Your SlideShare is downloading. ×
Nhl
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

Nhl

663
views

Published on

Published in: Health & Medicine, Technology

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
663
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
53
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • With 60,000 new cases, North America had the highest estimated incidence of lymphoma in the world for the year 2000.
  • Although it was originally designed for staging Hodgkin’s disease, the modified Ann Arbor staging system is also commonly used to define the extent of disease in NHL. 83 However, this system does not address certain prognostic or therapeutic issues known to be important in NHL, such as bulky disease (lesion >10 cm in diameter). Each of the stages is further subdivided “ A” – patients without B symptoms “ B” – patients with B symptoms (unexplained weight loss, sweats, high fever, or pruritis) “ E” – extranodal lymphoid malignancies; a symbol for the specific site may also be used: nodes (N), spleen (S), liver (H), pleura (P), lung (L), bone (O), bone marrow (M), skin (D)
  • Transcript

    • 1. Lymphoma’sLymphoma’s Where They BeginWhere They Begin • Lymphomas are aLymphomas are a cancer of thecancer of the lymphatic systemlymphatic system – Lymphatic vesselsLymphatic vessels – Lymph nodesLymph nodes (underarms, groin,(underarms, groin, neck, spleen, tonsilsneck, spleen, tonsils and bone marrow)and bone marrow)
    • 2. Lymphoma’sLymphoma’s Where They BeginWhere They Begin • The Lymphatic system is our bodies mainThe Lymphatic system is our bodies main fight against infectionfight against infection • Lymphocytes (B-cell and T-cell)Lymphocytes (B-cell and T-cell) – Carried through our lymphatic system andCarried through our lymphatic system and help our bodies fight infectionhelp our bodies fight infection – Lymphocytes are carried through the lymphLymphocytes are carried through the lymph vessels as well as the blood stream, sovessels as well as the blood stream, so cancer can start in nodes and spreadcancer can start in nodes and spread anywhere throughout the body.anywhere throughout the body. • The Lymphatic system is our bodies mainThe Lymphatic system is our bodies main fight against infectionfight against infection • Lymphocytes (B-cell and T-cell)Lymphocytes (B-cell and T-cell) – Carried through our lymphatic system andCarried through our lymphatic system and help our bodies fight infectionhelp our bodies fight infection – Lymphocytes are carried through the lymphLymphocytes are carried through the lymph vessels as well as the blood stream, sovessels as well as the blood stream, so cancer can start in nodes and spreadcancer can start in nodes and spread anywhere throughout the body.anywhere throughout the body.
    • 3. Lymphatic TissueLymphatic Tissue • Lymph nodes, spleen, liver, skin andLymph nodes, spleen, liver, skin and the respiratory, GI and GTU tractthe respiratory, GI and GTU tract • Lymphocytes undergo furtherLymphocytes undergo further proliferation and differentiation inproliferation and differentiation in lymphoid tissuelymphoid tissue – B-lymphocytesB-lymphocytes • tend to reside in lymph nodes & spleentend to reside in lymph nodes & spleen – T-lymphocytesT-lymphocytes • tend to circulate throughout the lymphatic systemtend to circulate throughout the lymphatic system
    • 4. Lymph Node - normalLymph Node - normal histologyhistology afferent lymphatic vessel capsule follicle (mainly B- cells) - germinal centre - mantle zone C cortex medulla paracortex efferent lymphatic vessel artery vein
    • 5. Thomas Hodgkin English pathologist, described the disease that bears his name in 1832.
    • 6. • A heterogeneous group of B- and T-cellA heterogeneous group of B- and T-cell malignancies that are diverse in cellularmalignancies that are diverse in cellular origin, morphology, cytogeneticorigin, morphology, cytogenetic abnormalities, response to treatment,abnormalities, response to treatment, and prognosisand prognosis • Any of a large group of cancers ofAny of a large group of cancers of lymphocytes (white blood cells).lymphocytes (white blood cells). NON-HODGKIN’SNON-HODGKIN’S LYMPHOMA (NHL):LYMPHOMA (NHL):
    • 7. Former First Lady Jacqueline Kennedy Onassis
    • 8. • Incidence of 13.3/100,000 per yearIncidence of 13.3/100,000 per year • Predominates in the 40-70 yearsPredominates in the 40-70 years age groupage group – most common neoplasm in themost common neoplasm in the 20-40 age group20-40 age group • Incidence is risingIncidence is rising – 150% growth over the past 30150% growth over the past 30 yearsyears – increasing by 4% annually sinceincreasing by 4% annually since 1970’s1970’s • Mortality rate is also risingMortality rate is also rising – 2% rise per year2% rise per year – third highest rise, exceeded onlythird highest rise, exceeded only by lung cancer in women andby lung cancer in women and malignant melanomamalignant melanoma NHL INCIDENCENHL INCIDENCE
