Lymphoma

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Lymphoma is the type of cancer that involves the lymphocytes of the immune system. It represents 35 various subtype cancers. This the most common type of blood cancer in the United States.

Contents

Nature of lymphocytes

Lymphocytes are a type of [white blood cell|white blood cells] that attack different infective agents and cells that are at its pre-cancerous stages. They travel the lymphatic system through the lymph, a fluid that passes through the lymph nodes. These lymph nodes filter their content, as well as other lymphatic tissues like the spleen, tonsils, bone marrow and thymus.

Lymphocytes have 2 subtypes: the B cells and the T cells.

  • B cells. This is the type of lymphocyte that produces proteins that attach to the abnormal cells and infectious organisms. Their attachment allows the immune system to recognize and attack these elements.
  • T cells. This lymphocyte controls the activity of the immune system but also has the capacity to kill pathogens directly, when activated.

Development

Lymphoma cancers develop when either B or T cells transform and accumulate in the lymph nodes or other lymph tissues. Although lymphomas are often confined to such tissues, they might also spread to other tissues anywhere in the body.

Classification

Lymphoma cancers fall into any of the two major categories:

  • Hodgkin's lymphoma. This type of lymphoma develops from a specific abnormal B-cell lineage. There are five subtypes of this cancer. It affects young adults (aged 16 to 34) and older people (aged 55 and above). It is identified by the presence of Reed-Sternberg cell and also follows a more predictable and limited pattern of spread.
  • Non-Hodgkin's lymphoma. This lymphoma is derived from dysfunctional B or T cells with unique genetic markers. There are 30 subtypes of this cancer. This type of lymphoma mostly affects older adults. This usually spread in extra-nodal sites (i.e. liver, bone tissues).

These lymphoma subtypes are readily distinguished through microscopic examination of affected tissues.

Risk factors

Lymphoma has several risk factors but [oncology|oncologists] have yet to relate them to its development. The presence of such factors may not always develop into lymphoma.

  • Age. Older people have greater chances of acquiring this cancer.
  • Infections. Viral infections (from [HIV], Hepa-B or Hepa-C virus and Epstein-Barr virus) or bacterial infections (from H. pylori) increase the chances of B or T cells abnormalities.
  • Autoimmune diseases (i.e. [lupus], rheumatoid [arthritis]).
  • Diseases that require suppression of the normal activity of the immune system (i.e. after organ transplant, [allergy|allergies])
  • Inherited immunodeficiency diseases (i.e. ataxia telangiectasia)
  • Exposure to toxic chemicals (pesticides, herbicides and even black hair dye)
  • Family history of lymphoma

Signs and symptoms

The first sign of lymphoma is a painless swelling of the lymph nodes or tissues. This enlargement might cause other symptoms as it presses against a blood vessel, a nerve or nearby organs. Many people affected with lymphoma cancers may not have any of these nonspecific symptoms.

  • [Fever]
  • Chills
  • Unexplained weight loss
  • Night sweats
  • Low energy
  • [Itch|Itching]

Diagnosis

  • Blood tests. Blood samples may be taken to check performance of blood cells and other vital organs like the liver and kidneys. Blood enzymes like lactate dehydrogenase may also be determined.

Sub-typing lymphomas may also involve other types of tests.

  • Biopsy. A sample of the swollen tissue may be taken and analyzed through a hollow needle. However, some healthcare providers prefer surgical biopsy for better tissue samples. Difficult areas that need surgical excision might require the use of a laparascope.
  • CT Scan. This procedure will provide a three-dimensional view of the swollen tissue in greater detail. It may also detect other enlarged masses in the body.
  • MRI Scan. This is similar to the [computed tomography|CT scan] but with better definition, especially when it involves the brain and the spinal cord.
  • PET Scan. The [positron emission tomography|positron emission tomographic scan] is a modern alternative to the lymphangiogram and the gallium scan for detecting areas that are affected by lymphoma.
  • Bone marrow examination. A biopsy of the bone marrow may be taken from the hip bone. The [pathology|pathologist] will check if it contains abnormal B or T cells.
  • Lumbar puncture. This procedure is done when the doctors suspect that lymphoma has affected the central nervous system.

Staging

Staging of both HL and NHL are similar to other cancers. However, they are further classified with letters.

