Non-Hodgkin lymphoma

Epidemiology factors

Represents 4.1% of all new cancers in the US

Higher incidence in Non-Hispanic white males

Higher male predominance than HL

More common in the United States, Canada, and Europe and less likely in Asian countries

Most common age range

65-74

Median = 68

Etiology

Cause unknown

Not caused by inheritance but rather by DNA that has mutated during one's lifetime

Immune system abnormalities

Overexposure to certain chemicals

Radiation exposure: nuclear reactor accidents, radiation therapy, and EBRT with adjuvant chemo

Changes in the structure and function of B or T cells are the source of the progression of cancer

Which autoimmune disorders are associated with increased risk?

Sjögren syndrome, systemic lupus, and rheumatoid arthritis

Which viruses are associated with increased risk?

Epstein–Barr, AIDS, HIV, hepatitis C, or human T-lymphotropic virus type 1 (HTLV-1), or with certain bacteria, such as Helicobacter pylori

Prognostic indicators

More dependent on histology than Hodgkin lymphoma

Two groups: indolent and aggressive

Indolent: slow-growing and causes little problems at the time of diagnosis; median survival time can be as long as 20 years

Aggressive: faster growing

The risk of relapse for both groups is the highest after the first 2 years of treatment

Clinical presentation

Symptoms of NHL mimic those of HL, enlarged lymph nodes, night sweats, weight loss, fever, and itching are all common with diagnosis

Found in lymph nodes but is also in a wide variety of locations in the body

Symptoms manifest according to the location of the disease, the surrounding organs, and the extent of the disease

Most common site of extranodal involvement

GI system, specifically the stomach

Other common sites are Waldeyer's ring, skin, bone marrow, sinuses, thyroid, CNS, and GU system

Detection and Diagnosis

Thorough H&P (knowledge of occupational risks and patient’s medical history can give a suggestion of NHL)

Imaging Studies: chest radiograph, CT, PET, MRI, US helpful in determining extent and initial staging

Lab Studies: CBC (anemia, thrombocytopenia, leukopenia, lymphocytosis, and thrombocytosis could all be signs of disease)

Serum chemistry studies: liver function tests, lactic acid dehydrogenase, and calcium levels may be abnormal

Serum beta-2 microglobulin level may be elevated

HIV serology

Human T- cell lymphotropic virus-1 serology

The relapse of aggressive NHL in the CNS has a good prognosis

False

Why is a prophylactic treatment approach incorporated into the treatment protocols for the aggressive subtypes of lymphoblastic and Burkitt lymphomas?

Recurrence tends to happen early after diagnosis and its incidence is around 30%

Staging

Ann Arbor Staging System

(does not always encompass the variety that may come from the many different types of

NHLs and fails to classify extranodal sites)

Grading of the malignant cells is important in the determination of a treatment plan

True

Primary treatments

chemotherapy, radiation therapy, immunotherapy, and stem cell transplants

What treatment has been proven effective and is almost always given?

Chemotherapy

Most common chemo regimen

CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)

NHL is radiosensitive, however, radiation therapy is almost always used ________

Adjuvantly or in combination with chemotherapy or another technique

(Indolent NHL in early stages I and II can be treated with radiation alone)

When radiation is given, the involved site is included along with the related drainage clusters nearby. These fields are treated to a dose of _____

35-45 Gy

Patients with ________ can be treated with aggressive chemotherapy and radiation, followed by bone marrow transplant

Advanced or recurrent disease

________ is used to boost the immune system into fighting off cancer cells

Immunotherapy

Prognostic indicators

Varies among the different types. Generally, survival is dependent on age, stage, location, and histology at the time of diagnosis

Overall 5-yr survival

74%

Pattern of spread is …

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