Non-Hodgkins Lymphoma Essay Example

diseases as part of its immune system function. It comprises organs like the thymus, spleen, tonsils, lymph nodes, and lymphatic vessels. Lymph nodes can be found in groups under the skin in different areas including the neck, underarms, groin, chest, and abdomen.

Lymph nodes are connected by lymphatic vessels, which transport lymph - a clear liquid derived from the body's tissue. Eventually, this lymphatic fluid returns to the bloodstream. NHL (Non-Hodgkin's Lymphoma) begins when a lymphocyte becomes abnormal, leading to division and multiplication of these cells, resulting in the production of more irregular or cancerous cells (Jaffe ES, Pittaluga S, pg 1379-1396, 2005). The majority of NHL cases do not show identifiable risk factors, and even those who have risk factors do not seem to develop the condition.

Several factors can affect the likelihood of being diagnosed with NHL, including infections. Infections of different kinds can increase the risk of NHL in different ways. Certain viruses, such as HTLV-1 and EBV, directly affect the DNA of lymphocytes and cause them to become cancerous cells. In particular, infection with HTLV-1 raises the risk of certain types of T-cell lymphomas. This virus is commonly found in Japan and the Caribbean region but is also present worldwide.

Less than 1% of lymphomas in the United States are caused by HTLV-1, a virus transmitted through sexual intercourse and contaminated blood. It can also be passed to infants through breast milk from infected mothers. In regions of Africa where Burkitt lymphoma is common, infection with EBV poses a significant risk for this disease. In developed countries like the US, HIV-infected patients often associate EBV with lymphomas. Additionally, it has been linked to the

development of nasal T-cell lymphoma and post-transplant lymphoma. Exposure to certain chemicals may also contribute as a factor.

Research suggests a possible link between certain chemicals (such as benzene, herbicides, and insecticides) and an increased risk of developing NHL. Ongoing studies are examining these potential relationships further. Additionally, it has been found that certain chemotherapy drugs used for cancer treatment can raise the likelihood of developing leukemia or NHL several years later. For example, individuals who have received treatment for Hodgkin disease have a higher chance of subsequently developing non-Hodgkin's lymphoma.

It is unclear if this is caused directly by the illness or as a result of the treatment. The risk of acquiring this condition is greater in individuals who are 60 years old and older. People with weakened immune systems, such as those who have undergone organ transplants (like kidney, heart, or liver) and take immunosuppressive medications to prevent rejection of the transplant, are more vulnerable to NHL. These individuals have an increased chance of developing NHL.

The risk of developing non-Hodgkin's lymphoma (NHL) is higher for individuals with weakened immune systems, such as those infected with the human immunodeficiency virus (HIV) or children born with genetic syndromes causing immune deficiencies. Inherited immune deficiency diseases can be passed on to children, but individuals without these diseases do not pass on an increased risk of lymphoma to their children (Adams & Terry, 2009).

Non-Hodgkin's lymphoma may cause swollen lymph nodes in areas like the neck, groin, underarm areas, or above the collar bone. These affected lymph nodes may be detected as lumps under the skin by patients themselves, family members, or healthcare professionals. It is important to note

that enlarged lymph nodes are usually caused by infections rather than lymphomas. Abdominal lymphomas can result in swelling and tenderness due to tumors or large fluid collections. If a lymphoma causes swelling near the intestines it can lead to blocked feces passage resulting in abdominal pain, nausea, or vomiting.

Lymphoma originating in the thymus or lymph nodes in the chest can cause coughing or difficulty breathing due to pressure on the trachea. These lymph nodes are located near the superior vena cava (SVC), a major vein that carries blood from the head and arms back to the heart. Lymphomas in this area can compress the SVC, resulting in a condition called SVC syndrome where veins accumulate blood. Symptoms of SVC syndrome include swelling, bluish-red discoloration in the head, arms, and upper chest, as well as breathing difficulties and changes in consciousness if it affects the brain.

The SVC syndrome is a critical condition that needs immediate treatment. In addition to the local effects of cancer growth, NHL can cause general symptoms like weight loss, fever, night sweats, fatigue, and severe itching. These symptoms are commonly known as B symptoms among medical professionals. B symptoms frequently occur in lymphomas with fast growth rates. Many of the NHL-related symptoms do not definitively indicate the presence of cancer.

Swollen lymph nodes can be caused by non-cancerous issues like infections or other types of cancers. Doctors typically wait a few weeks to observe if the nodes stay enlarged, as an infection could be the cause rather than NHL. Antibiotics might be prescribed to test if they lead to node shrinkage. If the nodes keep growing or remain unchanged, a biopsy is usually

performed where a small piece or the entire node is removed for microscopic examination and lab tests.

