What you need to know about lymphoma Last updated Fri 24 November 2017 By Markus MacGill Reviewed by Yamini Ranchod, PhD, MS Treatment Symptoms Causes Risk factors Types Diagnosis Outlook Lymphoma is a cancer of the lymphatic system. It affects a type of white blood cells known as lymphocytes. These help fight disease in the body. They play an important role in the immune system. This type of cancer starts in the white blood cells, or lymphocytes. As it is present in the bloodstream, it can spread, or metastasize, to different parts of the body. Lymphoma can occur at any age, but it is one of the most common causes of cancer in children and young adults aged 15 to 24 years. It is often treatable. In the United States, the lifetime risk of getting Non-Hodgkin lymphoma is 2.1 percent. The risk of getting Hodgkin lymphoma is around 0.2 percent. Fast facts on lymphoma Here are some key points about lymphoma. More detail is in the body of this article. Lymphoma is a cancer of the lymph nodes and lymphatic system. The two main types are Hodgkin and non-Hodgkin. Non-Hodgkin is the most common. The main symptom is usually an enlargement of lymph nodes that does not go away as it normally would after infection. There is no way to prevent lymphoma, but survival rates after treatment are good. Treatment Swollen glands that do not go away can be a sign of lymphoma. Swollen glands that do not go away can be a sign of lymphoma. Treatment depends on the type of lymphoma and the stage it has reached. Indolent, or slow-growing lymphoma may need only watchful waiting and no treatment. If treatment is necessary, it can involve: Biologic therapy: This is a drug treatment that stimulates the immune system to attack the cancer cells by inserting living microorganisms into the body. Antibody therapy: Synthetic antibodies are inserted into the bloodstream to combat the cancer's antigens. Chemotherapy: Aggressive drug treatment is used to kills cancer cells. Radioimmunotherapy: This delivers high-powered radioactive doses directly into the cancerous B-cells and T-cells to destroy them. Radiation therapy: This is used to focus on small areas of cancer. Stem-cell transplantation: This can restore damaged bone marrow following high-dose chemotherapy or radiation therapy. Steroids: These may be injected to treat lymphoma. Surgery: This can be used to remove the spleen or other organs after the lymphoma has spread. Surgery is used more often for obtaining a biopsy. Symptoms The signs and symptoms of lymphoma are similar to those of illnesses such as viral diseases and the common cold, but they continue for longer than would normally be expected. Some people will have no symptoms, but some may notice a swelling of the lymph nodes. These are located all around the body, often in the neck, groin, abdomen, or armpits. The swellings are normally painless, but pain may occur if the enlarged glands press on organs, bones, and other structures. This can be confused with back pain. Lymph nodes can swell during common infections, such as a cold, but in lymphoma the swelling does not go away. Pain is also more likely to accompany the swelling if it is due to an infection. The overlap of symptoms can lead to misdiagnosis. Anyone who has ongoing swelling of the glands should see their doctor. Other symptoms of both types of lymphoma may include: ongoing fever without infection night sweats, fever, and chills weight loss and loss of appetite unusual itching persistent fatigue, unusual tiredness, or lack of energy pain in lymph nodes after drinking alcohol Additional symptoms that can indicate Non-Hodgkin lymphoma include: persistent coughing shortness of breath pain or swelling of the abdomen Pain, weakness, paralysis, or otherwise altered sensation can occur if an enlarged lymph node presses against spinal nerves or the spinal cord. Lymphoma can spread rapidly from the lymph nodes to other parts of the body through the lymphatic system. As cancerous lymphocytes spread into other tissues, the body's ability to fight infection weakens. Causes Cancer happens when there is uncontrolled growth of abnormal cells that thrive and spread instead of dying as they would in the life cycle of a normal cell. Lymphatic tissue is connected throughout the body. If cancer cells develop in the lymphatic system, they can spread easily from their original location to other tissues and organs, including those outside the system. Lymphoma most often spreads to the liver, bone marrow, or lungs. In Hodgkin lymphoma, the cancer usually affects one lymph node after another in order. In non-Hodgkin lymphoma, tumors may arise in disparate lymph nodes, skipping some nodes. Exactly what causes lymphoma is unclear, but there are some risk factors. Risk factors The two different types of lymphoma have different risk factors. Non-Hodgkin lymphoma Risk factors for non-Hodgkin lymphoma include: Age: Most lymphomas occur in people aged 60 years and older, but some types are more likely to affect children and young adults. Sex: Some types are more likely in women, others are more likely in men. Ethnicity and location: In the U.S., African-Americans and Asian-Americans are at lower risk of non-Hodgkin lymphoma than white Americans, and it is more common in developed nations. Chemicals and radiation: Nuclear radiation and some chemicals used in agriculture have been linked to non-Hodgkin lymphoma. Immunodeficiency: A person with a weak immune system is more at risk. This can be due, for example, to HIV ro AIDS, medications taken after an organ transplant. Autoimmune disease: This is when the immune system attacks the body's own cells. Examples include rheumatoid arthritis and celiac disease. Infection: Certain viral and bacterial infections that transform lymphocytes increase the risk, such as the Epstein-Barr virus (EBV), which causes glandular fever. Breast implants: These can cause anaplastic large cell lymphoma in the breast tissue. Body weight and diet: Obesity has been implicated in the development of lymphoma, although more research is needed to confirm the link. Hodgkin lymphoma Risk factors for Hodgkin lymphoma include: Infectious mononucleosis: Infection with EBV can cause mononucleosis, which increases the risk of lymphoma. Age: People between the ages of 20 and 30 years and people over the age of 55 years have a higher risk Sex: It is slightly more common in men. Location: Hodgkin lymphoma is most common in the U.S., Canada, and northern Europe. It is least common in Asia. Family: If a sibling has the condition, the risk is slightly higher, and very high if the sibling is an identical twin. Affluence: People of higher socioeconomic status are at greater risk HIV infection: This can weaken the immune system and increase the risk of lymphoma. Diagnosis There are no routine screenings for lymphoma. If a person has persistent viral symptoms, they should see a doctor. The doctor will ask about the patient's personal and family medical history, and try to rule out other conditions. They will also carry out a physical examination, including an inspection of the abdomen and chin, neck, groin, and armpits, where swellings may occur. The doctor will look out for signs of infection near lymph nodes, since this can account for most cases of swelling. Tests for lymphoma Tests will confirm whether lymphoma is present. Blood tests and biopsies can detect the presence of lymphoma and distinguish between them. A biopsy involves taking a sample of lymph tissue for examination in a laboratory. The surgeon may remove a whole lymph or a part of one. In some cases, a needle can be used to take a tissue sample. A bone marrow biopsy may be necessary. This may need a local anesthetic, a sedative, or a general anesthetic. Biopsies and other tests can confirm the stage of the cancer, to see whether it has spread to other parts of the body. ( courtecy;-

