Lymphoma

What you do, what you eat, and how you handle stress impact your overall state of well-being.

Non-Hodgkin’s Lymphoma (NHL) is the most common type of lymphoma. Hodgkin’s lymphoma is less common, and has a slightly higher cure rate.  According to SEER data, in 2011 there were 530,919 people living with NHL in the United States. There has been a 73 percent rise between 1973 and 1991 in NHL with continued increases ever since.

Approximately 2.1 percent of men and women will be diagnosed with non-Hodgkin lymphoma at some point during their lifetime, based on 2008-2010 SEER data, and the 5 year survival rate is 69.3%.

The survival rate for lymphoma has greatly increased in the past 40 years, especially in children. The five-year relative survival rate for NHL patients has risen from 31 percent in Caucasians from 1960 to 1963 to 71.2 percent for all races from 2003 to 2009. In youths under 20, the 5 year survival rate is 84.5%, which is a significant improvement since most youths did not survive 5 years in the 1970s. NHL and Hodgkin lymphoma account for 11% of total cancer diagnoses in children.[1]

Some of the many subtypes of NHL include: B cell and T cell types , follicular lymphoma, cutaneous lymphoma, marginal zone lymphoma, mantle cell lymphoma, Burkitt’s lymphoma, and lymphoblastic lymphoma . Lymphoplasmacytic lymphoma is a related lymphoma also known as Waldenstrom’s macroglobulinemia.  Other lymphomas may be named for their site of presentation, such as CNS lymphoma.

BREAK UNHEALTHY HABITS
Do not smoke, especially if you have hepatitis C. Heavy smoking doubles the risk of having NHL. Hepatitis C positive individuals who are heavy smokers have a nearly 4-fold higher risk of developing non-Hodgkin lymphoma than non-smokers.[2]

Causes/Contributing Factors

A number of risk factors are known to be associated with lymphoma. Among the most well-established risk factors include:

  1. Being of Caucasian race and male gender in the United States.[3]
  2. Aging is a major risk factor for most lymphomas although there are some types that occur more commonly in childhood.
  3. Exposure to environmental radiation or being treated with radiation and chemotherapy for other diseases significantly increases the risk of lymphoma.
  4. Having HIV or other immune system problems, including other cancers and viral infections such as CMV and EBV, increases the risk.[4] Infection with hepatitis C nearly doubles the risk of NHL.

Other risk factors include:

  1. Obesity and high BMI has been found to be a predictor of worse outcomes specifically for chronic lymphocytic leukemia and small lymphocytic lymphoma (vs. diffuse large B cell lymphoma and follicular lymphoma).[5]
  2. Pesticide and herbicide exposure. Human studies are demonstrating that exposure to pesticides increases the risk of NHL, especially in individuals who work and live on or near farms.[6][7]  Specifically, diffuse large B-cell lymphoma was positively associated with phenoxy herbicide exposure.[8] Glyphosate is a major concern with lymphoma risk.[9] Additionally, home pesticide use has been associated with a several fold increase in risk for NHL in children.[10]
  3. A number of genetic variants have been associated with risk, particularly when combined with environmental toxin exposure.[11]
  4. Smoking, alcohol use and sedentary lifestyle
  5. Autoimmune disease: a number of autoimmune diseases have been associated with a higher risk of NHL, although the absolute risk is still small.[12]
REDUCE STRESS
Meditation, stress relief, yoga and other modalities to reduce overall stress emotionally and physically have positive effects on lymphoma.[13]

Relevant Diagnostic Testing

A biopsy of the swollen lymph node (s) is recommended and is often preceded by imaging of the body part affected, which can include x-ray, ultrasound, positron emission tomography (PET) computed tomography (CT) or MRI. Once the disease has been detected, other testing of the cancer cells includes cytogenetics and flow cytometry, as well as PET/CT.

Blood testing assesses white and red blood cells (RBC, CBC) and liver function are also routinely part of the diagnosis and monitoring of lymphomas

STAY ACTIVE
Exercise is a well-established way to prevent cancer development, including lymphoma. One study found that women who sat for 6 hours a day had a 28% higher risk of NHL than those who sat for 3 hours per day.[14]

Dietary Action Plan

Emphasize:

  1. Cruciferous vegetables, such as broccoli, cauliflower, cabbage, contain DIM and I3C.
  2. Whole foods (foods that are as close to their natural form as possible)
  3. Low sugar/low glycemic diet (Glycemic index (GI) and glycemic load (GL) are measures of the effect on blood glucose level after a food containing carbohydrates is consumed)
  4. Omega-3 fatty acids, found in cold water fish such as sardines, wild-caught salmon, cod, mackerel, tuna
  5. High fiber, from whole grains, beans, vegetables and fruits
  6. Healthy fats, from avocados, nuts, seeds, olive oil, coconut oil, cold water fish
  7. For animal protein, choose lean poultry and fish over red meat, and aim to view meat as a condiment rather than a staple. Try to choose grass fed and organic meats and eggs whenever possible. Eat no fish larger than a salmon to minimize environmental contaminants, including mercury.

