Treatment of lymphoma

Treatment of lymphoma

Biologic Therapy

This treatment increases the body's natural ability to fight cancer. It does this by giving a boost to the immune system. The types of biologic therapy:

• Monoclonal Antibodies: These are drugs like Rituxan®, which directly target lymphoma cells and do not harm normal cells.
• Radioimmuno therapy: These are therapies like Rituxan®, which have a radioisotope attached to them.
• Interleukin 2: This is a medicine that activates the immune system so that it can kill cancer cells.
• Vaccines: These are treatments that help the body protect itself against the lymphoma.

Chemotherapy

This treatment uses drugs to kill cancer cells and reduce the size of cancer tumors. There are many types of chemotherapy drugs. Many drugs are often used together for chemotherapy.

Radiation Therapy

This treatment uses radiation (high energy x-rays) to kill cancer cells.The treatment often only takes place in the part of your body where the lymphoma is located.

Transplants

Sometimes high doses of chemotherapy destroy the lymphoma cells and your bone marrow, which is the "factory" for blood cells. To help the bone marrow make new healthy blood cells, some stem cells (immature cells that will grow up into red blood cells, white blood cells, and platelets) may be taken with a special machine before chemotherapy is given.

These cells are then transplanted into the body. These transplanted cells will then find their way to the bone marrow and restore it, so that it can build healthy new blood cells.

There are two types of transplants:
1) Autologous transplants which uses your own bone marrow or stem cells.
2) Allogeneic transplants which uses bone marrow or stem cells from a donor.

Watchful Waiting

This means that the patient does not have to get any active treatment now. But, he may need to get treatments later.

Clinical Trials

These are research studies that help doctors learn more about lymphoma treatment. They can also help people with cancer, because it allows them to receive the treatment. Often, clinical trials are the only way patients can receive new treatments, which are not otherwise available.

Clinical trials can help doctors learn about many ways to help their patients like:

• New types of treatments.
• Ways to prevent cancer.

While clinical trials can provide many benefits, they can also be harmful for some patients. The patient should speak with his doctor, nurse, or health care team about clinical trials.

Lymphoma causes and diagnosis

Lymphoma causes and diagnosis

Causes

Non-Hodgkin's lymphoma

§  Age - most non-Hodgkin lymphomas are in people 60 years of age and over

§  Sex - there are different rates of different types of non-Hodgkin's lymphoma across the sexes

§  Ethnicity and location - in the US, African-Americans and Asian-Americans are less prone than white Americans, and the disease is more common in developed nations of the world

§  Chemicals and radiation - some chemicals used in agriculture have been linked, as has nuclear radiation exposure

§  Immune deficiency - for example, caused by HIV infection or in organ transplantation

§  Autoimmune disease, in which the immune system attacks the body's own cells

§  Infection - certain viral and bacterial infections increase the risk. The Helicobacter Infection has been implicated, as has the Epstein Barr Virus (the virus that causes glandular fever)¹³

Hodgkin's lymphoma

§  Infectious mononucleosis - infection with Epstein-Barr virus

§  Age - two specific groups are most affected: typically people in their 20s, and people over the age of 55 years

§  Sex - slightly more common in men

§  Location - most common in the US, Canada and northern Europe; least common in Asia

§  Family - if a sibling has the condition, the risk is slightly higher, and very high if there is an identical twin

§  Affluence - people from higher socioeconomic status are at greater risk

§  HIV infection

Diagnosis

 

-          Blood tests

The doctor may take some blood from the arm using a needle and syringe. This will be sent to a pathology laboratory to be examined. These tests will also tell the doctors how well the other organs such as liver and kidneys are working.

-          Bone marrow biopsy

Lymphoma cells can spread to bone marrow. In a bone marrow biopsy, a sample from the bone marrow is taken with a needle. The bone marrow is usually taken from the back of the hipbone.

The patient will have a local anaesthetic and possibly some sedative so he does not feel pain during the biopsy. The sample will be looked at under a microscope to see if the lymphoma has spread to the bone marrow.

-          Computerised tomography (CT) scan

A CT scan is a special type of x-ray that gives a three-dimensional (3-D) picture of the organs and other structures in the body. It usually takes about 30 to 40 minutes to complete this painless test.

-          Gallium scan

In this test the whole body is checked. The patient will have an injection of radioactive gallium, a sort of metal. After a few days, when it has had time to circulate around the body, the patient will return to the hospital to have pictures of the body taken with a special camera (a gamma camera).

