Non-Hodgins Lymphoma with Case Study Example

Non-Hodgkin’s Lymphoma is a cancer of the lymphocytes the white blood cells. The lymphocytes and lymph system are essential in our body’s immune protection. It is an abnormal growth rate of these cells. Since lymph is found throughout the body it is easily spread from one area to another. In 2008 there were over 66,000 new cases and just over 19,000 deaths from it (cancer. gov). It is categorized as slow growing or fast growing, as well as if it starts in the T-cells or the B-cells. Lymphomas from B cells are most common in the United States. The lymphoma can develop in any of the lymph tissues, and discovery of which kind of lymphoma determines the treatment options (cancer. org). Causes Although there are no definite causes to Non Hodgkin’s lymphoma there have cases where it has been linked to persons with another ailment. Autoimmune diseases like RA and SLE have been linked to NHL. Exposures to chemicals such as benzene and treatments in chemotherapy have been seen in trends to cause NHL. People who are immunocompromised like HIV patients and those that are on immunosuppressant from transplants are also at risk for Lymphomas. Also, people having excessive exposure to large amounts of radiation, like cancer treatments have an increased risk of developing this lymphoma. NHL is mostly seen in the older community so age is also a risk factor. Also chronic diseases may increase the chances of getting a lymphoma due to the increased risk of mutations from constantly producing new lymph cells. Some patients can be born with a disease that can lead to NHL due to a defect in their DNA. It is not likely that they can pass on the NHL to their offspring if they don’t have the underlying disease. Most often it develops independently. Discovery Lumps in the skin and lymph nodes can be discovered by the patient, their partner or doctor. Where the lump is located can also give extra symptoms. For instance, if it is found near the skin there would be a swelling in the surrounding tissue. If it’s in the abdomen it can cause severe pain and possible digestive problems. If the lymphoma is on the skin t can cause an itchy patch. If it is in the chest cavity it can cause trouble breathing. Case Study: Non-Hodgkin’s Lymphoma Shannon Z is an active 58 yr old female. In her early twenties she had undergone chemotherapy and radiation for her treatment of breast cancer. When she noticed the lump in her neck she immediately went to see her doctor. The doctor ordered some blood tests and a biopsy of the lump. Her doctor wasn’t very concerned because fighting an infection can also cause enlarged nodes in the neck. She ordered the tests anyway because of the patient’s medical history. Along with the lump, she experienced drenching night sweats which are another symptom of NHL but she thought it was a side effect of menopause. Other signs to look for would be persistent fevers and a sudden loss of weight, usually 10 % body weight or more. An incisional biopsy is a surgical technique used to obtain a sample of the node for observation. This was used because the enlarged node was close to the skin surface. There are other biopsies available. Fine needle biopsies can also be used but often don’t provide enough sample to determine if its lymphoma or not but does not require surgery. Lumbar punctures look for lymphoma in the CNS. Bone marrow aspiration looks for the cancer inside the bone and bone marrow by removing pieces of the bone and/or marrow. Laboratory tests All samples must be diagnosed be a trained pathologist with experience in lymphomas. The most important test would be those differentiating if the patient has a cancer, then T cell lymphoma from the B cell lymphoma. If a concrete diagnosis can’t be made from looking at the cells then other methods must be used. Methods like Immunocytochemistry involve using fluorescent tags on the surface of the cells can differentiate the different lymphomas from each other and non cancerous diseases. Flow cytometry uses antibody tagging and laser beams to cause the cells to emit light if they have the antigen. This is important because different NHL’s have specific antigens. Discovery of the type of NHL helps determine the treatment route. Blood tests cannot determine a lymphoma but they do show significance of the rate of growth of the lymphoma. CT scans and MRIs provide the doctors with images of the size of the actual lymph nodes and how many growths there are through the body. Prognosis There are two staging systems for NHL. The most common is the Ann Arbor system. It uses 1-4 to stage the severity of the disease. Stage 1 has lymphoma in one area in the lymph system and one outside the system (organ). A lymphoma is considered stage 2 if it is found exclusively in 2 areas above or 2 areas below the diaphragm and organs in close proximity to lymph. Stage 3 occurs when it is found on both sides of the diaphragm and other organs near lymph. Stage 4 is when lymphoma reaches the bone marrow, CSF, or an organ not next to a lymph source. This system is used in conjunction with the International Prognosis Index. The IPI uses the age of the patient, stage of the cancer, patient everyday performance status, location of the tumors, and levels of LDH (increases as the lymphoma spreads) Good Prognostic FactorsPoor Prognostic Factors Age 60 or belowAge above 60 Stage I or IIStage III or IV No lymphoma outside of lymph nodes, or lymphoma in only 1 area outside of lymph nodesLymphoma present in more than 1 organ of the body outside of lymph nodes PS: Able to function normallyPS: Needs a lot of help with daily activities Serum LDH is normalSerum LDH is elevated (Chart provided from www. cancer. org) Treatment Chemotherapy is often used in conjunction with radiation for low levels, or with medications like Rituxan or Zavalin. Rituxan is an antibody that targets the cancerous cells. Zavalin is an antibody with a radioactive component. The antibody attaches itself and the radioactive isotope destroys the cell. These drugs are used for the more persistent lymphomas because chemo and radiation have been proven very effective against the lymphoma. Stem cell transplantation is also another option. Once diagnosed, patients are requested to have frequent physicals and blood tests to track the growth of the cancer. Resources http://www. oncologychannel. com/nonhodgkins/diagnosis. shtml http://www. cancer. org http://www. cancer. com http://www. mayoclinic. org