NON HODGKIN’S LYMPHOMA
What is Non-Hodgkin’s Lymphoma (NHL)?
Lymphoma begins when B cells, T cells, or NK cells in the lymphatic system change and grow uncontrollably, which sometimes may form a tumor. Non-Hodgkin lymphoma (NHL) is a term that refers to the many other types of cancer of the lymphatic system, which can have different symptoms and signs, physical findings, and treatments.
Because lymphatic tissue is found in most parts of the body, NHL can start almost anywhere and can spread to almost any organ. It most often begins in the lymph nodes, liver, spleen, or bone marrow, but it can also involve the stomach, intestines, skin, thyroid gland, brain, or any other part of the body.
It is very important to know which type and subtype has been diagnosed because this information helps doctors determine the best treatment and a patient’s prognosis (chance of recovery).
Non-Hodgkin’s Lymphoma is more common in adults than children.
What Causes Non-Hodgkin’s Lymphoma and what are the risk factors?
Certain types of Non-Hodgkin’s Lymphoma are caused or triggered by Infections. Most common causes are as under:-
- EBV and Burkitts lymphoma
- Hepatitis C
- Helicobacter Pylori causing lymphoma of the stomach.
- HIV infection increases the incidence of high grade lymphomas
- Long term intake of drugs suppressing the immune system as after solid organ transplants
- Primary immunodeficiency and autoimmune diseases
- Histopathological diagnosis reveals two major subtypes: T cell Non-Hodgkin’s Lymphoma and B cell Non-Hodgkin’s Lymphoma.
- B cell Non-Hodgkin’s Lymphoma is more common
- This is further classified as HIGH GRADE and LOW GRADE
- Detection of cell surface antigens by Immunohistochemistry (IHC) is confirmatory.
- Complete Blood Count: Aanemia and Thrombocytopenia may be seen. Eosinophil count is often raised
- Bone Marrow Biopsy: This is necessary to ascertain the extent of the disease. Rarely, the presentation is with Bone Marrow Involvement alone.
- PET-CT Scan: This has revolutionised the diagnosis and management of NHL. In the early days, surgery was performed to find the extent of the disease in the abdomen. With the advent of Contrast-enhanced CT Scan, the need for surgery was obviated. However, the response of the disease was measured by complete disappearance of enlarged glands. Many a time this did not happen and a repeat biopsy was needed. PET scan allow us to see the metabolic activity in the affected areas and disappearance of NHL will be marked by absence of metabolic signal previously seen at the time of diagnosis.
- Additional Tests: Serum LDH, ECG, Echocardiogram and Lung Function Tests are done before starting treatment.
What are the risk factors for Non-Hodgkin’s Lymphoma?
- Being male: Non-Hodgkin’s Lymphoma is more common in men than in women.
- Age: Likelihood of getting Non-Hodgkin’s Lymphoma increases with age.
- Impaired immune system: NHL is most common among those who have an impaired immune system, an autoimmune disease, or HIV or AIDS. It also occurs among those who take immunosuppressant medicines, such as medicines following an organ transplant.
- Viral infections: A viral infection, such as Epstein-Barr virus, increases the risk of developing NHL.
- Bacterial infections: Infection with Helicobacter pylori increases the risk of lymphoma involving the stomach.
- Environmental exposure: Exposure to agricultural pesticides or fertilizers, solvents, and other chemicals may increase the risk of developing NHL.
What are the Symptoms?
The symptoms are protean. They range from painless lymph node enlargement to fits and paralysis. Most patients have ‘B symptoms’ defined by
- A painless swelling of the lymph nodes in the neck, underarms, or groin. This is the most common symptom.
- Fever above 380C (100.4 F)
- Drenching Night sweats.
- Feeling very tired.
- weight loss > 10% of baseline body weight
- Itchy skin.
- Reddened patches on the skin.
- A cough or shortness of breath.
- Pain in the belly or back.