Lymphoma

Lymphoma

The lymphatic system is part of the immune system. It consists of a network of vessels that carry a fluid called lymph, similar to the way that the network of blood vessels carry blood throughout the body. Lymph contains white blood cells called lymphocytes that are also present in blood and tissues. Lymphoma is a form of cancer that affects the immune system - specifically, it is a cancer of immune cells called lymphocytes, a type of white blood cell. These lymph nodes filter the lymph, which may carry bacteria, viruses, or other microbes. At infection sites, large numbers of these microbial organisms collect in the regional lymph nodes and produce the local swelling and tenderness typical of a localized infection. Lymphocytes recognize infectious organisms and abnormal cells and destroy them. There are two major subtypes of lymphocytes: B lymphocytes and T lymphocytes, also referred to as B cells and T cells. There are two broad types of lymphoma and many subtypes:

• Non-Hodgkin: Most people with lymphoma have this type.
• Hodgkin

These two types occur in the same places, may be associated with the same symptoms, and often have similar appearance on physical examination. However, they are readily distinguishable via microscopic examination of a tissue biopsy sample because of their distinct appearance under the microscope and their cell surface markers. Non-Hodgkin and Hodgkin lymphoma each affect a different kind of lymphocyte. Every type of lymphoma grows at a different rate and responds differently to treatment. Even though lymphoma is cancer, it is very treatable. Many cases can even be cured. Classification is a complicated process, but it helps surgeons and physicians to determine the best course of action for treating the cancer.

A number of different classification systems have been proposed over recent years, with the most commonly used system devised by the World Health Organization (WHO). This lymphoma classification system helps physicians to standardize how they discuss lymphoma.

Lymphoma is different from leukemia. Each of these cancers starts in a different type of cell.

• Lymphoma starts in infection-fighting lymphocytes.
• Leukemia starts in blood-forming cells inside bone marrow.

The symptoms and signs of lymphoma are very similar to those of simple illnesses such as viral illnesses and the common cold, and this can cause problems with delayed diagnosis. The difference is that the symptoms of lymphoma persist long after the usual run of a viral infection.

Diagnosis and treatment of leukemia

Diagnosis and treatment of leukemia

Diagnosis

In addition to a medical history and a physical exam to look for signs of leukemia, the diagnosis of leukemia typically involves laboratory studies of a blood sample. Abnormal numbers of blood cells may suggest a diagnosis of leukemia, and the blood sample may also be examined under the microscope to see if the cells appear abnormal.

·         Physical exam. The doctor will look for physical signs of leukemia, such as pale skin from anemia, swelling of the lymph nodes, and enlargement of the liver and spleen.

·         Blood tests. By looking at a sample of the blood, the doctor can determine if the patient has abnormal levels of white blood cells or platelets — which may suggest leukemia.

·         Bone marrow test. A sample of the bone marrow may also be obtained to establish the diagnosis. For a bone marrow aspirate, a long, thin needle is used to withdraw a sample of bone marrow from the hip bone, under local anesthesia. A bone marrow biopsyinvolves insertion of a thick, hollow needle into the hip bone to remove a sample of the bone marrow, using local anesthesia.

Treatments for leukemia

As the various types of leukemias affect patients differently, their treatments depend on what type of leukemia they have. The type of treatment will also depend on the patient's age and his state of health. As treatment has improved, the aim of virtually all health care professionals should be complete remission - that the cancer goes away completely for a minimum of five years after treatment. Treatment for patients with acute leukemias should start as soon as possible, this usually involves induction therapy with chemotherapy, and takes place in a hospital. When a patient is in remission he will still need consolidation therapy or post induction therapy. This may involve chemotherapy, as well as a bone marrow transplant (allogeneic stem cell transplantation). If a patient has Chronic Myelogenous Leukemia (CML) his treatment should start as soon as the diagnosis is confirmed. He will be given a drug, probably Gleevec (imatinib mesylate), which blocks the BCR-ABL cancer gene. Gleevec stops the CML from getting worse, but does not cure it. There are other drugs, such as Sprycel (dasatinib) and Tarigna (nilotinb), which also block the BCR-ABL cancer gene. Patients who have not had success with Gleevec are usually given Sprycel and Tarigna. All three drugs are taken orally.