According to Richardson P, Hideshima T, Anderson KC (2004), in situations where certain factors such as the size, texture, or location of a node or the presence of other symptoms strongly suggest cancer, an immediate biopsy may be required. The process of diagnosis and testing heavily relies on different types of biopsies. Doctors select the most suitable biopsy method based on each patient's specific circumstances. When lymphoma is suspected, the commonly used biopsy technique is either an excisional or incisional biopsy. This procedure involves a surgeon cutting through the skin to remove either the entire node (excisional biopsy) or a small portion of a large tumor (incisional biopsy).

When the node is near the skin surface, a simple operation with local anesthetic is usually done. However, if the node is inside the chest or abdomen, general anesthesia is needed. This method is typically effective in getting a sufficient sample for diagnosing NHL type. It's preferred as long as it doesn't cause excessive discomfort to the patient (NCCN, 2009). In a fine needle aspiration (FNA) biopsy, a doctor uses a thin needle connected to a syringe to extract tissue from a tumor mass. On the other hand, a core needle biopsy involves using a larger needle to remove a slightly bigger piece of tissue.

The doctor can identify and focus on a node near the body's surface by palpating it. In cases where the tumor is located deep inside the body, a computed tomography (CT) scan or ultrasound can assist in guiding the needle. It is worth noting that needle biopsy does

not require surgery; however, it may not yield sufficient sample for an unequivocal diagnosis in certain situations. Thankfully, significant improvements in laboratory testing and doctors' proficiency have greatly enhanced the precision of this procedure. These methods are mainly utilized for staging confirmed lymphoma cases but also serve diagnostic functions.

The bone marrow aspiration and biopsy procedures are usually done after lymphoma is diagnosed to check if the cancer has spread to the bone marrow. These tests are commonly done together. Usually, samples are taken from the pelvic bone's back, but occasionally they may be obtained from other bones like the sternum. During a bone marrow aspiration, the patient will lie on a table either on their side or stomach. The doctor will clean the skin over the hip and then use local anesthetic to numb both the area and surface of the bone, which might cause a brief stinging or burning feeling.

A thin, hollow needle is inserted into the bone and a syringe suctions out a small amount of liquid bone marrow (about 1 tsp). Despite the anesthetic, most patients experience brief pain during marrow removal. Following the aspiration, a bone marrow biopsy is typically performed using a slightly larger needle that is twisted downward into the bone, removing a small piece of bone and marrow. The biopsy may also cause brief pain. After the procedure, pressure is applied to the site to control any bleeding. (Harms R, Berge K, Hagen P, Litin S, Sheps S, 2009)

A lumbar puncture/spinal tap is performed to examine lymphoma cells in the cerebrospinal fluid (CSF), which bathes the brain and spinal cord. The patient may either lie on their

side or sit up during this test. The doctor numbs a lower area of the back over the spine and then inserts a small, hollow needle between the spinal bones to extract some fluid. (Shea JD & Hanes G, 2009)

If lymphoma spreads to the chest or abdomen, fluid can accumulate and be sampled through pleural or peritoneal fluid sampling.

Pleural fluid or peritoneal fluid is obtained by inserting a hollow needle into the chest or abdomen. Before the procedure, a local anesthetic is given to numb the skin. The extracted fluid is then examined under a microscope to identify lymphoma cells.

Blood tests are used to measure specific cell types and chemicals in the blood. Although not conclusive for diagnosing lymphoma, these tests can sometimes help determine the stage of the disease.

Patients with preexisting lymphoma may experience decreased blood counts, indicating the impact of lymphoma on new blood cell production in the bone marrow. Elevated levels of lactate dehydrogenase (LDH) found in blood tests often indicate rapid growth of lymphomas. Additionally, other blood tests can identify liver or kidney issues caused by the spread of lymphoma or adverse effects from specific chemotherapy drugs. These tests can also determine if treatment is necessary to address abnormal mineral levels in the bloodstream.

They can also be done to ensure proper blood clotting. (PDQ, 2009) Imaging tests utilize x-rays, sound waves, magnetic fields, or radioactive particles to generate body interior images. These tests serve various purposes such as detecting potentially cancerous areas, assessing cancer spread, and evaluating treatment effectiveness. Chest x-rays are commonly performed to examine lymph nodes enlargement in this region. (Johnston L, pg 176, 1999)

The CT

scan, a type of x-ray, can generate detailed images of the body and show soft tissue details. It is useful in detecting enlarged lymph nodes or organs in different areas like the abdomen, pelvis, chest, head, and neck. Moreover, CT scans can accurately guide a biopsy needle to a specific area of concern. Similarly, MRI scans also provide detailed images of soft tissues in the body.

MRI scans utilize radio waves and powerful magnets to produce detailed body images, distinguishing them from x-rays. The absorption of these radio waves by the body generates a distinct energy pattern that varies according to tissue type and specific diseases. In order to improve visibility, gadolinium, a contrast material, is typically introduced intravenously prior to the scan. Allergic reactions related to gadolinium are generally rare occurrences. MRI scans are particularly beneficial for examining the brain and spinal cord.

