It is a tumor that occurs in those cells of the body by which the body fights any foreign substances, these fighting cells are known as lymphocytes. These cells are found in the various parts of the body like lymph nodes,...
Introduction:
It is a tumor that occurs in those cells of the body by which body fights with any foreign substances, these fighting cells are known as lymphocytes. These cells are found in the various parts of the body like lymph nodes, spleen, thymus, bone marrow. In lymphoma, there is change in lymphocytes and there is abnormal multiplication of lymphocytes.
There are two variants of lymphoma:
- Non-Hodgkin
- Hodgkin
Both Non-Hodgkin and Hodgkin lymphoma have different types of lymphocyte cells. Each variant of lymphoma multiplies at a rate and reacts differently to therapy.
Lymphoma is curable, and the symptoms can vary depending on the type of lymphoma and the stage at which it is present. Your therapist can help you find the best cure for your variant and staging of the illness.Lymphoma is completely dissimilar from leukemia. Every variant of this cancers occurs in a non identical type of cell.
Lymphoma begins in infection-fighting lymphocytes.
Leukemia begins in blood-forming cells that are present inside bone marrow.
Lymphedema : In this there is fluid accumulation in cavities of body due to any destruction of lymph nodes or any problem create in lymphatic system thats why this is whole different variant from lymphoma. Non-Hodgkin lymphoma It is the most common type, mainly occurs from B and T lymphocytes (cells) in the lymph nodes or lymphatic tissues present in the whole body. In non hodgkin lymphoma proliferation of cancerous cells sometimes does not affect each and every lymph node. Sometimes it affects contralateral lymph nodes and sometimes similar side lymph nodes.
Hodgkin Lymphoma
Hodgkin lymphoma is a tumor of the immune system, and the medical prejudices can recognize it only by seeing the Reed-Sternberg cells, which are excessive large B lymphocytes. In patients with Hodgkin lymphoma, the tumor usually moves from one lymph node to another whether it is a present contralateral or ipsilateral lymph node.
Types of Lymphoma
- Hodgkin lymphoma
- Non hodgkin lymphoma
- Burkitt lymphoma
- Cutaneous T cell lymphoma
- Cutaneous B lymphoma
Causes of Lymphoma
You will be more at risk for developing lymphoma if you:
- Are 60 yrs old or older than it for non-Hodgkin lymphoma
- If your age is between 17and 45 or elder than 55 years for Hodgkin lymphoma
- there are some subtypes which are less common in males, as some subtypes of lymphoma may be more common in females.
- If the patient had weak immune system due to HIV/AIDS, or any grafting of organs occurs recently, or because you have a hereditary immune disease
- Have an immune systems disease like RA, Sjögren's syndrome, SLE, or intestinal disease.
- Have been infected with a virus such as EB virus, hepatitis C, or human T-cell leukemia/lymphoma (HTLV-1)
- Have any near or loved ones who in past has lymphoma
- Were in contact with any type of aromatic carbons or chemicals that kill bugs and weeds
- Past history of treatment for Hodgkin or non-Hodgkin lymphoma
- Were treated for cancer in recent time with radiation.
Symptoms of Lymphoma
- Inflamed tissues (lymph nodes) are present in the neck, armpit, or groin and these do not cause any discomfort.
- Cough
- Shortness of breath
- Mild or severe Fever
- Night sweats
- Fatigue
- Weight loss
- Itching
Some Additional Symptoms of Non Hodgkin Lymphoma Include:
- Chronic coughing
- Pain or inflammation in the abdomen
- Pain, weakness, paralysis, or altered sensation may occur if an enlarged lymph node presses against spinal nerves or the spinal cord.
Through the lymphatic system lymphomas will spread fast and easily from the lymph nodes to the other regions of the body. The immune system will not be able to fight properly against the infections because of the fast movement of cancerous lymphocytes.
Complications of Lymphoma
- After the treatment there are some unexplained complications which the patient has to bear lifelong.
- Weak immune system is the most ordinary and important complication of non hodgkin lymphoma. Sometimes it will become more dangerous while you are under treatment.
