MEDICAL BLOGS:LYMPHOMAS

Lymphoma is cancer that begins in infection-fighting cells of the immune system, called lymphocytes. These cells are in the lymph nodes, spleen, thymus, bone marrow, and other parts of the body. When you have lymphoma, lymphocytes change and grow out of control.

                                      

There are two main types of lymphoma:
Every type of lymphoma grows at a different rate and responds differently to treatment.
Scientists don't know what causes lymphoma in most cases.
  *When did you first notice changes?
  * Do you have pain? Where?
  * How is your appetite?
  * Have you lost any weight
  * Do you feel tired or weak?
  * Have you ever been treated for lymphoma or another cancer?
  * Do you have any infections or illnesses?
  * Do any cancers run in your family?
You might get a lymph node biopsy to check for cancer cells. For this test, your doctor will remove all or part of a lymph node, or use a needle to take a small amount of tissue from the affected node.
These include:
   * Immunophenotyping
   * Flow cytometry
   * Fluorescence in situ hybridization testing
Classification systems generally classify lymphoma according to:
1)  Whether or not it is a Hodgkin lymphoma
2) Whether the cell that is replicating is a T cell or B cell
3) The site from which the cell arises

CT scan or PET scan imaging modalities are used to stage a cancer.
   * What stage is my cancer?
   * Have you treated people with this kind of lymphoma before?
   * What treatments do you recommend?
   * How will the treatments make me feel?
   * What will help me feel better during my treatment?
   * Are there any complementary treatments I could consider, along with the medical care? Are there any I should avoid?
The main treatment for non-Hodgkin lymphoma are:
   * Chemotherapy. It uses drugs to kill cancer cells.
   * Radiation therapy. It uses high-energy rays to destroy cancer cells.
   * Immunotherapy. It uses your body's own immune system to attack cancer cells.
   * Radiation therapy
   * An autologous transplant uses your own stem cells.
   * An allogeneic transplant uses stem cells taken from a donor
Treatment for these types of lymphoma typically consists of aggressive chemotherapy, including the CHOP or R-CHOP regimen. A number of people are cured with first-line chemotherapy
Most relapses occur within the first two years, and the relapse risk drops significantly thereafter.
For people who relapse, high-dose chemotherapy followed by autologous stem cell transplantation is a proven approach.
Advanced Hodgkin disease requires systemic chemotherapy, sometimes combined with radiotherapy. Chemotherapy used includes the ABVD regimen, which is commonly used in the United States. Other regimens used in the management of Hodgkin lymphoma include BEACOPP and Stanford V. Encouragingly, a significant number of people who relapse after ABVD can still be salvaged by stem cell transplant.
Lymphoma treatment can cause side effects. Talk to your medical team about ways to relieve any symptoms you have.
Also ask your doctor about changes to your diet and exercise that will help you feel better during your treatment. Ask a dietician for help if you're not sure what types of food to eat. Exercises like walking or swimming can relieve fatigue and help you feel better during treatments like chemotherapy and radiation. You might also try alternative therapies like relaxation, yoga, meditation to relieve the pain.
  * The kind of lymphoma you have
  * How far the cancer has spread
  * Your age
  * The type of treatment you get
  * Other associated health problems you may have.

·      Non-Hodgkin: Most people with lymphoma have this type.

·      Hodgkin

Non-Hodgkin and Hodgkin lymphoma each affect a different kind of lymphocyte. 

Even though lymphoma is cancer, it is very treatable.

