Whenever you get sick, what's the first thing that you do? Know what you have. Either it's a simple fever or a complicated illness, the very first thing that you do is to gather information to find out your current condition. The same thing with lymphoma, whether you research things on your own or go to a doctor (although this should always be the case since self diagnosis can bring you only so far) for advice, your target is to get all you need know about the disease.

Lymphoma is basically a cancer of the lymphatic system. The system is composed of various nodes or glands situated in different places of our body. These glands are connected by vessels that carry the lymph fluid or the white blood cells which help fight diseases. As you might have remembered in your high school biology class, the white blood cells help fight the bacteria and diseases that enter our body. And because these glands are connected to each other, once lymphoma hits a gland, there's a good chance that the cancer cells spread throughout the body via the lymph vessels. You should know this fact out front: no cure has been discovered yet that would eliminate the disease. Nonetheless, there are new techniques, medicines and medical procedures that have brought more positive treatments for people with lymphoma.

There are two kinds of lymphoma, namely Hodgkin's lymphoma and Non Hodgkin's lymphoma (NHL). The first one, the Hodgkin's disease owes its name to Thomas Hodgkin (1798-1866). He was the first one who published a paper about the disease. This kind of lymphoma is capable of spreading from one lymph node to another. It is also observed that people diagnosed with Hodgkin's lymphoma has the presence of Reed-Sternberg cells which can only be detected by the aid of a microscope.

The other kind of lymphoma is the non-Hodgkin kind. This kind is described as having larger than normal lymph nodes and is accompanied by fever and weight loss. There are about 16 sub-types which do not fall under the conditions described by Hodgkin's lymphoma. These sub-types are grouped according to aggressiveness which basically means the cancer cells are fast-growing. NHL lymphomas include chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), Burkitt lymphoma, mantle cell lymphoma, follicular lymphoma; diffuse large B-cell lymphoma and immunoblastic large cell lymphoma.

Treatment is either radiation therapy or chemotherapy. The age, sex and stage of the cancer's development plays a role in determining the kind of treatment patients will undergo. Early detection is crucial. Most of the patients do survive the treatment especially if they have been diagnosed during the early stages of the lymphoma.

Some of the more common symptoms of lymphomas include painless swelling in the lymph nodes of the neck, underarm, or groin. People with lymphomas also might experience fever, tiredness, weight loss, itchiness, red patches on the skin, nausea, vomiting and sometimes abdominal pain.

Those with low-grade lymphomas will encounter a very slow growth of the cancer cells and will experience very few of the symptoms. The problem with low-grade lymphomas is that even though they respond well to chemotherapy, they oftentimes return and is considered incurable unlike high-grade lymphomas. With the latter, treatment involves chemotherapy, with or without radiation therapy.

Admittedly, the information above is not all that you need to know about lymphoma. There are more facts that you need to find out for yourself especially if you have been diagnosed with having lymphoma.

Lymphoma simply means cancer of the lymphatic system. However, as simple as it sounds the disease is quite complex. So it is only natural to begin asking your doctor about lymphoma right from the start. But it is essential that you ask the right questions as well. Never be shy about asking questions that you think sounds stupid. Your future health is on the line so it is imperative that you be properly informed.

We often ask our doctors what causes lymphoma. Unfortunately, the answer to this question remains to be a big fat unknown. Doctors and scientists have yet to identify the singular cause of the cancer. However, what they were able to do was identify the different risk factors involve that might affect the development of lymphoma. It seems that prolong exposure to hazardous chemicals, herbicides, pesticides and even drugs that suppress the body's immune system have been tied to the high chances of developing cancer of the lymphatic system. Avoiding these situations would be a good life choice or at the very least if you work in the industry where handling chemicals or pesticides are necessary you should take the necessary precautions to protect our bodies from harm.

You need to ask your doctor what type of lymphoma you have. There are two kinds: the Hodgkin's lymphoma which is immediately identifiable under the microscope due to the presence of a particular cell. This is actually the most common kind of lymphoma. The rest of the cases that don't adhere to the conditions and appearance of Hodgkin's lymphoma are simply classified as non Hodgkin's lymphoma. Even though they have similarities, the two kinds of lymphoma use slightly different treatment procedures which are why it is important that your doctors are able to identify what kind you have.

