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Non-hodgkin's lymphoma

MagazineJune 2000 (Vol. 11 Issue 3)Non-hodgkin's lymphoma

The disease that killed Jacqueline Onassis, one of the fastest rising forms of cancer, represents an immune system slowly being poisoned by too many chemicals, too much fat, too many allergies and too little water

The disease that killed Jacqueline Onassis, one of the fastest rising forms of cancer, represents an immune system slowly being poisoned by too many chemicals, too much fat, too many allergies and too little water.

It took the death of a 20th century icon, Jacqueline Kennedy Onassis, to bring non Hodgkin's lymphoma (NHL) to the world's attention. With her passing, we began to realise that this once rare form of cancer was not so rare anymore. In the last 20 years, the incidence of NHL increased by approximately 73 per cent. A large proportion of that increase occurred between 1973 and 1987, when the incidence of NHL rose by a massive 51 per cent (Science, 1991; 254: 1131-8).

Scientists admit that they are baffled by the steady rise of this immune system cancer, which now accounts for around 3 per cent of all cancers. It is unlikely that improved diagnostic procedures are the sole explanation since there are few accurate screening tests for NHL. Instead, it is immunosuppression in its many modern forms which appears to provide the key.

To some extent, the rise in NHL has mirrored the rise in the increasing use of immunosuppressive drugs for organ transplantation, rheumatoid arthritis, HIV, lupus and some cancer therapies. There is also an association with the Epstein-Barr virus and hepatitis C virus as well as immune system assaults such as blood transfusions.

The term 'non Hodgkin's lymphoma' is something of a catch all phrase as it covers several different cancers of the lymphatic system, that complex network of cells and channels that runs throughout the body, providing a crucial foundation for the immune system.

Unlike the link between smoking and lung cancer, the causes of NHL are not straight forward. It is probably the result of a complex series of interactions within the body in response to poisons, both within and without.

The good news is that the course of NHL is different from other cancers and is not unalterable. Certainly, it is a disease that can kill quickly, but it can also linger for many years without much impact on a person's life. The experience of holistic practitioners is that NHL can regress and even disappear when immunosuppressive drugs are withdrawn and other challenges to the immune system taken away.

Chemical crisis

To understand the importance of the link between toxins and immunesystem cancer, it is helpful to know that the role of the lymphatic system is primarily to clear debris and help defend the body.

The lymphatics are thin vessels which branch out like veins and carry lymph a watery colourless fluid to all parts of the body. Clusters of bean shaped organs called lymph nodes are found along this network under the arms and in the pelvis, neck and abdomen. The lymph nodes make infection fighting lymphocytes and antibodies; they also act like a filter and drain, inspecting lymph fluid for foreign matter.

Because lymphatic tissue lies throughout the body, NHL can start (and spread) to almost anywhere, including the liver, bone marrow and spleen.

We are only just beginning to appreciate the impact that exposure to noxious chemicals has on the immune system. In a review of environmental factors associated with NHL, 54 statistically significant associations between NHL and solvent exposure were reported (Cad Saude Publica, 1998; 14 Suppl 3: 41-66).

It has been demonstrated that the incidence of NHL rises among people with extreme exposure to poisons, such as the accidental release of toxic chemicals, or in regions with unusually high concentrations of certain industrial activities. In 1976, an accidental release of large quantities of dioxins in Seveso, Italy, resulted in the exposure of more than 5000 local residents. Follow up studies demonstrated elevated rates of NHL and soft tissue sarcomas among exposed residents (Epidemiology, 1993; 4: 398- 406).

Pesticides in everyday use, such as phenoxyacetic acid herbicides used extensively to control terrestrial broad leaf plants, are also implicated. The most common phenoxyacetic acid herbicides are 2,4-D (2,4-dichloro) and 2,4,5-T (2,4,5,-trichloro), which together make up Agent Orange.

One study found that farmers who used 2,4-D, the most common lawn pesticide, more than 20 days a year were six times more likely to develop NHL than people who were not exposed. In addition, frequent herbicide users who also mixed the herbicides themselves were eight times more likely to develop this type of cancer (JAMA, 1986; 256: 1141- 7).