- But this problem gradually disappears, sometimes it takes months and sometimes years for complete healing of the immune system.
- Weak immune system makes the patient more prone to infections and there is increased chances of developing disease from these infections.
Pathophysiology:
The pathophysiology of lymphoma is not well understood in most of the malignancies, and particularly in the malignancies which are present in the children. The development of disease is multifactorial, with infection, genetic factors and environmental substituents all are potentially involved. In adults,a rich lifestyle factors like obesity, smoking and alcohol intake all are combined with increased risk of lymphoma.
Diagnosis:
Physical exam: Swollen lymph nodes, in the region of neck, underarm and groin, as well as inflammation of spleen or liver.
Biopsy: Taking a lymph node for examination For the laboratory testing a small piece of lymph node or a lymph node should be removed by the biopsy procedure. There Are some tests with advanced technology which can determine whether the lymphoma cells are present and if present then what types of cells are involved.
Blood tests: By counting the number of cells whether they are T cells or B cells in the blood test report we can determine which type of disease is present.
We can determine the disease also by taking a small piece of bone marrow for examination.
Bone marrow aspiration and biopsy:
In this process, a long needle is injected into the triangular bone which is present in our butt region for the sample which is from bone marrow. After this , this sample is completely analyzed for any presence of lymphoma cells.
Imaging tests:
There are some imaging tests which are referred by doctors for the confirmation of the tumor that it is not spread into any other parts of the body by lymphatic drainage.
The most common tests may include-
- CT scan
- MRI
- Positron emission tomography (PET).
- X-ray imaging of the chest, abdomen, and pelvis
- ultrasound
Spinal tap:
A long thin needle is used by surgeons to take out the spinal fluid for the assessment and further confirmation of the lymphoma. This is a most secure test which causes very less damage to adjacent tissues and involves only a certain quantity of cerebrospinal fluid (CSF)—the fluid that is present in the brain and spinal cord—so that it should be examined for the presence of lymphoma cells. This test is mainly done for certain types of lymphoma or it is done for the patient who shows signs that this tumor may involve the brain also.
Chest x-ray:
For enlarged or inflamed lymph nodes chest x-ray is best for the diagnosis.
Body CT:
For detection of inflamed lymph nodes or organs and any problem or disturbances in the abdomen, pelvis, chest, head and neck can be seen in CT scan of the body.
CT scan is also used for biopsy needle to go precisely into the area that shows symptoms of disease or area that is affected so that a tissue sample can be taken and checked carefully under a microscope. This procedure is also known as CT-guided needle biopsy.
PET scan:
A PET scan shows those things which are not seen by CT scan, this uses a minute quantity of irradiated material,those help to visible and macro sized lymph node whether it is cancer causing or not and discover cancer cells present throughout the body which are not able to find out on a CT scan. PET scanning can also be done after therapy to determine whether the cancer reacts to treatment or not.
Bone scan:
This test is mainly used to check whether the lymphoma goes into the bone or not.In this test, a radioactive isotope named as technetium-99m is injected into a vein which passes to damaged areas of bone. This test is mainly done to check the patient is that he has bone pain or not. It also shows whether lymphoma reaches till the bones or not.
MRI:
MRI scan means the image of a small area can be visualized in slices.a small image is cut into thousands of parts which is quite helpful in diagnosis. It is mainly done in lymphomas only for checking whether the lymphoma spread to the spinal cord or brain or not.It gives quite satisfactory results in examination of the body as well as head or neck region
Abdominal ultrasound:
Abdominal ultrasound is used to detect the enlarged lymph nodes, especially those lymph nodes which are present in the abdomen. Ultrasonography is also used to image the abdominal organs and kidneys, which may be affected by enlarged lymph nodes.
Prevention
- Due to the unrecognized cause of lymphoma it is not easy to prevent lymphoma from occurring. But if you ever sometimes think that you have similar signs and symptoms as that of lymphoma it is necessary to consult with your doctor and have proper diagnosis and treatment plan.