    • 9. Estimated Incidence of NHLEstimated Incidence of NHL in the Year 2000 (Worldwide)in the Year 2000 (Worldwide) Micronesia Melanesia Caribbean Australia/New Zealand Northern Africa Western Africa Northern Europe Southeast Asia Eastern Europe South Central Asia North America 0 10,000 20,000 30,000 40,000 50,000 60,000 Micronesia Melanesia Caribbean Australia/New Zealand Northern Africa Western Africa Northern Europe Southeast Asia Eastern Europe South Central Asia North America
    • 10. B-Cell CancersB-Cell Cancers
    • 11. EtiologyEtiology • Not known.Not known. • It is a late manifestation in HIV infection.It is a late manifestation in HIV infection. • Specific lymphoma types are associated with EBV,HHV8Specific lymphoma types are associated with EBV,HHV8 • Gastric lymphoma can be associated with H.pyloriGastric lymphoma can be associated with H.pylori infection.infection. • Some lymphomas are associated with specificSome lymphomas are associated with specific chromosomal lesion.chromosomal lesion. • Lymphomas occur in congenital immunodeficiencyLymphomas occur in congenital immunodeficiency states, immune suppressed individuals and after organstates, immune suppressed individuals and after organ transplantaion.transplantaion.
    • 12. PathogenesisPathogenesis
    • 13. Malignant transformation of either the T or B cells Differentiation in the peripheral lymphoid tissues Predisposing •Gender •Race •Family History •Infections •Immune System Deficiency Disorders •Autoimmune Disorders •Chemical Exposure •Radiation Exposure •Lifestyle Factors Precipitating •Unknown (idiopathic)
    • 14. T lumphocytes proliferate on antigenic stimulation and migrate into follicles, where they intact in B lymphocytes These activated follicles becme germinal centers, containing macrophages, follicular dendrite cells and maturing T and B cells Develops in any lymphoid tissues (lymph nodes
    • 15. Spreads to various lymphoid tissues throughout the body, especially the liver, spleen and bone marrow Non-hodgkin’s lymphoma Group of tumors will develop
    • 16. Most common: •painless enlargement of one or more lymph node, usually in the neck, armpits, or groin. (painless, superficial lymphadenopathy) •Usually asymptomatic Systemic B Sx: •Drenching night sweats •Unexplained weight loss •Fever •Severe itching
    • 17. Types of LymphomaTypes of Lymphoma • Indolent (low grade)Indolent (low grade) – Life expectancy in years,Life expectancy in years, untreateduntreated – 85-90% present in Stage III or IV85-90% present in Stage III or IV – IncurableIncurable • IntermediateIntermediate • Aggressive (high grade)Aggressive (high grade) – Life expectancy in weeks,Life expectancy in weeks, untreateduntreated – Potentially curablePotentially curable
    • 18. STAGING OF NHLSTAGING OF NHL
    • 19. • Stage is the term used to describe theStage is the term used to describe the extent of tumor that has spread throughextent of tumor that has spread through the body( I and II are localized where as IIIthe body( I and II are localized where as III and IV are advanced.and IV are advanced. • Each stage is then divided into categoriesEach 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,B: Systemic Symptoms such as fever, night sweats and weight lossnight sweats and weight loss – E: Spreading of disease from lymphE: Spreading of disease from lymph
    • 20. The Non-Hodgkin’s Lymphoma Pathologic Classification Project. Cancer. 1982;49:2112. MODIFIED ANN ARBORMODIFIED ANN ARBOR STAGING OF NHLSTAGING OF NHL • Stage IStage I Involvement of a single lymph node regionInvolvement of a single lymph node region • Stage IIStage II Involvement ofInvolvement of ≥≥2 lymph node regions on2 lymph node regions on the samethe same side of the diaphragmside of the diaphragm • Stage IIIStage III Involvement of lymph node regions on bothInvolvement of lymph node regions on both sides of the diaphragmsides of the diaphragm • Stage IVStage IV Multifocal involvement ofMultifocal involvement of ≥≥1 extralymphatic1 extralymphatic sites ± associated lymph nodes or isolatedsites ± associated lymph nodes or isolated extralymphatic organ involvement with distant nodalextralymphatic organ involvement with distant nodal involvement.involvement.
    • 21. CATEGORIECATEGORIE SS OF NON-OF NON- HODGKIN’SHODGKIN’S LYMPHOMALYMPHOMA
    • 22. • Two main types of Non-Hodgkin’sTwo main types of Non-Hodgkin’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%)
    • 23. • B-Cells help make antibodies, which are proteinsB-Cells help make antibodies, which are proteins that attach to and help destroy antigensthat attach to and help destroy antigens • Lymphomas are caused when a mutation arisesLymphomas are caused when a mutation arises during the B-cell life cycleduring the B-cell life cycle • Various different lymphomas can occur duringVarious different lymphomas can occur during several different stages of the cycleseveral different stages of the cycle – Follicular lymphoma, which is a type of B-cellFollicular lymphoma, which is a type of B-cell lymphoma is caused by a gene translocationlymphoma is caused by a gene translocation which results in an over expressed gene calledwhich results in an over expressed gene called BCL-2, which blocks apoptosis.BCL-2, which blocks apoptosis.
