LYMPHOMA- DR RANJAN SHETTY
Lymphomas are one of the most common typesof blood cancers affecting individuals of all ages.
While all other cancers are well known, not many people are aware about lymphomas, there is little information regarding how it presents, what are the ways of diagnosis, and how best to get it treated
Awareness and education about the disease is vital for early diagnosis and effective therapy.
There are two broad categories of lymphomas, termed as Hodgkin's, and Non hodgkins lymphoma. Non-Hodgkin's lymphomas are more common, accounting for majority of cases. The word cancer continues to evoke fear and despair amongst patients and relatives, but early diagnosis and effective treatment can cure many lymphomas, and give long disease free survival
Lymphoma is a cancer of the lymphocytes (white blood cells) which playa key role in our immune system. The lymphatic system is part of the circulatory system, comprising a network of conduits called lymphatic vessels that carry a clear fluid called lymph towards the heart.
Lymph nodes are found in the neck, underarms, chest, abdomen, and groin. Lymphatic tissue is also located in other parts of the body, including the stomach, skin, and small intestine.
Lymphomas develop because of one or more changes in the genes of a lymphocyte; these changes alter how the cell grows and divides and may make the cells immortal. What causes these changes in genes in a given case of lymphoma is often not known, and there may be combination of multiple factors
There are few known risk factors for lymphoma which include, immune deficiency states, certain chronic infections, individuals previously treated for cancer, family history of lymphoma, and like many diseases old age is a risk factor too.Unhealthy lifestyles like smoking, obesity, very high calorie diet may increase the risk of cancer
The most common symptom of lymphoma is painless swelling at the lymph node regions, commonly in the neck, armpit, and groin areas. Other symptoms are unexplained loss of appetite and weight, prolonged fever, fatigue, persistent unexplained itching. Many of these symptoms may also be caused by various common clinical conditions other than lymphoma, hence it is best to discuss with a physician if one has these symptoms
If one has symptoms suggestive of lymphoma, they must consult doctors who are experts in the field. Usually a thorough medical history is taken, including information about symptoms, duration of symptoms, possible risk factors, family history, and other medical conditions. The doctor will examine, paying special attention to the lymph nodes and other areas of the body that might be involved, including the spleen and liver.
If the doctor suspects that lymphoma might be causing the symptoms, he or she will recommend, blood investigations, imaging studies which could be CT scan, or a PET CT scan,biopsy of the enlarged lymph node and bone marrow studies. It may take a few days before the diagnosis is confirmed
Lymphomas do not spread by touch or close contact.
Treatment of lymphoma depends on the type of lymphoma, stage of the disease, age of the patient and how well the patient is at the time of the diagnosis
Various modalities used in the treatment of lymphoma are
Chemotherapeutic agents are chemicals used to treat cancers. They act systemically and destroy cancer cells. Chemotherapy forms the main backbone of lymphoma treatment
Radiation therapy use ionizing radiation to kill cancer cells, this modality is used mainly to treat localized lymphoma, or as a combined modality of treatment with chemotherapy
Used to treat relapsed and refractory lymphomas which don't respond well to therapy. High dose chemotherapy, with or with outradiation therapy is administered before stem cells are infused into the patient . Stem cell infusion allows one to administer very high dose chemotherapy to kill cancer cells as in autologous stem cell transplantation where stem cells are collected from patient, stem cells mayalso lead to immunologic destruction of remaining cancer cells as is the case with allogenic stem cell transplantation where stem cells are collected from a donor. This modality of treatment can cure patients with disease which is refractory to other therapies.
Complications of therapy depend upon the type of chemotherapeutic protocols used. Common side effectsare nausea, vomiting, decrease in blood counts, loss of hair, fatigue. Most of therapy related side effects can be effectively managed and patients usually tolerate the treatment well
A 43 years old man presented with complaints of high grade fever on & off, loss of weight (about 10kg), generalized weakness since 1 year. He was evaluated at many centers and was started on anti-tubercular therapy. Fever, loss of appetite, generalized body pain persisted. He came to our hospital in October 2015. At presentation he had generalized lymph node swellings, generalized wasting, fever, and enlargement of liver and spleen. Further tests confirmed he had advanced stage lymphoma, with secondary hemophagocytic lymphohistiocytosis. He was started on chemo immunotherapy with dramatic improvement in his symptoms. He has recovered from his illness and has returned to work.
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