- If there is any family history of lymphoma it is very necessary to diagnose this disease and consult with your doctor about this.
- If there is a recent transplantation of kidney and any other organ it has high chances for lymphoma to occur prevention should be taken by giving the proper diet and care to the patient.
- In Africa there are high chances to develop lymphoma but this mainly occurs due to gene mutation.In patients who are immunosuppressed and are HIV positive there are high chances to prevent immunoboosters being given to the patient.
Depending upon the signs and symptoms sjown by the patient is recommended to a hematologist which specializes in blood diseases.
Treatment
Treatment is decided on the basis of variant and staging of lymphoma and the age and health of the patient. For some types of lymphoma, if the disease is complex but grows gradually (indolent), then we have a choice to wait for sometime and observe the disease.
For curing the lymphoma there are various treatments which are introduced some of them are discussed below:
- Chemotherapy: Chemotherapy, used im isolation or in conjunction with radiation therapy, is one of the important methods of treating the lymphoma. It includes the usagr of cancer-destroying agents that are taken by mouth or injection.
CNS prophylaxis, in this chemotherapy is directly inserted into the spinal cord by creating a small hole in lumbar region, it is used to cure certain types of non-Hodgkin lymphoma that are already proliferatrs to the brain or are at great danger for such growth. In addition, steroid drugs can also be used to relieve symptoms like swelling and inflammation.
- Radiation therapy: Radiation therapy uses sternous radiation like x rays to sunken tumors and destroy tumor cells. Patients with lymphoma are cured by external beam therapy in which beams of high potential x-rays are focussed by a device which is present externally to the patient and aimed at the tumor and cancerous lymph nodes.
External beam therapy will also be used in isolation or in conjunction with chemotherapy.
- Monoclonal antibody therapy (also called targeted therapy): This therapy involves invitro generated products known as monoclonal antibodies that are transformed to concede and sticks to the outer portion of tumor caausing cells. Monoclonal antibodies can completely change and look like naturally produced antibodies in the body that destroys invading alien molecules ,which are visible microscopically. Monoclonal antibodies will also be combined with a chemotherapeutic drug or radioactive material,and allows the antibody to give a direct dose of the cancer destroying factors to the cancer cell.
Two most frequent monoclonal antibodies which are used in the treatment of lymphoma are:
- Rituximab - This drug is used in many patients with "B-cell" lymphoma and can also be conjugated with chemotherapy and/or radiation therapy.
- Brentuximab vedotin - which joins a chemotherapeutic medicine with a monoclonal antibody that sticks to a particular molecule (CD30) on the surface of Hodgkin disease cells and some other types of lymphoma.
- Radioimmunotherapy (other name is radiolabeled monoclonal antibody therapy): This therapy combines a monoclonal antibody with a radioactive material, such as Yttrium-90 with Ibritumomab Tiuxetan.The radiolabeled monoclonal antibody passes into the body and traverses and then combines with the cancerous cell and then allows excessive.
dose of radiation to be delivered directly to the cancer.
- Biologic therapy: This therapy includes in vivo or in vitro-made products which are designed to improve or reinstate the body's natural immune system against tumor or to impede with specific biologic pathways within the lymphoma cells. Interferon is a variant of biologic remedy that influence the multiplication of cancer cells and can steady the growth of carcinoma. Lenalidomide and ibrutinib are precedents of factors that impede with metabolic pathways within the lymphoma cells.
- Stem cell transplant: In this treatment a healthy bone marrow is inserted in the patient in place of infected bone marrow whether it is patients own or it is donated by some donor this helps in the growth of new bone marrow in the body. A stem cell transplant may be an option if lymphoma returns after treatment.
Prognosis
The prognosis of any individual suffering from this disease mainly depends on the type and the stage at which lymphoma is present. There are a number of lymphomas that are treated and cured with fewer complications.
There are different variants of lymphoma that grow gradually.
In these cases, the surgeons made their choice not to treat the disease because of their prognosis of the disease. Even without curing the disease, the patient lives a healthy long-term life.