Causes:

You might be more likely to get it if you:

·      Are in your 60s or older

·      Are male

·       Have a weak immune system from HIV/AIDS, an organ transplant, or because you were born with an immune disorder

·       Have an immune system disease such as rheumatoid arthritis, Sjogren's syndrome, lupus, or celiac disease

·       Have been infected with a virus such as Epstein-Barr, hepatitis C virus, T- cell leukemia/lymphoma (HTLV-1), or human herpesvirus 8 (HHV8)

·       Have a close relative who had lymphoma

·      Were exposed to benzene or chemicals that kill bugs and weeds

·       Were treated for Hodgkin or non-Hodgkin lymphoma in the past

·       Were treated for cancer with radiation

Symptoms:

·      Swollen glands (lymph nodes), often in the neck, armpit, or groin

·       Cough

·       Shortness of breath

·       Fever

·      Night sweats

·      Stomach pain

·      Fatigue

·       Weight loss

·      Itching

Getting a Diagnosis

Before you have any tests, your doctor will want to know:

Your doctor will check you for signs of lymphoma and will feel for swollen lymph nodes. This symptom doesn't mean you have cancer. Most of the time, an infection unrelated to cancer causes swollen lymph nodes.

You might also have one of these tests to see how far the lymphoma has spread:

·      Blood test. 

·      Bone marrow aspiration or biopsy. Your doctor uses a needle to remove fluid or tissue from your bone marrow, to look for lymphoma cells.

·      Chest X-ray.

·      MRI..

·      PET scan. It uses a radioactive substance to look for cancer cells in your body

·       Molecular test. It looks for changes to genes, proteins, and other substances in cancer cells to help your doctor figure out which type of lymphoma you have.

Several classification systems have existed for lymphoma, which use histological and other findings to divide lymphoma into different categories. The classification of a lymphoma can affect treatment and prognosis

Hodgkin lymphoma

Hodgkin lymphoma is one of the most commonly known types of lymphoma and differs from other forms of lymphoma in its prognosis and several pathological characteristics. It is marked by the presence of a type of cell called the Reed Sternberg cell.

Non-Hodgkin lymphomas

Non-Hodgkin lymphomas include all lymphomas, except Hodgkins lymphoma, and are more common than Hodgkin lymphoma. A wide variety of lymphomas are in this class, and the causes, the types of cells involved, and the prognosis vary by type. The incidence of non-Hodgkin lymphoma increases with age. It is further divided into several subtypes.

STAGING OF CANCER:

After a diagnosis and before treatment, a cancer is staged. This helps to determine, if the cancer has spread, and if so, whether locally or to distant sites. Staging is reported as a grade between I (confined) and IV (spread).Staging is carried out because the stage of a cancer impacts its prognosis and treatment.

The Ann Arbor staging system is routinely used for staging of both HL and NHL. In this staging system, I represents a localized disease contained within a lymph node, II represents the presence of lymphoma in two or more lymph nodes, III represents spread of the lymphoma to both sides of the diaphragm, and IV indicates tissue outside a lymph node.

Questions You Can Ask Your Doctor

   *What type of lymphoma do I have?

Treatment

The treatment you get depends on what type of lymphoma you have and how far it has spread.

The main treatments for Hodgkin lymphoma are:

   * Chemotherapy

If these treatments don't work, you might have a stem cell transplant. First you'll get very high doses of chemotherapy. This treatment kills cancer cells, but it also destroys stem cells in your bone marrow that make new blood cells. After chemotherapy, you will get a transplant of stem cells to replace the ones that were destroyed.

Two types of stem cell transplants can be done:

Many low-grade lymphomas remain indolent for many years. Treatment of an assymptomatic patient is often avoided. In these forms of lymphoma, such as follicular lymphoma, watchful waiting is often the initial course of action as the risks of treatment outweigh the benefits.

Treatment of more aggressive, forms of lymphoma can result in a cure in the majority of cases, but the prognosis for patients with a poor response to therapy is worse.

Hodgkin lymphoma typically is treated with radiotherapy alone, as long as it is localized.

Taking Care of Yourself:

Your outlook depends on:

Getting Support

·      You can get support from people who have gone through this kind of illness.

·      Contact the Leukemia & Lymphoma Society or Lymphoma Research Foundation to learn more.

·      Team Yoddhas online support group in India

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Author- 

   

Dr. Gayatri Bhat

Doctor , blood cancer survivor and a member of Yoddhas Medical Expert Panel