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Lymphomas are cancers that originate in the lymphatic system. The lymphatic system operates throughout the body as the backbone of your immune system. It works to help your body fight infections. The lymphatic system is made up of: lymphoid tissue, lymphatic vessels, and lymphatic fluid. Lymphoid tissue is mostly composed of lymphocytes, a type of white blood cell. The two most common lymphocytes involved in lymphoma are T cells and B cells. Both can develop into cancerous lymphoma cells, but B cells cause most lymphomas in the United States.
Lymph nodes are small organs about the size of a bean. Most of the cells in lymph nodes are lymphocytes. Lymphocytes are white blood cells that are active in fighting infection. There are two types of lymphocytes: T-cells and B-cells. B-cells produce antibodies that help the body to destroy viruses and bacteria. T-cells help to fight off diseases like fungal infections and tuberculosis. Lymph nodes are found in your chest, abdomen, pelvis, arm pit, neck and other areas of the body. Your lymph nodes swell if an infection is present.
White cells and red cells are made in bone marrow. There are two types of white cells in the marrow: granulocytes and lymphocytes. The majority of the lymphocytes in bone marrow are B-cells. Some lymphomas begin from bone marrow B-cells.
The spleen is a small organ located on the left side of the abdomen near the ribs. The spleen makes immune system cells, including lymphocytes. It also filters out and destroys damaged blood cells, bacteria, and cellular wastes.
The thymus plays an important role in the development of T lymphocytes in an infant. Although it gradually decreases in size, the thymus continues to play an important role in immunity throughout your life.
Tonsils and adenoids are collections of lymphoid tissue located at the back of the throat. They help the body to fight off infection from bacteria and viruses that pass through the nose and throat.
The stomach and intestines contain lymphoid tissue.
There are two types of lymphoma: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. These two kinds of lymphoma have different clinical profiles.
Although uncommon, Hodgkin’s lymphoma (also known as Hodgkin’s disease) is the most curable form of cancer. It starts in the lymph nodes, usually in the chest, neck, or under the arms. As it spreads from lymph node to lymph node, the nodes become enlarged. Eventually, the cancer cells enter the blood stream and spread to other parts of the body.
The two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma.
The National Cancer Institute (NCI) reports that there will be over 9,300 new cases of Hodgkin Lymphoma in the United States in 2013. Of these, nearly 2,000 will die. Lymphomas are the third major cause of cancer for children and adolescents under the age of 20. Hodgkin lymphoma occurs less frequently than Non-Hodgkin’s lymphoma (NCI).
There are several risk factors for Hodgkin lymphoma.
Diagnosis of Hodgkin lymphoma begins with an assessment of the overall health history and a physical exam. Lymph node biopsies are performed to determine the type of lymphoma. Doctors use a system called staging to determine the extent of the disease. Stages are numbered from I to IV and increase as the cancer spreads from the lymph nodes to other organs. The staging process begins with health history assessment and a physical. Tests used in the staging process include imaging tests, blood tests, and bone marrow aspiration and biopsy.
Bone marrow aspiration is performed by inserting a special needle attached to a syringe into the bone marrow. Generally, the back of the hip bone (called the posterior iliac crest) is used. When the needle is inside the marrow the doctor pulls back the syringe. This causes some of the marrow to enter the syringe. The sample is looked at under the microscope and sent for cultures. A bone marrow biopsy removes a small amount of bone and a small amount of fluid and cells from inside the bone (bone marrow).The bone marrow biopsy tells doctors how well the marrow is functioning.
Treatment depends on the stage of the disease. Treatment options for Hodgkin lymphoma include chemotherapy, radiation, and stem cell transplant.
If caught early, Hodgkin lymphoma is highly curable. Some 85 percent of patients diagnosed with Hodgkin lymphoma are alive and well five years later. Of that group, 80 percent will be completely cured.
Non-Hodgkin lymphoma also originates in lymphocytes and is characterized as being fast or slow growing. Prognosis depends upon the type and stage of the disease at the time of diagnosis. Many people with fast-growing NHL can be cured and those with slow-growing NHL can manage the disease. The Leukemia and Lymphoma Society of America reports that in 2011 nearly 663,000 people were living with or in remission from lymphoma. More than 500,000 of these had NHL (LLS).
Non-Hodgkin lymphoma can arise in T or B-cells, though the majority of cases arise in B-cells. The National Cancer Institute estimates that there will be more than 70,000 new cases of NHL in the U.S. in 2012. Of these, close to 20,000 deaths can be expected (NCI).
Types of B-cell NHL include:
Types of T-cell NHL include:
There are several risk factors for Non-Hodgkin lymphoma.
Many of the symptoms of lymphoma occur in other diseases. Symptoms of lymphoma include:
Diagnosis of NHL begins with health history assessment and a physical examination. Blood tests and imaging studies are the same as those used for Hodgkin lymphoma.
The approach to treatment of NHL differs from that of Hodgkin lymphoma. Slow-growing or inactive tumors may not be treated until symptoms occur. This period of watchful waiting can last for several years. During this time, your doctor will schedule follow-up appointments to see if the disease is spreading. Treatment options include:
The outlook for NHL can be difficult to determine as there are so many diverse factors to consider. However, the American Cancer Society claims that 63 percent of patients diagnosed with NHL will still be alive five years later, and 51 percent at 10 years after diagnosis (ACS). As treatments continue to improve, so do the long-term survival rates for NHL.
Written by: Verneda Lights and Matthew Solan
Medically reviewed : Brenda B. Spriggs, MD, MPH, FACP
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