Leukemia: What you need to know

Last updated Mon 27 November 2017

y Christian Nordqvist

Reviewed by University of Illinois-Chicago, School of Medicine

1. Causes
 
2. Sym

Leukemia is a cancer of the blood or bone marrow. Bone marrow produces blood cells. Leukemia can happen when there is a problem with the production of blood cells. It usually affects the leukocytes, or white blood cells.

It is most likely to affect people over the age of 55 years, but it is also the most common cancer in those aged under 15 years.

In the United States, 62,130 people are expected to receive a diagnosis of leukemia in 2017, and around 24,500 deaths will likely be due to this disease.

Acute leukemia develops quickly and worsens rapidly, but chronic leukemia gets worse over time.

Fast facts on leukemia

Here are some key points about leukemia. More detail is in the main article.

• About 62,130 new cases of leukemia are expected to be diagnosed in the United States in 2017.
• Leukemia is one of the most common childhood cancers, but it most often occurs in older adults.
• Leukemia can be fatal, but there are ways of treating and controlling the disease and its symptoms.

Causes

Leukemia happens when the DNA of immature blood cells, mainly white cells, becomes damaged in some way.

This causes the blood cells to grow and divide continuously, so that there are too many.

Healthy blood cells die after a while and are replaced by new cells, which are produced in the bone marrow.

The abnormal blood cells do not die when they should. They accumulate, occupying more space.

As more cancer cells are produced, they stop the healthy white blood cells from growing and functioning normally, by crowding out space in the blood.

Essentially, the bad cells crowd out the good cells in the blood.

Risk factors

Some factors increase the risk of developing leukemia.

