Lymphoma

Definition:
The most common type of lymphoma is called Hodgkin’s disease. All other lymphomas are grouped together and are called non-Hodgkin’s lymphomas...CLICK & SEE

The lymphatic system is part of the body’s immune defense system. Its job is to help fight diseases and infection.

The lymphatic system includes a network of thin tubes that branch, like blood vessels, into tissues throughout the body. Lymphatic vessels carry lymph, a colorless watery fluid that contains infection-fighting cells called lymphocytes. Along this network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarms, groin, neck, chest, and abdomen.

Other parts of the lymphatic system are the spleen, thymus, tonsils, and bone marrow. Lymphatic tissue also is found in other parts of the body, including the stomach, intestines, and skin.

Non-Hodgkin’s lymphoma, also called non-Hodgkin lymphoma, is cancer that originates in your lymphatic system, the disease-fighting network spread throughout your body. In non-Hodgkin’s lymphoma, tumors develop from lymphocytes — a type of white blood cell.

Non-Hodgkin’s lymphoma is more common than the other general type of lymphoma — Hodgkin’s disease.

Many different subtypes of non-Hodgkin’s lymphoma exist. The most common non-Hodgkin’s lymphoma subtypes include diffuse large B-cell lymphoma and follicular lymphoma.

Within normal lymph nodes there are microscopic clusters (follicles) of specialized lymphocytes. In some malignant lymphomas, the lymphocytes arrange themselves in a similar pattern that is called follicular or nodular. Small cell and follicular lymphomas typically have a chronic course with an average survival of 6 to 12 years. In the more aggressive lymphomas, the normal appearance of the lymph node is lost by diffuse involvement of tumor cells, which are usually moderate-sized or large.

Hodgkin’s disease, the most common lymphoma, has special characteristics that distinguish it from the others. Often it is identified by the presence of a unique cell, called the Reed-Sternberg cell, in lymphatic tissue that has been surgically removed for biopsy.

Hodgkin’s disease tends to follow a more predictable pattern of spread, and its spread is generally more limited than that of the non-Hodgkin’s lymphomas. By contrast, the non-Hodgkin’s lymphomas are more likely to begin in extranodal sites (organs other than the lymph nodes, like the liver and bones).

There are about ten different types of Non-Hodgkin’s lymphoma. Some types spread more quickly than others. The type is determined by how the cells look under a microscope (histology). The histologies are grouped together, based on how quickly they spread, into low-grade, intermediate-grade, or high-grade lymphomas.

Symptoms :
The most common symptom of non-Hodgkin’s lymphomas is a painless swelling in the lymph nodes of the neck, underarm, or groin. Other symptoms may include fevers, night sweats, tiredness, weight loss, itching, and reddened patches on the skin. Sometimes there is nausea, vomiting, or abdominal pain.

Symptoms of non-Hodgkin’s lymphoma may include:

*Swollen lymph nodes in your neck, armpit or groin
*Abdominal pain or swelling
*Chest pain, coughing or trouble breathing
*Fatigue
*Fever
*Night sweats
*Weight loss

As lymphomas progress, the body is less able to fight infection. These symptoms are not sure signs of cancer, however. They also may be caused by many common illnesses, such as the flu or other infections. But it is important to see a doctor if any of these symptoms lasts longer than 2 weeks.

Causes:
The cause of most lymphoma is unknown. Some occur in individuals taking drugs to suppress their immune system.

Non-Hodgkin’s lymphoma occurs when your body produces too many abnormal lymphocytes — a type of white blood cell.
Normally, lymphocytes go through a predictable life cycle. Old lymphocytes die, and your body creates new ones to replace them. In non-Hodgkin’s lymphoma, your lymphocytes don’t die, but continue to grow and divide. This oversupply of lymphocytes crowds into your lymph nodes, causing them to swell.

B cells and T cells

There are two types of lymphocytes, and non-Hodgkin’s lymphoma usually involves one or the other.

