NON-HODGKINS LYMPHOMA
Introduction
Epidemiology
Risk Factors
Signs & Symptoms
Diagnosis
Clinical staging
Treatment
Classification
Prevention
1. INTRODUCTION
Malignant Lymphoma
Hodgkin
Non-Hodgkin
The NHLs are a heterogeneous group of
lymphoproliferative malignancies with differing patterns
of behavior and responses to treatment
Like Hodgkins lymphoma, NHL usually originates in
lymphoid tissues and can spread to other organs.
NHL, however, is much less predictable than Hodgkins
lymphoma and has a far greater predilection to
disseminate to extra nodal sites.
The prognosis depends on the histological type, stage,
and treatment.
2. EPIDEMIOLOGY
4-5% of cancer in US
2005: 58 875 cases, 18 840 will die
Both adults & children
Men are more common than women
White > african & asian american
Risk of getting NHL during lifetime :
- Men : 1/46
- Women : 1/55
Risk of dying : 1/100
3. RISK FACTOR
Men > Women
Age , Risk
Weakened Immuned system
- inherited disease
- autoimmune disease
- human immunodeficiency virus (HIV)
- drugs given because you had an organ
transplant.
infected with
- HTLV-1
- EBV
- Helicobacter pylori
exposed to certain chemicals
- ingredients in pesticides
- herbicides
- solvents
- fertilizers
4. SIGNS & SYMPTOMS
Most common : painless swelling of the lymph nodes
in the neck, underarm (axilla), or groin.
Other :
- Unexplained fever
- Night sweats
- Constant fatigue
- Unexplained weight loss and anorexia (poor appetite)
- Itchy skin (pruritus)
- Reddened patches on the skin
Symptoms above cant 100% determine NHL
- flu, other infection
- only doctor can make diagnosis
Swollen Lymph Node
5. DIAGNOSIS
Physical examination
Medical history
Biopsy
- excisional
- incisional
- fine needle aspiration
Imaging studies
- chest x-ray
- computed tomography (CT) scan
- PET scan
- MRI
- Lymphangiogram:
To diagnose whether the cancer has
spread around the lymph system or to
other areas.
- CBC
- Blood chemistry analysis
- Lumbar puncture
- Bone marrow test
Biopsy
X - Ray
CT Scan
6. CLINICAL STAGING
Stage I: This stage applies to those who have lymphoma in only one
lymph node area or one organ.
Stage II: This stage applies to those who have lymphoma in two or
three lymph node areas near each other, such as all in the neck and
chest.
Stage III: This stage applies to those who have lymphoma in several
lymph node areas in the neck, chest and abdomen.
Stage IV: This stage applies to those who have widespread
lymphoma in their lymph nodes and other organs, such as lungs
and liver.
Doctors may add a letter after your stage to describe more about
your disease.
- E (such as stage IIIE) means your cancer is extranodal (goes
beyond your lymph nodes).
- S (such as stage IIIS) means the cancer is in your spleen.
7. TREATMENT
Chemotherapy
Radiation Therapy
Bone Marrow Transplantation
Biological Therapy
Chemotherapy
Uses drugs to kill cancer cell
Enter bloodstream & travel through body
Disadvantages kill healthy cell
Drug combination in cycle
Given alone or with radiation therapy
Vein or mouth
Side effect :
- Nausea and vomiting
- Fatigue or tiredness
- Hair loss
- Esophagitis or irritation of the swallowing tube
Radiation Therapy
External beam
Linear accelerator
Short burst of x-ray
Square-shaped manner
Also kill other cell
Bone Marrow Transplantation
injection of healthy stem cells from a
donor's bone marrow into your vein
The new stem cells travel through the
bloodstream to your bone cavities.
Stem cells are cells that can produce red
blood cells, white blood cells, and
platelets.
Biological Therapy
using medications or substances made by
the body to increase or restore your
body's natural defenses against cancer
It is also called immunotherapy
Monoclonal antibodies and interferon are
examples of biological therapy used to
treat some types of lymphoma.
