LYMPHOMA – Symptoms and Treatments

Lymphoma is a type of cancer that begins in immune system cells called lymphocytes. Like other cancers, lymphoma occurs when lymphocytes are in a state of uncontrolled cell growth and multiplication. Lymphocytes are white blood cells that move throughout the body in a fluid called lymph. They are transported by a network of vessels that make up the lymphatic system, part of the immune system.

The lymphatic system – whose job it is to fight infections or anything else that threatens the body – is also comprised of lymph nodes that exist throughout the body to filter the lymph that flows through them. The lymph nodes swell and tenderize when a large number of microbial organisms collect inside of them, indicating local infection.

There are two primary types of lymphocytes: B cells and T cells. Both are designed to recognize and destroy infections and abnormal cells. B cells produce proteins that travel throughout the body, attaching themselves to infectious organisms and abnormal cells and alerting the immune system that the pathogen needs to be destroyed. T cells actually kill the pathogens directly and serve a function in regulating the immune system from over- or under-activity.

Lymphoma occurs when lymphocyte B or T cells transform and begin growing and multiplying uncontrollably. Abnormal lymphocytes collect in one or more lymph nodes or in lymph tissues such as the spleen or tonsils, and eventually they form a mass of cells called a tumor. Tumors 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.

In the United States each year, some 54,000 people are diagnosed with NHL and 7,000 are diagnosed HL. It is the most common type of blood cancer in the US. The European Union sees over 50,000 cases of NHL every year.

Hodgkin’s name comes from the physician Thomas Hodgkin, who in the nineteenth century (1832) first described Hodgkin’s disease. Now it is officially called Hodgkin’s lymphoma. There are many variants of Hodgkin’s disease all wit the name non-Hodgkin’s lymphoma (NHLs). There are about 30 to 40 different forms of non-Hodgkin lymphomas, which are very different in behavior, presented in the body and sensitivity to therapy. That makes it very difficult to provide good detailed information about NHL. This text is therefore mainly intended a an orientation on the large NHL groups.

The cause of non-Hodgkin’s lymphoma is unknown. There are some rare forms where viruses play a role, which may develop in patients with congenital immune disorder or during treatments that suppress the immune system, such as after kidney, heart, lung or liver treatments. It is in all cases based on aggressive cells derived from the lymphocytes, a type of white blood cells that play a role in our defense.

Some patients with non-Hodgkin’s lymphoma have few complaints and suffer from a swollen lymph node. Often they cause swelling in the neck above the collarbone, under the armpit or groin (which is painless). Sometimes the swelling is growing rapidly, but usually it grows slowly. Depending on where the NHL begins, the symptoms may include stomach or abdominal pain (localization in the stomach, spleen or abdomen), skin disorders (localization in the skin), complaints of the throat or nose (localization in the tonsils, oral cavity or nasal cavities and paranasal sinuses), tightness of the chest (localization of NHL nodes behind the lungs or confusion (localization in the brains). In general, there may be symptoms of unexplained severe weight loss (more than 10 percent of the original weight) with mostly good appetite, profuse night sweats (waking up with wet clothes and bedding should be changed) or unexplained fever.

The diagnosis of non-Hodgkin’s lymphoma is done by taking a biopsy from an abnormal lymph node or other affected area and then it will be examined under a microscope. Sometimes the disease is identified by the pathologist (the specialist who examines the lymph node under a microscope), but the identification is often difficult, because there is so many different types. This requires special expertise. Specialist pathologists work primarily in specialized cancer hospitals. Certain infections or inflammation can sometimes treacherous look like an NHL.

There is no specific treatment method because of the great diversity of types of NHL and NHL patients. It is important to know that a group of patients can be cured. Cured refers to: the NHLs lymphoma is destroyed and it will never come back. There are also not so aggressive forms of NHL that not always require a treatment, or where the treatment will catch it. Most of the times lymphomas are treated by combinations of chemotherapy, monoclonal antibodies, immunotherapy, radiation, and hematopoietic stem cell transplantation.

Bexxar™ is a monoclonal antibody that has a radioactive substance called iodine 131 attached to it. The monoclonal antibody in Bexxar seeks and binds to a protein receptor (named CD20) on the surface of both normal and malignant B cells. Once bound to the target cells, Bexxar delivers radiations, which enhances the killing effect of the antibody.

The treatment, if needed, can not be set until comprehensive examination is finished. This research takes time (at least two to three weeks) and thus leads to a long period of uncertainty, but this is inevitable. During that waiting time preparations can be taken to undergo the upcoming treatment as best as possible. The better the condition of a patient, the better the treatment will catch on and may be tolerated. Any weight loss can be corrected using extra diet. If a patient smokes, it should seriously try to stop. While most NHL chemotherapy do not permanently affect fertility, it is for male patients recommended for to freeze sperm. Again, this is something than can be organized during the waiting time.