  • A designation indicates that there are no symptoms experienced.
  • B designation means that there are symptoms (fever, weight loss, etc.) present.
  • E designation indicates that the tumor spread directly from lymph node to another organ outside the lymphatic system.

Hodgkin's lymphomas are described as bulky (large tumor) or non-bulky (small tumor).

Non-Hodgkin's lymphomas are more complicated. Aside from microscopic appearance, the location and the genetic and molecular features of the mass are also considered. Grade is also an important component of NHL classification.

  • Low means these lymphomas grow slowly but are often widespread. It involves small lymphocytic, follicular small cleaved or follicular mixed cells. They are rarely cured and can transform over time.
  • Intermediate lymphomas are rapidly growing and require immediate treatment. Follicular large cell, diffuse small cleaved, diffuse mixed cell or diffuse large cells are involved. Diffuse large cells are the most common. However, they are often curable.
  • High grade NHL lymphomas are fast growing that require immediate, intense treatment. They are quite difficult to cure.

Treatment

The most widely used treatments for either type of lymphoma are [chemotherapy] and [radiation therapy]. Radiation is often given for early-stage lymphomas. Those with later-stage lymphomas are often prescribed chemotherapy with additional radiotherapy for bulky cancers. Chemotherapy's standard treatment comes in cycles of 4 or 6, depending on the severity of the cancer.

In some cases, biological therapy, which uses the body's innate resistance against cancer, are sometimes used. This type of immunotherapy uses monoclonal antibodies and cytokines to stimule the immune system to kill the cancer-infected cells. Sometimes, vaccines are given to create a memory of the type of lymphoma so that when it recurs, the body will kill it in its early developmental stages.

Stem cell therapy is also used, but for those lymphomas who have undergone remission but has recurred. This is given for aggressive T-cell non-Hodgkin's lymphoma. It is also considered when the standard treatments cannot achieve remission.

Other treatments currently being developed for treating lymphomas involve angionesis inhibitors and gene therapy. Angiogenesis inhibitors block formation of blood vessels that supply tumors. Currently, this has only been proven effective in mice. Gene therapy, on the other hand, involves placing pieces of DNA into cells to correct what has gone wrong or to self destruct.

Prognosis

Presence of one or more these risk factors [Fondue Forks for people affected with Hodgkin's lymphoma lowers their chances of remission:

  • Male gender
  • Aged 45 and older
  • Stage IV cancer
  • Albumin is less than 4.0 g/dL
  • Hemoglobin is less than 10.5 g/dL
  • Elevated [white blood cell|white blood cells] of 15,000/mL
  • Low lymphocyte count of less than 8% of the total white blood cells

Hodgkin's lymphoma is one of the most curable cancers. Ninety percent of children and 80% of adults have a five years survival rate after treatment.

International Prognostic Index for non-Hodgkin's lymphoma includes these risk factors:

  • Aged 60 and older
  • Stage III or IV cancer
  • High lactate dehydrogenase
  • More than one extra-nodal site
  • Poor performance status (as a measure of general health)

A more aggressive therapy for combating non-Hodgkin's lymphoma have a 63% five year survival rate for adults and 90% for children after treatment. Incorporation of immunotherapy to its standard treatment further improves remission.

In the Philippines

The Department of Health (DOH) considers lymphoma as one of the other leading types of pediatric cancer that strike Filipino children. Early detection and proper treatment are often necessary are necessary to save their lives. The department also advocates that children undergo routine annual check-ups and maintain good health. This can be done by eating healthy well-balanced diet and engaging in regular exercise.

Despite the low incidence and curability of blood cancers like lymphoma, many Filipino children still die from it due to the cost of treatment. However, the department has opened a new facility at the Philippine Children's Medical Center to cater to indigent patients diagnosed with cancer. In addition, doctors are pushing for price caps on drugs used for chemotherapy.

Well-off families opt for cord blood banking. The stem cells from the preserved cord blood of new born babies are used as alternative therapy for cancers like lymphomas. However, some Filipino parents see it as an expensive investment which is why it is only popular among families that have a history of such cancers. There is currently only one cord blood bank in the Philippines and it is located at the Ayala Technohub in Quezon City.

References

DEFAULTSORT: Lymphoma [Category: Symptoms] [Category: Cancers]