First, what is lymphoma? Lymphoma is cancer that begins in cells of
the lymphatic system. The lymphatic system, (or “Lymph System” is made up of organs
and tissues that produce and transport your white blood cells (which are the cells that
fight infections and other diseases). The parts of your body included in the lymph system
are the lymph vessels, lymph nodes, spleen, thymus gland, tonsils, and bone marrow. When
the white blood cells in these organs or tissues start growing at faster rates than normal
the lymphatic organs swell and this is called lymphoma.
What is Non-Hodgkin Lymphoma? Non-Hodgkin lymphoma is a type of cancer that
develops in the white blood cells in your body. Your doctor will be able to tell if
you have this type of lymphoma after taking a biopsy of your cells and studying it under
a microscope. There are many different types of Non-Hodgkin lymphoma, and it's important
to understand some specifics around this disease to be better prepared. Let’s get started!
What are risk factors for NHL? Research is being done to discover why people
develop lymphoma. More than half of the people diagnosed with NHL are over the age of 65.
Immune system disorders, such as HIV/AIDS, are associated with a higher risk of NHL and
some bacteria and viruses have also been implicated in NHL. For example, a bacteria known as H.
Pylori-- which is the bacteria known to cause stomach ulcers--may cause mucosa-associated
lymphoid tissue lymphoma of the stomach- also known as MALT lymphoma. So, some organs that
are lined with mucous sheets might be able to become infected with lymphoma. Another
example is the Epstein-Barr virus (EBV)-- the virus that causes an illness commonly
known as “mono”-- is associated with some types of NHL. We know that some lymphomas
have genetic predisposition- (CLL- chronic lymphocytic leukemia, SLL- small lymphocytic
lymphoma). Additionally we know that non hodgkins lyphomas generally result from a progressive
accumulation of genetic lesions. Despite this, there are no widely accepted genetic tests
that tell us who is more likely to develop NHL.
What parts of my body will be impacted by Non-Hodgkin lymphoma?
In America, a man has a lifetime risk of 1 in 41 of developing Non-Hodgkin Lymphoma and
a woman has a lifetime risk of 1 in 52. If found and treated early, non-Hodgkin Lymphoma
is cureable, so it's important to know the symptoms and get treated right away.
Non-Hodgkin lymphoma is specifically known for being able to start anywhere in the body---while
Hodgkin lymphoma usually starts in the neck or the armpit area. Furthermore, because lymphatic
tissue is connected throughout the body, NHL can spread almost anywhere. While NHL often
starts in the lymph nodes, liver, spleen, or bone marrow, other organs that are often
involved include the stomach, intestines, skin, thyroid gland, and brain. If the lymphoma
has spread to other organs by the time it is discovered, the disease may be more serious.
What are b-cells, t-cells, and NK cells? These are the cells in your immune system
and are important to know because they provide the different sites for lymphoma cancer to
develop. ​​ B-cells are cells that make antibodies or
cells that fight foreign invaders in your body. Lymphomas of b-cell origin account for
about 90% of all lymphomas in people who live in western countries.
T-cells are a white blood cell that help your b-cells fight infection. T-cell lymphomas
account for about 10% of lymphomas. NK Cells, or natural killer cells, are a third
type of white blood cells that attack and break down foreign substances in your body.
Less than 1% of people with lymphoma have NK-cell lymphoma.
What are some key symptoms of lymphoma? Signs and symptoms of Non-Hodgkin lymphoma
may include: enlarged lymph nodes in the abdomen, groin, neck, or underarms, an enlarged spleen
or liver, fatigue, shortness of breath, fever that cannot be explained by an infection or
other illness, random and unexplained weight loss, sweating including night sweats), itchy
skin, and chills. More specific systems include: Unexplained weight loss of more than 10% of
the patient’s original body weight during the 6 months before diagnosis
Unexplained fever with temperatures above 100.4ºF (38ºC)
Drenching night sweats. Patients often state that their clothes or sheets on the bed are
actually soaked. How are NHL cancers classified?
You may hear a doctor refer to someone’s lymphoma as stage 1, 2, 3, or 4. Staging describes
where the cancer is located, how much or whether it has spread, and the impact of the cancer
on other organs of the body. Stage 1 is the most localized and Stage 4 is the most spread
and aggressive. Non-Hodgkin lymphoma is often further classified by growth rate. The first
category is indolent, or slow-growing, cancers. For example, these include Follicular lymphoma,
Cutaneous T-cell lymphoma, and Lymphoplasmacytic lymphoma. The second group are more aggressive
and fast-growing cancers. For example, these include Diffuse large B-cell lymphoma, Anaplastic
large-cell lymphoma, and Burkitt lymphoma.
What is follicular lymphoma? Follicular lymphoma is the most common type
of indolent lymphoma, accounting for 20% of all lymphoma cases in the United States. This
cancer is usually found in the bone marrow or lymph nodes and is most common in middle-aged
or older adults. In many cases, follicular lymphoma grows so slowly that the only treatment
required is monitoring its growth. Other treatment is needed if it progresses or spreads to other
areas of the body.
What is Diffuse large B-cell lymphoma (DLBCL)? DLBCL is the most common form of lymphoma,
about 30% of NHL cases in the U.S. are the DLBCL type. Approximately 40% of the time,
this type spreads to other organs outside of the lymph system. DLBCL can be cured in
about half of the patients who develop it. The most common chemotherapy is a regimen
of four drugs: cyclophosphamide, doxorubicin, vincristine, and prednisone plus an antibody
therapy known as rituximab.
What is Burkitt's lymphoma? Burkitt lymphoma is also known as Burkitt
cell leukemia because it is a blood cancer. Burkitt’s lymphocytes are often called the
“fastest growing human tumor” because it can spread and be fatal very quickly. However,
treatment of early stage I and II is usually successful with survival rates higher than
90%. In Africa, 98% of cases of Burkitt's are associated with Epstein-Barr virus infection,
but this form of cancer is rare in the U.S, with only 1,200 people being diagnosed each
year, the majority of whom are over age 40.
How is non-Hodgkin lymphoma treated? Chemotherapy is the main treatment for NHL,
with the addition of radiation therapy when necessary. Chemotherapy is generally successful
in treating and often curing NHL. Other treatments include: immunotherapy/targeted therapy, radioimmunotherapy,
chimeric antigen receptor (CAR) T-cell therapy, and in rare cases, bone marrow/stem cell transplantation.
That’s all for today, please reach out to your doctor if you have other questions.