The following are either known or suspected factors:

• artificial ionizing radiation
• viruses, such as the human T-lymphotropic virus (HTLV-1) and HIV
• benzene and some petrochemicals
• alkylating chemotherapy agents used in previous cancers
• hair dyes
• smoking

Genetic predisposition: Some people appear to have a higher risk of developing leukemia because of a fault in one or several genes.

Down syndrome: People with Down syndrome appear to have a higher risk, possibly due to certain chromosomal changes.

It has been suggested that exposure to electromagnetic energy might be linked to leukemia, but there is not enough evidence to confirm this.

Treatment

There are various types of leukemia, and they affect people differently. Treatment options will depend on the type of leukemia and the person's age and overall state of health.

Progress in medicine means that treatment can now aim for complete remission, where the cancer goes away completely for at least 5 years after treatment.

In 1975, the chances of surviving for 5 years or more after receiving a diagnosis of leukemia were 33.1 percent. By 2009, this figure had risen to 62.9 percent.

The main type of treatment is chemotherapy. This will be tailored to the type of cancer a patient has.

If treatment starts early, the chance of remission is higher.

Types of treatment include:

• targeted therapy
• interferon therapy
• chemotherapy
• radiation therapy
• surgery
• stem cell transplantation

Chemotherapy can affect the whole body, but targeted therapy is aimed at a specific part of the cancer cell.

Some types of chronic leukemia do not need treatment in the early stages, but monitoring is essential. The oncologist may suggest watchful waiting with frequent doctor's visits.

For a type of leukemia known as chronic myeloid leukemia (CML), a bone marrow transplant may be effective. Younger patients are more likely to undergo transplantation successfully.

Early signs

Signs and symptoms of leukemia vary.

They may include:

• being tired all the time
• weight loss
• having fevers or chills
• getting frequent infections

There is more information on symptoms later in this article.

Types

Leukemia can be divided into four main groups. These groups distinguish acute, chronic, lymphocytic, and myelogenous leukemia.

Chronic and acute leukemia

During its lifespan, a white blood cell goes through several stages.

In acute leukemia immature, useless cells develop rapidly and collect in the marrow and blood. They are squeezed out of the bone marrow too early and are not functional.

Chronic leukemia progresses more slowly. It allows more mature, useful cells to be made.

In other words, acute leukemia crowds out the good cells more quickly than chronic leukemia.

Lymphocytic and myelogenous leukemia

Leukemias are also classified according to the type of blood cell they affect.

Lymphocytic leukemia occurs if the cancerous changes affect the type of bone marrow that makes lymphocytes. A lymphocyte is a kind of white blood cell that plays a role in the immune system.

Myelogenous leukemia happens when the changes affect the type of marrow cells that go on to produce red blood cells, other types of white cells, and platelets.

Acute lymphocytic leukemia (ALL)

Also known as acute lymphoblastic leukemia, this is the most common type of leukemia among young children. It can also affect adults, especially after the age of 65 years. Among children, the 5-year survival rate is higher than 85 percent.

The subtypes of ALL are:

• precursor B acute lymphoblastic leukemia
• precursor T acute lymphoblastic leukemia
• Burkitt's leukemia
• acute biphenotypic leukemia

Chronic lymphocytic leukemia (CLL)

This is most common among adults over 55 years, but younger adults can also have it. It is the most common type of leukemia in adults, and it rarely affects children. It is more common in men than in women.

A person with CLL has an 82 percent of surviving 5 years after diagnosis.

Acute myelogenous leukemia (AML)

AML is more common in adults than in children. It affects men more often than women.

It develops quickly, and symptoms include fever, difficulty breathing, and pain in the joints. Environmental factors can trigger it.

Chemotherapy is the main treatment. Sometimes, a bone marrow transplant may be recommended.

Chronic myelogenous leukemia (CML)

CML mostly affects adults. According to the National Cancer Institute, the 5-year survival rate is 65.1 percent.

However, many people with CML have a gene mutation that responds to targeted cancer therapy, called Gleevec, or imatinib. For those people whose cancer is susceptible to Gleevec, the 5-year survival rate can be up to 90 percent.

Symptoms

Signs and symptoms of leukemia include the following:

Poor blood clotting: Immature white blood cells crowd out platelets, which are crucial for blood clotting. This can cause a person to bruise or bleed easily and heal slowly. They may also develop petechiae, small red to purple spots on the body, indicating a minor hemorrhage.