*B cells. B cells fight infection by producing antibodies that neutralize foreign invaders. Most non-Hodgkin’s lymphoma arises from B cells.

*T cells.
T cells are involved in killing foreign invaders directly. Non-Hodgkin’s lymphoma occurs less often in T cells.
Whether your non-Hodgkin’s lymphoma arises from your B cells or T cells helps to determine your treatment options.

Risk factors:
In most cases, people diagnosed with non-Hodgkin’s lymphoma don’t have any obvious risk factors, and many people who have risk factors for the disease never develop it. Some factors that may increase the risk of non-Hodgkin’s lymphoma include:

*Medications that suppress your immune system. If you’ve had an organ transplant, you’re more susceptible because immunosuppressive therapy has reduced your body’s ability to fight off new illnesses.

*Infection with certain viruses and bacteria
. Certain viral and bacterial infections appear to increase the risk of non-Hodgkin’s lymphoma. Viruses linked to increased non-Hodgkin’s lymphoma risk include HIV, hepatitis C virus and Epstein-Barr virus. Bacteria linked to an increased risk of non-Hodgkin’s lymphoma include the ulcer-causing Helicobacter pylori.

*Chemicals.
Certain chemicals, such as those used to kill insects and weeds, may increase your risk of developing non-Hodgkin’s lymphoma. More research is needed to understand the possible link between pesticides and the development of non-Hodgkin’s lymphoma.

*Older age.
Non-Hodgkin’s lymphoma can occur at any age, but the risk increases with age. It’s most common in people in their 60s or older.

Diagnosis:

Tests and procedures used to diagnose non-Hodgkin’s lymphoma include:

*Physical examination. Your doctor may conduct a physical exam to determine the size and condition of your lymph nodes and to find out whether your liver and spleen are enlarged.

*Blood and urine tests. Swollen lymph nodes are common and most often signal that your body is fighting an infection. Blood and urine tests may help rule out an infection or other disease.

*Imaging tests. An X-ray or computerized tomography (CT) scan of your chest, neck, abdomen and pelvis may detect the presence and size of tumors. Magnetic resonance imaging (MRI) scans can help your doctor determine whether your brain and spinal cord are affected. Doctors also use positron emission tomography (PET) scanning to detect non-Hodgkin’s lymphoma. Imaging tests can help determine the stage of your lymphoma.

*Removing a sample of lymph node tissue for testing.
Your doctor may recommend a biopsy procedure to sample or remove a lymph node for testing. Analyzing lymph node tissue in a laboratory may reveal whether you have non-Hodgkin’s lymphoma and, if so, which type.

*Looking for cancer cells in your bone marrow.
To find out whether the disease has spread, your doctor may request a biopsy of your bone marrow. This involves inserting a needle into your pelvic bone to obtain a sample of bone marrow.

Determining your type of non-Hodgkin’s lymphoma
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Doctors classify non-Hodgkin’s lymphoma into many different types. Several methods for classifying types of non-Hodgkin’s lymphoma exist. Each method uses different combinations of factors, including:

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*Whether your cancer involves B cells or T cells

*How the cells appear when examined using a microscope

*Specific genetic changes within the cancer cells

*Which antigens are present on the surface of the cancer cells

Doctors also assign a stage (I through IV) to the disease, based on the number of tumors and how widely the tumors have spread.

Treatment:
Treatment isn’t always necessary
If your lymphoma appears to be slow growing (indolent), a wait-and-see approach may be an option. Indolent lymphomas that don’t cause signs and symptoms may not require treatment for years.

Delaying treatment doesn’t mean you’ll be on your own. Your doctor will likely schedule regular checkups every few months to monitor your condition and ensure that your cancer isn’t advancing.

Treatment for lymphoma that causes signs and symptoms
If your non-Hodgkin’s lymphoma is aggressive or causes signs and symptoms, your doctor may recommend treatment.

