the lymphoma

What is lymphoma?
Lymphoma is a form of cancer -- a disease of the body's cells. Normal, healthy cells grow, divide and replace themselves in an orderly manner. When cancer is present, the cells grow abnormally and may continue to grow out of control, forming too much tissue -- a tumor.
Lymphoma encompasses a variety of cancers specific to the lymphatic system. The lymphatic system is an important network of glands and vessels which make up the body's main line of defense against disease (immune system). This network manufactures and circulates lymph throughout the body. Lymph is a clear, watery fluid that contains white blood cells that fight infection and disease called lymphocytes. Along the network are bean-shaped organs called lymph nodes or glands. The nodes are responsible for the manufacture and storage of these infection-fighting cells. Lymph nodes are clustered in the neck, under the arms, in the groin and abdomen and may swell and become tender when the body is fighting infection (such as mono or strep throat).
When lymphoma occurs, some of the cells in the lymphatic system grow abnormally and out of control. Eventually, they may form a tumor which continues to grow as the cancerous cells reproduce. If all the cells are the same, they are called malignant or cancerous, because they will continue to grow and eventually harm the body's systems. Because there is lymph tissue throughout the body, the cancer cells may spread to other organs, or even into the bone marrow.
What is Hodgkin's disease?
Hodgkin's lymphoma or Hodgkin's disease represents about eight percent of all lymphoma, according to the Leukemia Society of America, but it is the more well-known form of lymphoma and all other forms of lymphoma are grouped as non-Hodgkin's lymphoma.
In 1666, the lymphatic disease that later became known as Hodgkin's disease was first described by the "father of microscopical anatomy," Marcelle Malpighi, an Italian professor of medicine. In 1832, it was a paper by Dr. Thomas Hodgkin that provided the first solid documentation on actual cases of the lymphatic disease. In 1865, Samual Wilks published a paper that confirmed the disease and credited Hodgkin with the name.
Hodgkin was an English scholar and Quaker physician born in Tottenham, Middlesex, England in August 1798. Educated at the University of Edinburgh, he joined the staff of Guy's Hospital in London in 1825. He devoted his life to medical practice, reform and education and was one of the foremost humanitarians in 19th century England. After a life dedicated to the service of those around him, Hodgkin died in April 1866 in Palestine (later known as Israel).
The primary difference between Hodgkin's disease and non-Hodgkin's lymphoma is the presence of a specific abnormal cell: Reed-Sternberg cells (named after the doctors that first described them in detail). These large, malignant cells are found in diseased tissues and are thought to be a type of malignant B lymphocyte. Normal, healthy B-cells produce antibodies that guide the immune system in fighting and killing harmful bacteria. As the number of Reed-Sternberg cells increases, the disease advances, destroying healthy normal cells.
There are different names for Hodgkin's disease: lymphocyte predominance, nodular sclerosis, mixed cellularity, lymphocyte depletion and unclassified.
What causes Hodgkin's disease?
Risk factors are anything that can increase the chance of developing a disease. They may be lifestyle-related, genetic (inherited) or environmental. The risk factors that a relate to other cancers such as diet, smoking and unprotected sun or pesticide exposure are not related to Hodgkin's disease. In fact, there are few risk factors that link directly to the development of Hodgkin's disease.
Age/Sex:
The disease occurs more often in males in the primary age categories, early adulthood (15-40) and late adulthood (after 55).
Genetic:
Brothers and sisters of Hodgkin's disease patients have an above-average chance of developing the disease but the significance of the family relationship as the primary cause is not known.
Infection:
The Epstein-Barr virus (EBV), which causes mononucleosis, may be linked to an increase in the risk of developing Hodgkin's. EBV is a virus that infects B-lymphocytes, causing them to grow and live longer. If the body's T-cell production is compromised, then the B-cells continue to accumulate, increasing the chance for the disease to develop. However, more than half of all Hodgkin's patients have no evidence of a previous EBV infection so a definitive relationship is still unclear.
Medical Conditions:
People with compromised immune systems are at greater risk for Hodgkin's disease but Hodgkin's disease is less common than other cancers such as NHL in these patients.
• Human immmunodeficiency virus (HIV or AIDS virus) infection poses a risk factor for developing Hodgkin's disease
• Organ transplant patients undergo drug therapy that suppress their immune system (T-cells) to keep it from attacking the new organ(s). Depending on the drugs used, this intentional suppression poses a significant risk to the patient of developing Hodgkin's disease.
Unfortunately, the bottom line is that most patients with Hodgkin's disease have no known risk factors, therefore the true cause of Hodgkin's disease is still unknown. However, it is important to note that Hodgkin's is NOT contagious so patients pose no health risk to others at any time and possessing a risk factor does not mean a person will develop Hodgkin's disease.
