of chest and about heart, and also larynx. Miner’s asthma. Lungs feel as though smoke had been inhaled.

Aching in arms; worse in shoulder. Pain in anterior corral nerves. Joints stiff. Tiredness. Knee-joints crack.

Natrum Muriaticum

The provings are full of such symptoms, a great medicine for certain forms of intermittent fever, anemia, chlorosis, many disturbances of the alimentary tract and skin. Great debility; most weakness. Coldness. Emaciation is most notable in the neck. Great liability to take cold. Dry mucous membranes. Constrictive sensation throughout the body. Great weakness and weariness. Oversensitive to all sorts of influences. Hyperthyroidism. Goiter. Addison’s disease. Diabetes. Stricture of lachrymal duct with suppuration. Nasal discharges. Hungry, yet loose flesh. Manse’s irregular; usually profuse. Vagina dry. Leucorrhea acrid, watery. Cough from a tickling in the pit of stomach, accompanied by stitches in liver.

Scrophularia Nodosa

A powerful medicine whenever enlarged glands are present. Hodgkin’s disease. A valuable skin remedy. It has a specific affinity for the breast; very useful in the dissipation of breast tumors. Eczema of the ear. Pruritus vaginae. Lupoid ulceration. Scrofulous swellings (Cistus). Painful hemorrhoids. Tubercular testis. Epithelioma. Nodosities in the breasts. Pain in all flexor muscles.

Vertigo felt in vertex, greater when standing; drowsiness; pain from forehead to back of head. Eczema behind the ear. Crusts lacteal. Distressing photophobia. Spots before eyes. Stitches in eyebrow. Sore eyeballs. Inflammation about auricle. Deep ulcerated auricle. Eczema around the ear.

Pain in liver on pressure. Colic below navel. Pain in sigmoid flexure and rectum. Painful, bleeding, protruding piles. Violent dyspnea, oppression of chest with trembling. Pain about bifurcation of trachea. Asthma in scrofulous patients. Prickling itching, worse back of hand.

Ferrum Phosphoricum

The remedy for the first stage of all febrile disturbances and inflammations before exudation sets in. Anamia with hemorrhage and general debility and constipation. Hyperemia of optic disc and retina, with blurred vision. Otitis media. Mouth hot; fauces red, inflamed. Ulcerated sore throat. Tonsils red and swollen. Eustachian tubes inflamed. Sore throat of singers. Subacute laryngitis with fauces inflamed and red. First stage of diphtheria. Ranula in vascular, sanguine constitutions. Vomiting of undigested food. Vomiting of bright red blood. Sour eructation. Hemoptysis.

China officinalis

Vomiting of undigested food. Slow digestion. Weight after eating. Ill effects of caffeine. Hungry without appetite. Flat taste. Darting pain crosswise in hypogastric region. Flatulence; belching of bitter fluid or regurgitation of food gives no relief; worse eating fruit. Hiccough. Belatedness is better by movement. Indurated glands; scrofulous ulcers and caries. Intermittent fevers, paroxysms anticipate; return every week.  Debilitating night-sweats. Free perspiration is caused by every little exertion, especially on single parts.

Much flatulent colic; better bending double. Tympanitic abdomen. Pain in right hypochondrium. Gall-stone colic. Liver and spleen swollen and enlarged. Jaundice. Gastro-duodenal catarrh.

Stool undigested, frothy, yellow; painless; worse at night, after meals, during hot weather, from fruit, milk, beer. Very weakening, with much flatulence. Difficult even when soft. Bloody leucorrhea. Heart irregular with weak rapid beats followed by strong, hard beats.

Phytolacca Decandra

Aching, soreness, restlessness, prostration, are general symptoms guiding to Phytolacca. Pre-eminently a glandular remedy. Glandular swellings with heat and inflammation. Has a powerful effect on fibrous and osseous tissues; fasciae and muscle sheaths; acts on scar tissue. Syphilitic bone pains; chronic rheumatism. Sore throat, quinsy, and diphtheria. Tetanus and opisthotonos. Decrease of weight. Retarded dentition. Fistula lachrymal. High fever, alternating with chilliness and great prostration.

Skin itches, becomes dry, shrunken, pale. Papula and pustular lesions. Most useful in early stages of cutaneous diseases. Disposition to boil, and when sloughing occurs. Squamous eruptions. Syphilitic eruptions. Swelling and induration of glands. Venereal buboes. Scarlatina-like rash. Warts and moles.