How far the disease has spread and how serious is the condition? This is pertinent information before treatment is implemented. There are basically four stages of lymphoma development. The first stage is where the cancer cells are just in one part of your body so far. At this stage the cancer cells are isolated in at least one lymph node. The second stage is more complex for the cancer cells are in two or more lymph nodes or regions. The cancer cells are located either above or below the diaphragm. This stage is also referred to as "locally advanced disease."

The next stage is the "advance disease" which is the third stage already. The cancer cells at this point are already on both sides of the diaphragm. The final stage or stage four means the cancer cells have already spread to other parts of the body.

The next series of questions would be concerning the treatment. What are the treatment recommendations and what are the procedures for the treatment. There are a number of treatment options available. Among them is biologic therapy which uses methods like monoclonal antibodies, radio immunotherapy, interleukin 2 and vaccines that boost the body's capability of protecting itself from lymphoma. Other treatments include the conventional chemotherapy and radiation therapy.

Asking your doctor about lymphoma means to get all the information about the disease in order for you to be prepared physically, mentally and psychologically on the next steps that you would need to undergo.

The most commonly used treatments for lymphoma are chemotherapy and radiotherapy. Chemotherapy involves the administration or application of drugs infused into the veins of the patients. Chemotherapy could also be taken in the form of oral pills. Radiotherapy uses high-energy light rays that are specially and strategically directed at the cancer cells targeted. This form of therapy could be delivered even over small body areas (involved field radiation) or over large areas (extended field radiation).

Such lymphoma treatments are quite toxic. They are designed to strategically kill targeted cancer cells. It is not impossible that during the process, several normal cells are also being damaged. Thus, there are inevitable side effects. However, rest assured that most side effects of lymphoma treatments are only temporary. Such unlikely effects are resolved soon following completion of the treatments. Here are some of the commonly identified side effects of treatments used to cure lymphoma.

Feeling sick

There are chemotherapy drugs that could certainly make you feel nauseous or sick. There could even be several episodes of vomiting especially when chemotherapy comes with radiotherapy for the abdomen. Nausea is often prevented through administration of anti-emetics drugs prior to every cycle of chemotherapy combined with radiotherapy. These days, there are even medicines that help control nausea and vomiting.

Hair loss

Chemotherapy usually leads to excessive loss of hair. The extent of alopecia could depend on the drug used in the session. There are other effective drugs that could lead to this problem. However, there is no need to worry because hair is almost always beginning to grow back a few months after completion of the treatment. In some cases, it may take more than a year before hair growth restarts.

Falling blood count and infection

 During the course of the radiotherapy or chemotherapy, your blood count could fall below optimal or normal levels. Needless to say, your white blood cells are the most affected. You know that when white cell counts dip, the body could develop several forms of infections, often accompanied by fever. Contact your doctor at once when fever appears. You might need special treatment to boost your white cell count and take care of the infection. Any drop in red blood cells could easily be remedied through blood transfusions.

Loss of appetite

 Chemotherapy and radiotherapy could alter your sense of taste especially during the duration of the treatment. However, like in hair loss, the sense of taste may return to normal following completion of the lymphoma treatment. Meanwhile, you should strive to take even small meals and drink plenty of water and fluids more frequently. Remember the importance of maintaining your overall nutrition during the treatment.

Sore mouth and sore skin

 Lymphoma treatments could lead to sore mouth several weeks after the start of the program. Thus, you could feel difficulty or even pain in drinking and swallowing food. In most cases, doctors recommend temporarily switching to mashed foods that are much easier to swallow. Radiotherapy could cause soreness on the skin. However, such a problem is of no concern as skin sores easily go away immediately after radiation treatment. 

When a person is diagnosed with a condition known as lymphoma, his life should evolve in more than just having laboratory tests and deciding what treatment to take. During the entire course of the treatment and several years following its completion, there are many other issues that would come and go, like coping with side effects from treatments, possible remission and relapse, understanding the concepts of disease response, and arranging for necessary funding for the treatment. The immediate family of the patient should also readily provide support in any form other than financial. The issues should be immediately understood and addressed.

