Lymphoma - Biomed PDF

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Summary

LymphomaLymphoma 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. Lymphoma is a heterogeneous g...

Description

Lymphoma 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. Lymphoma is a heterogeneous group of malignancy of lymphocytes accumulated in lymph nodes and other lymphoid organs and tissues. - If you have lymphoma, abnormal lymphocytes can collect in your lymph nodes, often in your armpits, neck or groin. However, abnormal lymphocytes can collect in almost any part of your body. They might be found in lymph nodes deeper in your body or in other parts of your lymphatic system, like your spleen. Less commonly, lymphoma can be extranodal, which means it starts in areas outside of the lymphatic system. These areas can include your lungs, liver or bones. - There are two main types of lymphomas which are Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL) Hodgkin Lymphoma  Definition and Pathogenesis Hodgkin Lymphoma originates from b cells. These B cells acquired a mutation of becoming mature. As it acquires the mutation it stops B cells from producing effecting Ig immunoglubin gene therefore there is a defective immunoglobulin. Hodgkin lymphoma is divided into two main subtypes which are: -

Nodular lymphocyte predominant Hodgkin Lymphoma (NLPHL) which accounts for 5% of the Hodgkin lymphoma. Classic Hodgkin Lymphoma (CHL) which accounts for 95% of Hodgkin lymphoma

Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) This is distinguished from classic lymphoma using morphology of the cell and immunophenotype. The cancer cells in NLPHL are large cells called popcorn cells (because they look like popcorn), which are variants of Reed-Sternberg cells. NLPHL usually starts in lymph nodes in the neck and under the arm. It can occur in people of any age, and is more common in men than in women. This type of HL tends to grow more slowly

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If a sample is stain with CD15 AND CD30 its shows a negative staining which means that it did not stain Whereas it show a positive stain when stained with CD20 and CD45 It has a popcorn like appearance

CLASSIC HODGKIN LYMPHOMA (CHL) The cancer cells in CHL are called Reed-Sternberg cells. These cells are usually an abnormal type of B lymphocyte. Enlarged lymph nodes in people with CHL usually have a small number of Reed-Sternberg cells with a lot of normal immune cells around them. These other immune cells cause most of the swelling in the lymph nodes. Reed-Sternberg cells do not express the classic B cell marker such CD20 AND CD79 but they are positive against CD30 AND CD15 so it is opposite to the Nodular Lymphocyte predominant Hodgkin Lymphoma. Classic HL has 4 subtypes: -

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Nodular sclerosis Hodgkin lymphoma or NSCHL: This is the most common type of Hodgkin disease in developed countries. It accounts for about 7 out of 10 cases. It's most common in teens and young adults, but it can occur in people of any age. It tends to start in lymph nodes in the neck or chest. Mixed cellularity Hodgkin lymphoma or MCCHL: This is the second most common type, found in about 4 out 10 cases. It's seen mostly in people with HIV infection. It's also found in children or the elderly. It can start in any lymph node but most often occurs in the upper half of the body. Lymphocyte-rich Hodgkin lymphoma: This sub-type isn't common. It usually occurs in the upper half of the body and is rarely found in more than a few lymph nodes. Lymphocyte-depleted Hodgkin’s lymphoma: This is a rare form of Hodgkin disease. It's seen mainly in older people and those with HIV infection. It's more aggressive than other types of HL and likely to be advanced when first found. It's most often in lymph nodes in the abdomen (belly) as well as in the spleen, liver, and bone marrow.

 Clinical manifestations Signs and symptoms of Hodgkin’s Lymphoma may include: -

Painless swelling of lymph nodes in your neck, armpits or groin Persistent fatigue Fever Night sweats Unexplained weight loss Severe itching Enlargement of the spleen (splenomegaly)

 Diagnostic work up

Blood test: full blood count shows high level of neutrophil and eosinophil and a Low lymphocyte with a normal level of platelet count. -

The patient will have an increase Erythrocyte Sedimentation Rate (ESR) especially when they have diseases like inflammation, infection, or cancer. ESR can also be used for disease progression monitoring Increased C-reacting protein when the liver is affected Increased lactase dehydrogenase as a result of the cells needing more energy

Bone marrow biopsy: bone marrow sample – biopsy may be carried out to see if the cancer has spread to your bone marrow; this involves using a long needle to remove a sample of bone marrow from your pelvis and can be done using a local anaesthetic

Stages of Hodgkin's lymphoma include: Stage 1: The cancer is limited to one lymph node region or a single organ. Stage 2: In this stage, the cancer is in two lymph node regions or the cancer has invaded one organ and the nearby lymph nodes. But the cancer is still limited to a section of the body either above or below the diaphragm. Stage 3: When the cancer moves to lymph nodes both above and below the diaphragm, it's considered stage III. Cancer may also be in one portion of tissue or an organ near the lymph node groups or in the spleen. Stage 4: This is the most advanced stage of Hodgkin's lymphoma. Cancer cells are in several portions of one or more organs and tissues. Stage IV Hodgkin's lymphoma affects not only the lymph nodes but also other parts of the body, such as the liver, lungs or bones. -

Letters A and B to indicate whether you're experiencing symptoms of Hodgkin's lymphoma: A means that you don't have any significant symptoms as a result of the cancer. B indicates that you may have significant signs and symptoms, such as a persistent fever, unintended weight loss or severe night sweats.

 Treatments of Hodgkin’s lymphoma

A combination of Chemotherapy and Radiotherapy is used to treat Hodgkin's Lymphoma. The choice of treatment is mainly based on the stage of the disease -

Chemotherapy is a drug treatment that uses chemicals to kill lymphoma cells. Chemotherapy drugs travel through your bloodstream and can reach nearly all areas of your body. Chemotherapy is often combined with radiation therapy in people with early-stage classical type Hodgkin's lymphoma. Radiation therapy is typically done after chemotherapy. In advanced Hodgkin's lymphoma, chemotherapy may be used alone or combined with radiation therapy.

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Radiotherapy is most often used to treat early-stage Hodgkin lymphoma, where the cancer is only in 1 part of the body. Treatment is normally given in short daily sessions, Monday to Friday, over several weeks. You shouldn't have to stay in hospital between appointments. Radiotherapy itself is painless, but it can have some significant side effects. These can vary and will be directly related to the part of your body being treated. For example, treatment to your throat can lead to a sore throat, while treatment to the head can lead to hair loss. When there is a relapse of the disease, Biopsy and restaging is needed. Radiation will be needed for the naïve area that has not been radiated.

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When the patient is less than 65 years old stem cell transplantation can be done.

The different types of drugs used are: ABVD A = Adriamycin (Doxorubicin) B = Bleomycin V = Vinblastine D = Dacarbazine BEACOPP B = Bleomycin E = Etoposide A = Adriamycin (Doxorubicin) C = Cyclophosphamide O = Oncovin (Vincristine) P =Procabazine P = Prednisolone...