Prevention
Since most people with Hodgkin's disease have no known risk factors, there is no way to prevent lymphomas from developing. By working to prevent the one potential significant risk factor, HIV, we are able to reduce the chances of developing lymphomas but not prevent them entirely. As for the other potential factors, not enough is known about their relationship with Hodgkin's to provide practical means of prevention.
Treatment
There are many individual factors that are key in determining the right course of treatment for you. Treatment for Hodgkin's disease depends not only on its stage and location in the body, but also on your age, health status and other personal preferences. Staging refers to the degree to which the cancer has spread beyond its original site to other parts of the body. For additional information on staging, please visit the American Cancer Society site at www3.cancer.org/cancerinfo/load_cont.asp?st=ds&ct=20.
As with all treatment decisions, be sure to evaluate the whole picture. Learn all you can about the duration, side effects and long-term impact of each option presented. Do not hesitate to seek a second opinion. Because of the tremendous progress made in the treatment of Hodgkin's disease, the main goal of your cancer care team should be a total cure.
There are two main methods to treat Hodgkin's disease: chemotherapy and radiation therapy.
Because the goal of Hodgkin's treatment is to completely kill the cancer, chemotherapy treatment usually involves more than one type of drug because different drugs kill cells differently. The combinations of drugs used to treat Hodgkin's may be referred to in an abbreviated form using initials of the more pronounceable names such as MOPP and ABVD.
External beam radiation usually is used to treat Hodgkin's when the disease is localized to one area of the body or is so large in mass that even chemotherapy cannot completely kill all the cancerous cells. In this treatment, a concentrated beam of high-energy rays (or particles) is delivered to the infected body part from a machine outside the body. The radiation slows cell growth or destroys the cells altogether. Previously, it was the protocol to treat surrounding lymph node areas to make sure the disease had not spread but because radiation may severely damage nearby healthy skin, today doctors prefer an "involved field radiation" method where only the diseased area is treated. Many doctors choose an integrative approach which combines chemotherapy and radiation methods. If the cancer is resistant to chemotherapy and radiation, then a bone marrow or stem cell transplant may be called for. Further details on the treatment of Hodgkin's disease may be found at the American Cancer Society site at www3.cancer.org/cancerinfo/load_cont.asp?st=tr&ct=20.
Surgery is only used for a biopsy and to determine the stage of Hodgkin's disease. It is not a treatment method for Hodgkin's as it may be with other more localized cancers.
On a positive note, according to the American Cancer Society about 90% of newly diagnosed patients are cured with chemotherapy.


What is non-Hodgkin's lymphoma (NHL)?
There are two main types of lymphocytes: B lymphocytes (B-cells) and T lymphocytes (T-cells). Normal, healthy B-cells produce antibodies that guide the immune system in fighting and killing harmful bacteria. Normal, healthy T-cells recognize and destroy virus-infected or cancer cells. They also can release substances called cytokines that attract other types of white blood cells, which then digest the infected cells. In an organ transplant, it is the T-cells that must be suppressed so they do not attack the new organ, causing the body to reject it.
Non-Hodgkin's lymphoma (NHL) occurs with the malignant (cancerous) growth of B or T cells. Although both types can develop into lymphomas, B-cell lymphomas are much more common, accounting for 85% of all cases of NHL compared to T-cell lymphomas, which account for 15% of all cases of NHL, according to the American Cancer Society.
There are over 29 different types of NHL, each differentiated by the type of cancer cell. Some scientists classify cells by growth rate: indolent refers to slow growth and aggressive refers to fast-growing cells. Some also classify NHLs by cell type: T-cell, large cell, B-cell and follicular cell, etc.. For a more complete listing of lymphoma types, please see the Lymphoma Information Network's classification and typing page at [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
What causes NHL?
Anything that can increase the chance of contracting lymphoma is considered a risk factor. This may be lifestyle-related, environmental or genetic (inherited) factors.
• Lifestyle risk factors
While risk factors for some cancers include extended exposure to strong sunlight without protection, a high-fat, low-fiber diet, smoking, and excessive alcohol consumption, none of these strongly affect a person's risk of developing NHL.
• Environmental risk factors (influences in our surroundings)
Radiation
Patients treated with both radiation therapy and chemotherapy have an increased risk of developing secondary leukemias or NHL. Exposure to nuclear reactor accidents and atomic bombs as well as patients treated with radiation therapy for other cancers have a risk of contracting NHL but it may not occur right away.
Chemicals
Certain herbicides and insecticides are associated with increased risk of developing NHL. Some chemotherapy drugs (not all) used to treat other cancers may increase the risk of developing leukemia or NHL five to 10 years later and patients treated for Hodgkin's disease have a 4-5% risk of developing NHL over a 10-year period, according to the American Cancer Society.
Organ Transplant
Transplant patients undergo drug therapy that suppress their immune system (T-cells) to keep it from attacking the new organ(s). Depending on the drugs used, this intentional suppression poses a significant risk to the patient of developing NHL.
