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Lymphoma

The cancer of the lymphatic system is known as lymphoma. The lymphatic system is a part of the body’s disease-fighting or immune system.
The lymphatic system includes the lymph nodes, bone marrow, spleen, and thymus gland.

Types:
The two main types of lymphoma are:
1. Hodgkin’s lymphoma: This type of lymphoma usually occurs in the B lymphocytes. The abnormal cells are known as Reed-Sternberg cells, which are modified B lymphocytes. It starts in the upper body lymph nodes, like the neck, chest, and underarms. It spreads (metastasizes) to the different parts of the body through the blood vessels.

It can affect the lungs, liver, spleen, or bone marrow.
It is commonly seen in people who are approximately 40 years old.

2. Non-Hodgkin’s lymphoma: It is the most common type of lymphoma. The healthy lymphocytes do not die, but instead, continue to grow and divide. This causes an increase in the accumulation of the lymphocytes in the lymph nodes, causing swelling of the lymph nodes. This type of lymphoma can originate from the B lymphocytes and the T lymphocytes. However, it is more common in the B cells. It can begin in any part of the body, and it spreads to distant parts of the body.

It is commonly seen in people above 55 years of age.

Causes:
The exact cause of lymphoma is unknown. Lymphoma begins when a lymphocyte (a type of white blood cell) develops genetic changes (mutations). These mutations cause the growth and multiplication of the diseased lymphocytes. The accumulation of these ineffective and diseased lymphocytes in the lymph nodes leads to the swelling of the lymph nodes, liver, and spleen.

Risk factors:

The factors that may increase the risk of developing lymphoma include:

  • Age above 55 years
  • More common in men
  • A weak immune system
  • Presence of infections like Epstein-Barr virus (a type of herpes virus that normally spreads through saliva and other body fluids) and Helicobacter pylori infection (a type of bacterial infection usually found in the stomach)
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Symptoms

The signs and symptoms of both types of Lymphoma include- 

  • Fatigue, Weakness
  • Weight loss
  • Night sweats
  • Painless lump/swelling in the neck, arm pit or groin
  • Shortness of breath, Chest pain
  • Persistent cough
  • Fever
  • Itchy skin

Diagnosis

  • Physical examination: The doctor checks for swollen lymph nodes in the underarm, neck, and groin region.
  • Lymph node biopsy: A part or all of the lymph node is excised (removed) by the surgeon and sent to the laboratory to check for the presence of cancer cells.
  • Blood tests: This helps in assessing the cellularity and for the determination of the variation in the lymphocytes count.
  • Bone marrow aspiration and biopsy: A sample of bone marrow is removed and sent to the laboratory to look for lymphoma cells.
  • Imaging tests: Tests like CT scans, MRI scans, PET scans are recommended to look for the signs of lymphoma in the other parts of the body.

 

Treatment

The treatment depends on how far the cancer has spread and the stage of the cancer.
  • Chemotherapy is the combination of drugs to destroy the cancer cells. 
  • Radiation Therapy uses high energy X-Rays to kill the cancer cells.
  • Immunotherapy is the stimulation of body’s own immune system or the usage of man-made immune proteins to combat the cancer cells.
  • Bone Marrow Transplant / Stem cell Transplant is the usage of bone marrow or stem cells from a compatible donor, preferably closest relatives, in order to replace the diseased bone marrow affected by the cancer cells.

Risks

A Bone Marrow Transplant entails the following risks:

  • Graft-versus-Host disease - donor cells start to attack those of the recipient and hence causes immunity problems
  • Graft rejection - donor stem cells do not function effectively in the recipient and fail to differentiate into blood cells.
  • Thrombocytopenia and anaemia
  • Infections and Bleeding
  • Damage to the liver
  • Delayed growth in children
  • Clotting- in blood vessels 

After Procedure

  • After a bone marrow transplant procedure, the patient is monitored to check for signs of graft rejection. Medication for graft versus host disease (GVHD) is given for preventing graft rejection.
  • Antibiotics, antifungals, and antivirals are the different types of medications given to prevent infections.
  • Regular blood tests are done to check if the blood counts are back to normal and to check how well the donor’s stem cells are functioning in the recipient.
  • In cases of too much blood loss or very slow recovery, blood transfusions may be required.
  • Follow-up appointments with the doctor are required for both Hodgkin and non-Hodgkin type of lymphoma. The periodicity of follow-up depends on the type and stage of lymphoma, the type of treatment done, the side effects caused due to the treatment, and the overall health of the patient.
  • The doctor may prescribe regular CT scans and PET scans to check for any possibility of recurrence of the lymphoma.
  • For patients who have undergone treatment for Hodgkin’s lymphoma, the doctor recommends vaccination for flu every year, and vaccination for pneumonia once every seven years.
  • Generally, the prognosis for Hodgkin’s lymphoma is better as compared to non-Hodgkin’s lymphoma.

 

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