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Lymphoma

Overview

Lymphoma is a type of blood cancer that occurs when B or T lymphocytes, the white blood cells, multiply uncontrollably and live longer than they are supposed to. Lymphocytes are white blood cells that move throughout the body in a fluid called lymph. They are a part of the immune system and help protect the body from infection and disease. Lymphoma may develop in the lymph nodes, spleen, bone marrow, blood or other organs and eventually they form a tumour. Tumours grow and invade the space of surrounding tissues and organs, depriving them of oxygen and nutrients. If abnormal lymphocytes travel from one lymph node to the next or to other organs, the cancer can spread or metastasize. Lymphoma development outside of lymphatic tissue is called extranodal disease.

Symptoms

The primary symptom that manifests when a patient is suffering from lymphoma is the swelling of lymph nodes. This is because the enlarged lymph nodes can encroach on the space of blood vessels, nerves, or the stomach, leading to swollen arms and legs, to tingling and numbness, or to feelings of being full, respectively. The other symptoms that a patient suffers from are; fever, night sweats, weight loss, loss of appetite, fatigue, respiratory distress and itching.

Causes

The following are some of the causes as well as the risk factors of lymphoma cancer: GENETICS One of the causes behind lymphoma cancer is the genetic predisposition to the disease that has been inherited from a family member. It is believed that one can be born with certain genetic mutations or a fault in a gene that makes one statistically more likely to develop cancer later in his life. CARCINOGENS A carcinogen is a substance or radiation that is an agent directly involved in causing cancer. This could be due to the ability to damage the genome or to the disruption of cellular metabolic processes. They are also responsible for damaging DNA, and aiding in cancer. Exposure to certain pesticides, herbicides and solvents such as benzene has been associated with lymphoma. Similarly, black hair dye has been linked to higher rates of NHL.

Diagnosis

A lymph node biopsy is done in order to diagnose lymphoma cancer. Lymph node biopsy is a partial or total excision of a lymph node which is examined under the microscope. After lymphoma is diagnosed, a variety of tests may be carried out to look for specific features characteristic of different types of lymphoma. These include:

• Immunophenotyping
• Flow cytometry
• FISH testing
• Treatment

The classification of lymphoma has a direct effect on the treatment and the prognosis. Classification systems generally classify lymphoma according to:

• Whether or not it is a Hodgkin’s lymphoma
• Whether the cell that is replicating is a T cell or B cell
• The site that the cell arises from
• Prognosis and treatment is different for Hodgkin’s lymphoma and between all the different forms of Non Hodgkin’s lymphoma. Another factor that the prognosis depends on is the grade of the tumour, referring to how quickly a cancer multiplies and manifests. LOW-GRADE LYMPHOMA Many low-grade lymphomas remain sluggish for many years. In these lymphomas, metastases are very likely. For this reason, treatment of the non-symptomatic patient is often avoided. In these forms of lymphoma, watchful waiting is often the preliminary course of action. The main reason behind delaying the treatment is because the harms and risks outweigh the benefits. If a low-grade lymphoma is becoming symptomatic, radiotherapy or chemotherapy is the treatment option. A person suffering from this can live a near-normal life but the disease remains incurable. HIGH-GRADE LYMPHOMA Treatment of some other, more aggressive, forms of lymphoma can result in a cure in the majority of cases. Treatment for these types of lymphoma typically consists of aggressive chemotherapy, including the CHOP or R-CHOP regimen. Hodgkin lymphoma typically is treated with radiotherapy alone, as long as it is localised. Advanced Hodgkin disease requires systemic chemotherapy, sometimes combined with radiotherapy. Chemotherapy used includes the ABVD regimen.

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