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Lymphoma

What is lymphoma?

Blood cancer is an expression used synonymously for all cancers that originate from the bone marrow where blood is produced or originate from the blood. Lymphoma accounts for 50 percent of blood cancers. Lymphoma is divided into two types: Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma. Non-Hodgkin's lymphomas are about 8 times more common than others.

There are also subtypes of two important types of lymphoma cancer. There are at least 40-50 subtypes of Non-Hodgkin's lymphoma. On the other hand, 6-8 subtypes of Hodgkin's lymphoma can be stated. Clinical course of all of them, their responses to the treatment, the medications used in their treatment differ from each other. For this reason, after diagnosing lymphoma, it is also necessary to accurately determine which subtype the disease is. Therefore, the search for the best hospital for the treatment of lymphoma is becoming very important. For the treatment of lymphoma, the hospitals with an experienced and qualified team of physicians and advanced technological infrastructure should be preferred.

What are the symptoms of lymphoma (Lymph) cancer?

• Growing mass and lymph nodes in the body:
The first thing that comes to mind when you say a symptom of lymphoma is that usually the patient has noticed a growing mass in his/her body. This mass can apply pressure on certain areas. Lymph cancer reveals itself as a clinical symptom mainly by pathological growth of glands called “lymph nodes”. Because the place where the tumor mass grows is mainly the lymph nodes. Therefore, great majority of the patient appeal to the hospital by noticing enlarged lymph nodes in the neck, armpits, and inguinal areas.

Lymphoma occurs not only with the growth of lymph nodes. It is a disease that can also affect the liver, spleen, gastrointestinal system, and lung. Every tissue in the body has potential to be held by lymphoma. Hence, organ involvement can occur. Bone marrow can also show involvement due to these diseases.

• The table of prolonged and aggravated flu:
One of the symptoms of lymphoma is that the patient may show flu-like symptoms because his/her immune system is not functioning sufficiently. Influenza is a disease that is expected to recover within week from as from starting. In addition, when sinusitis and lung infections occur, the period may be prolonged. But if there are such conditions that take for weeks and aggravate the table of infection, you must contact a specialist necessarily.

• Weight loss and night sweating:
Some patients may also have complaints related to the systemic effects of cancer, such as fever, weight loss, night sweating. If lymphoma is suspected clinically when the patient comes with these symptoms, he/she is examined for understanding the presence of a growing and detectable mass. It also should be controlled whether there is a mass or lesion in the body of the patient through imaging methods.

• Complaints specific to the region where the mas affected:
Lymph node swelling that is one of the symptoms of lymphoma can also occur in the thoracic cage or abdominal cavity. It may not be directly realized how much the mas has grown here . But the pressure created by this can cause complaints in the patient. Lymph growing in the thoracic cage can lead to problems such as chest pain, dry cough, and shortness of breath. A mass growing in abdominal region negatively affects functioning of the stomach and intestinal system. Abdominal pain, diarrhea, constipation, and digestive disorders are also symptoms of lymphoma.

• Same symptoms as other diseases:
Lymphoma can also reveal itself with symptoms of allergic cough, asthma attacks and sinusitis. Because none of the signs and symptoms of lymphoma are specific to the disease alone. Many other diseases may have same symptoms. Sometimes the symptom of lymph cancer occurs in a similar way to rheumatic diseases. The patient may appeal to the hospital with complaints of rheumatic disease, and the condition may occur with the help of research. In short, lymphoma can mimic any disease. Therefore, the symptoms of lymphoma should be taken into consideration.

• Swelling of one of the tonsils:
One of the signs of lymph cancer is the growth of one of the two tonsils, rather than swelling of both tonsils. Asymmetric growth has a higher risk of development of lymphoma. The tonsil is actually a lymphoid tissue. Like lymph node, it is a lymphoid tissue located in inside of the mouth in the throat and is an organ of this system. It can hold that area there and lead to growth. Since the growth of the tonsils is primarily suggestive of an infection, the patient is prescribed infection treatment. It is expected that if any improvement is not achieved despite use of medication within 10 days period, other underlying causes should be researched.

How is lymphoma diagnosed?