Remember that lymphoma treatment could be long and very complicated. Every type of treatment (radiation, chemotherapy, stem cell transplantation, and antibodies) could bring about its own complications and issues. There are known side effects of taking such lymphoma treatments. They include hair loss, fatigue, weakness, loss of appetite, sore mouth, and sore skin. Red blood and white blood count could also fall as such cells could also be killed along with cancer cells during treatment. In some cases, there is nausea, vomiting, and difficulty or pain in swallowing and drinking.

For the financial aspect, understand that lymphoma treatment could be significantly expensive. Several treatments and drugs may be covered under health insurances and government grants but still overall costs could be high. The patient could opt to take financial aid from the government specifically granted to cancer patients. There are even non-government organizations that provide financial support to lymphoma and other cancer patients.

The patient should understand treatment response as well as survival. When treatment is completed, the doctors should immediately assess treatment response. Once all diseases seem to have already disappeared, the patient has had a complete response. He is in a stage of remission. When the disease reappears in the future, there is a condition called a relapse. The patient should very well understand the possibility for both remission and relapse. The doctor should explain each very carefully to the patient.

There are issues following the lymphoma treatment. Patients who win the initial battle against the disease should still expect significant issues in the coming years. Lymphoma and the treatments used have long-term effects. The survivor's battle is not yet over after complete recovery. In the coming years after the treatment, these could still be expected: cancer-related fatigue, infertility, memory problems, and possible heart damages.

Lastly, the lymphoma patient should not feel alone. The patient needs to feel that his battle against the disease is not fought by him alone. Moral and emotional support could be important. The family members and the loved ones of the patient could take significant roles in supporting the affected individual. Some people fail to recognize the fact that recovery from lymphoma goes beyond mere monetary expenses. Physical recovery from the disease should be complemented by emotional and mental recovery. In this aspect, making the patient feel loved and supported by people around him would definitely help.

There are many types of cancer and it is best that you become aware of the symptoms of signs of each so that you won't be surprised after spending lots of time thinking about things and realizing that you are already infected with one. Many kinds of the cancer disease are hard to determine, especially at the first phase, which is a vital stage to know if you have this so that you can undergo the necessary medications while the sickness can still be cured. One kind of cancer with symptoms that are confusing is known as lymphoma. Most of the signs and changes on your body that will occur if you have this can also happen in other kinds of illnesses.

This kind of cancer starts in the lymphocytes, which can be found in the body's immune system. The condition will develop into solid tumor on the lymphoid cells. This illness is categorized in many types that are part of an extensive group of disorders that are referred to as hematological neoplasm.

If you are starting to feel vital changes on your system, you must not disregard this. Check these common symptoms of this illness and consult your doctor for more information and proper treatment.

1. It is a good habit to check your body for any kinds of lumps that are already growing at certain areas. In this case, enlarged lymph nodes usually develop in the groin, armpits and neck. You will notice these if you are going to inspect your body when you are done bathing or when you are changing clothes. These lumps are painless, especially during the first few weeks of the cancer development. These nodes usually lead to other symptoms that are not exclusive to this kind of sickness.

2. The cells that are infected with whatever is causing the illness produce special chemicals that may cause the whole body to itch. This may become intolerable no matter what kind of creams you put on your skin, so you may be more determined to get checked by a professional. It may be okay to resort to self-medication during the first day or even two, but you really have to take the matter more seriously if the itchiness doesn't stop after you have tried everything. You wouldn't want to be faced with greater consequences as a result of your inaction, so you really have to consult the doctor to know what's the matter.

3. As the cancer cells grow, you will feel weaker and won't have the energy to do things that you used to enjoy. These cancer cells utilize most of the body's nutrients. Aside from this, you are also losing the drive to eat. This will lead to alarming weight loss and if you are not going to do anything about it, you will find it hard to enjoy life and become productive.

Even if you don't have it, it will help to be armed with the right information about how to detect if you have lymphoma. It is also very important to undergo overall body exam once a year to make sure that you are fit and you are not suffering from any kinds of illnesses.

Many people that suffer from lymphoma, the cancer of the lymph system, remain undiagnosed for a long time because they don't know the symptoms to watch out for.

The alarming signs of lymphoma would include enlarged nodes that are usually painless lumps that are seen in the neck, armpits or groin; sudden dropping of weight; continuous or internment fever, excessive sweating at night time, extreme itchiness every part of the body, the rapid loss in appetite; the feeling exhaustion or fatigue, weakness despite regular eating and rest, and swollen neck and face along with non stop breathlessness.