Throat dark red or bluish red. Much pain at root of tongue; soft palate and swollen tonsils. Throat feels rough, narrow, hot. Tonsils swollen; dark-red appearance. Shooting pain into ears on swallowing. Pseudo-membranous exudation, grayish white; thick, tenacious yellowish mucus, difficult to dislodge. Tension and pressure in parotid gland. Ulcerated sore throat and diphtheria; pain at root of tongue extending to ear. Uvula large, dropsical. Quinsy; tonsils and fauces swollen, with burning pain. Mumps. Follicular pharyngitis.

Sore spot in right hypochondrium. Rheumatism of abdominal muscles. Colic at navel. Burning griping pains. Bruised feeling through epigastrium and abdomen. Constipation of the aged and those with weak heart. Bleeding from rectum. Urine scanty, suppressed, with pain in kidney region. Nephritis.

Mastitis; mammae hard and very sensitive. Tumors of the breasts with enlarged axillary glands. Cancer of breast. Breast – hard, painful and purple hue. Mammary abscess. Cracks and small ulcers about nipples. Irritable breasts, before and during menses. Galactorrhea. Menses too copious and frequent. Ovarian neuralgia. Painful induration of testicles. Shooting along perineum to penis.

Baryta iodide

Acts on the lymphatic system, increased leucocytosis. Quinsy. Indurated glands, especially tonsils and breasts. Strumous ophthalmia, with tumefaction of cervical glands and stunted growth. Tumors. excellent medicine for lymphoma and especially indicated when the lymphatic glands especially cervical glands are involved. Exhaustive sweat and perspiration.

Calcarea iodide

It is in the treatment of scrofulous affections, especially enlarged glands, tonsils. Thyroid enlargements about time of puberty. Flabby children subject to colds. Secretions inclined to be profuse and yellow. Adenoids. Uterine fibroids. Croup. Polypi of nose and ear. Enlarged tonsils are filled with little crypts.

Chronic cough; Pain in chest, difficulty breathing after syphilis and mercurializing. Hectic fever; green purulent expectoration. Croup. Pneumonia. Indolent ulcers, accompanying varicose veins. Easy perspiration. Copper-colored and papulous eruptions, tinea, favus, crusta lactea, swelling of the glands, skin cracked, falling out of hair.

Plumbum Metallicum

Amaurosis. Anemia. Aneurysm. Anhidrosis. Asthma. Atrophy. Bone exostoses. Brain softening; brain tumor. Bright’s disease. Cystitis. Diplopia. Dropsy. Dysmenorrhea. Dysuria. Emaciation. Epilepsy. Epulis. Ganglion. Hemoptysis. Hemorrhoids. Headache. Hernia – strangulated. Hyperesthesia. Hypopyon (accumulation of WBC in eyes). Ichthyosis. Intermittent fever. Intestinal obstruction. Intussusception. Jaundice. Jaw tumor. Kidney’s affections; granular kidneys. Liver affections. Lockjaw. Locomotor ataxy. Melancholia. Metrorrhagia. Myelitis. Nephritis. Numbness. Esophageal stricture. Paralysis – diphtheritic; agitans. Perichondritis. Proctalgia. Progressive muscular atrophy. Prolapsus ani. Colon or Colorectal cancer. Sciatica. Spin diseases; spinal sclerosis; spinal tumor. Spleen – affections. Stricture. Tabes mesenterica. Tobacco habits and related diseases. Tongue cancer – paralysis. Typhlitis. Umbilicus abscess. Umbilical hernia. Uric-acidemia. Vaginal spasm, vagainal tumors, cancers. Vaginismus. Varicose.

Baryta Carbonica

Aneurysm. Apoplexy. Atrophy. Baldness. Brain affections. Cysts. Foot-sweat. Glandular swellings. Hemorrhoids. Colon or Colorectal cancer. Heart affections. Memory defective. Esophageal spasm. Panaras. Paralysis. Parotitis. Prostate cancer. Quinsy. Throat sore. Tonsillitis. Tumors. Warts. Wens.

