Non Hodgkin’s lymphoma (NHL) refers to a group of closely related cancers that affect white blood cells in the lymphatic system.
All types of non-Hodgkin’s lymphoma are divided into two main groups: B-cell lymphomas derived from abnormal B lymphocytes and T-cell lymphomas derived from abnormal T lymphocytes. The disease most often presents as a malignancy of the lymph nodes, but cancer can also affect other organs, such as the central nervous system or the skin.
Common non-Hodgkin’s lymphoma symptoms
Symptoms may vary from individual to individual. It is very dependent on the location of the tumor in the body. Sometimes, in the early stages, NHL is asymptomatic (asymptomatic).
The most common symptom can usually be painless swelling of the lymph nodes, usually in the neck, above the collar bone or in the chest area, underarms, loins, legs or ankles. Non-Hodgkin’s lymphomas can begin anywhere in the lymphatic framework or in organs, for example, the spleen or digestive organs.
Although some lymphomas are localized, the disease can spread to distant parts of the body outside of the lymphatic system.
Other symptoms associated with NHL may include fever, night sweats, difficulty breathing, cough, nausea, persistent itching, poor appetite, fatigue, and unexplained weight loss.
Overview of lymphoma symptoms
Symptoms of lymphoma can range from non-existent to severe. In extreme cases, such as when the disease affects the central nervous system, the patient may suffer from confusion and/or seizures and acute neurological disorders. However, most patients do not experience pain or discomfort, especially in the early stages.
Unfortunately, many of the symptoms of the disease are not specific, and the disease is often confused with other common diseases such as colds, flu, or respiratory infections. Of course, most people who report non-specific symptoms do not have lymphoma, but anyone who experiences persistent symptoms should see a doctor rule out the possibility of lymphoma.
Non-specific lymphoma symptoms:
- unexplained weight loss
- lack of energy
Physical examination of lymphoma
If lymphoma is suspected, a complete physical examination should be performed. The doctor feels (feels) the lumps in the neck, under the chin, around the tonsils, shoulders, elbows, under the arms, and in the groin area. Other parts of the body are also examined to see if there is swelling in the chest or abdomen, especially in the spleen and liver.
Any signs of the presence of lymphoma seen on physical examination will be followed by additional diagnostic tests, such as biopsy, blood test, x-ray, scan, and possibly bone marrow and cerebrospinal fluid.
Common lymphoma symptoms
The most common symptom is usually painless, swollen lymph nodes or underarms. Some people may also experience enlarged lymph nodes in other parts of the body, such as the spleen, groin, legs, or ankles. In addition, swelling may occur in the abdomen, where enlarged lymph nodes may cause discomfort or swelling.
Other common symptoms may include fever, fatigue and anemia, the latter due to low red blood cells. The patient may also have an increase in infection, which can be caused by a lower number of functioning white blood cells and damage to the immune system.
In most cases, however, the patient does not suffer pain in the early stages of the disease.
Less common lymphoma symptoms
In some cases, swollen lymph nodes can cause compression of the blood vessels, where expanding lymphoma can cause edema (swollen tissue) or thrombosis (blood clots).
Very rarely, lymphoma can be found in the eye, testicles, skeleton, or central nervous system.
Typical symptoms associated with lymphoma:
- painless swollen lymph nodes in the neck, chest, armpits, groin or spleen
- sweating and/or fever, especially at night
- abnormal fatigue
- losing weight
- persistent itching
- persistent cough
- persistent shortness of breath (especially if the chest is affected)
- pain in the lymph nodes after drinking alcohol.
The physician may use the categories “systemic” or “A” and “B” if he refers to the stage or location of the disease.
“Systemic” means that the symptoms affect the whole body. Such symptoms may include sweating, fever or weight loss. The systemic symptoms are “B.” also called a category. Category “A”, on the other hand, is used to describe a patient without systemic symptoms.
Causes of non-Hodgkin’s lymphoma
Like HD, the causes of non-Hodgkin’s lymphoma are not known. However, the risk factors are similar to those of Hodgkin’s disease. Possible factors include:
The majority of people diagnosed with NHL are over the age of fifty: About ninety percent of non-Hodgkin’s lymphomas occur in adults, and the risk increases with age. The majority of people diagnosed with the disease are fifty years old. NHL is more common in men than women. However, research has also shown that young children are slightly more at risk for developing NHL if they are born with an immune deficiency.
