About diagnosing and treating lymphomas

The lymphomas constitute a diverse group of malignancies that arise from the uncontrolled growth of the cellular components of the lymphoreticular (immune) system. Malignancies of the lymphocytic system may present locally; however, the majority are widespread at the time of diagnosis because of the ability of immune cells (lymphocytes) to circulate freely in the blood and lymphatic systems.

The lymphomas are divided into two major subgroups — Hodgkin’s disease and non-Hodgkin’s lymphoma.

Lymphomas have been studied in great detail, and many factors concerning gene rearrangements and the activation of abnormal genes are known and have provided valuable clues about the inherent mechanisms of lymphomas and cancer itself. They are considered to be among the most controllable or curable of all cancers.  

The distinction between Hodgkin’s disease and non-Hodgkin’s lymphoma is important because the clinical course, prognosis and treatments are different in the two processes. The lymphomas are divided into B cell and T cell varieties. Most lymphomas are B cell cancers.

  The behavior of malignant non-Hodgkin’s lymphomas is highly variable. Some people with lymphomas have a rapid progressive disease and become quite ill with fever, weight loss, sweats and generally have a poor clinical course.  Other individuals follow a much more indolent course and the disease can be limited to lymph nodes and cause no symptoms for many years.

The incidence of lymphomas, particularly non-Hodgkin’s lymphoma, have increased during the last several decades. One reason for this is the association of this disease with the acquired immune deficiency syndrome (AIDS).  

But in addition to that association, the disease has increased in the general population for unclear reasons.

Lymphomas are predominantly a malignancy of the lymphocyte and the malignancy can be thought of as a refractory event to the regulation and differentiation of this cell. Depending on where in the cell cycle the differentiation is blocked determines the type of lymphoma that may develop.

Hodgkin’s disease currently accounts for approximately 15 percent of all lymphomas. The interest in it certainly is heightened because of the disproportionate number of people with Hodgkin’s disease who are young adults.  Therefore, it needs to be viewed as a particularly serious health problem.     

Non-Hodgkin’s lymphoma is diagnosed nearly six times as often as Hodgkin’s disease and the death rate from it is far greater. There are probably several causative factors for non-Hodgkin’s lymphoma, including viral infections, genetic abnormalities and other disturbances in the immune system caused by other diseases (AIDS).  

Non-Hodgkin’s lymphomas encompass a spectrum of cancers ranging from an indolent disease, which can occasionally undergo even spontaneous regression, to a rapidly progressive malignancy that can be fatal within weeks if left untreated.

The lymphomas can also cause immunosuppression, infections and other abnormalities associated with humoral secretion of factors.

The diagnosis of lymphoma is confirmed by biopsy. Treatment often requires a multidisciplinary approach.  This can involve surgery, radiation therapy, chemotherapy and immunotherapy.  There are a multitude of chemotherapy agents that can be used in lymphoma.  

In addition to chemotherapy, new treatments that include monoclonal antibodies and therapeutic agents that are attached to radioactive compounds, which are directly injected and single out lymphoma cells in a specific way, are redefining the way lymphomas are treated.

The ongoing study of lymphomas is determining many of their intrinsic characteristics and growth patterns.  

New therapeutic modalities to treat lymphomas are being established rapidly at this time. It is hoped that the study and treatment of lymphomas will also demonstrate ways that other cancers can be treated.

Dr. Kruger is an oncologist with a practice in Sharon.

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