In order to diagnose lymphoma, it is necessary to take a piece from the affected area for a biopsy. Final diagnosis is made by histopathological examination. For this reason, the patients with lymph node enlargement is recommended that a piece of the lymph node is taken with fine needle aspiration biopsy or TRU-CUT biopsy primarily by physicians of by Interventional Radiology. In areas where Interventional Radiology cannot reach, surgical removal of lymph nodes and execution of histopathological examination should be carried out by the physicians of General Surgery or ENT.

What are the types of lymphoma ( Lymph cancer )?

The most common cancers in Hematology are lymphomas that are lymph node cancer. These diseases are divided into two large groups as Hodgkin's lymphoma and Non-Hodgkin's lymphomas (English: Non-Hodgkin's lymphoma). Non-Hodgkin's lymphomas constitute a group that has many different biology and processes, and in which the diseases with different treatments gathered.

Hodgkin's Lymphoma

Hodgkin's lymphoma reveals itself with an increase in lymph nodes. In some patients, symptoms of Hodgkin's Lymphoma are observed in the form of weight loss, night sweating, and recurrent fever. In order to determine the stage of the disease, computed tomography and bone marrow biopsy are usually required.

Hodgkin's lymphoma is one of the types of cancer that has a high success rate of treatment today. At each stage, treatment is carried out with the goal of completely eliminating the disease. There are some groups in the world that work to record developments in the treatment of Hodgkin's lymphoma and conduct large-scale studies, and one of them is German Hodgkin Study Group (GHSG). Factors called risk factors are important in treatment of disease private to the patient. In patients who is at early stage and does not have bad risk factors, a short-term chemotherapy and radiation therapy called ABVD is sufficient. But if the disease has progressed, a much more effective treatment (escalated BEACOPP protocol) may be required to completely destroy the disease and prevent its recurrence. If there has been a relapse, high-dose chemotherapy and autologous stem cell transplantation are usually the best treatment option to completely eliminate the disease.

Non Hodgkin's Lymphoma

Non-Hodgkin's lymphomas are divided into 3 large groups:

  • Indolent (slow-progressive) lymphomas,
  • Aggressive (rapidly progressing)
  • Very aggressive (very rapidly progressing) lymphomas

 

Course of these diseases and their treatment also vary greatly. Non-Hodgkin's lymphomas are also divided into 2 groups in terms of immunological cell type: B-cell and T-cell lymphomas. Generally, T-cell lymphomas have a worse prognosis than B-cell lymphomas. Therefore, in modern treatment of T-cell lymphomas, more intensive and effective methods of treatment are selected. While chemotherapy protocol called CHOP had been applied in most Non-Hodgkin's lymphomas in the past, today more effective treatments, that vary according to subtype of the disease and are private to the disease, are carried out. It is even possible to treat some types of lymphoma with antibiotic agents without using chemotherapy. For example, some types and stages of lymphomas that form in the stomach or eye can be completely eliminated with antibiotic therapy. In order to be able to choose the most appropriate treatment that will be recommended to the patient, it is necessary to know exact subtype of lymphoma, its stage, and prognostic factors. Therefore, choice of fully equipped oncology center is very important.

What are the Most Common Types of Non-Hodgkin's Lymphomas?

Slow-progressive lymphomas

  • Follicular lymphoma
  • Chronic lymphocytic leukemia
  • Immunocytoma

Rapidly progressing lymphomas

  • Diffuse Large B-cell lymphoma
  • Majority of T lymphomas
  • Mantle cell lymphoma

Lymphomas that progress very quickly

  • Burkitt lymphoma
  • Lymphoblastic B lymphoma
  • Lymphoblastic T lymphoma

 

Slow-Progressive (indolent) Lymphomas:
The disease is usually diagnosed at stage III or IV. If the disease is diagnosed at stage I or II, treatment is performed with the goal of destroying the disease with radiation therapy. Chemotherapy is administered in certain cases in further stages; if there is no need for this, the patient is monitored without treatment (In English “wait and see”) because starting treatment earlier than necessary in these cases does not give the patient an advantage. A medication, that is called Rituximab and targets CD20 molecule on B-lymphoma cells, affects response rates and response time by reinforcing effect of chemotherapy.

