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Non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma (NHL) is a type of cancer that originates in the lymphatic system. The lymphatic system is a network of vessels, nodes, and organs, including lymph nodes, spleen, and thymus, that play a vital role in the body's immune system. Its primary function is to help fight infections and diseases.

What is Non-Hodgkin's Lymphoma?

Non-Hodgkin's lymphoma is a form of cancer that originates within the lymphatic system, a crucial part of the body's immune system responsible for fighting infections. In this condition, abnormal growth of white blood cells called lymphocytes leads to the development of tumors throughout the body.

Non-Hodgkin's lymphoma is a broad classification encompassing various subtypes, including diffuse large B-cell lymphoma and follicular lymphoma, which are among the most frequently encountered ones. The other major category is Hodgkin's lymphoma.

Fortunately, advancements in the diagnosis and treatment of non-Hodgkin's lymphoma have significantly enhanced the outlook for individuals afflicted with this disease.

What are the types of Non-Hodgkin's Lymphoma?

Non-Hodgkin lymphomas are divided into 3 large groups: Indoline (slowly progressive) lymphomas, aggressive (rapidly progressive) and very aggressive (very rapidly progressive) lymphomas. The course and treatment of these diseases show great differences. Non-Hodgkin lymphomas are also divided into 2 groups in terms of immunological cell type: B-cell and T-cell lymphomas. Generally, T-cell lymphomas have a worse prognosis than B-cell lymphomas. Therefore, more intensive and effective treatment methods are chosen in the modern treatment of T-cell lymphomas. While the chemotherapy protocol named CHOP was given to most of the Non Hodgkin lymphomas in the past, today more effective treatments specific to the disease, varying according to the subgroup of the disease, are applied. It is even possible to treat some types of lymphoma with antibiotic agents without the use of chemotherapy. For example, some types and stages of lymphomas that occur in the stomach or eyes can be completely eliminated with antibiotic treatment. In order to choose the most appropriate treatment to be offered to the patient, the subgroup, stage and prognostic factors of lymphoma should be known exactly. Choosing a fully equipped oncology center is very important in this sense.

The Most Common Types of Non-Hodgkin Lymphomas

  • Slowly progressive lymphomas

  • Rapidly progressive lymphomas

  • Very rapidly progressive lymphomas

  • Follicular lymphoma

  • Diffuse large B-cell lymphoma

  • Burkitt lymphoma

  • Chronic lymphocytic leukemia

  • The majority of T lymphomas

  • Lymphoblastic B lymphoma

  • Immunocytoma

  • Mantle cell lymphoma

  • Lymphoblastic T lymphoma

Slowly Progressing (indolen) Lymphomas: The disease is usually diagnosed in stage III or IV. If the disease is diagnosed in stage I or II, treatment is done with the aim of eliminating the disease with radiation therapy. In advanced stages, chemotherapy is applied in certain cases, if it is not necessary, the patient is followed without treatment (in English "wait and see"), because in these cases, starting treatment before necessary does not provide an advantage to the patient. In B-cell indolene lymphomas, a drug called Rituximab, which targets the CD20 molecule on B-lymphoma cells, increases the effect of chemotherapy and significantly affects response rates and response times.

Rapidly Progressive (aggressive) Lymphomas: Diffuse large B-cell lymphomas constitute a significant portion of aggressive lymphomas. Treatment is applied to completely eradicate the disease and consists of Rituximab and CHOP chemotherapy. In aggressive T-cell lymphomas, adding Etoposide to the CHOP protocol (CHOEP protocol) increases the success rate, as demonstrated by German and Scandinavian studies. Because most aggressive T-cell lymphomas have a poor prognosis, high-dose chemotherapy and autologous stem cell transplantation, following 6 cycles of chemotherapy, play an important role in the permanent control of the disease.

Mantle cell lymphoma: Mantle cell lymphomas, on the other hand, are an aggressive lymphoma equivalent, in which significant progress has been made in recent years. In young patients, drug therapy is prescribed first. In young patients, stem cells are collected from the patient after this treatment, high-dose treatment and stem cell transplantation give the best results. In elderly patients, maintenance therapy after chemotherapy prolongs life expectancy.

Very Rapidly Progressing Lymphomas: Another group is very aggressive lymphomas. The most important are Burkitt lymphoma and lymphoblastic lymphomas. These types of lymphoma are mostly seen in younger patients. Burkitt lymphoma is the fastest growing cancer in humans. The goal of treatment in these diseases is to eradicate the disease. However, this goal cannot be achieved with simple treatments. The disease can be permanently eliminated with chemotherapies consisting of many drugs and reminiscent of leukemia treatment.

What are the symptoms of Non-Hodgkin's Lymphoma?

The indications and manifestations of non-Hodgkin's lymphoma can encompass:

  1. Enlarged lymph nodes in the neck, armpits, or groin.

  2. Abdominal discomfort or swelling.

  3. Chest pain, cough, or breathing difficulties.

  4. Persistent fatigue.

  5. Fever.

  6. Night sweats.

  7. Unexplained weight loss.

What are the causes of Non-Hodgkin's Lymphoma?

In many cases, the exact cause of non-Hodgkin's lymphoma is unknown to doctors. The disease initiates when the body produces an excessive number of abnormal lymphocytes, a type of white blood cell.

Typically, lymphocytes follow a predictable life cycle, where old ones die and are replaced by new ones. However, in non-Hodgkin's lymphoma, lymphocytes do not undergo their normal life cycle, leading to continuous production of new lymphocytes. This surplus of lymphocytes congregates in the lymph nodes, causing them to swell.

Non-Hodgkin's lymphoma mainly originates from two types of lymphocytes:

  • B cells: B cells combat infections by generating antibodies that neutralize foreign invaders. The majority of non-Hodgkin's lymphoma cases arise from B cells, including subtypes like diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, and Burkitt lymphoma.

  • T cells: T cells directly engage in killing foreign invaders. Non-Hodgkin's lymphoma involving T cells is less common. Subtypes of T cell-related non-Hodgkin's lymphoma include peripheral T-cell lymphoma and cutaneous T-cell lymphoma.

The type of lymphocyte involved (B cell or T cell) plays a role in determining the available treatment options for non-Hodgkin's lymphoma.

Non-Hodgkin's lymphoma typically manifests with cancerous lymphocytes in the lymph nodes, but it can also spread to other parts of the lymphatic system, such as lymphatic vessels, tonsils, adenoids, spleen, thymus, and bone marrow. In some cases, non-Hodgkin's lymphoma can affect organs outside the lymphatic system.

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