Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Your doctor will usually refer you to an oncologist for evaluation and
treatment. Some large academic medical centers have oncologists who specialize
in lymphomas.
The treatment plan depends mainly on the following:
The type of non-Hodgkin's lymphoma
Its stage (where the lymphoma is found)
How quickly the cancer is growing
The patient's age
Whether the patient has other health problems
If there are symptoms present such as fever and night sweats (see above)
If you have a slow-growing non-Hodgkin's lymphoma without symptoms, you may not
require treatment for the cancer right away. You will be watched closely by your
health-care team. These cancers might not require treatment for years, although
close follow-up is necessary. If the indolent lymphoma produces symptoms,
therapy will usually consist of chemotherapy and biological therapy. Stage I and
II often require radiation therapy.
For an aggressive type of lymphoma, a combination of chemotherapy and
biological therapy is usually indicated, and sometimes radiation therapy will be
added.
If treatment is required, there are several options that are utilized alone or
in combination:
Chemotherapy: This is a drug treatment either as an injection or oral form
that kills cancer cells. This treatment can involve one medication or multiple
medications and be given alone or in conjunction with other therapies. This
therapy is given in cycles, alternating treatment periods and nontreatment
periods. The repetition of these cycles and the number of cycles will be
determined by your oncologist based on the staging of your cancer and the
medications used. Chemotherapy also harms normal cells that divide rapidly. This
can lead to hair loss, GI symptoms, and difficulty with your immune system.
Radiation therapy: High doses of radiation are used to kill cancer cells and
shrink tumors. This modality can be used alone or in conjunction with other
therapies. Side effects usually depend on the type and dosage of the therapy as
well as the area undergoing radiation therapy. Universally, patients tend to get
tired during radiation therapy, especially toward the later stages of
treatment.
Stem cell transplant: This procedure allows you to receive large doses of
chemotherapy or radiation therapy to kill the lymphoma cells that might not be
killed with standard levels of therapy. This therapy is used if your lymphoma
returns after treatment. For this therapy, you need to be admitted to the
hospital. After the therapy, healthy stem cells (that were either taken from
you before the therapy or from a donor) are injected to form a new immune
system.
Biological drugs: These are medications that enhance your immune system's
ability to fight cancers. In NHL, monoclonal antibodies are used for treatment.
The therapy is administered via an IV, and the monoclonal antibodies bind to the
cancer cells and augment the immune system's ability to destroy cancer cells.
Rituximab (Rituxan) is such a drug used in the treatment of B cell lymphoma.
Side effects for this treatment are usually flu-like symptoms. Rarely, a person
can have a severe reaction, including a drop in blood pressure or difficulty
breathing.
Radio immunotherapy medications: These are made of monoclonal antibodies that
transport radioactive materials directly to cancer cells. Because the
radioactive material is traveling and binding directly to the cancer cell, more
radiation is delivered to the cancer cell and less to the normal tissue.
Ibritumomab (Zevalin) and tositumomab (Bexxar) are two drugs approved for this
use in lymphomas. Side effects usually include getting very tired or
experiencing flu-like symptoms.
Additional aspects of cancer treatments
In addition to medical therapies, patients will also require supportive
care. You should have the opportunity to learn about your disease and the
treatment options and discuss this with your care team. Most cancer centers will
have support groups where you can share your concerns with other patients and
learn from their experiences.
Some patients find moderate physical activity helpful. You should discuss
with your doctor what kind of activities are appropriate.
Eating the appropriate amounts of foods, as well as the right foods, is an
important part of your treatment. Speaking with a nutritionist can be very
helpful.
In addition, vitamin deficiencies (especially vitamin D) have recently been
linked to worse survival in some subgroups of cancer patients. Patients should
discuss their nutritional requirements with their health-care team.
Appropriate
caloric intake is important especially if nausea is present as a result of your treatments. Some people find that exercise can help their
nausea during therapy. Acupuncture has also shown to decrease the side effects
of cancer treatments.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia).
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
HIV (human immunodeficiency virus) is the cause of AIDS (acquired immunodeficiency syndrome). HIV is a type of virus called a retrovirus, which infects humans when it comes in contact with a break in the skin or tissues such as those that line the vagina, anal area, mouth, or eyes.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation (gastritis) of the inner lining of the stomach in humans. This bacteria also is the most common cause of ulcers worldwide.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Hodgkin's disease is a cancer of the lymphatic system with symptoms that include unexplained, recurring fevers, unexplained weight loss, itchy skin, and painless swelling of the lymph nodes in the neck, underarm, and groin. Treatment for adult Hodgkin's disease depends on the staging of the disease, the lymph nodes' size, and the health of the patient.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded with abnormal cells or deposits. Symptoms of an enlarged spleen may include weakness and fatigue, easy bleeding, and poor white blood cell function. Treatment of an enlarged spleen is focused toward the cause of the splenomegaly. Surgery may be required to remove the spleen.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Superior vena cava syndrome is compression of the superior vena cava vein located in the upper chest. Causes of superior vena cava include lung cancer, lymphoma, other cancers in the chest, blood clots in the superior vena cava, or infection. Symptoms of the syndrome include shortness of breath. Superior vena cava syndrome is diagnosed by ultrasound, chest x-ray, CT scan, and in some cases biopsy. Treatment depends upon the cause of the syndrome.
Most often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
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