Rapidly Progressive (aggressive) Lymphomas:
Diffuse large B-cell lymphomas make up a significant part of aggressive lymphomas. The treatment is carried out with the aim of completely eliminating the disease, and it consists of Rituximab and CHOP chemotherapy. As for aggressive T-cell lymphomas, addition of Etoposide to the CHOP protocol (CHOEP protocol) enhances the success rate as German and Scandinavian studies have indicated. Since prognosis is bad for most aggressive T-cell lymphomas, high-dose chemotherapy, and autologous stem cell transplantation after 6 courses of chemotherapy play an important role in permanent control of the disease.

Mantle cell lymphoma is aggressive lymphoma in which important stages have been recorded in recent years. In young patients, medication treatment is firstly prescribed. In young patients, after this treatment, stem cells are collected from the patient, and high-dose treatment and stem cell transplantation give the best results. In elder patients, maintenance treatment after chemotherapy prolongs life expectancy.

Lymphomas That Progress Very Quickly: Another group is very aggressive lymphoma. The most important one of them are Burkitt's lymphoma and lymphoblastic lymphomas. These types of lymphoma are most often observed in young patients. Burkitt's lymphoma is the fastest-progressing type of cancer in humans. Objective of the treatment for these diseases is to destroy the disease. But this objective is not achievable with simple treatments. Chemotherapy that consists of a large number of medications and is reminiscent of leukemia treatment, can permanently destroy the disease.

 

What is follicular lymphoma?

Follicular lymphoma (FL) is a slow-moving disease originating from germinal center B cells, and it is the second most common non-Hodgkin's lymphoma subtype in western world. FL is characterized by diffuse lymphadenopathy, bone marrow involvement, spleen size and, to less extent, involvement of non-lymph node sites.

 

 

What are the different types of non-Hodgkin's lymphoma?

The NHL is examined in two main headings:
A-) Slowly developing or otherwise low-grade or indolent
B-) Rapidly developing or otherwise called high-grade or aggressive

 

A-) Slowly Developing or Indolent NHL
Follicular lymphoma is the most common type of slowly developing NHL.

  • Chronic lymphocytic leukemia
  • Cutaneous T-cell lymphoma
  • Lymphoplasmacytic lymphoma
  • Marginal zone lymphoma
  • Mucosa-associated lymphoid tissue (MALT) lymphoma
  • Small cell lymphocytic lymphoma
  • Waldenström macroglobulinemia

 

B-) Fast-Developing or Aggressive NHL
Diffuse large B–cell lymphoma is the most common type of rapidly developing NHL.

  • AIDS-related lymphoma
  • Anaplastic large cell lymphoma
  • Burkitt lymphoma
  • Central nervous system (CNS) lymphoma
  • Follicular lymphoma
  • Lymphoblastic lymphoma
  • MALT lymphoma (transformed)
  • Mantle cell lymphoma (most types)
  • Peripheral T-cell lymphoma (most types)

 

There is treatment for all types of NHL. Healing can be achieved in some of rapidly developing NHL patients. Through treatment, the disease can be controlled fo years in the patient with slowly developing NHL.

 

What is the difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma?


Both are malignant lymphomas originating from B-Cell. Chemotherapeutic agents used in the treatment are different.

 

 

What are the causes of lymphoma? Is lymphoma genetic?

People infected with human immunodeficiency virus (HIV) have a high risk of development of lymphoma. Prevalence of NHL is higher in communities engaged in agriculture. In the studies conducted, the relationship between organochlorne, organophosphate and phenoxid compounds found in pesticides used to control harmful plants and pests and lymphoma was detected. Number of lymphoma cases that develop due to exposure to such substances is unknown.

 

Exposure to certain viruses and bacteria is also associated with NHL. It is projected that virus or bacterial infection enhances the possibility of the factor causing the cancer in the cell by leading to densely proliferation of lymphoid cells.

