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  Lymphoma

Lymphoma is cancer of the lymphatic system. The lymphatic system is a complex network of a network of tubes or vessels that move fluid, fat, lymphocytes and proteins into the blood stream. The lymphatic system also filters unwanted substances, bacteria, virus and microorganisms from tissues. The cancer originates from lymphocytes and histiocytes (rarely). These cells form the reticulendothielial system. Lymphocytes are a type of white blood cells - T and B cells that are important for the immune system. Lymph is the fluid that is transported through the lymphatic system.

Lymphoma Cancer
Lymphoma


Lymphoma is part of a large group of diseases known as hematological neoplasms. Usually lymphoma is classified as Hodgkin’s Lymphoma (discovered by Thomas Hodgkin in 1832) and non Hodgkin’s lymphoma. The classification of lymphoma is more detailed than these two types.

Symptoms:

Common symptoms for lymphoma - both Hodgkin’s and non-Hodgkin’s are night sweats, enlarged lymph notes, enlarged spleen, enlarged liver, high fevers, itchy skin - known as pruritus, fatigue, reddened skin patches and weight loss. Swelling of lymph nodes usually occurs in the neck, underarm, chest or groin.

Unfortunately, these symptoms are non-specific and are often confused with the flu or other infections.

Diagnosis:

Many diseases and conditions can cause the lymph nodes to swell. It is important to determine if the swelling is caused by lymphoma or other types of cancer. Diagnosis of lymphoma is made through a biopsy - removing the lymph nodes for exam by a pathologist. Blood tests are used to determine the functioning of organs, to determine where the lymphoma may have spread and to determine treatment. PET scan or positron emission tomography is used to detect where the lymphoma is in the body. Sometimes a Gallium Scan is used in place of a PET scan. A Gallium Scan is a medical test that uses a special camera that targets specific tissues that are made visible by a radioactive tracer. The tracer used is radioactive gallium citrate, which is injected into a vein in the arm. It moves through the body and accumulates in places where higher build up of white blood cells is present. It takes three to four days for the tracer to accumulate in the ‘hot spots’, so this test is slightly more involved then a PET scan.

Treatment:

Treatment depends on the age of the patient, relative health of the patient and type of lymphoma involved. The World Health Organization has three major classifications for lymphoma, T-cell tumors, B-cell tumors and natural cell killers.

Here are the types of lymphoma diagnosed according to the World Health Organization:

B-Cell Lymphomas:

• Diffuse large B cell lymphoma
• Plasma cell neoplasms
 Plasma cell myeloma
 Plasmacytoma
 Monoclonal immunoglobulin deposition diseases
 Heavy chain diseases
• Extranodal marginal zone B cell lymphoma (MALT lymphoma)
• Nodal marginal zone B cell lymphoma
• Follicular lymphoma
• Chronic lymphocytic leukemia/small lymphocytic lymphoma
• B-cell prolymphocytic leukemia
• Lymphoplasmacytic lymphoma/Waldenström macroglobulinemia
• Splenic marginal zone lymphoma
• Mantle cell lymphoma
• Mediastinal (thymic) large B cell lymphoma
• Intravascular large B cell lymphoma
• Primary effusion lymphoma
• Burkitt lymphoma/leukemia
• lymphomatoid granulomatosis
• Extranodal NK/T cell lymphoma, nasal type

T-Cell Lymphomas:

• Adult T cell leukemia/lymphoma
• T cell prolymphocytic leukemia
• T cell large granular lymphocytic leukemia
• Enteropathy-type T cell lymphoma
• Hepatosplenic T cell lymphoma
• Mycosis fungoides/Sezary syndrome
• Primary cutaneous CD30-positive T cell lymphoproliferative disorders
• Primary cutaneous anaplastic large cell lymphoma
• Lymphomatoid papulosis
• Angioimmunoblastic T cell lymphoma
• Peripheral T cell lymphoma, unspecified
• Anaplastic large cell lymphoma

Natural Killer Cell Lymphomas:

• Blastic NK cell lymphoma
• Aggressive NK cell leukemia
• Extranodal NK/T cell lymphoma, nasal type

Other Lymphoma classifications are based on International Classification of Diseases for Oncology (ICD-O).

Here are other Lymphoma classifications:

Hodgkin Lymphoma
• Nodular lymphocyte-predominant Hodgkin lymphoma
• Classical Hodgkin lymphoma
• Nodular sclerosis
• Mixed cellularity
• Lymphocyte-rich
• Lymphocyte depleted
Immunodeficiency-Associated Lymphoproliferative Disorders
• Associated with a primary immune disorder
• Associated with the Human Immunodeficiency Virus (HIV)
• Post-transplant
• Associated with Methotrexate therapy
Histiocytic and Dendritic Cell Neoplasms
• Histiocytic sarcoma
• Langerhans cell histiocytosis
• Langerhans cell sarcoma
• Interdigitating dendritic cell sarcoma/tumour
• Follicular dendritic cell sarcoma/tumour
• Dendritic cell sarcoma, unspecified

The options for treatment include surgery, chemotherapy and radiation therapy. Biologic, which is relatively new, uses the body’s natural cancer fighting ability to defeat lymphoma.

The goal for treatment is complete remission. Treatment is defined by stages: induction, salvage and maintenance. Induction therapy is the initial therapy aimed at achieving remission. Salvage therapy is the alternate therapy when induction therapy does not succeed at achieving remission. Maintenance therapy is therapy that is given intermittently during remission to maintain remission.

Remission can be partial or complete. Remission does not mean that the patient is cured; it means that lymphoma cells may still be in the body, but are undetectable and asymptomatic. A recurrence is when lymphoma returns in the patient. Remission length depends on the stage of the cancer, the grade of the cancer, the type of the cancer and the age and health of the patient. A remission may last months, years or a lifetime. Durable remission is remission that lasts a long time. Partial remission indicates that a tumor has shrunk to less than half its original size prior to therapy.

Lymphoma’s response to therapy is defined as improvement, stable disease, progression and refractory disease. Improvement indicates that the tumor is shrinking, but is still larger than half its pre-treatment size. Stable disease indicates there has been no response - either growing or shrinking to treatment. Progression indicates that the lymphoma becomes worse. Refractory disease defines lymphoma as resistant to treatment.

The longer the remission is the better the prognosis.

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