Non-Hodgkin's Lymphoma

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Definition/Description

Non-Hodgkin's lymphoma (NHL) is "a group of lymphomas affecting lymphoid tissue and occuring in persons of all ages." "The lymphoid malignancies present as solid tumors arising from cells of the lymphatic system. The lymph nodes are ususally involved first, and any extranodal lymphoid tissue, particularly the spleen, thymus, and GI tract, may also be involved. The bone marrow is commonly infiltrated by lymphoma cells, but this is rarely the primary site of a lymphoma. 

Lymphomas are classified according to the World Health Organization (WHO) which relies on the histochemical, genetic and cytologic features of the cells. Lymphomas are classified as either B-cell or T-cell lymphomas."

Prevalence

"NHL can affect any age range of individuals. It is more common in middle aged adults between the ages of 40 to 60." "NHL comprises a large group of lymphoid malignancies (about 30 different specific types) and affects over 67,000 people per year, making this the 5th most common cancer in the United States."  

B-cell lymphomas: account for approximately 85% of non-Hodgkin lymphomas in the United States.

• Diffuse large B-cell lymphoma: is one of the more common types on non-Hodgkin lymphoma in the U.S. and affects about 1 out of 3 cases (or 33%).
• Follicular lymphoma: affects about 1 out of 5 cases of non-Hodgkin lymphoma in the U.S.
• Small lymphocytic lymphoma: accounts for about 5% to 10% of all lymphomas.
• Mantle cell lymphoma: accounts for about 5% of lymphomas.
• Marginal zone B-cell lymphomas: account for about 5% to 10% of lymphomas.
• Primary mediastinal B-cell lymphoma: accounts for about 2% of all lymphomas. About 2 out of 3 people with this type are females in their 30s.
• Burkitt lymphoma: accounts for about 1% to 2% of all lymphomas. Close to 90% of patients with this type are males in their 30s.
• Lymphoplasmacytic lymphoma: accounts for 1% to 2% of all lymphomas.
• Hairy cell leukemia: is rare but accounts for about 1,000 people in the U.S. each year.

T-cell lymphomas: account for less than 15% of non-Hodgkin lymphomas in the United States.

• Precursor T-lymphoblastic lymphoma/leukemia: accounts for about 1% of all lymphomas.
• Peripheral T-cell lymphomas: are comprised of 7 different types of lymphoma and account for about 5% of all lymphomas.
  
  

    

Characteristics/Clinical Presentation

"NHL presents in a similar manner as Hodgkin's disease, but NHL is usually more widespread and less predictable. The disease starts in the lymph nodes, although early involvement of the orophryngeal lymphoid tissue or the bone marrow is common, as is abdominal mass or gastrointestinal involvement with complaints of vague back or abdominal discomfort." "The most common manifestation is painless enlargement of isolated or generalized lymph nodes of the cervical, axillary, supraclavicular, inguinal, and femoral (pelvic) chains." "The development of these enlargements may occur slowly & progressively or rapidly depending on lymphoma type (indolent or aggressive)." "Indolent disease may be minimally active & treatable for many years."

"Extranodal sites of involvement may include the nasopharynx, GI tract, bone, thyroid, testes and soft tissue. Abdominal lymphoma may cause abdominal pain & fullness, GI obstruction or bleeding, ascites, back pain & leg swelling. Lymph node enlargement in the chest can lead to compression of the trachea or bronchus, causing shortness of breath & coughing."

"Primary CNS lymphoma is a NHL restricted to the nervous system. Presenting symptoms may include: headache, confusion, seizures, extremity weakness/numbness, personality changes, difficulty speaking & lethargy. (Prior to the spread of HIV, this type of lymphoma was rare.)"

Clinical Signs & Symptoms of NHL:

• Enlarged lymph nodes
• Fever
• Night Sweats
• Pallor
• Fatigue
• Weight Loss
• Bleeding
• Infection
• Red skin & generalized itching of unknown orgin
• Pain in the chest, abdomen or bones for unknown reason

Associated Co-morbidities

"Studies in the 1990s linked NHL to two widespread environmental contaminats: exposure to benzene & polychlorinated biphenyls (PCBs). Benzene can be found in cigarette smoke, gasoline, industrial pollution & 70% comes from automobile emissions. PCBs are found throughout the food chain (highest in meats, dairy & fish products)."

The development of NHL secondary to immunodeficienies may be due to a decrease in the host's surveillance mechanism against transformed cells and their inability to mount an adequate immune response (attack).

Risk Factors for Malignant Lymphomas:

• Age (icreased risk with increasing age)
• Gender (males are more likely than females)
• Ultraviolet light exposure
• Blood transfusions
• A diet high in meats, dairy, fish or fats
• Past treatment for Hodgkin lymphoma
• Environmental Contaminants:*Benzene
• Herbicides & Pestisides
• Polychlorinated biphenyls (PCBs)
• Radiation (indlucing chemotherapy for another cancer)
• Viral Infection:*Epstein-Barr virus (EBV), mononucleosis virus
• HIV
• Human T-lymphotrophic virus type I (HTLV-1)
• Congenital Immunodeficiency Syndroms:*Hepatitis C
• Immunocompromise/immunodeficiency:
• Chronic disease or illness; autoimmune diseases
• Immunosuppresants
• Cancer treatment with alkylating or cytotoxic agents
• Inherited immune deficiencies
• AIDS
• Obesity (women)
• Methotrexate (used to treat rheumatoid arthritis, RA)
• Helicobacter pylori bacteria (gastric lymphoma)

Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Causes

"Several possible etiologic mechanisms are hypothesized for NHL. Immunosuppression, possibly in combination with viruses or exposure to certain infectious agents, could be the primary cause." The other causes may be related to the associated risk factors (See Above).

Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports

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Resources

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Recent Related Research (from Pubmed)

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References

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