Aside from the lymph system, experts say that lymphoma can also occur in the other parts of the body or organs such as the stomach. So, when at least three of these symptoms become persistent, it would be best for you to consult a doctor so he or she could request for lymphoma diagnosis for you.

Options for lymphoma diagnosis

If you want to have an idea what are the options for you when you decide to undergo diagnosis for lymphoma, the most common tests and procedures would include biopsy, knowing the type of lymphoma and other related tests. 

1. Biopsy. This is considered as the "first step" in diagnosis for lymphoma. Usually, doctors perform what they call "excisional biopsy" wherein a small sample of tissue will be acquired from the affected organs or nodes of the patient. Once the sample is acquired, an expert called "pathologist," will examine it under the microscope. Here, it can be seen if the patient has cancer cells that would cause lymphoma. The most common type of biopsy given to those who are at risk is "lymph node biopsy". However, when the cancerous cells affect areas such as the brain, the skin, or the abdomen or stomach, a biopsy from the mentioned organ will be prioritized. A more specific type of biopsy for lymphoma is called "Lymph Node Biopsy and Fine Needle Aspiration Cytology" or FNAC which intends to get more sample for to produce a well-detailed diagnosis.

2. How to determine the type of lymphoma. Once the biopsy has been made, the next would be how to determine the type of lymphoma there is. There are over 20 types of lymphoma but these all fall under two category including Hodgkin or non-Hodgkin lymphoma. This can be determined by the pathologist once he or she places the sample of tissue under a microscope. Here, physical appearance of the cells will be scrutinized carefully.

3. Succeeding tests after the diagnosis. After the biopsy and after the type of lymphoma has been determined, a series of tests and other examinations will follow. These are very important to be able to know exactly how much of the cancer cells have spread out and the potential damage it has brought to the organ/s affected. Other tests might include Bone Marrow Test and PET Scans for Lymphoma among others. These are crucial for the patient so he or she would undergo necessary treatments that would make the condition a lot better.

Hodgkin's lymphoma or otherwise known as Hodgkin's disease is one of two kinds of lymphoma or a cancer of the lymphatic system. Thomas Hodgkin was the first person who published documented studies of the disease hence the cancer was named after him. Hodgkin's lymphoma is different from the other kind of lymphoma mainly through the presence of Reed-Sternberg cells in the cancer cells. These Reed-Sternberg cells can be seen through an open biopsy. In contrast, cells seen on non-Hodgkin's lymphomas are mutated B-cells or T-cells.

It has been observed that Hodgkin's lymphoma oftentimes begin to develop in the lymph nodes in the neck. This is again quite different from non-Hodgkin's lymphoma which beings in different locations in the body. Nonetheless, since this is cancer we're talking about, from the neck lymph node spreading to other lymph node groups, the lungs, spleen, and bone marrow is only natural and inevitable if no treatment is undergone. It seems also that Hodgkin's lymphoma targets the immediate nearby lymphatic regions before leaving eventually the lymphatic system and spreading throughout other organs of the body.

According to studies, Hodgkin's lymphoma is more likely to develop in young adolescents particularly those within the age range of 15 to 24 as well as those who are more than 60 years old. Again this is quite different from non-Hodgkin's lymphoma which rarely happens in young people and instead is more common to people aged 60 years old and above.

In determining a diagnosis, one can actually self-diagnose at least initially. A doctor's expertise is still needed, of course, for a more accurate diagnosis of the disease. The symptoms that have been reported are not that different from the other kinds of lymphoma. The presence of a painless lump in the lymph nodes in the neck, underarm, or groin, recurrent fevers, unexplained weight loss, night sweats and itchy skins are among the warning signals of developing lymphoma.

Among the usual tests your doctors would require you to undertake includes blood tests to check abnormalities in the blood counts, blood chemistry, and abnormal erythrocyte sedimentation rate (ESR), X-rays to look at the lymph nodes, computerized tomography or CT scan and magnetic resonance imaging or MRI scans of the chest, pelvis, and abdomen to see if the cancer has already spread to other parts of the body.

Other scans that could be used to properly diagnose and determine the stage of the cancer are the positron emission tomography or PET scan which scans the cancer at a cellular level and the gallium scan which looks for radioactive intake of gallium which can mean the onset of the disease. There are other tests and procedures which doctors might conduct on you all in the aid of a proper and accurate diagnosis.