Symptoms and risk factors of leukemia

Symptoms and risk factors of leukemia

Symptoms of leukemia

§  Poor blood clotting: As immature white blood cells crowd out blood platelets, which are crucial for blood clotting, the patient may bruise or bleed easily and heal slowly - he may also develop petechiae.

§  Affected immune system: The patient's white blood cells, which are crucial for fighting off infection, may be suppressed or not working properly. The patient may experience frequent infections, or his immune system may attack other good body cells.

§  Anemia: As the shortage of good red blood cells grows the patient may suffer from anemia - this may lead to difficult or labored respiration (dyspnea) and pallor.

§  Other symptoms: Patients may also experience nausea, fever, chills, night sweats, flu-like symptoms, and tiredness. If the liver or spleen becomes enlarged the patient may feel full and will eat less, resulting in weight loss. Headache is more common among patients whose cancerous cells have invaded the CNS (central nervous system).

Causes

Scientists don't understand the exact causes of leukemia. It seems to develop from a combination of genetic and environmental factors. In general, leukemia is thought to occur when some blood cells acquire mutations in their DNA. Certain abnormalities cause the cell to grow and divide more rapidly and to continue living when normal cells would die. Over time, these abnormal cells can crowd out healthy blood cells in the bone marrow, leading to fewer healthy white blood cells, red blood cells and platelets, causing the signs and symptoms of leukemia

The following are either known causes, or strongly suspected causes:

§  Artificial ionizing radiation

§  Viruses - HTLV-1 (human T-lymphotropic virus) and HIV (human immunodeficiency virus)

§  Benzene and some petrochemicals

§  Alkylating chemotherapy agents used in previous cancers

§  Maternal fetal transmission (rare)

§  Hair dyes

§  Genetic predisposition - some studies researching family history and looking at twins have indicated that some people have a higher risk of developing leukemia because of a single gene or multiple genes.

§  Down syndrome - people with Down syndrome have a significantly higher risk of developing leukemia, compared to people who do not have Down syndrome. Experts say that because of this, people with certain chromosomal abnormalities may have a higher risk.

§  Electromagnetic energy - studies indicate there is not enough evidence to show that ELF magnetic (not electric) fields that exist currently might cause leukemia.

Leukemia

Leukemia

Leukemia is cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system. The DNA of immature blood cells, mainly white cells, becomes damaged in some way. This abnormality causes the blood cells to grow and divide uncontrollably. Normal blood cells die after a while and are replaced by new cells which are produced in the bone marrow. The abnormal blood cells do not die so easily, and accumulate, occupying more and more space. As more and more space is occupied by these faulty blood cells there is less and less space for the normal cells - and the sufferer becomes ill. Quite simply, the bad cells crowd out the good cells in the blood. There are different types of leukemia, based upon how quickly the disease develops and the type of abnormal cells produced. Leukemia is called an acute leukemia if it develops rapidly. Large numbers of leukemia cells accumulate very quickly in the blood and bone marrow, leading to symptoms such as tiredness, easy bruising, and susceptibility to infections. Acute leukemia requires fast and aggressive treatment.

The Types of Leukemia

The onset of leukemia can be acute (sudden onset) or chronic (slow onset). In acute leukemia, cancer cells multiply quickly. In chronic leukemia, the disease progresses slowly and early symptoms may be very mild.

Leukemia is also classified according to the type of cell. Leukemia involving myeloid cells is called myelogenous leukemia. Myeloid cells are immature blood cells that would normally become granulocytes or monocytes.Leukemia involving lymphocytes is called lymphocytic leukemia. There are four main types of leukemia:

Acute Myelogenous Leukemia (AML)

Acute myelogenous leukemia (AML) can occur in children and adults. According to National Cancer Institute (NCI), about 21,000 new cases of AML are diagnosed annually in the United States. This is the most common form of leukemia.

Acute Lymphocytic Leukemia (ALL)

Acute lymphocytic leukemia (ALL) occurs mostly in children. About 6,000new cases of ALL are diagnosed annually.

Chronic Myelogenous Leukemia (CML)

Chronic myelogenous leukemia (CML) affects mostly adults. About 7,000new cases of CML are diagnosed annually.

Chronic Lymphocytic Leukemia (CLL)

Chronic lymphocytic leukemia (CLL) is most likely to affect people over the age of 55. It’s very rarely seen in children. About 15,000 new cases of CLL are diagnosed annually.

Hairy cell leukemia is a very rare subtype of CLL. Its name comes from the appearance of the cancerous lymphocytes under a microscope.