Infections
• Human immunodeficiency virus (HIV or AIDS virus) infection poses a risk factor for developing certain types of NHL.
• T-cell leukemia/lymphoma virus (HTLV-1) increases the risk of developing certain types of T-cell NHL. In the United States it causes less than 1% of lymphomas, according to the American Cancer Society. HTLV-1 belongs to the same family as HIV, and like HIV is spread through sexual intercourse, breast milk and contaminated blood.
• Burkitt's lymphoma is common in Africa where infections from malaria and the Epstein-Barr virus (EBV) are key risk factors. EBV is a virus that infects B-lymphocytes, causing them to grow and live longer. If the body's T-cell production is compromised B-cells continue to accumulate, increasing the chance for a DNA mutation that can develop into NHL. See below for additional information on genetic mutations.
• According to the American Cancer Society, recent discovery shows that the bacteria that causes stomach ulcers (Helicobacter pylori) can also cause some types of stomach lymphoma when the body's immune system reacts to the ulcer bacteria by overproducing certain lymphocytes. This discovery is important because treatment of the bacteria with antibiotics could prevent some NHL in the stomach from developing and antibiotics may be helpful in treating some patients who have already developed lymphomas of the stomach.
• Genetic risk factors
Children born with abnormal or deficient immune systems have an increased chance of developing NHL during childhood or as young adults. While some of these immune deficiencies may be inherited and passed on to children, NHL survivors do NOT pass an increased risk of cancer on to their children.
There has been recent progress in understanding how DNA may play a part in causing normal lymphocytes to become cancerous. Cancers can be caused by DNA defects (mutations) which cause genes that direct cell growth (oncogenes) to overproduce or genes that slow growth or promote cell death (tumor surpressor genes) to fail. Some DNA mutations can be inherited, increasing a risk for certain types of cancer but NHL is NOT one of the cancers caused by these inherited gene mutations.
NHL-related DNA mutations are usually acquired after birth and often appear for no apparent reason though some may result from lifestyle (cancer-causing drug exposure) or environmental (radiation exposure) risk factors. When a cell divides, its DNA is duplicated and if an exact copy of the DNA is not produced, the "mistake" cells may slip past the body's repair efforts and continue to divide and grow, producing cancerous cells.
Unfortunately, the bottom line is that most patients with NHL have no known risk factors, therefore the true cause of non-Hodgkin's lymphoma is still unknown. However, it is important to note that NHL is NOT contagious so patients pose no health risk to others at any time and possessing a risk factor does not mean a person will develop NHL.
Some facts and figures according to the American Cancer Society
• Over 54,900 people are predicted to be diagnosed with NHL in 2000 (31,700 men and 23,200 women).
• The figure above includes adults and children and although some types of non-Hodgkin's lymphoma are among the most common childhood cancers, over 95% of non-Hodgkin's lymphoma cases occur in adults.
• The risk of developing non-Hodgkin's lymphoma increases throughout life, with the elderly at greatest risk.
• NHL is the fifth most common cancer in the United States, excluding non-melanoma skin cancers.
• Since the early 1970s, incidence rates for non-Hodgkin's lymphoma have nearly doubled. The American Cancer Society estimates that approximately 26,100 Americans (13,700 men and 12,400 women) will die of this cancer in 2000.
Prevention
Since most people with NHL have no known risk factors, there is no way to prevent lymphomas from developing. By working to prevent the significant known risk factor, HIV, we are able to reduce the chances of developing lymphomas but not prevent them entirely.
With respect to chemotherapy and radiation treatments, both of which compromise the immune system and increase a risk for developing NHL, doctors are currently studying alternative methods of treating cancers that reduce the risk of NHL. However, the life-threatening impact of the diseases successfully treated through chemotherapy and radiation and the immediate life savings of organ transplantation must be balanced against the potential risk of developing NHL later in life.
Treatment
Treatment depends on the stage and grade of the lymphoma. The grade determines how rapidly it is likely to grow; stage determines how far the disease has progressed. Grades are determined by examination of a tissue sample under a microscope. However, the specific type of lymphoma or part of the body affected by the disease may play an even greater part in determining treatment protocol.
Surgery may be used to obtain tissue samples for diagnosis and classification of lymphoma but it is rarely used to treat NHL unless the cancer is localized to certain organs. The most common treatment is chemotherapy. If the cancer is localized, radiation also may be used in conjunction with chemotherapy. Some types of very advanced and non-responsive lymphomas may call for bone marrow or stem cell transplants but not in all cases. Monoclonal antibodies also are becoming more and more available and can be effective in fighting very specific types of cancer. This treatment is generally used for patients whose NHL has either not responded to chemotherapy or has relapsed. Clinical trials are now being held on the effectiveness of monoclonal antibodies. Some doctors prescribe a "watch and wait" pattern whereby they may halt treatment for a period of time to see how an indolent (slow growth or almost dormant) lymphoma is going to progress in order to determine the best course of treatment