Everything You Need to Know About Lymphoma – From Causes to Treatment

Introduction lymphoma

Lymphomas are a group of diseases characterized by the spread of malignant lymphoid cells to the lymph nodes. Lymphomas differ from CLL, because lymphomas do not usually spread to peripheral blood and Bone morrow, until the very late stages.  There are two major types of lymphomas: Hodgkin’s disease (HD) also called Hodgkin's lymphoma, and Non-Hodgkin Lymphoma (NHL). Lymphoma is cancer of the lymphatic system. The lymphatic system is part of our immune system it helps us fight infections. A lymphoma starts when the lymphocytes become abnormal. The abnormal cells make more abnormal cells, which means you have many more lymphocytes than usual, but they can’t fight as well as they should. These abnormal cells circulate around the lymphatic system and start to build up in the lymph nodes forming a lump. You may notice swollen glands in your neck, armpit, or your groin. Lymphoma affects white blood cells called lymphocytes. 

Types of lymphoma

1. Hodgkin's lymphoma:

Hodgkin's lymphoma: is a cancer that begins in the lymphocytes, a type of white blood cell and primarily affects the lymph nodes it is characterized by the presence of reed-Sternberg cells, which are large, abnormal lymphocytes. Bimodal age related incidence rate with peak incidence in both young, adult and elderly Patient generally present with Lymph node enlargement. Histological examination effected very mixed cellular infiltrate including Lymphocytosis, Plasma cells, Eosinophil’s, and Fibroblast. Reed Sternberg which is the essential cells in   diagnosis of HD (large and appears binuclate or multinucleated cells with prominent nucleoli). Subtypes of classical Hodgkin's lymphoma include: Nodular sclerosis, mixed cellularity,   Lymphocyte-depleted, and Lymphocyte-rich. Primary treatment: chemotherapy is often the first line of treatment Hodgkin’s lymphoma involving the use drugs to destroy cancer cells.  

2. Non-Hodgkin Lymphoma (NHL):

Non-Hodgkin Lymphoma is a diverse group of lymphoid malignancies originating from B cells, T cell, or natural killer cells. It is characterized by the proliferation of lymphoid cells in lymph nodes or extranodal sites. Are neoplastic clonal proliferation of lymphocytes, in any individual tumor the malignant clone will be either B cells or T cells but not both. (B cells 80-85%).  NHL can affect in all ages predominantly of older adults.  Histological examination can also categories NHD into favorable or low grade cases and unfavorable or high grade cases. The patients usually present with lymph node enlargement, localized or widespread. NHL and HD are of unknown etiology but risk group include patients with viral infection e.g. AIDS, Human T- cell lymphocytotrophic virus (HTLV-1), and also patients with auto-immune disorders e.g. rheumatoid arthritis and etc. Clinical presentation of NHL is quite similar to that of HD, i.e., fever, night sweat, weight loss, painless lymphadenopathy. Haematology lab work ups are usually normal until very late stages of the disease.  BM shows no significant changes until the very late stages.

Sign and symptoms lymphoma

The symptoms for both HD and NHL are similar including: Painless enlarged lymph nodes (usually in the neck), fever, night sweat, and weight loss.  Clinical investigations of the advanced stages of the disease might reveal increased susceptibility to infections, spread of malignancy to other lymph nodes, and other organs (e.g., liver, spleen, BM, Pb, etc.) leading to organ failure and death within 1-2 years. In the early stages, the spread from one lymph node to another in HD is predictable or systemic (from one, to the most adjacent, then to the furthest, where as spread in NHL is unpredictable and could reach even non-lymphatic organs.  HD accounts for up to 25% of all lymphoma cases.

Causes and risk factors

• Weak immune system or autoimmune disease

• Certain infections like HIV, Epstein-Barr virus

• Exposure to chemicals or radiation

• Family history of lymphoma

• Age

• Lifestyle factors like smoking and obesity

Diagnosis of lymphomas

Routine histological examination of effected tissues are always important and in some cases may be all that is needed to make the correct diagnosis.  Immunophenotyping: helpful done by flowcytometery on routine sections. Peripheral blood shows a normal picture in early stages, which changes as the disease progresses and lymphocytopenia will occur. Only about 10% of patients present with normocytic normochromic anemia. BM aspirates are useless especially in the early stages. Routine CBC, and BM are considered useless in diagnosis.

Haw to treatment lymphoma

HD and NHL are treated by the implementation of radio-, or chemotherapy. Radiotherapy is more useful in early forms of these diseases. Combination therapy is the choice treatment for the later stages.

Haw to prevention of lymphoma

• Maintain a healthy immune system

• Adopt a balanced diet and regular exercise

• Avoid exposure to harmful chemicals, pesticides, and radiation

• Prevent and treat chronic infections (e.g. HIV, hepatitis C, EBV)

• Quit smoking and limit alcohol

Conclusion

Lymphoma is a cancer of the lymphatic system that affects lymphocytes. Early diagnosis and proper treatment greatly improve recovery. Advances in therapy have increased survival rates, and ongoing research continues to enhance treatment outcomes.