Some examples include:

  • Epstein-Barr virus (EBV) infection –in patients of certain geographical areas – is closely related to African Burkitt's lymphoma. The role of the virus is not clear, this is because of that African Burkitt's lymphoma is also observed in people who do not have EBV infection. Epstein-Barr virus infection can lead to NHL risk in those whose immune systems are suppressed as a result of organ transplantation and related treatment.
  • Human T-lymphotropic virus (HTLV) is associated with a type of T-cell lymphoma in some geographical areas such as southern Japan, Caribbean, South America, and Africa.
  • Bacteria, that is called Helicobacter pylori and leads to stomach ulcers, plays a part in the formation of lymphoid tissue (MALT) lymphoma associated with the mucosa in the stomach wall.
  • About a dozen hereditary syndromes can increase predisposition to NHL in people later in life. These hereditary diseases are not frequently observed; however, it is being investigated whether the genes leading to predisposition also play a role in sporadic NHL formation in healthy individuals.

 

Type of disease is determined by genetic analysis of lymphoma cells.
Genetic structure of cells that have been determined to be lymphoma is also analyzed, thus its subtype is accurately determined. This result is extremely important for the success of lymphoma treatment. After exact diagnosis of lymphoma is made, it should be investigated whether the disease has spread to the body. PET-CT is also most often performed for this. Via this study, location of involvement caused by lymphoma is detected.

 

How is lymphoma cancer treated?

Lymphoma treatment is started when exact diagnosis of lymphoma is primarily made. The parts taken by the biopsy are examined under a microscope. Owing to this, lymphoma is diagnosed. But this morphological assessment is not enough to reveal a subtype of the disease. In order to make an accurate diagnosis, different tests are necessarily required. In addition, special tests are also performed to determine type of lymphoma through special staining techniques.

 

Very important improvements have been made in hematological cancers in recent years. These improvements consists of a better understanding of biological characteristics of blood cancers, and of advances in diagnosis and success in treatment. A large number of medications used in the treatment of many diseases in Hematology have shown their effectiveness in new clinical trials; and medications that have interesting impact style and target cancer cell become prominent.

Staging is important for correct treatment of lymphoma.
For the treatment of lymphoma, patients can appeal to a physician at very different stages. Generally, lymphoma is divided into 4 stages according to prevalence. Stages 1 and 2 are called early, and 3 and 4 are called more advanced in the stages of lymphoma. After final diagnosis of lymph cancer is made, a special evaluation is carried out to determine its stage. In other words, via this scoring technique, it is possible to see to what extent the patient will respond to the treatment. A number of factors, that include the patient's age, level of value called LDH in the blood, whether the disease is at an advanced stage, whether there is involvement elsewhere other than the lymph node, are all combined and scored. According to this scoring, the patients fall into low or high-risk group. If the patient's risk profile is high, it is less likely to benefit from standard lymphoma treatments. For this reason, these groups of patients may undergo more severe treatments. If the risk profile is low, more standard treatments are preferred.

 

Chemotherapy for the Treatment of Lymphoma (Lymph cancer)

Chemotherapy has an important place in the treatment of lymphoma. How and how chemotherapy will be administered differs depending on the condition of the disease. As well as standard medication methods that can be applied as outpatient, high-dose chemotherapy is also administered to the patients with rapid course and high risk as they will receive it under hospitalization. Chemotherapy intervals for the treatment of lymphoma are usually 3-4 weeks, and final result is expected from the treatment after 6 courses are performed. During this period, the response received through mid-term evaluation is also observed. These follow-ups are performed after the second or third cycle.
Chemotherapy is one of the most commonly used treatment methods for blood cancers, especially for the treatment of lymphoma. Different combinations of medications are used for each disease. Severity of medications also increases when standards are exceeded, and high doses are administered. Problems may develop due to hair loss, gastrointestinal system disorders, wounds inside of the mouth, the patient's loss of appetite, weight loss, fatigue, and intervening severe infections that are observed in many classical chemotherapies because these medications damage health cells also. As the complications that may occur in this type of treatment can be foreseen in advance, necessary precautions are taken, and it is ensured that the patient overcomes treatment period as free of risk.