Thuja Occidentalis

Abdomen distended, tumors. Angina pectoris. Anal fistula; fissure. Asthma. Balanitis. Cancer. Catalepsy. Chorea. Clavus. Condylomas. Constipation. Convulsions. Coxalgia. Diarrhea. Colon or Colorectal cancer. Dyspareunia. Dysmenorrhea. Ear polypus. Enuresis. Epilepsy. Epulis. Eyes tumors; granular eye inflammation. Fatty tumors. Feet fetid. Flatus – incarcerated. Frontal sinuses catarrh. Ganglion. Gleet. Gonorrhea. Hemorrhage. Hemorrhoids. Hair affections. Headache. Hernia. Herpes zoster. Ichthyosis. Intussusception. Jaws – abnormal growth. Joints cracking. Levitation. Morvan’s disease. Mucous patches. Muscae volitantes. Myopia. Naevus. Neck cracking. Onanism. Ovarian pain, tumors. Ozaena. Neuralgia. Nose – chronic catarrh; nasal polypus. Paralysis. Pemphigus. Polypus. Post-nasal catarrh. Prostate cancer. Ptosis. Ranula. Rheumatism – gonorrheal. Rickets. Seminal emissions, nocturnal emissions. Sycosis. Syphilis. Tea and coffee side effects. Teeth caries. Tongue ulcers, tumors; tongue biting. Toothache. Tumours. Vaccination. Vaccinosis. Vaginismus. Warts. Whooping-cough.

Hydrastis

Cancer. Chancroids. Asthma. Catarrh. Chancroids. Constipation. Corns. Dyspepsia. Eczema impetiginized. Ears, affections of. Faintness. Fistula. Gastric catarrh. Gonorrhea. Hemorrhoids. Jaundice. Colon or Colorectal cancer. Leucorrhea. Lip cancer. Liver affections. Colon or Colorectal cancer. Lumbago. Lupus. Menorrhagia. Metrorrhagia. Mouth, sore. Nails affections. Nipples sore. Noises in the head. Nursing-women’s sore mouth. Ozaena. Placenta, adherent. Post-nasal catarrh. Rectum affections. Sciatica. Seborrhea. Stomach affections. Syphilis. Taste of mouth disordered. Deafness due to throat disease. Throat sore. Tongue affections. Typhus. Ulcers. Uterus affections.

Calcarea Carbonica

Abdomen abnormally large. Alcohol effects. Anemia. Ankles weakness. Appetite depraved. Beard – sycosis. Bone diseases. Brachial neuralgia. Breasts painful. Bronchial glands affections. Calculus. Cancers. Caries. Cataract. Chilblains. Chorea. Cold. Consumption. Corpulency. Coryza. Cough. Coxalgia. Croup. Crusta lactea. Debility. Delirium tremens. Dentition. Diabetes. Diarrhea. Dropsy. Dyspepsia. Ear affections. Epilepsy. Epulis. Eyes affection. Fever – intermittent. Fistula. Gallstones. Glandular swellings. Gleet. Goiter. Gonorrhea. Gouty swellings. Headache. Hernia. Herpes. Hydrocephalus. Hypochondriasis. Hysteria. Impotence. Joints affections. Lactation defective. Leucocythemia. Leucorrhea. Lupus. Masturbation. Melancholia. Menstruation, disorders of. Milk-fever. Miller’s phthisis. Miscarriage. Molluscum contagiosum. Naevus. Nervous fever. Neuralgia. Night terrors. Paralysis. Parotitis. Peritonitis. Perspiration. Plethora. Polyps. Colon or Colorectal cancer. Pregnancy. Prosoplasia. Psoriasis palmaris. Ranula. Renal colic. Rhagades. Rheumatism. Rickets. Ringworm. Sciatica. Scrofula. Skin affections. Sleep disorders. Insomnia. Smell disorders. Spinal affections. Stone-cutter’s phthisis. Strains. Sycosis. Sycosis menti. Tabes mesenterica. Tapeworm. Taste disordered. Teeth carious. Toothache. Trachea affections. Tuberculosis. Tumors. Typhoid. Urticaria. Uterus, affections of. Varices. Vertigo. Walking, late. Warts.

Argentum Nitricum

Acidity. Addison’s disease. Anamia. Chancre. Dyspepsia. Epilepsy. Eructation. Erysipelas. Eyes affection Flatulence. Gastric ulcer. Colon or Colorectal cancer. Gonorrhea. Hands swelling. Headache. Heartburn. Impetigo. Locomotor ataxy. Neuralgia. Ophthalmia neonatorum. Paralysis. Prostate, enlargement of. Scarlatina. Smallpox. Spinal irritation. Syphilis. Taste – altered. Throat affections. Tongue ulcerated. Warts. Zona.