Avoid:

  1. Foods that have been treated with pesticides and herbicides, especially glyphosate
  2. Processed and grilled meats. Also, try to limit intake of red meat
  3. Fast foods, fried foods, baked goods and packaged, processed foods
  4. Sugar, sweeteners and artificial sweeteners
  5. Vegetable oils, shortening, margarine and anything with hydrogenated or partially hydrogenated oils
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Lymphoma Supplement Program

Multiple nutritional supplements have been associated with reduced cancer incidence and/or cancer progression. The list below contains those with the greatest evidence-base and benefit, though it is not necessary that they all be included.

Supplement Info

 

Includes:

  • Vitamin D3
  • Indole-3-carbinol (IC3)
  • DIM
  • Curcumin
  • Quercetin
  • Resveratrol
  • COQ10
  • Forskolin
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[1] Jaglowski SM1, Linden E, et al. Lymphoma in adolescents and young adults. Semin Oncol. 2009 Oct;36(5):381-418. doi: 10.1053/j.seminoncol.2009.07.009.

[2] Talamini R, Polesel J, Montella M, Maso LD, Crispo A, Spina M, Franceschi S, Crovatto M, La Vecchia C. Smoking and non-Hodgkin lymphoma: case-control study in Italy. Int J Cancer. 2005 Jul 1;115(4):606-10.

[3] Wu XC, Andrews P, Chen VW, Groves FD. Incidence of extranodal non-Hodgkin lymphomas among whites, blacks, and Asians/Pacific Islanders in the United States: anatomic site and histology differences. Cancer Epidemiol. 2009 Nov;33(5):337-46.

[4] Robbins HA, Shiels MS, Pfeiffer RM, Engels EA. Epidemiologic contributions to  recent cancer trends among HIV-infected people in the United States. AIDS. 2014 Mar 27;28(6):881-90.

[5] Leo QJ, Ollberding NJ, Wilkens LR, Kolonel LN, Henderson BE, Le Marchand L, Maskarinec G. Obesity and non-Hodgkin lymphoma survival in an ethnically diverse  population: the Multiethnic Cohort study. Cancer Causes Control. 2014 Jul 29.

[6] Salem EA, Hegazy MM, El Khouley EA. Pesticide exposure as a risk factor for lymphoproliferative disorders in adults. East Mediterr Health J. 2014 Jun 18;20(6):363-71.

[7] Pahwa M, Beane Freeman L, Spinelli JJ, Blair A, Pahwa P, Dosman JA, McLaughlin JR, Demers PA, Hoar Zahm S, Cantor KP, Weisenburger DD, Harris SA. 0409 The North American Pooled Project (NAPP): Pooled analyses of case-control studies of pesticides and agricultural exposures, lymphohematopoietic cancers and sarcoma. Occup Environ Med. 2014 Jun;71 Suppl 1:A116.

[8] Schinasi L, Leon ME. Non-Hodgkin lymphoma and occupational exposure to agricultural pesticide chemical groups and active ingredients: a systematic review and meta-analysis. Int J Environ Res Public Health. 2014 Apr 23;11(4):4449-527.

[9] Eriksson M, Hardell L, Carlberg M, Akerman M. Pesticide exposure as risk factor for non-Hodgkin lymphoma including histopathological subgroup analysis. Int J Cancer. 2008 Oct 1;123(7):1657-63.

[10] Buckley JD1, Meadows AT, Kadin ME, et al. Pesticide exposures in children with non-Hodgkin lymphoma. Cancer. 2000 Dec 1;89(11):2315-21.

[11] Kokouva M1, Koureas M, Dardiotis E, et al. Relationship between the paraoxonase 1 (PON1) M55L and Q192R polymorphisms and lymphohaematopoietic cancers in a Greek agricultural population. Toxicology. 2013 May 10;307:12-6. doi: 10.1016/j.tox.2012.07.003. Epub 2012 Jul 16.

[12] Fallah M1, Liu X2, Ji J2, Försti A3, et al. Autoimmune diseases associated with non-Hodgkin lymphoma: A nationwide cohort study. Ann Oncol. 2014 Jul 31. pii: mdu365. [Epub ahead of print]

[13] Cohen L1, Warneke C, Fouladi RT, et al. Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer. 2004 May 15;100(10):2253-60.

[14] Teras LR, Gapstur SM, Diver WR, Birmann BM, Patel AV. Recreational physical activity, leisure sitting time and risk of non-Hodgkin lymphoid neoplasms in the  American Cancer Society Cancer Prevention Study II Cohort. Int J Cancer. 2012 Oct 15;131(8):1912-20. doi: 10.1002/ijc.27445. Epub 2012 Mar 8.

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