 

Radiotherapy for the Treatment of Lymphoma (Lymph cancer) In addition to chemotherapy, actinotherapy, in other words. radiotherapy, is sometimes used as a support in the treatment of lymphoma. In cases that the disease is common, Radiotherapy is benefited to eliminate the pressure that very grown lymph in any location may apply and to relieve this location even not with the intention of treatment of the treatment.

 

Immunotherapy in the Treatment of Lymphoma

In the treatment of lymph cancer, except chemotherapy, one of the treatments, that is often used or combined, is immunotherapy . A number of medications called “monoclonal antibodies” developed for cancer cell are often used in treatment. Feature of these medications is that they stick to the lymphoma cells, and then activating immune system, they destroy them by means of immune system. There are also “monoclonal antibody” treatments that are used in combination with chemotherapy to treat lymphoma and differ according to type of each lymphoma. Such treatments increase the chances of success.

 

 

Target-specific rational drug treatments

There are treatments for lymphoma that have been applied for the last 10-20 years, but their momentum and recognition have increased over the last 10 years. Target-specific treatments are currently not limited to ”monoclonal antibodies" only. A set of other medications and molecules that are not monoclonal antibodies have also been developed. They are called ”target-specific“ or ”rational drug". Owing to rational drug, target-specific molecules disrupt a number of mechanisms that are present in cancer cells and are not present in healthy cells. For this reason, when the drugs are administered to the patient, cancer cell is very intensively affected, and while healthy cells are minimally affected. Side effects of drugs used in target-specific treatments are never the same as the side effects of classic chemotherapy drugs. Almost all patients do not experience problems such as hair loss, nausea, vomiting, loss of appetite. Side effects that are mild and very easily controlled are also tolerated by the patients.

 

Effective option for the treatment of lymphoma: Bone Marrow Transplantation
Bone marrow or stem cell transplantation is often performed to treat lymphoma. There are two types of bone marrow. Successful results are obtained through transplantations, that consist of two types; one is called autologous transplantation that is performed by use of patient's own stem cell and the other one is called allogeneic transplantation that is performed by use of another person's stem cell. Purposes of execution of both are different from each other. In general, main point of execution of bone marrow or stem cell transplantation is that a bone marrow or stem cell transplantation is not a initial treatment. As soon as the patient is diagnosed, a bone marrow transplantation is not performed to treat lymphoma. In the treatment of lymphoma, it is firstly aimed to destroy or suppress the disease through chemotherapy, immunotherapy and radiotherapy, and then, the method of transplantation is appealed according to the response received and if is found necessary. In some diseases, even if standard treatment is given at the initial level and success is achieved with this, the disease will most likely recur after a while. In order to minimize the risk of recurrence in such patients, stem cell transplantation is performed.

 

Autologous Stem Cell Transplantation in the Treatment of Lymph Cancer (Lymphoma)

Even if the disease is destroyed with standard treatment, microscopic cancer cells that are invisible remain behind, and they must be destroyed via very high doses of chemotherapy. Because of this treatment, the bone marrow forming blood cells is also affected. For this reason, the patient's own stem cells are taken by various methods before the treatment of lymphoma and stored by freezing following exposed to special procedures. Then very high dose of chemotherapy is administered to the patient. After the treatment is over, the patient's own bone marrow cells that were previously stored are again transplanted to the patient. These cells settle in the bone marrow and multiply there and begin to produce blood. In other words, bypass had been done and those cells had been saved. However, autologous transplantation may not always be performed. Because bone marrow of the patient who has involvement in their bone marrow cannot be taken, sibling who have 25% possible compatibility, or mother and father, and if necessary, bone marrow bank are appealed.

 

 

What should be considered after lymph (lymphoma) cancer treatment?

The patient is recommended to come to his/her physician for the purpose of control at regular intervals. Because there is always a possibility of recurrence of the disease. Other points that should be considered are the same as in general cancers.

 

Why should I have Memorial Health Group lymphoma cancer treatment?

Memorial Bone Marrow Centers, that is highly equipped and has A+ hospitals with high technology and has strong and experienced physician team and staff, carry out the treatment of lymphoma, one of the most common blood cancers, with council's decision that is private to patient and multidisciplinary.

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