Cicuta Virosa

Cancer. Catalepsy. Bladder, paralysis of. Cerebro-spinal meningitis. Coccygodynia. Concussions. Convulsions. Eczema. Epilepsy. Epithelioma. Eyes inflammation. Facial eruption. Hiccough. Hysteria. Impetigo. Meningitis. Myelitis. Numbness. Esophageal stricture. Paralysis. Psoriasis. Puerperal convulsions. Screaming. Strabismus. Stuttering. Tetanus. Trismus. Waking, weeping on. Parasites, worms.

Belladonna

Abscess. Acne. Amaurosis. Apoplexy. Bladder weakness. Boils. Brain affections. Bronchial glands chronic diseases. Carbuncle. Colic. Constipation. Convulsions. Cough. Croup. Delirium tremens. Depression. Diarrhea. Dysentery. Colon or Colorectal cancer. Ear affections. Enteric fever. Epilepsy. Erysipelas. Erythema. Excitement. Eye affections. Glandular swellings. Goiter. Gout. Hemorrhoids. Headache. Heart affections. Hydrocephalus. Hydrophobia. Hyperemia. Influenza. Kidney affections. Lung affections. Malignant pustule. Mania. Measles. Meningitis. Menstruation. Mouth affections. Mumps. Neuralgia. Nose, affections of. Nyctalopia. Nymphomania. Paralysis. Para metritis. Perichondritis. Peri metritis. Peritonitis. Phlegmasia alba dolens. Pleurisy. Pneumogastric paralysis. Pneumonia. Pregnancy disorders. Puerperal mania. Rheumatism. Roseola. Scarlatina. Sensitiveness. Sleep disorders. Smell disordered. Strangury. Taste, disordered. Tenesmus. Testicles affections. Thirst. Throat chronic infections. Tongue affections. Tuberculosis. Ulcers. Uterine affections. Vaccinia. Vertigo. Whooping-cough.

Conium Maculatum

Asthma. Bladder inflammation. Breast affections; breasts painful. Bronchitis. Bruises. Cancer. Cataract. Chorea. Cough. Depression of spirits. Diphtheritic paralysis. Dysmenia (membranous). Erysipelas. Eyes affection. Galactorrhea. Herpes. Hypochondriasis. Jaundice. Liver – enlarged. Melancholia. Colon or Colorectal cancer. Menstruation disorders. Numbness. Ovaries affections. Paralysis; Landry’s. Peritonitis. Phthisis. Painful breasts. Prostatitis. Ptosis. Scrofula. Spermatorrhea. Sterility. Stomach, affections. Testicles affections. Tetters. Trismus. Tumors. Ulcers. Vertigo. Vision disordered. Wens.

Kalium Iodatum

Actinomycosis. Aneurysm. Anhidrosis. Bright’s disease. Bubo. Bunions. Cancer. Caries. Cold. Condylomas. Consumption/Tuberculosis. Cough. Croup. Debility. Dropsy. Otalgia; tinnitus. Emaciation. Erythema nodosum. Eyes affections; cysts on lids. Fibroma. Glandular swellings. Gonorrhea. Gout. Gumma. Hemorrhages. Hay fever. Housemaid’s knee. Influenza. Intra-menstrual hemorrhage. Joint affections. Laryngitis. Liver diseases. Colon or Colorectal cancer. Locomotor ataxy. Lumbago. Lung’s hepatization; Lung’s oedema. Menstruation disorders. Neuralgia. Nodes. Noises in ears. Nystagmus. Abnormal odor of body. Edema glottidis. Pancreatitis. Paralysis. Pleurisy. Prostate diseases. Rheumatism. Rickets. Rupia. Sciatica. Scrofula. Smallpox. Spine, Pott’s curvature of. Spleen. Syphilis. Tic-douloureux. Tongue, neuralgia of. Tumours. Ulcers. Wens.

Arsenicum Bromatum

Glandular tumors and indurations, carcinoma, locomotor ataxia.

