Non-Hodgkin's lymphoma

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Malignant lymphoma, high_grade B cell

Non-Hodgkin lymphoma (NHL) is a type of cancer that originates in lymphocytes, a subset of white blood cells integral to the immune system. This particular lymphoma is distinguished from Hodgkin's disease, another subtype of lymphoma. In essence, NHL encompasses a variety of lymphoma forms, each having distinct features and characteristics.

Centrocyte, centroblast and follicular dendritic cell in a follicular lymphoma

Background

Lymphomas, in general, may develop in any organ linked with the lymphatic system. This includes organs like the spleen, thymus, and tonsils. The majority of NHL cases initiate with the infiltration of lymph nodes, which is termed as nodal lymphoma. However, specific subtypes may be concentrated exclusively in the lymphatic organs.

Malignant Burkitt’s lymphoma, a non-Hodgkin’s lymphoma

Diagnosis and Treatment

For a confirmed diagnosis of lymphoma, a biopsy of the involved tissue is necessary. Prior to initiating treatment, a commonly adopted strategy is "watch and wait." This approach allows doctors to evaluate the progression of NHL and its impact on the patient before settling on a therapeutic regimen. For indolent or low-grade lymphoma, supportive measures may suffice. On the other hand, aggressive high-grade NHL necessitates treatment with chemotherapy and potentially radiation therapy as well.

Symptoms

The hallmark symptom of NHL is the painless enlargement of lymph nodes, commonly observed in the neck, underarm (axilla), or groin regions.

Histopathology of a centroblast in follicular lymphoma

Other manifestations include:

• Persistent fever
• Night sweats
• Constant fatigue
• Unanticipated weight loss and reduced appetite (or anorexia)
• Itchy skin (pruritus)
• Erythematous skin patches

It's crucial to recognize that these symptoms are non-specific to NHL and can arise from less severe ailments such as the flu. Therefore, a physician's consultation is paramount for an accurate diagnosis. Early stages of NHL may be asymptomatic, underscoring the importance of seeking medical attention irrespective of pain or discomfort.

Classification and Etiology

Over time, various nomenclatures have emerged to classify the diverse subtypes of NHL. Typically, these classifications are based on the microscopic appearance of the cancer cells and their growth patterns. NHL can be aggressive (high-grade) with a rapid growth trajectory, or indolent (low-grade) which grows at a slower pace. Notably, while indolent lymphomas are resistant to chemotherapy, aggressive lymphomas can often be treated successfully with it. Detailed classifications of lymphoma can be explored on the dedicated lymphoma page.

As for the etiology or causation of most lymphomas, definitive causes remain elusive. However, associations with certain viruses are observed. For instance, Burkitt's lymphoma, classical Hodgkin's disease, and majority of AIDS-related lymphoma cases correlate with Epstein-Barr virus infections. Additionally, some lymphomas are linked with bacteria, as seen with lymphoma of the stomach resulting from Helicobacter infections.

The prevalence of NHL has witnessed a significant surge in recent decades, with reasons for this uptick remaining unclear. While the exact cause is undetermined, certain risk factors have been identified, including age, gender, weakened immune systems, and environmental exposures.

Staging and Treatment Modalities

Once NHL is diagnosed, determining its stage or extent becomes vital for devising an optimal treatment strategy. Staging evaluates the distribution of the cancer, its spread within and beyond the lymphatic system, and its invasion into vital organs. This categorization uses the Ann Arbor staging system, which was originally developed for Hodgkin's lymphoma.

The treatment for NHL is multifaceted and often requires a collaborative effort from specialists like hematologists and oncologists. Common therapeutic modalities encompass chemotherapy, radiation therapy, bone marrow transplantation, and in certain scenarios, surgery. A significant emphasis is also placed on participating in clinical trials that evaluate pioneering treatment methodologies for NHL.

Non-Hodgkin's lymphoma Resources
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