Frequent infections: The white blood cells are crucial for fighting off infection. If these are suppressed or not working properly, frequent infections can result. The immune system may attack other good body cells.

Anemia: As the shortage of good red blood cells grows, anemia can result. This can involve difficult or labored breathing and pale skin.

Other symptoms: There may be nausea, fever, chills, night sweats, flu-like symptoms, weight loss, bone pain, and tiredness. If the liver or spleen becomes enlarged the person may feel full and will eat less, resulting in weight loss.

Weight loss can also occur even without an enlarged liver or spleen. Headache may indicate that the cancerous cells have invaded the central nervous system (CNS).

These can all be symptoms of other illnesses. Tests are needed to confirm a diagnosis of leukemia.

Diagnosis

A doctor will carry out a physical examination and ask about personal and family medical history. They will check for signs of anemia and feel for an enlarged liver or spleen.

They will also take a blood sample for assessment in the laboratory.

If the doctor suspects leukemia, they may suggest a bone marrow test. Bone marrow is taken, usually from the hip, using a long, fine needle. This can help to show which kind of leukemia, if any, is present.

Outlook

The outlook for people with leukemia depends on the type.

All patients who experience remission will need to undergo regular monitoring, including blood tests and possible bone marrow tests, to ensure the cancer has not returned.

If the leukemia does not return, the doctor may decide, over time, to reduce the frequency of the tests.

What you need to know about lymphoma

Last updated Fri 24 November 2017

By Markus MacGill

Reviewed by Yamini Ranchod, PhD, MS

1. Treatment
 
2. Symptoms
 
3. Causes
 
4. Risk factors
 
5. Types
 
6. Diagnosis
 
7. Outlook

Lymphoma is a cancer of the lymphatic system. It affects a type of white blood cells known as lymphocytes. These help fight disease in the body. They play an important role in the immune system.

This type of cancer starts in the white blood cells, or lymphocytes. As it is present in the bloodstream, it can spread, or metastasize, to different parts of the body.

Lymphoma can occur at any age, but it is one of the most common causes of cancer in children and young adults aged 15 to 24 years. It is often treatable.

In the United States, the lifetime risk of getting Non-Hodgkin lymphoma is 2.1 percent. The risk of getting Hodgkin lymphoma is around 0.2 percent.

Fast facts on lymphoma

Here are some key points about lymphoma. More detail is in the body of this article.

• Lymphoma is a cancer of the lymph nodes and lymphatic system.
• The two main types are Hodgkin and non-Hodgkin. Non-Hodgkin is the most common.
• The main symptom is usually an enlargement of lymph nodes that does not go away as it normally would after infection.
• There is no way to prevent lymphoma, but survival rates after treatment are good.

Treatment

Swollen glands that do not go away can be a sign of lymphoma.

Treatment depends on the type of lymphoma and the stage it has reached.

Indolent, or slow-growing lymphoma may need only watchful waiting and no treatment.

If treatment is necessary, it can involve:

• Biologic therapy: This is a drug treatment that stimulates the immune system to attack the cancer cells by inserting living microorganisms into the body.
• Antibody therapy: Synthetic antibodies are inserted into the bloodstream to combat the cancer's antigens.
• Chemotherapy: Aggressive drug treatment is used to kills cancer cells.
• Radioimmunotherapy: This delivers high-powered radioactive doses directly into the cancerous B-cells and T-cells to destroy them.
• Radiation therapy: This is used to focus on small areas of cancer.
• Stem-cell transplantation: This can restore damaged bone marrow following high-dose chemotherapy or radiation therapy.
• Steroids: These may be injected to treat lymphoma.
• Surgery: This can be used to remove the spleen or other organs after the lymphoma has spread.

Surgery is used more often for obtaining a biopsy.

Symptoms

The signs and symptoms of lymphoma are similar to those of illnesses such as viral diseases and the common cold, but they continue for longer than would normally be expected.

Some people will have no symptoms, but some may notice a swelling of the lymph nodes. These are located all around the body, often in the neck, groin, abdomen, or armpits.

The swellings are normally painless, but pain may occur if the enlarged glands press on organs, bones, and other structures. This can be confused with back pain.

Lymph nodes can swell during common infections, such as a cold, but in lymphoma the swelling does not go away. Pain is also more likely to accompany the swelling if it is due to an infection.

