The cells in most organs have a short
lifespan. Therefore, to continue functioning the body needs to replace these lost cells by the process of cell division.
Under normal conditions there is a balance
in which new cells replace old, and each cell carries out tasks
specific to its kind.
Lymphoma is a blood cell cancer caused when lymphocytes -- a type of white blood cell
that help to fight infection -- are damaged in ways that affect
how the cells grow and survive.
...
The damaged cells reproduce and do not die off as do normal lymphocytes.
The abnormal cells accumulate and eventually form tumors, most typically in
the
lymphatic system
(lymph nodes, bone marrow, spleen) but also in other parts of the
body such as the skin.
Risk factors for
developing a lymphoma include
chronic infection, immune deficiencies, environmental toxins, and
older age. Lymphomas probably arise most often from
multiple causes (including random cell copy errors) over many years.
The
symptoms of lymphoma include
unexplained: enlarged
lymph glands, fatigue, persistent
fever, drenching night sweats, and weight loss.
The symptoms of lymphoma are similar to common medical conditions,
such as infection where normal lymphocytes accumulate to fight off
infection. Low levels of lymphoma may not cause
symptoms, but symptoms can range from mild to severe.
The
diagnosis of a lymphoma requires a tissue biopsy to examine the
cells to see if they are abnormal (clonal: all derived from each
other) or normal lymphocytes (diverse, polyclonal, polytypic) --
"reactive" to an infection.
The diagnostic
tests will
also determine the type of lymphoma based on the
maturation stage of
the lymphocyte - sometimes referred to as the histology, which
is based on the unique features of the cells in different stages of
maturation (differentiation).
The features of the
cells are identified by
staining tests to see what sticks to the receptors on the cell
surface.
The most common histologies are Diffuse Large B-cell
Lymphoma and Follicular Lymphoma.
Lymphomas are
broadly classified:
* In Hodgkin's disease, the abnormal lymphocyte is the
Reed-Sternberg cell
(a B lymphocyte. This particular lymphocyte isn't found in other types of
lymphomas.
All other types of lymphomas are called non-Hodgkin's
(NHL). Important clinical differences are the very high cure rate of
Hodgkin's; that it tends to affect
younger people* ; and that the
incidence rate of Hodgkin's is lower than NHL.
** B- and T-cells are the two distinct types of
lymphocytes. B-cells are antibody-producing cells.
T-cell lymphomas are
much less common than the B-cell types.
*** Genetic mutations and expression (which genes are
damaged, or turned on or off) can vary within the same diagnostic types of
lymphoma, affecting how they behave and respond to treatment.
The
treatment of lymphoma depends
on type of lymphoma,* the grade, the stage
(how widespread it is), one's age and general health, and whether the
lymphoma has been treated before.
* An
accurate diagnosis is important, and a
second evaluation of the biopsy sample
is often recommended because different types of lymphoma can look
similar under the microscope and may be treated differently.
Importantly, unlike
"solid" cancers, lymphomas are treatment-sensitive and can be effectively treated and/or
cured even at an advanced stage.
Indolent lymphoma might be
observed,
or treated conservatively as needed, or treated with intent to
achieve a durable remission and possible cure.
Aggressive
lymphomas are generally treated soon after diagnosis with the intent to cure.
Because there are
so many types of lymphoma and because best practice is evolving
rapidly, we recommend that patients consult a
lymphoma specialist for a second opinion. For the less
common types of lymphoma and the higher-risk types, consulting an expert is
very important in
order to take advantage of the latest advances in treatment,
including
clinical trials*.
* Contrary
to widespread public perception, clinical trials rarely if ever
use placebo controls (sugar pills).
Investigational protocols, carefully evaluating the safety and
efficacy of new protocols that are thought to work by mechanisms
that may overcome resistance to standard treatments - or improve
on the safety and efficacy of standard treatments, can compare
well to standard approaches as described here:
7 Clinical
Circumstances to Consider Clinical Trials - patient centered
criteria.
See
also for Best Practice guidelines:
Cancer.gov and
NCCN.org
Recommended article:
Dr. Sharman's CLL & Lymphoma Blog:
Making sense of all the different lymphomas
And our Getting Started resources:
Guidelines
at Diagnosis |
Getting
Started |
Focus on Clinical Trials
and Lymphoma
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