Non-Hodgkin's Lymphoma

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Overview

Lymphomas are cancers of the lymphatic system - the body's blood-filtering tissues that help to fight infection and disease. Like other cancers, lymphomas, occur when cells divide too much and too fast. Growth control is lost, and the lymphatic cells may overcrowd, invade, and destroy lymphoid tissues and metastasize (spread) to other organs.

There are two general types of lymphomas: "Hodgkin's Disease" (named after Dr. Thomas Hodgkin, who first recognized it in 1832) and non-Hodgkin's lymphoma. The lymphatic tissue in Hodgkin's disease contains specific cells - Reed-Sternberg cells - that are not found in any other cancerous lymphomas or cancers. These cells distinguish Hodgkin's disease (HD) from non-Hodgkin's lymphomas (NHLs).

Anatomy
The lymphatic system - the target of lymphomas - includes the lymph nodes and other organs that make up the immune and blood-forming (hematopoietic) elements of the body.

The lymph nodes are oval, pea-sized organs. They are found beneath the skin along the route of large blood vessels, and they are grouped in areas such as the neck, underarms, groin, abdomen (trunk), and pelvis (hips). The lymph nodes are linked throughout the body by narrow tubes known as lymphatic vessels. These vessels carry lymph, a colorless liquid that is collected from the body's tissues; chyle, a milky fluid taken from food in the intestine during digestion; lymphocytes, specialized white blood cells; and other blood cells. The lymphatic fluids and lymphocytes ultimately are funneled back into the bloodstream through a connection in the left upper chest.

Other organs that contain lymphatic tissue and so are affected by lymphoma include the:

• Spleen, a "ductless gland" that is located on the left side of the body under the lower rib cage; it is makes lymphocytes and other infection-fighting cells, stores healthy blood cells, and filters the blood);
• Thymus gland, a gland located in front of the heart; it produces immature T-cells that, when mature, are involved in immune system responses;
• Bone marrow, the inner region of the bones;
• Adenoids, the lymphatic tissue in the post-nasal area; and
• Tonsils, the rounded mass of lymphatic tissue at the back of the throat

Both Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NHLs) begin in lymphatic tissues and can invade other organs. But NHLs are much less predictable than HD, and they are more likely to spread to areas beyond the lymph nodes.

Anatomically, lymphomas are composed of malignant lymphocytes. Lymphocytes are a normally occurring part of the white blood cell series. The lymphocyte population can be simplistically divided into B-cells, T-cells and null cells. The job of B-cell lymphocytes is to participate in the immune system by producing antibodies. The job of the T-cell lymphocytes is to direct the participation of B-cells and other cell types in an overall immune response; they are the conductors of the immune system. Lymphomas are the malignant counterpart of these normal cells.

NHL Facts
Non-Hodgkins lymphoma (NHL) is a heterogenous disease. Each year, there are approximately 50,000 new cases and almost 25,000 deaths from the disease in the United States. Unlike Hodgkins disease, NHL is comprised of approximately 10 different subtypes (in the Working Formulation) and 20 different disease entities in the Revised European-American Lymphoma Classification (REAL) system.

These subtypes are grouped into 3 biologic states- low grade, intermediate grade, and high grade lymphomas. Therapy is determined by several factors, including the biologic state of the lymphoma, the stage of lymphoma, the presence or absence of symptoms (e.g., weight loss, night sweats, organ dysfunction), and the overall general health of the patient.

A number of factors, including congenital and acquired immunodeficiency states, and infectious, physical, and chemical agents, have been associated with an increased risk for NHL. Infectious agents, such as viral infections (e.g., Epstein barr virus, HIV, human T-cell leukemia virus), and bacterial infections (e.g., heliobacter pylori) may be associated with the development of NHL. Additionally, physical and chemical agents such as pesticides, solvents, arsenate, and lead, as well as hair dyes, radiation exposure (high dose), and paint thinners may also increase the risk.

Non-Hodgkins lymphoma occurs more often in patients between the ages of 40 and 70. Risk for disease recurrence and overall survival rate can be predicted by using an international prognostic index (IPI) which takes into account age, stage of disease, general health (also known as performance status), number of extra nodal sites, and presence or absence of an elevated serum enzyme named LDH (lactate dehydrogenase).

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