The duration of treatment varies by type of NHL, by stage of disease and the risk profile of the patient and can vary from a few months up to six months. In some cases, the end of the treatment will be continued with a maintenance treatment to reduce the risk of recurrence. Treatment usually consists of cell-killing drugs in the form of chemotherapy regimens, which may consist of tablets, but sometimes also types that can only be given through the bloodstream. Each two, three or four weeks via an infusion.

During and after the treatment research must be done again to check if NHL responds well to the given therapy. This means that scans or other tests are repeated midway and at the end of therapy. The first year after treatment: intensive monitoring (every two months). In subsequent years the intensity will go down. After five years checks will be repeated once a year. Basically a patient should be checked for the rest of his/her life. The first year for a possible return of non-Hodgkin’s lymphoma. In later years checks are focused on possible upcoming side effects of the treatment.

How is lymphoma classified? There are two types of lymphoma: Hodgkin lymphoma (HL, also called Hodgkin’s disease) and non-Hodgkin lymphoma (NHL). Both HL and NHL can occur in the same places and have similar symptoms. Their differences are visible at a microscopic level.

Hodgkin lymphoma develops from a specific abnormal lineage of B cells. There are five subtypes of HL. NHL may derive from either abnormal B or T cells, and its 30 subtypes are distinguished by unique genetic markers. The large number of lymphoma subtypes has led to a complicated classification scheme that involves microscopic appearance and well-defined genetic and molecular configurations.

Signs And Symptoms

The symptoms for both versions of lymphoma are quite similar, and lymphoma can occur in almost any part of the body, with Hodgkin’s lymphoma starting from the upper portion of the body in particular like the chest, underarms and neck.

Common symptoms of lymphoma include:•Painless swelling of the lymph nodes
•Excessive sweating at night during sleep
•Enlargement of the spleen leading to abdominal pain
•Abnormal, and often dramatic, weight loss
•Unexplained fever
•Heavy itching
•Chills
•Fatigue and shortness of breath

The majority of these symptoms aren’t specific and can be attributed to other diseases or ailments that are unrelated to lymphoma, or any other cancer, for that matter. The easiest way to determine whether these symptoms should be attributed to lymphoma is if they persist for an extended period of time, and have no other possible explanation.

Causes/Risk Factors

At the moment, there is no clear cut explanation as to what causes lymphoma, whether it is Hodgkin’s or NHL. However, there are some notable risk factors that have been discovered over the years.

For NHL, these risk factors include:•People who live in farming communities have been found to be at a higher risk of developing NHL, with some studies showing evidence of a correlation between NHL and chemicals used to kill insects and weeds.
•Medical conditions that affect the immune system like HIV or autoimmune disease.
•Any form of medication that might suppress the immune system.
•While NHL can occur at any age, the potential risk factors for developing this form of cancer increase with age.

Risk factors for Hodgkin’s lymphoma include:•Males are at a slightly higher risk for developing Hodgkin’s disease.
•Weakened immune system due to HIV or AIDS, or an organ transplant that requires the use of a medication to suppress the immune system.
•While it still remains unclear, there has been evidence showing possible signs of an increased risk factor amongst blood relatives, primarily siblings.

Indisputable risk factors have yet to be determined at this time.

Test/DiagnosisWhen a person shows any signs or symptoms that might suggest some form of lymphoma, a physician might request extensive blood tests to be performed and will refer the patient to a cancer and blood disease specialist. These blood tests determine the performance of blood cells and vital organs. A biopsy is also commonly performed where a sample of tissue from a swollen area is examined by a pathologist. Imaging tests are also used to determine if a lump or mass is present to adminster a biopsy.

Treatment

There are several methods of treatment for lymphoma depending on its classification and stage. For Hodgkin’s lymphoma, types of treatment include:

•Radiation therapy: high energy rays are used to decrease the size of any mass lymphoma cells. The radiation is restricted to only the areas of the body that are affected by Hodgkin’s lymphoma.
•Chemotherapy: a combination of drugs are administered to kill off lymphoma cells. Sometimes chemotherapy is used in conjunction with radiation therapy.
•Bone marrow or stem cell transplant: not commonly used due to the effectiveness of radiation therapy and chemotherapy. However, this form of treatment is typically considered if other therapies have proven to be ineffective.

The treatment for NHL is similar to Hodgkin’s lymphoma, with the inclusion of one more form of treatment called the watch-and-wait method:•Watch-and-wait: also referred to as “watchful waiting,” this method allows the physician to monitor NHL without committing to any particular form of treatment, like chemotherapy. Patients are required to visit their doctors more frequently so they can monitor if the disease begins to progress. This eliminates any side effects that are associated with common NHL treatments for patients diagnosed with early stages of NHL who may not need immediate treatment.

Sources
•Medline Plus
•PubMed Health: Non-Hodgkin lymphoma
•PubMed Health: Hodgkin’s lymphoma