In another study, men in Iowa and Minnesota who regularly handled the pesticides and insecticides carbaryl, chlordane, diazinon, dichlorvos and dichloro-diphenyl-trichloro-ethane, lindane, malathion and toxaphene were at least 50 per cent more likely to contract NHL than non farmers (Cancer Res, 1992; 52: 2447-55).

Studies in Sweden have shown similar results for the use of herbicides and fungicides (Cancer, 1999; 85: 1353-60), and the use of the insecticide lindane has been shown to increase the risk of NHL by as much as 50 per cent (Am J Ind Med, 1998; 33: 82-7), with long term users most at risk.

Other toxins

Increased exposure to PCBs (polychlorinated biphenyls), which are found in detergents, flame retardants, plastics and insulation materials as well as in hairspray and other personal care items, may also be linked to the continuing rise in NHL

Researchers at the National Cancer Institute (NCI) in Bethesda, Maryland, matched the blood of 74 NHL patients against that of 147 controls without NHL. They found that blood concentrations of PCBs were 9 per cent higher in NHL sufferers than in those without the disease (Lancet, 1997; 350: 240-4).

Another study of those exposed to the flame retardant tetra-BDE found that NHL patients had significantly higher blood concentrations of the chemical. At risk groups include professional car, bus and truck drivers (Lakartidningen, 1998; 95: 5890-3).

Benzene (chemically similar to lindane and DDT) is another common toxin linked to NHL (J Pathol, 1999; 189: 448-53). According to naturopath Hulda Clark, it is found in a huge range of everyday products from toothpaste and breakfast cereal to bottled water and lubricated condoms (The Cure for All Cancers, Promotion Publishing, 1993).

In the UK, 70 per cent of benzene exposure is due to vehicle exhaust emissions (J Pathol, 1999; 189: 448-53).

There is also evidence to suggest that exposure to electromagnetic fields (EMFs) may be a risk for certain types of cancer, including NHL (Cancer Causes Control, 1994; 5: 189-94, 299-309; Radiat Environ Biophys, 1996; 35: 11-8; Am J Epidemiol, 1988; 128: 21-38).

Finally, long term use (more than ten years) of hair dye, particularly very dark brown or black, may be increasing your risk of NHL and multiple myeloma anywhere from two to four times (Cancer Causes Control, 1999; 10: 617-25; J Natl Cancer Inst, 1994; 86: 210-5; Am J Public Health, 1992; 82: 1673-4). Some recent studies have found no increased incidence (J Natl Cancer Inst, 1994; 86: 1466-70; Am J Public Health, 1998; 88: 1767-73). Nevertheless, some researchers believe that hair dyes may account for as many as 20 per cent of all cases of NHL in women. It is probably no coincidence that hair dye manufacturers now cover themselves by labelling their products with a caution if they contain toxins such as phenylenediamines.

Ultraviolet (UV) light

One intriguing potential cause of NHL is exposure to UV light for instance, that used by sunbeds and for treating psoriasis and other skin diseases. Because there is a close link between NHL and skin cancer, scientists suspect that UV light long associated with skin cancer because of its immunosuppressant effects may also be a cause of lymphoma.

To test the theory, researchers at University Hospital in Uppsala, Sweden and the Danish Epidemiology Science Centre in Copenhagen studied 113,010 patients who had various skin cancers and lymphomas (BMJ, 1995; 310: 1491-5). (In both countries, the rate of NHL has been rising at a rate of 2-4 per cent per year.) They found a strong association between NHL and skin cancer, with the risk of NHL increased twofold if skin cancer had already been diagnosed. They concluded that exposure to UV light may have contributed to the recent increase in NHL.

More interesting is the evidence of a link between NHL and sunlight. Researchers in Sweden found that the risks for NHL, increased the further south individuals resided (Int J Cancer, 1999; 80: 641-5). Not surprisingly, Caucasians are most affected by UV exposure. There is some evidence that migration from one latitude to another (sunnier) climate can increase the risk (Br J Cancer, 1996; 73: 945-50).

