Lymphoma

Lymphoma is a term for a group of cancers that originate in the lymphatic system. Lymphoma happens when a lymphocyte — a type of white blood cell — undergoes a malignant change and begins to multiply eventually crowding out healthy cells and creating tumours which enlarge to lymph nodes or other sites in the body.

Every year, September 15th marks the World Lymphoma Awareness Day (WLAD) — a day dedicated to raising awareness of lymphoma, which is fast becoming an increasingly common form of cancer. Lymphoma is increasing in incidence and is a potentially life-threatening disease. One million people worldwide live with lymphoma and nearly 1,000 people are diagnosed with the disease everyday, but there continues to be very little awareness of the signs and symptoms of lymphoma.

In 1832, Thomas Hodgkin published the first description of lymphoma, specifically Hodgkin’s lymphoma which is named after him. Since then many other forms of lymphoma have been described, grouped under several proposed classifications. In 1982 the category non-Hodgkin lymphoma (NHL) was introduced, itself divided into 16 different diseases. The designations ‘indolent’ (slow growing) or ‘aggressive’ (fast growing) are applied to different types of NHL. Each group is diagnosed and treated differently. NHL has to be differentiated from Hodgkins Lymphoma for the latter has the presence of an abnormal cell called the reed.

As per Shaukat Khannum Cancer registry of December 2007, NHL is the second most common cancer after breast cancer. Its incidence increases with age. It usually begins with a painless swelling of one or more lymph nodes in association with some times fever, night sweats and weight loss. The reasons for the development of NHL are unknown, but immune suppression may play a role in the development of some.

Certain viruses such as HIV, Helicobacter Pyloric and HTLV have been associated with certain types of NHL. About a dozen unknown, inherited syndromes can predispose individuals to later development of NHL. Some ingredients in germicides and pesticides may also be linked to it.

Treatment for NHL is generally aimed at destroying as many lymphoma cells as possible and inducing a complete remission. Chemotherapy and radiation therapy are the two principal forms of treatment. Although radiation therapy is not the sole or principal curative therapy; it is in important additional treatment in some cases. Newer treatment modalities have revolutionised NHL’s management. Especially monoclonal antibody against CD-20 receptors expressed abundantly on lymphoma cells, when combined with chemotherapy, can dramatically improve overall survival. Other treatment options for some NHL subtypes include stem cell transplantation and watch-and-wait strategy.

The five-year survival rate for NHL patient has risen from 31 per cent from 1960 to 1963 to nearly 69 per cent for people of all races from 1999 to 2005. This growing survivor population has special needs for medical follow up.

Newer agents and drug combinations, progress in stem cell transplantation, better supportive care and studies of new drugs in clinical trials contribute to improved outcome and better quality of life for people living with 
lymphomas.