Hydrastis Canadensis

Alcoholism. Asthma. Cancer. Catarrh. Chancroids. Constipation. Corns. Dyspepsia. Eczema impetiginized. Ears affections. Faintness. Fistula. Gastric catarrh. Gonorrhea. HHemorrhoids Jaundice. Leucorrhea. Lip cancer. Liver affections. Colon or Colorectal cancer. Lumbago. Lupus. Menorrhagia. Metrorrhagia. Mouth, sore. Nails affections. Nipples, sore. Noises in the head. Nursing-women’s sore mouth. Ozaena. Placenta, adherent. Post-nasal catarrh. Rectum, affections of. Sciatica. Seborrhea. Stomach affections. Syphilis. Taste – disordered. Deafness along with throat infection. Tongue affections. Typhus. Ulcers. Uterus affections.

Chelidonium Majus

Antrum of Highmore, inflammation of. Cancer. Chest, affections of. Chorea. Constipation. Cough. Diarrhea. Dyspepsia. Gallstones. Gonorrhea. Hemoptysis. Hemorrhoids. Headache. Influenza. Jaundice. Lachrymal fistula. Laryngismus. Liver affections. Nephritis. Neuralgia. Nose-bleed. Pleurodynia. Pneumonia. Rheumatism. Scald-head. Stiff-neck. Taste, altered. Tumors. Warts. Whooping-cough. Yawning.

Berberis Vulgaris

Biliary colic. Bilious attack. Bladder affections. Calculus. Duodenum – catarrh. Dysmenorrhea. Fevers. Fistula. Gallstones. Gravel. Herpes. Irritation. Jaundice. Joint affections. Knee, pain in. Leucorrhea. Liver disorder. Lumbago. Ophthalmia. Oxaluria. Renal colic. Polypus. Rheumatism. Sacrum, pain in. Side pain. Spermatic cords, neuralgia of. Spleen, affections of. Tumors. Urine disorders. Vaginismus. Cancer.

Conium Maculatum

Conium maculatum is a excellent medicine for breast cancer where mammary glands is hard and sore. A typical breast cancer that is scirrhous adenocarcinomas, which begins in the ducts and invades the parenchyma. Sometimes the condition is associated with inflammation of breast tissue.

The region is hard and nodular, tender to touch. Piercing pains, worse at night. Burning and stinging type of pain in the breast. The skin over the tumor is adherent.

Occasionally there is discharge of pus from nipple. The lesion is hard, almost cartilaginous. The edges are distinctly serrated and irregular, associated with productive fibrosis. The breasts are painful even to the touch of the clothes or the jar of walking. Cancer after injury (like a blow) or trauma to breast.

Hydrastis canadensis

Indurated glands. Swelling of the mammary gland. Alcoholism. Asthma. Cancer. Catarrh. Chancroids. Constipation. Corns. Dyspepsia. Eczema impetiginized. Ears affections. Faintness. Fistula. Gastric catarrh. Gonorrhea. Hemorrhoids. Jaundice. Leucorrhea. Lip cancer. Liver affections. Lumbago. Lupus. Menorrhagia. Metrorrhagia. Mouth sore. Nails affections. Nipple’s sore. Noises in the head. Nursing-women sore mouth. Ozaena. Placenta adherent. Post-nasal catarrh. Rectum affections. Sciatica. Seborrhea. Stomach affections. Syphilis. Taste disorders. Throat related deafness. Throat chronic infections. Tongue affections. Typhus. Ulcers. Uterus affections.

Iodium

Appetite disordered. Atrophy. Brain atrophy. Breasts affections. Cancer. Chilblains. Chyluria. Constipation. Consumption. Coryza. Cough. Croup. Debility. Diabetes. Diarrhea. Colon or Colorectal cancer. Diphtheria. Emaciation. Enteric fever. Galactorrhea. Goiter Hemorrhoids. Headaches. Heart hypertrophy; affections. Hiccough. Hydrocephalus. Iritis. Jaundice. Joints affections. Lactation disorders. Laryngitis Leucorrhea. Liver affections. Lymphatic swellings. Melancholia. Mollities ossium. Ovaries affections; ovarian dropsy. Ozaena. Prostate gland, enlarged. Rheumatic gout. Rheumatism. Salivation. Scars. Seborrhea. Sterility. Syphilis. Tabes mesenterica. Throat affections. Uterus affections. Voice, affections of. Vomiting. Worms.