Food allergies

Scientific evidence suggests a link between some cancers and food allergies or sensitivities. The central question is whether food allergies protect people from cancer or predispose them to it.

William McWhorter, of the US NCI, has studied the link extensively and reported that 13 such studies found allergy to be protective and two found it to be a risk factor.

In the 1971-1975 First National Health and Nutrition Examination Survey of 6108 adults, there was a highly significant positive association between the history of any allergy and the development of any cancer. Even after controlling for factors such as age, sex, smoking and race, there was a strong association between allergies expressed as hives, and lymphatic malignancies (Cancer, 1988; 62: 451-5).

One explanation is that, although allergies stimulate the immune system and thus may be protective, in the long term, such sustained 'allergic stress' may lead to an exhausted immune system. One finding in the McWhorter study supports this: the most protective effect was found in the youngest adults surveyed those 25-34 years old who had a 0.7 per cent risk of developing

cancer (Cancer, 1988; 62: 453).

Other links have been made between coeliac disease and NHL. In

the textbook Modern Nutrition in Health and Disease (Philadelphia: Lea & Febiger, 1980: 1177), Maurice Shils reported incidences of intestinal lymphomas in coeliac patients ranging from 6.2-10 per cent in three studies.

Shils remarks, "Males above 40 years of age with long standing coeliac syndrome who are not eating a gluten free diet are a major risk group."

Finding a cure

While our understanding of what causes NHL is growing, our ability to treat it remains stubbornly unevolved. First line conventional treatment still includes radio and chemotherapy, immunosuppressive drugs such as interferon alpha and rituximab (a genetically engineered monoclonal antibody), surgery, and bone marrow and stem cell transplants.

What has hampered our understanding and treatment of NHL is that, unlike most solid tumours, it may initially respond well to chemotherapy. The resulting disease regression is often viewed as a cure and chemotherapy considered a success especially in a profession which still uses five year

survival as the gold standard for cancer (and other) treatments.

Other research, however, indicates that even if NHL responds well initially to chemotherapy, the disease often recurs and the drugs don't work the second time around because of a decreased sensitivity to the drug (Leuk Lymphoma, 1995; 18: 303-10).

American Frank Wiewel, of People Against Cancer, is one of a growing number who believes that the number of potential 'cures' for NHL is as large as the number of people who suffer from it.

"Cancer is a symptom and most cancer research focuses on chemotherapy and its ability to target and suppress the symptom," he says. "Rarely does it focus on what cancer patients, indeed all of us, want long term survival and quality of life.

The focus on a five year survival rate is also meaningless because lymphoma doesn't progress like other cancers. It is a disease which waxes and wanes, and can do so over a period of many years."

Wiewel says the PAC currently has members who are 20 year survivors of NHL. Although he doesn't believe there is one simple blanket therapy for NHL "experience has taught us that people respond to cancer treatments; cancers don't" he strongly believes that whatever is toxic to the body is almost always at the root of disease.

He also advocates a low protein, low fat diet and adequate hydration with alkalised water (see boxes on pages 1 and 2).

This opinion is echoed by Ralph Moss (Questioning Chemotherapy, Equinox Press, 1995) who believes that the chemotherapy, rather than the disease, diminishes quality of life and often is the cause of death in cancer patients. He describes the side effects of the drug 'cocktail' ICE (ifosfamide + carboplatin + etoposide), used for NHL and other cancers, as reported in the Journal of Clinical Oncology. Of patients given a mid range dose, 50 per cent had CNS and lung complications. Among high dose patients, 61 per cent showed liver toxicity, 81 per cent had ear damage and 70 per cent suffered kidney toxicity. More than 90 per cent had 'adverse pulmonary events' and an extraordinary 94 per cent suffered heart damage.

>From an holistic point of view, NHL is best described as a cry for help from a polluted body. All the available evidence suggests that, to reduce the risk of developing NHL and to fight it once it occurs, taking multiple actions to detoxify our environments both inside and outside the body may be the most positive and productive way to deal with this renegade cancer.

!APat Thomas


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