Non-HodgkinNon-Hodgkin’’s s LymphomaLymphoma

Dr. Tjatur Winarsanto SpPDDr. Tjatur Winarsanto SpPD

RST CiremaiRST Ciremai

20112011

LymphomaLymphoma

History and OverviewHistory and Overview StatisticsStatistics What it effects (biology)What it effects (biology) Classification and StagingClassification and Staging SymptomsSymptoms Causes and Risk FactorsCauses and Risk Factors Diagnosis and TreatmentDiagnosis and Treatment

LymphomaLymphoma’’ssWhere They BeginWhere They Begin

Lymphomas are a Lymphomas are a cancer of the cancer of the lymphatic systemlymphatic system• Lymphatic vesselsLymphatic vessels• Lymph nodes Lymph nodes

(underarms, groin, (underarms, groin, neck, spleen, tonsils neck, spleen, tonsils and bone marrow)and bone marrow)

Lymphatic SystemLymphatic System

American Medical Association

Non-HodgkinNon-Hodgkin’’s Lymphoma s Lymphoma StatisticsStatistics

for 2004for 2004 54,370 new cases 54,370 new cases 19,410 deaths19,410 deaths

• In California Alone there are est. 5,550 new In California Alone there are est. 5,550 new cases and a Death rate of 1,730 (California has cases and a Death rate of 1,730 (California has the highest incidence and Death rate for Non-the highest incidence and Death rate for Non-HodgkinHodgkin’’s Lymphomas Lymphoma

• Non-HodgkinNon-Hodgkin’’s Lymphoma is the 6s Lymphoma is the 6thth and 7 and 7thth most deadly cancers for men and women most deadly cancers for men and women

• Recent studies have shown that overweight Recent studies have shown that overweight patients are more likely to die then those patients are more likely to die then those patients who are in better shape.patients who are in better shape.

ClassificationClassification

Usually classified by how the cells Usually classified by how the cells look under a microscope and how look under a microscope and how quickly they grow and spreadquickly they grow and spread• Aggressive lymphomas (high-grade Aggressive lymphomas (high-grade

lymphomas)lymphomas)

• Indolent Lymphomas (low-grade Indolent Lymphomas (low-grade lymphomas)lymphomas)

Non-HodgkinNon-Hodgkin’’s Lymphomas LymphomaStagingStaging

Stage is the term used to describe the Stage is the term used to describe the extent of tumor that has spread through extent of tumor that has spread through the body( I and II are localized where as III the body( I and II are localized where as III and IV are advanced.and IV are advanced.

Each stage is then divided into categories Each stage is then divided into categories A, B, and EA, B, and E• A: No systemic symptomsA: No systemic symptoms• B: Systemic Symptoms such as fever, night B: Systemic Symptoms such as fever, night

sweats and weight losssweats and weight loss• E: Spreading of disease from lymph node to E: Spreading of disease from lymph node to

another organanother organ

StagingStaging

Non-HodgkinNon-Hodgkin’’s Lymphomas Lymphoma

Two main types of Non-HodgkinTwo main types of Non-Hodgkin’’s s Lymphoma:Lymphoma:

B-Cell and T-Cell LymphomasB-Cell and T-Cell Lymphomas•B-Cell lymphomas (80%)B-Cell lymphomas (80%)•T-Cell lymphomas (15%)T-Cell lymphomas (15%)

B-Cell Lymphoma (80%) B-Cell Lymphoma (80%)

B-Cells help make antibodies, which are B-Cells help make antibodies, which are proteins that attach to and help destroy proteins that attach to and help destroy antigensantigens

Lymphomas are caused when a mutation Lymphomas are caused when a mutation arises during the B-cell life cyclearises during the B-cell life cycle

Various different lymphomas can occur Various different lymphomas can occur during several different stages of the cycleduring several different stages of the cycle• Follicular lymphoma, which is a type of B-cell Follicular lymphoma, which is a type of B-cell

lymphoma is caused by a gene translocation lymphoma is caused by a gene translocation which results in an over expressed gene called which results in an over expressed gene called BCL-2, which blocks apoptosis.BCL-2, which blocks apoptosis.

B-Cell CancersB-Cell Cancers

T-Cell Lymphoma (15%)T-Cell Lymphoma (15%)

The T-cells are born from stem cells, The T-cells are born from stem cells, similar to that of B-cells, but mature similar to that of B-cells, but mature in the thymus.in the thymus.

They help the immune system work They help the immune system work in a coordinated fashion.in a coordinated fashion.• These types of lymphomas are These types of lymphomas are

categorized by how the cell is affectedcategorized by how the cell is affected Anaplastic Large cell Lymphoma, t-cell Anaplastic Large cell Lymphoma, t-cell

lymphoma caused by a gene translocation in lymphoma caused by a gene translocation in chromosome 5chromosome 5

Lymphoma.org

SymptomsSymptoms

Painful Swelling of lymph nodes Painful Swelling of lymph nodes located in the neck, underarm and located in the neck, underarm and groin.groin.

Unexplained FeverUnexplained Fever Night SweatsNight Sweats Constant FatigueConstant Fatigue Unexplained Weight lossUnexplained Weight loss Itchy SkinItchy SkinCancer Sourcebook

Causes and Risk FactorsCauses and Risk Factors

The Exact causes are still unknownThe Exact causes are still unknown• Higher risk for individuals who:Higher risk for individuals who:

Exposed to chemicals such as pesticides or Exposed to chemicals such as pesticides or solventssolvents

Infected w/ Epstein-Barr VirusInfected w/ Epstein-Barr Virus Family history of NHL (although no Family history of NHL (although no

hereditary pattern has been established)hereditary pattern has been established) Infected w/ Human Immunodeficiency Virus Infected w/ Human Immunodeficiency Virus

(HIV)(HIV)

Lymphoma.org

DiagnosisDiagnosis

X-RaysX-Rays CT scansCT scans Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI) BiopsyBiopsy LymphangiogramLymphangiogram

• Pictures of the lymphatic system taken Pictures of the lymphatic system taken w/ x-ray after a special dye is injected to w/ x-ray after a special dye is injected to illuminate lymph nodes and vesselsilluminate lymph nodes and vessels

TreatmentTreatment

Non-HodgkinNon-Hodgkin’’s Lymphoma is usually s Lymphoma is usually treated by a team of physicians including treated by a team of physicians including hematologists, medical oncologists and a hematologists, medical oncologists and a radiation oncologist.radiation oncologist.

In some cases such as for Indolent In some cases such as for Indolent lymphomas, the Doctor may wait to start lymphomas, the Doctor may wait to start treatment until the patient starts showing treatment until the patient starts showing symptoms, known as symptoms, known as ““watchful waitingwatchful waiting””

Treatment OptionsTreatment Options

ChemotherapyChemotherapy RadiationRadiation Bone Marrow TransplantationBone Marrow Transplantation SurgerySurgery Bortezomib (Velcade)Bortezomib (Velcade) ImmunotherapyImmunotherapy

Using the bodies own immune system Using the bodies own immune system combined with material made in a lab.combined with material made in a lab.

Survival RatesSurvival Rates

Survival Rates vary widely by cell Survival Rates vary widely by cell type and staging.type and staging.

• 1 Year Survival Rate: 77%1 Year Survival Rate: 77%

• 5 Year Survival Rate: 56%5 Year Survival Rate: 56%

• 10 Year Survival Rate: 42%10 Year Survival Rate: 42%

Cancer.org

Any Questions?Any Questions?