Phytolacca

Albuminuria. Angina pectoris, Anal fissure. Asthma. Barber’s itch. Boils. Bone diseases; Bone tumors. Breast affections. Cancer. Cholera. Cicatrix. Ciliary neuralgia. Constipation. Corpulence. Cough. Chronic diarrhea. Diphtheria. Diplopia. Dysentery. Dysmenia. Ears affections. Erythema nodosum. Eustachian tubes affections. Glands enlarged. Gleet. Glossitis. Gonorrhea. Gout. Granular conjunctivitis. Hemorrhoids. Headache. Hearing altered. Heart affections; hypertrophy; fatty. Impotence. Influenza. Intestinal catarrh. Itch. Lactation, abnormal. Laryngismus. Leucorrhea. Lichen. Liver affections. Lumbago. Lupus. Mouth ulcers. Mumps. Neuralgia. Nipples – sore and painful. Nursing is painful. Orchitis. Ozaena. Pan ophthalmitis. Paralysis, diphtheritic. Parotitis. Prostate affections. Rectal cancer. Respiration is abnormal. Rheumatism; syphilitic; gonorrheal. Ringworm. Rodent ulcer. Salivation. Sciatica. Sewer-gas poisoning. Spinal irritation. Spleen, pain in. Stiff-neck. Syphilis. Syphilitic eruptions. Tetanus. Throat, sore; diphtheritic; herpetic; granular. Toothache. Tumors. Ulcers. Uterus, affections of. Warts. Wens.

Calcarea fluor

Calcarea Fluor corresponds to hard indurated swellings in the breast. Fibroadenomas as well as breast cancer. Adenoids. Aneurysm. Bone affections. Breast indurations.Cataract. Catarrh. Cold sores. Corneal opacities. Cough. Exostosis. Flatulence. Glands indurated. Hemoptysis. Herpes. Hodgkin’s disease. Joints cracking. Liver affections. Lumbago. Nodes. Ozaena. Parturition. Post Nasal catarrh. Strains. Syphilis.

Some other Homeopathic medicines commonly used for cancer:

Asenicum Album. Arsenicum Iodatum, Acalypha Indica, Alumina, Ammonium Carbonicum, Andrographis or Andrographolide, Anthemis Nobilis, Apis Mellifica, Aranea Diadema, Argentum Metallicum, Argentum Nitricum, Artemisia Vulgaris, Astragalus, Aurum Arsenicum, Aurum Iodatum, Aurum Metallicum, Aurum Muriaticum, Natronatum.

Baryta Carbonica, Bromium, Bryonia Alba. Caladium Seguinum, Carbo Animalis, Cadmium Metallicum, Carcinosinum (in high), Carbo Vegetabilis, Calcarea Fluorata, Causticum, Cistus Canadensis, Cobaltum Metallicum, Cobaltum Nitricum, Collinsonia Canadensis, Condurango, Conium Maculatum, Crotalus Horridus, Cobaltum Muriaticum. Elaps Corallinus, Euphorbium. Folliculinum. Graphites, Ginseng. Hippozaeninum (in high.), Hydrastis. Iodum, Ionised Radiation. Kreosotum, Kali Carbonicum, Kali Iodatum. Lachesis Mutus, Lapis Albus, Lilium Tigrinum, Lycopodium Clavatum. Methylenum Coeruleum. Natrum Muriaticum, Nitricum Acidum. Phosphorus, Platinum Metallicum, Phytolacca. Sabina Officinalis, Scirrh.(100), Sepia Succu, Silicea (100), Silica Terra, Staphysagria Sulphur, Sulphuric Acid, Symphytum Officinale. Terebinthinate Oleum, Tetramethylpyrazine, Teucrium Marum Verum, Theridion Curassavicum, Tuberculinum Bovinum. Viscum Album.

In case if urinary tract is involved try to select from following medicines:

Ionized Radiation. Anilinium. Arsenicum Album. Asparagus Officinalis. Barosma.Crenulatum. Atropa Belladonna. Benzoicum Acidum. Berberis Vulgaris. Cannabis Sativa. Cantharis Vesicatoria. Meloe Vesicatorius. Chimaphila Umbellata. Erythroxylum Coca. Crotalus Horridus. Curare Woorari. Epigaea Repens. Formica Rufa. Helonias Dioica. Hepar Sulphuris Calcareum. Kali Iodatum, Kali Hydriodicum. Kali Phosphoricum. Mercurius Solubilis Hahnemanni. Moschus Moschiferous. Nitricum. Acidum. Phosphorus. Populus Tremuloides. Sarsaparilla Officinalis. Solidago Virga. Aurea. Veratrum Viride.