Treatment planning takes into account the type of lymphoma, the stage of disease, whether it is likely to grow slowly or rapidly, and the general health and age of the patient. Common treatment options for several types are as follows:

Low Grade

Low-grade lymphomas include small lymphocytic, follicular small cleaved, and follicular mixed cell. For low-grade lymphomas, which usually grow very slowly and cause few symptoms, the doctor may wait until the disease shows signs of spreading before starting treatment.

Although low-grade lymphomas grow slowly and respond readily to chemotherapy, they almost invariably return and are generally regarded as incurable. The long-term outcome has not been favorably affected by the use of intermediate chemotherapy. Single agent or combination chemotherapy or radiation therapy may be required when the disease progresses or begins to cause symptoms.

Intermediate and High Grades
Intermediate grade includes follicular large cell, diffuse small cleaved, diffuse mixed cell, and diffuse large cell. The chance of recovery and choice of treatment depend on the stage of the cancer, age, and overall condition. Whatever the origin, the features that best predict the prognosis and guide decisions about therapy are the size, shape and pattern of the lymphocytes as seen microscopically.

Intermediate- and high-grade lymphomas are curable. Treatment for intermediate- or high-grade lymphomas usually involves chemotherapy, with or without radiation therapy. In addition, surgery may be needed to remove a large tumor.

Combination chemotherapy is almost always necessary for successful treatment. Chemotherapy alone, or abbreviated chemotherapy and radiation, cure 70 to 80 percent of patients with limited   intermediate-grade lymphoma. Advanced  disease can be eradicated in about 50 percent of patients.

Hodgkin’s Disease
The usual treatment for most patients with early stage Hodgkin’s disease is high-energy radiation of the lymph nodes. Research has shown that radiation therapy to large areas at high doses (3,500 to 4,500 rads) is more effective in preventing relapse than radiation of the diseased nodes alone.

Combination chemotherapy also is effective in the treatment of early stage Hodgkin’s disease. In addition, chemotherapy is the treatment of choice for advanced (stages III and IV) Hodgkin’s disease and for patients who have relapsed after radiotherapy. Drugs and radiation are sometimes given together, mainly in treating patients with tumors in the chest or abdomen.

Coping and support:
A diagnosis of cancer can be overwhelming. With time you’ll find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helps to:

*Learn everything you want to know about your cancer
. Find out everything you need to know about your cancer in order to help you make treatment decisions. Ask your doctor for the type and stage of your cancer, as well as your treatment options and their side effects. Ask your doctor where you can go for more information. Good places to start include the National Cancer Institute and the Leukemia & Lymphoma Society.

*Build a strong support system. Having a support system of close friends and family may help you cope. Though you may feel tempted to keep to yourself, be open with your loved ones. Friends will ask you if there’s anything they can do to help you. Think of requests ahead of time, such as preparing meals or just being there to talk.

*Connect with other cancer survivors.
Sometimes you’ll feel as if your friends and family can’t understand what you’re going through. In these cases, other cancer survivors can offer support and practical information. You may also find you develop deep and lasting bonds with people who are going through the same things you are. Ask your doctor about support groups in your area. Or go online to Internet message boards, such as those offered by the Leukemia & Lymphoma Society.

*Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But don’t choose goals you can’t possibly reach. You may not be able to work a 40-hour week, for example, but you may be able to work at least part time. In fact, many people find that continuing to work can be helpful.

*Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for when you may need to rest more or limit what you do.

*Stay active. Receiving a diagnosis of cancer doesn’t mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it. Stay involved as much as you can.

*Look for a connection to something beyond yourself.
Having a strong faith or a sense of something greater than yourself may help you cope with having cancer. It may also help you maintain a more positive attitude as you face the challenge of cancer.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/non-hodgkins-lymphoma/DS00350
http://www.healthscout.com/ency/68/304/main.html#SymptomsofLymphoma

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