Dr. Fred Piaser
Longevity and Diet
Parent and Child
Lymphoma, A Detailed UpdateLymphoma is a cancer that starts in cells that are part of the body's immune system. Knowing the type of lymphoma is important because this determines the treatment options and outlook (prognosis). This is an in depth article on lymphoma. If you wish to look at an overview of this diesease go to the article, "Lymphoma Overview".
The lymph system (also known as the lymphatic system) is part of the immune system, which helps fight infections. It also helps fluids move in the body. The lymph system is composed mainly of::
Lymph nodes: Lymph nodes are bean-sized collections of lymphocytes and other immune system cells throughout the body, including inside the chest, abdomen, and pelvis. They can sometimes be felt as small lumps under the skin in the neck, under the arms, and in the groin. Lymph nodes are connected to each other by a system of lymphatic vessels. Lymph nodes get bigger when they fight an infection. Lymph nodes that grow because of infection are called reactive or hyperplastic nodes. These often hurt when they are touched. People with sore throats or colds might have enlarged neck lymph nodes. An enlarged lymph node is not always a sign of a serious problem, but it can be a sign of lymphoma.
Spleen: The spleen is an organ under the lower part of the rib cage on the left side of the body. The spleen makes lymphocytes and other immune system cells to help fight infection. It also stores healthy blood cells and filters out damaged blood cells, bacteria, and cell waste.
Bone marrow: The bone marrow is the spongy tissue inside certain bones, which is where new white blood cells (including some lymphocytes), red blood cells, and platelets are made
Thymus: The thymus is a small organ behind the upper part of the breastbone and in front of the heart. It is important in the development of T lymphocytes.
Adenoids and tonsils: These are collections of lymphoid tissue in the back of the throat. They help make antibodies against germs that are breathed in or swallowed.
Digestive tract: The stomach, intestines, and many other organs also have lymphoid tissue.
Types of LymphocytesLymphoid tissue is made up mainly of cells called lymphocytes, a type of white blood cell. The 2 major types of lymphocytes are B lymphocytes (B cells) and T lymphocytes (T cells). Normal B cells and T cells have different jobs.
B lymphocytes: B cells help protect the body from germs (bacteria and viruses) by making proteins called antibodies. The antibodies attach to the germs, marking them for destruction by other parts of the immune system. Almost all cases of Hodgkin disease start in B lymphocytes.
T lymphocytes: There are several types of T cells, and each has a special job. Some T cells directly destroy certain kinds of bacteria or cells infected with viruses or fungi. Other types of T cells play a role in either boosting or slowing the activity of other immune system cells.
Types of LymphomaThere are 2 kinds of lymphomas:
Signs & Symptoms of Lymphoma
PROGNOSIS for Hodgkin diseaseThe rates below are based on the stage of the cancer when it is first diagnosed. When looking at survival rates, it's important to understand that the stage of a cancer does not change over time, even if the cancer progresses. If a cancer comes back or spreads, the survival rates may be different from those shown below.
The 5-year survival rate is the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many of these people live much longer than 5 years, and many are cured.The numbers below are among the most current available. But to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Improvements in treatment since then might result in a better outlook for people now being diagnosed with these cancers.The numbers below come from the National Cancer Institute's SEER database, looking at more than 8,000 people diagnosed with Hodgkin disease between 1988 and 2001.
Other prognostic factors
Along with the stage of the Hodgkin disease, other factors can affect a person's prognosis (outlook). For example, some factors mean the disease is likely to be more serious and might prompt the doctor to give more intensive treatment:
PROGNOSIS for NON-Hodgkin diseaseHow is non-Hodgkin lymphoma staged?
Once non-Hodgkin lymphoma is diagnosed, tests are done to determine the stage (extent of spread) of the disease. The treatment and prognosis (outlook) for a patient with non-Hodgkin lymphoma depend in part on the stage of the lymphoma.
Tests used to gather information for staging include:
Ann Arbor staging systemA staging system is a way for members of a cancer care team to summarize the extent of a cancer's spread. The Ann Arbor staging system is most often used to describe the extent of non-Hodgkin lymphoma in adults.The stages are described by Roman numerals I through IV (1-4). Lymphomas that affect an organ outside the lymph system (an extranodal organ) have E added to their stage (for example, stage IIE), while those affecting the spleen have an S added.
Stage I Either of the following means the disease is stage I:
Other modifiers may also be used to describe the lymphoma stage:Bulky disease - This term is used to describe tumors in the chest that are at least one-third as wide as the chest, or tumors in other areas that are at least 10 centimeters (about 4 inches) across. It is usually designated by adding the letter X to the stage. Bulky disease might need more intensive treatment.
A vs. B - Each stage may also be assigned an A or B. The letter B is added (stage IIIB, for example) if a person has any of the B symptoms listed below:
Survival rates and factors that affect prognosis (outlook) for non-Hodgkin lymphomaThe overall 5-year relative survival rate for people with NHL is 69%, and the 10-year relative survival rate is 59%. The type and stage of the lymphoma provide useful information about a person's prognosis (outlook), but for some types of lymphomas the stage isn’t too helpful on its own. In these cases, other factors can give doctors a better idea about a person's prognosis.
International Prognostic IndexThe International Prognostic Index (IPI) was first developed to help doctors determine the outlook for people with fast-growing lymphomas. However, it has proven useful for most other lymphomas as well. The index depends on 5 factors:
Good prognostic factors are:
Poor prognostic factors are:
Revised International Prognostic IndexA more recent version of the IPI is based on people with fast-growing lymphomas who have received more modern treatment, including a newer drug called rituximab (Rituxan). The revised IPI uses the same factors but divides patients into only 3 risk groups:
The IPI allows doctors to plan treatment better than they could just based on the type and stage of the lymphoma. This has become more important as new, more effective treatments have been developed that sometimes have more side effects. The index helps doctors figure out whether these treatments are needed.
Follicular Lymphoma International Prognostic IndexThe IPI is useful for most lymphomas, but it's not as helpful for follicular lymphomas, which tend to be slower growing. Doctors have developed the Follicular Lymphoma International Prognostic Index (FLIPI) specifically for this type of lymphoma. It uses slightly different prognostic factors than the IPI.
Good prognostic factors
Poor prognostic factors
Patients are assigned a point for each poor prognostic factor. People without any poor prognostic factors would have a score of 0, while those with all poor prognostic factors would have a score of 5. The index then divides people with follicular lymphoma into 3 groups:
The study used to develop the FLIPI produced the following survival rates:
Risk group for 10-year survival rate
Copyright © 2010 Westbury Pediatrics