The overlap of symptoms can lead to misdiagnosis.

Anyone who has ongoing swelling of the glands should see their doctor.

Other symptoms of both types of lymphoma may include:

• ongoing fever without infection
• night sweats, fever, and chills
• weight loss and loss of appetite
• unusual itching
• persistent fatigue, unusual tiredness, or lack of energy
• pain in lymph nodes after drinking alcohol

Additional symptoms that can indicate Non-Hodgkin lymphoma include:

• persistent coughing
• shortness of breath
• pain or swelling of the abdomen

Pain, weakness, paralysis, or otherwise altered sensation can occur if an enlarged lymph node presses against spinal nerves or the spinal cord.

Lymphoma can spread rapidly from the lymph nodes to other parts of the body through the lymphatic system. As cancerous lymphocytes spread into other tissues, the body's ability to fight infection weakens.

Causes

Cancer happens when there is uncontrolled growth of abnormal cells that thrive and spread instead of dying as they would in the life cycle of a normal cell.

Lymphatic tissue is connected throughout the body. If cancer cells develop in the lymphatic system, they can spread easily from their original location to other tissues and organs, including those outside the system.

Lymphoma most often spreads to the liver, bone marrow, or lungs.

In Hodgkin lymphoma, the cancer usually affects one lymph node after another in order.

In non-Hodgkin lymphoma, tumors may arise in disparate lymph nodes, skipping some nodes.

Exactly what causes lymphoma is unclear, but there are some risk factors.

Risk factors

The two different types of lymphoma have different risk factors.

Non-Hodgkin lymphoma

Risk factors for non-Hodgkin lymphoma include:

• Age: Most lymphomas occur in people aged 60 years and older, but some types are more likely to affect children and young adults.
• Sex: Some types are more likely in women, others are more likely in men.
• Ethnicity and location: In the U.S., African-Americans and Asian-Americans are at lower risk of non-Hodgkin lymphoma than white Americans, and it is more common in developed nations.
• Chemicals and radiation: Nuclear radiation and some chemicals used in agriculture have been linked to non-Hodgkin lymphoma.
• Immunodeficiency: A person with a weak immune system is more at risk. This can be due, for example, to HIV ro AIDS, medications taken after an organ transplant.
• Autoimmune disease: This is when the immune system attacks the body's own cells. Examples include rheumatoid arthritis and celiac disease.
• Infection: Certain viral and bacterial infections that transform lymphocytes increase the risk, such as the Epstein-Barr virus (EBV), which causes glandular fever.
• Breast implants: These can cause anaplastic large cell lymphoma in the breast tissue.
• Body weight and diet: Obesity has been implicated in the development of lymphoma, although more research is needed to confirm the link.

Hodgkin lymphoma

Risk factors for Hodgkin lymphoma include:

• Infectious mononucleosis: Infection with EBV can cause mononucleosis, which increases the risk of lymphoma.
• Age: People between the ages of 20 and 30 years and people over the age of 55 years have a higher risk
• Sex: It is slightly more common in men.
• Location: Hodgkin lymphoma is most common in the U.S., Canada, and northern Europe. It is least common in Asia.
• Family: If a sibling has the condition, the risk is slightly higher, and very high if the sibling is an identical twin.
• Affluence: People of higher socioeconomic status are at greater risk
• HIV infection: This can weaken the immune system and increase the risk of lymphoma.

Diagnosis

There are no routine screenings for lymphoma. If a person has persistent viral symptoms, they should see a doctor.

The doctor will ask about the patient's personal and family medical history, and try to rule out other conditions.

They will also carry out a physical examination, including an inspection of the abdomen and chin, neck, groin, and armpits, where swellings may occur. The doctor will look out for signs of infection near lymph nodes, since this can account for most cases of swelling.

Tests for lymphoma

Tests will confirm whether lymphoma is present.

Blood tests and biopsies can detect the presence of lymphoma and distinguish between them.

A biopsy involves taking a sample of lymph tissue for examination in a laboratory. The surgeon may remove a whole lymph or a part of one. In some cases, a needle can be used to take a tissue sample. A bone marrow biopsy may be necessary. This may need a local anesthetic, a sedative, or a general anesthetic.

Biopsies and other tests can confirm the stage of the cancer, to see whether it has spread to other parts of the body.