Hodgkin's lymphoma has several sub-types, namely nodular sclerosis (NS) which hits the lower neck, chest and collarbone, lymphocyte predominance (LP) which is made of malignant L&H cells which have a "popcorn", mixed cellularity (MC) which has lymph nodes that are usually contain Reed-Sternberg cells and inflammatory cells, lymphocyte depleted (LD), and nodular lymphocyte predominant (NLP).

As they say, knowing is half the battle. Knowing more about Hodgkin's disease is a good thing. You can contribute fully to the decision making process if you know exactly the situation you are in.

Lymphoma is a type of cancer that affects the body's lymph system. Contrary to its name and to what some people might have told you, lymphoma is not just isolated on the lymph nodes and thymus gland for the lymph or lymphatic system is actually composed of the bone marrow, the thymus gland, the lymph nodes, tonsils, appendix and spleen. The system filters the waste or unwanted materials like fats and bacteria from the various body tissues. The one that picks up the body's dirt is the lymph, a clear or sometimes yellowish fluid. But the question remains, how does one get lymphoma?

Unfortunately however, the answer to that question is not a simple one. For one, despite the thousands of hours spent on medical research and laboratory testing the actual cause of the disease is still an unknown. DNA mutation is one of the possible cause of why lymphoma develops but what happens why DNA have to mutate remains a big question to the medical science community. Medical scientists, nevertheless, have found several factors that can possibly increase the risks of developing lymphoma.

As you might have already guessed, the two general factors are genetic and environmental factors. Genetics for one is still a complicated issue that most likely cannot be resolved soon with a concluding answer. Inheriting the disease cannot still be ascertained as a valid cause. However, it was found out the people with inherited immune disorders are most likely to develop lymphoma as well. Immune disorders such as lupus, rheumatoid arthritis and celiac disease appear to have a hand in the development of lymphoma.

Likewise, those that have immune system disorders are also at a higher risk of developing lymphoma. Those that belong to this type of disorders include patients with HIV/AIDS, Helicobacter Pylori and Epstein-Barr virus (EBV). People with compromised immune systems like those with HIV/AIDS and EBV are often candidates for lymphoma as well.

On the environmental factors side, it should be common knowledge by now that various health hazards such as exposure to chemicals and radiation causes a variety of diseases, disorders or health conditions. And this includes developing lymphoma. More specifically, solvents like acetone, alcohol (yes various alcohols), xylene, turpentine, and benzene have found to associated with lymphoma.

The same can be said with chemical herbicides and pesticides which make farmers and various workers in the agricultural sector at a higher risk on developing the disease. Some hair dye products have also been found to be a significant factor to the development of lymphoma in some patients. Although, it seems that the hair dye products that shown such effects were those manufactured before the 1980s.

How does one get lymphoma? To fully answer that question means giving more time and more funding to the medical science community to do their research and testing. Lymphoma cases are not going down and definitely the disease is not something that can be eradicated in a quick span of time. But for now, we should at least try to avoid the various factors that increase our risk of contracting the disease. Prevention is still the best cure.

In all kinds of diseases and ailments knowing what you have exactly can mean life and death. Identifying, categorizing and understanding your current condition allow doctors to determine the proper and most effective means of making you better. Without proper diagnosis, the prescribed treatment can be useless and at times even prove to be deadly. In the case of lymphoma, one would encounter terms like biopsy, bone marrow examination, blood tests, spinal tap and scans which are some of the basic procedures employed by medical experts to determine or confirm the presence of lymphoma.

Usually, the very first thing that helps determine if one has lymphoma is self diagnosis. Those that observe enlarged lymph nodes in the neck, armpits or groin would more often than not trigger alarm bells in the their heads. Lymphoma is a cancer of the lymph nodes and the immune system. As the cancer cells develop, a tumor is formed usually in the lymph nodes which manifests as painless lumps. Upon consultation, your doctor will issue a battery of tests to confirm if it is lymphoma and if it is indeed cancer determine what stage it is at to know the possible course of treatment.

