Lymphoma

Etty Widyastuti

UNILA/RSU Abdul Moeloek

Lymphomas
Where They Begin

Lymphomas are a cancer of the lymphatic system

Lymphatic vessels Lymph nodes (underarms, groin, neck, spleen, tonsils and bone marrow)

Lymphomas
Where They Begin

The Lymphatic system is our bodies main fight against infection Lymphocytes (B-cell and T-cell)
Carried through our lymphatic system and help our bodies fight infection Lymphocytes are carried through the lymph vessels as well as the blood stream, so cancer can start in nodes and spread anywhere throughout the body.

 Major Lymph node locations.

Lymphomas
Neoplasms of lymphoid cells may be divided into two major groups: Non-Hodgkins lymphoma ~70% Hodgkins lymphoma ~30% Predisposing factors 1. Oncogenes, both lymphomas & leukemias may share the same oncogenes. 2. Radiation increases the risk of lymphomas particularly radiation therapy for neoplastic disorders. 3. Environmental factors, Burkitt lymphoma is related to EBV infection (particularly in Central Africa). 4. Immunodeficiency states (congenital or acquired) are associated with an increased incidence of lymphomas; HIV is associated with CNS lymphoma.

Non-Hodgkin lymphomas
Arising from both T and B cells and their precursor cells. 85% of non-Hodgkins are of B-cell origin and involve marrow, lymph nodes, spleen and extranodal lymphoid tissue. Approximately 2/3rds of cases begin in lymph nodes, the remaining begin in extranodal lymphoid tissue. Multiple nodes are usually involved.

Non-Hodgkin lymphomas
Four general categories have been identified: 1. Precursor B-cell neoplasms: present as acute lymphoblastic leukemia/lymphoma. 2. Precursor T-cell neoplasms ALL/L involving the mediastinum, lymph nodes and spleen. These respond less well than B-cell precursor types. 3. Peripheral B-cell neoplasms occur in several forms and affects adults. B-cell types are the most malignant

4. Burkitt lymphoma is a rapidly growing B-cell lymphoma affecting children and adults. It is related to EB virus infection. Solid tumors are often located in extranodal tissue.

Classification
Usually classified by how the cells look under a microscope and how quickly they grow and spread
Aggressive lymphomas (high-grade lymphomas) Indolent Lymphomas (low-grade lymphomas)

Non-Hodgkins Lymphoma Staging

Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced ). Each stage is then divided into categories A, B, and E
A: No systemic symptoms B: Systemic symptoms such as fever, night sweats and weight loss E: Spreading of disease from lymph node to another organ

Staging

Symptoms
Painful Swelling of lymph nodes located in the neck, underarm and groin. Unexplained Fever Night Sweats Constant Fatigue Unexplained Weight loss Itchy Skin
Cancer Sourcebook

Diagnosis
X-Rays CT scans Magnetic Resonance Imaging (MRI) Biopsy BMP Immunogenic Cytogenic

Treatment Options
Chemotherapy Allopurinol Hydration Urine alkalinization Bone Marrow Transplantation Immunotherapy
Using the bodies own immune system combined with material made in a lab.

Areas of involvement: This usually involves a neoplastic process in contiguous lymph nodes usually in the neck and mediastinum. Extranodal involvement and disease above and below the diaphragm portend poor prognosis.

Pathologic findings
o Affected nodes show an inflammatory response to tumor cells and contain infiltrates of lymphocytes, plasma cells and eosinophils Reed-Sternberg cells (large binucleate cells (owl eyes)) surrounded other cells that identify five types:

Clinical features
fever, sweating, weight loss, etc., (characteristic of an inflammatory process).

Prognosis
depends on the stage of disease at the time of diagnosis; histological type has little influence on outcome. 5-years survival is 75%, Relapse after initial treatment has ~50% survival rate.

Severity is proportional to the number of RS cells and inversely proportional to the number of reactive lymphocytes

Clinical Differences Between Hodgkin and Non-Hodgkin Lymphomas Hodgkin Lymphoma Non-Hodgkin Lymphoma More often localized to a More frequent single axial group of involvement of nodes (cervical, multiple peripheral mediastinal, para-aortic) nodes Orderly spread by Noncontiguous spread contiguity Mesenteric nodes and Waldeyer ring and Waldeyer ring rarely mesenteric nodes involved commonly involved Extranodal involvement Extranodal uncommon involvement common