Ultrasound is a medical technique that utilizes sound waves and their reflections to generate an internal organs or masses image. The procedure involves the use of a transducer, resembling a microphone, which is applied on the skin after being lubricated with gel. The transducer emits sound waves and captures the echoes rebounding from the organs. Subsequently, these echoes are converted into a black and white image by a computer system that displays it on a screen. Ultrasound can be employed for lymph node examination on the surface and identification of enlarged lymph nodes or organs like the liver or spleen in the abdomen.

Swollen kidneys may occur due to enlarged lymph nodes obstructing the urinary outflow. PET scans, gallium scans, and bone scans are additional imaging tests utilized to evaluate the advancement of lymphoma.

Once non-Hodgkin's lymphoma is diagnosed, tests are conducted to determine the stage of the disease. The treatment and prognosis for NHL differ depending on the particular type and stage of lymphoma. The Ann Arbor staging system is used for this evaluation.

The Ann Arbor staging system is frequently utilized to describe the extent of NHL in adults. It employs Roman numerals I through IV (1-4) to indicate the stages. In case the lymphoma impacts extranodal organs, an E is added to signify the stage, while an S indicates spleen involvement. Stage I is recognized if either of these conditions exists: the lymphoma is limited to a single region like the neck, groin, or underarm, or it is present in a solitary area of a non-lymph organ (IE).

Stage II refers to the disease when either of the two conditions is met:
1. The lymphoma is present in two or more groups of lymph nodes on the same side of the diaphragm.
2. The lymphoma extends from a single group of lymph nodes into a neighboring organ, potentially affecting other lymph nodes on the same side of the diaphragm.

Stage III is identified when either of the following conditions is met:
1. The lymphoma is found in the lymph node areas on both sides of the diaphragm and may have spread into nearby organs or areas.
2. The lymphoma has spread to the spleen or both sides of the diaphragm, in addition to other lymph nodes.

Stage IV is determined by the presence of either of the following conditions:
1. The lymphoma has spread beyond the lymph system into an organ not adjacent to an affected node.
2. The lymphoma has spread to the

bone marrow, liver, brain, spinal cord, or tthe lining oft he lungs (pleura).

Each stage is assigned a Roman numeral along with an A or B designation. T_t^te letter B is added if any oft he "B symptoms" are present.

If a person experiences unexplained weight loss of more than 10% of their body weight, night sweats that soak the bed sheets, and an unexplained fever of at least 101.5°F, it indicates that the disease has progressed to a more advanced stage. On the other hand, if none of these symptoms are present, the stage is referred to as A. The type and stage of lymphoma offer crucial information regarding prognosis; however, in certain instances (particularly with fast-growing lymphomas), considering the stage alone is insufficient. In such cases, additional factors are taken into consideration for a better assessment of prognosis (Gribben JG, LaCasce AS, pg 1397-1419, 2005).

Treatment options for NHL have advanced in recent years and depend on the type, stage, and prognostic factors of the lymphoma. Each patient's treatment is tailored to their specific situation. Various types of treatment can be used, such as surgery, radiation therapy, chemotherapy, immunotherapy, bone marrow or peripheral blood stem cell transplantation, and participation in clinical trials. It is important for lymphoma patients to be aware of all their treatment options and seek a second opinion if possible to feel more confident in their chosen plan.

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Accessed on October 17, 2009 on the World Wide Web: http://www. cancer. gov/cancertopics/types/non-hodgkin Gribben JG,

LaCasce AS. Clinical manifestations, staging, and treatment of non-Hodgkin’s lymphoma. In: Hoffman R, Benz EJ, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlave P, eds. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, PA: Elsevier; 2005:1397-1419.

Harms R, Berge K, Hagen P, Litin S, Sheps S. (2009, September). Health Management and Resources. Retrieved October 12, 2009 from the World Wide Web: http://www. mayoclinic. com/health/non-hodgkins-lymphoma

Jaffe ES, Pittaluga S. The pathologic basis for the classification of non-Hodgkin’s lymphoma. In: Hoffman R, Benz EJ, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlave P, eds. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, PA: Elsevier; 2005:1379-1396.

Johnston L. (1999, May). Coping with the medical, financial, social and research aspects of NHL. Non-Hodgkin’s Lymphomas: Making Sense of Diagnosis, Treatment and Options. New York: Hendler Memorial Sloan Kettering Cancer Center.

National Cancer Institute.Physician Data Query (PDQ). Adult Non-Hodgkin Lymphoma Treatment. 009 Retrieved on October 18th 2009 from World Wide Web

National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Non-Hodgkin's Lymphoma Version 2nd Edition - 2009 Accessed on October 18th 2009 from World Wide Web

Richardson P., Hideshima T., Anderson KC.: Multiple lymphomas
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