A biopsy is usually the first test that your doctors will employ to confirm the presence of cancer in your lymph nodes. In a biopsy, a small sample of tissue cells is taken from the lump either through a needle or via surgery. The cells are then examined by a pathologist to confirm lymphoma cells and the diagnoses. By studying the sample cells, the can also determine the basic kind of lymphoma the patient has, whether it's Hodgkin or Non-Hodgkin lymphoma. But to determine the subtle details, doctors revert to the procedure called as immunohistochemistry which simply means looking for the unique properties of the tumor cell surface through the application markers such as fluorescent dye, enzyme, or colloidal gold to accurately classify the tumor.

You doctor would most likely require you to undergo several blood tests. The blood samples would be examined closely to see the state of your red blood cells, white blood cells and blood platelets. These tests would also help determine if the cancer has affected your body's way of producing blood. The blood tests could also show the condition of your kidneys and liver. And more importantly, the information gathered from the tests could serve as basic foundations for the kind of treatments or drugs that could be used for your speedy recovery.

Doctors might also require you to undergo a bone marrow test wherein a sample of the bone marrow is taken from your hip using a thin needle. It is a common procedure used to test for various cancers and other blood diseases. A spinal tap or lumbar puncture can also be ordered by your doctor in specific circumstances. This checks the fluid in your spinal cord and determines if any cancer cells have invaded the spine. This procedure involves inserting a thin needle at the lower part of your back and I can be quite painful and uncomfortable.

CT scans will also help determine where the tumors are exactly since it takes pictures of your body from different angles. An MRI scan, on the hand, will help determine if the cancer cells have spread to your nervous system or other body organs.

How doctors tests for lymphoma involves logical procedures whose main goal is finding out what exactly the patient has in order to determine what kinds of treatments would be used.

These are some facts according to the Leukemia & Lymphoma Society: 19.5 out of every 100,000 people in the world develop Non-Hodgkin's Lymphoma while 2.8 out of every 100,000 people in the world are diagnosed with Hodgkin's disease. Hodgkin's disease and Non-Hodgkin's Lymphoma are two of the main classifications of lymphoma, a cancer of the body's lymph system. The lymph system, being part of our immune system, is tasked to eliminate bacteria, diseases and infection from our body. But when the cells multiply abnormally, tumors begin to appear in the lymph nodes. You can feel these as lumps in the nodes of the neck, armpit and groin. Soon the cancer cells will spread in other parts of the body, how lymphoma spreads is a good thing to know.

Metastasis

 This is a word we often hear in cancer patients. This is actually a term which refers to the spreading of cancer to the rest of the body. Lymphoma at first is a single tumor in one of the many lymph nodes of the body. What happens when the cancer cells undergo metastasis is that cancer-infected cells break away from the main tumor and moves to another part of the body. The cancer cells use the bloodstream to move from one area of the body to another. The cancer cell can attach itself to another lymph node or to other organs of the body. When it fastened firmly, the cells reproduce again until it creates another mass of tissue to form as a tumor. Then the whole process repeats itself.

For lymphoma, the cancer cells use the lymphatic system of the body to spread. The lymphatic system of the body is pretty much like the bloodstream, it is spread although out the body since it is responsible for keeping the body clean from infections and diseases. The lymphatic system is an open canal where cancer cells can travel and create more tumors.

The tumors are pretty deadly. Because of the accelerated rate of growth, these cancer cells can continue to make the tumors grow. Soon enough the tumors grow large enough that the healthy tissues or organs are prevented to function normally. Eventually the healthy tissues or organs will stop functioning which spells death to the person.

Like any cancer, lymphoma has also a number of stages. These stages describe the severity of the condition and indicate how far the cancer cells have infected the body. Stage I is the first stage of the cancer. At this level, the cancer cells have only infected one lymph node or one part of the body. Because it is still developing, this stage is also referred to as the "early disease".

The second stage or Stage II is far more alarming. At this point the cancer cells have metastasis and have infected another one or even more lymph nodes or parts of the body. However, at Stage II the infection is limited to either above or below the person's diaphragm. This stage is called "locally advanced disease".

Stage III is known as the "advanced disease". The cancer cells at this stage have found its way on both sides of the diaphragm and have established a number of tumors in those areas. The final stage or Stage IV or "widespread disease" is described by spread of the cancer cells to one or more of the body's organs such as the bone, skin, liver or lungs.

This is how lymphoma spreads. That is why it is important for an early detection of the disease for proper and effective treatment.