Defective immune system: People with immune system disorders or immunocompromised individuals are at greater risk.
HIV / AIDS: People with HIV-infected or acquired immune deficiency syndrome (AIDS) are more likely to develop NHL.
Infection and Burkitt’s lymphoma: Several recent studies have shown that infection with Epstein-Barr virus (the virus responsible for mononucleosis) can significantly increase an individual’s chances of developing malignancies, especially Burkitt’s lymphoma. In addition, people who are infected with other viruses, such as T-lymphotropic virus type 1, also have a slightly increased risk.
Drugs: The drug relationship is particularly relevant to individuals who have been treated with certain medications for other cancers. An association has also been established between Dilantin, an anticonvulsant drug, and the likelihood of developing non-Hodgkin’s lymphoma.
Chemotherapy: Studies have shown that individuals treated with certain chemotherapeutic drugs may be at increased risk of developing NHL, with a probability of approximately It peaks in five to ten years.
Radiation: Radiation therapy for other cancer patients slightly increases the likelihood of developing NHL in later years. This risk additionally applies to people who have been exposed to atomic radiation previously.
Organ transplantation: Recipients of organ transplantation who are taking immunosuppressive drugs to counteract organ rejection are particularly at risk.
Carcinogens, chemicals, and environmental contaminants: Frequent exposure to certain petrochemicals, herbicides, and insecticides, such as herbicides, fertilizers, and insecticides, have been associated with a higher likelihood of developing NHL. The utilization of solvents containing phenoxy acids, as well as occupational exposure to wood, may likewise improve the probability of creating NHL.
Genetics: Recent studies suggest that a genetic predisposition to develop NHL is possible in people born with a deficient or weakened immune system. Further research is needed to explore the possibility of a hereditary relationship.
Lymphoma treatments: chemotherapy, radiation therapy and experimental methods
Physicians today have a number of options for approaching lymphoma, depending on the type, stage, and degree of the tumor or tumors, as well as other clinical prognostic factors.
For example, radiotherapy should only be used if the lymphoma is localized and has not yet spread to other parts or the body. In more severe cases, intensive chemotherapy should be required using a single drug or combination of drugs. Chemotherapy tends best to treat fast-growing and aggressive tumors.
Occasionally, for certain advanced non-Hodgkin’s lymphomas, when the patient does not respond to other approaches, bone marrow or peripheral blood stem cell transplantation may be used.
Treatment of lymphomas may also include a combination of radiation therapy and chemotherapy. In some cases, no treatment is used if the patient shows no symptoms. This strategy is often referred to as attentive anticipation.
Current non-Hodgkin lymphoma treatments and Clinical trials
The treatment strategy for NHL depends on several factors, including the type, stage, degree, and extent of lymphoma, as well as individual prognosis. Patients under the age of sixty tend to respond better than patients over the age of sixty. In younger patients, a better prognosis may be due to their ability to tolerate higher drug doses and resist the invasive side effects of various therapies.
Most patients with non-Hodgkin’s lymphoma get some type of chemotherapy, radiation treatment, natural treatment, bone or stem cell transplantation, or a combination of therapies. Surgery is also needed very occasionally.
In addition to traditional treatments based on chemotherapy and radiation therapy, a number of clinical trials are testing new approaches for many types of non-Hodgkin’s lymphoma. The results to date are impressive, with a number of advances, such as monoclonal antibody therapy, which is currently proving particularly effective in patients with aggressive forms of NHL.
The importance of clinical trials
Some patients have the opportunity to participate in clinical trials to evaluate promising new treatments for NHL. Participants in the clinical trial are vital in the fight against non-Hodgkin’s lymphoma.
General treatment strategies for non-Hodgkin’s lymphoma
“Watch and wait”
If the patient is asymptomatic or causes swelling that does not cause discomfort, doctors are more likely to “watch and wait” than to initiate aggressive forms of treatment. However, the disease is carefully controlled; in this situation, waiting does not adversely affect the outcome of future treatment.
Radiation is often used in the early stages of non-Hodgkin’s lymphoma or when the tumor is localized. In these situations, the five-year relative survival rate can be as high as 95 to 100 percent. Radiation treatment can be utilized alone or in combination with chemotherapy. Radiation therapy is sometimes used to relieve symptoms that may occur when other internal organs are affected.