8. CLASSIFICATION
Morphologic
Immune-Based
The Working Formulation
Updated REAL / WHO
Morphologic Classification
type of involvement
1956 Rappaport Classification
Simple, separate more aggressive & less
aggressive
Immune-Based Classification
Luke & Collins (1974) US
Kiel Classification Europe
Fits theoretic concepts of development of
lymphoid cell
Not gained universal acceptance bcoz :
- their complexity
- need ancillary test to reach precise diagnoses
Working Formulation Classification
1975, NCI develop The Working
Formulation of Non-Hodgkins Lymphoma
for Clinical Usage
Currently used in US
Working Formulation
Low-grade
A. Small lymphocytic, consistent with chronic
lymphocytic leukemia (SL)
B. Follicular, predominantly small-cleaved
cell
(FSC)
C. Follicular, mixed small-cleaved and large
cell (FM)
Intermediate-grade
D. Follicular, predominantly large cell (FL)
E. Diffuse, small-cleaved cell (DSC)
F. Diffuse mixed, small and large cell (DM)
G. Diffuse, large cell, cleaved or noncleaved
cell (DL)
High-grade
H. Immunoblastic, large cell (IBL)
I. Lymphoblastic, convoluted or
nonconvoluted cell (LL)
J. Small noncleaved-cell, Burkitt's or
non-Burkitt's (SNC)
Rappaport Classification
- Diffuse lymphocytic, well-differentiated (DLWD)
- Nodular lymphocytic,poorly differentiated (NLPD)
- Nodular mixed, lymphocytic and histiocytic (NM)
- Nodular histiocytic (NH)
- Diffuse lymphocytic, poorly differentiated (DLDP)
- Diffuse mixed, lymphocytic and histiocytic (DM)
- Diffuse histiocytic (DH)
- Diffuse histiocytic (DH)
- Diffuse lymphoblastic (DL)
- Diffuse undifferentiated Burkitt's or non-Burkitt's
(DU)
Updated REAL / WHO
Classification
Working formulation became outdated
Since 1995, members of the European and American
Hematopathology societies have been collaborating on a
new World Health Organization (WHO) classification,
which represents an updated version of the REAL
system.
3 major categories of lymphoid malignancies based on
morphology and cell lineage:
- B-cell neoplasms
- T-cell/natural killer (NK)-cell neoplasms
- Hodgkins lymphoma
I. B-cell neoplasm
IA Precursor B-cell neoplasm:
precursor B-acute lymphoblast
leukemia/lymphoblast lymphoma
(B-ALL, LBL).
IB Peripheral B-cell neoplasms.
1.
B-cell chronic lymphocytic
leukemia/small lymphocytic
lymphoma.
2.
B-cell prolymphocytic leukemia.
3.
Lymphoplasmacytic
lymphoma/immunocytoma.
4.
Mantle cell lymphoma.
5.
Follicular lymphoma.
6.
Extranodal marginal zone B-cell
lymphoma of MALT type.
7.
Nodal marginal zone B-cell lymphoma
( monocytoid B-cells).
8.
Splenic marginal zone lymphoma (
villous lymphocytes).
9.
Hairy cell leukemia.
10.
Plasmacytoma/plasma cell myeloma.
11.
Diffuse large B-cell lymphoma.
12.
Burkitt's lymphoma.
II. T-cell and putative NK-cell neoplasm
IIA. Precursor T-cell neoplasm: precursor
T-acute lymphoblast
leukemia/lymphoblast lymphoma
(T- ALL, LBL).
IIB. Peripheral T-cell and NK-cell
neoplasms.
1. T-cell chronic lymphocytic
leukemia/prolymphocytic leukemia.
2. T-cell granular lymphocytic leukemia.
3. Mycosis fungoides/Szary syndrome.
4. Peripheral T-cell lymphoma, not
otherwise characterized.
5. Hepatosplenic gamma/delta T-cell
lymphoma.
6. Subcutaneous panniculitis-like T-cell
lymphoma.
7. Angioimmunoblastic T-cell lymphoma.
8. Extranodal T-/NK-cell lymphoma,
nasal type.
9. Enteropathy-type intestinal T-cell
lymphoma.
10. Adult T-cell lymphoma/leukemia
(HTLV 1+).
11. Anaplastic large cell lymphoma,
primary systemic type.
12. Anaplastic large cell lymphoma,
primary cutaneous type.
13. Aggressive NK-cell leukemia.
III Hodgkins lymphoma (Hodgkins disease)
IIIA. Nodular lymphocyte-predominant Hodgkins
lymphoma.
IIIB. Classical Hodgkins lymphoma.
1. Nodular sclerosis Hodgkins lymphoma.
2. Lymphocyte-rich classical Hodgkins
lymphoma.
3. Mixed-cellularity Hodgkins lymphoma.
4. Lymphocyte-depleted Hodgkins
lymphoma
9. PREVENTION
Avoid Repeated Exposure to Certain
Chemicals
Avoid Exposure to HIV
THANK YOU