Chemotherapy remains one of the most widely used forms of NHL treatment. Chemotherapy is used as a single high-dose drug or drug combination and is often used in conjunction with radiation therapy.
The standard treatment for aggressive, diffuse, large B-cell lymphoma is cyclophosphamide, doxorubicin, vincristine, and prednisone, commonly referred to as CHOP.
A single treatment is usually used for less aggressive lymphomas when the patient has a bulky mass tumor or is overly suffering from other NHL symptoms. The most commonly used single alkylating agents are chlorambucil (Leukeran®) and cyclophosphamide (Cytoxan®). Chlorambucil is given daily as tablets, while cyclophosphamide is given as an injection every three to four weeks.
Several recent clinical trials have shown that the use of filgrastim, a growth factor known as a granulocyte-colony factor (G-CSF), can increase the number of immune cells in the bone marrow or peripheral blood cells of patients after chemotherapy. Researchers say G-CSF can significantly improve a person’s immune system and help restore bone marrow suppression associated with high-dose chemotherapy.
Steroid drugs are sometimes used in combination with chemotherapeutic drugs to treat NHL.
Generally, surgery is only recommended if the NHL tumor affects other internal organs.
Autologous transplantation is a promising new treatment that involves infusing autologous (patient’s own) peripheral blood progenitor cells after high-dose therapy (HDT). The goal is to allow a high dose of chemotherapy through the subsequent replacement of the patient’s healthy cells. HDT is known to cause severe bone marrow suppression, severe complications, and infections. However, with this new form of treatment, the patient’s own blood cells are rescued before treatment and then injected to build up the bone marrow.
Although stem cell and bone marrow transplants are a relatively new concept, the results of several clinical trials show that autologous transplants are particularly effective in the treatment of large B-cell, follicular, and mantle cell lymphomas. Autologous transplants can indeed be a breakthrough in the treatment of advanced and unresponsive cases of NHL.
Other new developments include the use of cell transplants from other healthy individuals (allogeneic transplantation). A further approach is needed to determine the effectiveness of this approach.
In recent clinical trials, rituximab (MabThera®, Rituxan®, or anti-CD20), a monoclonal antibody directed against the CD20 B-cell antigen, has a therapeutic effect in the treatment of diffuse large B-cell lymphomas.
They include monoclonal antibodies currently produced for the treatment of lymphoma, including the unmodified rituximab antibody, Campath 1H (anti-CD52) and epratuzumab (anti-CD22). The results to date are encouraging.
In addition, randomized trials are performed in elderly patients with diffuse large B-cell lymphoma to compare CHOP chemotherapy with rituximab and CHOP alone.
Zevalin has obtained FDA approval
FDA approval of the combination of Zevalin ™ (February 2002) and Rituxan showed a breakthrough in the treatment of B-cell non-Hodgkin’s lymphoma. Zevalin is approved for patients who have not responded to standard chemotherapy with a single dose of Rituxan.
Radioimmunotherapy can be used alone or in combination with conventional chemotherapy and involves the use of additional “hybrid” radioactive antibodies to target radiation or toxins to cancer cells, such as radioactive iodine (I-131) and yttrium (Y-90). This involves attaching radioisotopes to the antibody to kill cancer cells more effectively while minimizing damage to the patient’s healthy cell tissue.
Child-specific treatments for the NHL
Much attention is currently being paid to clinical trials for the special treatment of childhood lymphomas. The treatment of the three main types of childhood non-Hodgkin’s lymphoma depends on the stage of the child’s disease and the histological method (what the cancer cells look like under a microscope). The child’s age and general health are also important factors.
Much attention is currently being paid to clinical trials aimed at finding specific treatments for childhood lymphomas that cause minimal damage to healthy cell tissue in a developing child. For example, several studies are testing new treatments for advanced stages of childhood non-Hodgkin’s lymphoma.
Useful NHL treatment terminology
Primary therapy: This term refers to the first therapy used to treat the disease.
Partial Remission: Reduced to less than half the original tumor size after treatment.
Improvement: After treatment, the tumor shrinks, but is still more than half its original size.
Complete remission: All signs of the disease disappear after treatment; however, this does not mean complete eradication of the disease.
Sustained remission: Complete remission after primary therapy should be maintained for a long time (usually five years).
Healing: This term is used very carefully by doctors, referring to situations where there are no signs of the disease for at least five years after treatment.
Refractory Disease: This indicates a tumor that is resistant to treatment.
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