    • 24. • The T-cells are born from stem cells,The T-cells are born from stem cells, similar to that of B-cells, but mature in thesimilar to that of B-cells, but mature in the thymus.thymus. • They help the immune system work in aThey help the immune system work in a coordinated fashion.coordinated fashion. – These types of lymphomas are categorized byThese types of lymphomas are categorized by how the cell is affectedhow the cell is affected • Anaplastic Large cell Lymphoma, t-cell lymphomaAnaplastic Large cell Lymphoma, t-cell lymphoma caused by a gene translocation in chromosome 5caused by a gene translocation in chromosome 5
    • 25. •Diffuse Large B-Cell LymphomaDiffuse Large B-Cell Lymphoma (DLBLC).(DLBLC). DLBCL is the most commonDLBCL is the most common type of non-Hodgkins lymphoma,type of non-Hodgkins lymphoma, accounting for about 30% of all NHLaccounting for about 30% of all NHL cases. It is an aggressive, fast-growingcases. It is an aggressive, fast-growing lymphoma that usually affects adults butlymphoma that usually affects adults but can also occur in children. DLBCL cancan also occur in children. DLBCL can occur in lymph nodes or in organsoccur in lymph nodes or in organs outside of the lymphatic system. DLBCLoutside of the lymphatic system. DLBCL includes several subtypes such asincludes several subtypes such as mediastinal large B-cell lymphoma,mediastinal large B-cell lymphoma, intravascular large B-cell lymphoma,intravascular large B-cell lymphoma, and primary effusion lymphoma.and primary effusion lymphoma.
    • 26. • Follicular LymphomaFollicular Lymphoma (FLs).(FLs). FollicularFollicular lymphoma is the secondlymphoma is the second most common typemost common type lymphoma, accountinglymphoma, accounting for about 20% of all NHLfor about 20% of all NHL cases. It is usuallycases. It is usually indolent (slow growing)indolent (slow growing) but about half ofbut about half of follicular lymphomasfollicular lymphomas transform over time intotransform over time into the aggressive diffusethe aggressive diffuse large B-cell lymphoma.large B-cell lymphoma.
    • 27. • Mantle Cell LymphomaMantle Cell Lymphoma .. Mantle cell lymphoma is anMantle cell lymphoma is an aggressive type of lymphoma thataggressive type of lymphoma that represent about 7% of NHL cases.represent about 7% of NHL cases. It is a difficult type of lymphoma toIt is a difficult type of lymphoma to treat and often does not respond totreat and often does not respond to chemotherapy. It is found in lymphchemotherapy. It is found in lymph nodes, the spleen, bone marrow,nodes, the spleen, bone marrow, and gastrointestinal system. Mantleand gastrointestinal system. Mantle cell lymphoma usually develops incell lymphoma usually develops in men over agemen over age 60.60.
    • 28. • SmallSmall LymphocyticLymphocytic LymphomaLymphoma (SLL).(SLL). SLL is anSLL is an indolent type ofindolent type of lymphoma that islymphoma that is closely related toclosely related to B-cell chronicB-cell chronic lymphocyticlymphocytic leukemia (CLL).leukemia (CLL). It accounts forIt accounts for about 5% of NHLabout 5% of NHL cases.cases.
    • 29. • Marginal ZoneMarginal Zone LymphomasLymphomas (MZL).(MZL). MZLs are categorizedMZLs are categorized depending on where thedepending on where the lymphoma is located.lymphoma is located. Mucosa-associatedMucosa-associated lymphoid tissuelymphoid tissue lymphomas (MALT)lymphomas (MALT) usually involve theusually involve the gastrointestinal tract,gastrointestinal tract, thyroid, lungs, salivathyroid, lungs, saliva glands, or skin. MALT isglands, or skin. MALT is often associated with aoften associated with a history of anhistory of an autoimmune disorderautoimmune disorder (such as Sjogren(such as Sjogren syndrome in thesyndrome in the salivary glands orsalivary glands or Hashimoto's thyroiditisHashimoto's thyroiditis in the thyroid gland).in the thyroid gland).
    • 30. • Burkitt's LymphomaBurkitt's Lymphoma.. ThisThis is one of the mostis one of the most common types ofcommon types of childhood NHL,childhood NHL, accounting for about 40%accounting for about 40% of NHL pediatric cases inof NHL pediatric cases in the United States. Itthe United States. It usually starts in theusually starts in the abdomen and spreads toabdomen and spreads to other organs, includingother organs, including the brain. In Africanthe brain. In African children, it often involveschildren, it often involves facial bones and isfacial bones and is associated with Epstein-associated with Epstein- Barr infection.Barr infection.
    • 31. • LymphoblasticLymphoblastic LymphomaLymphoma. This. This lymphoma is alsolymphoma is also common in children,common in children, accounting for aboutaccounting for about 25% of NHL pediatric25% of NHL pediatric cases, most often boys.cases, most often boys. It is associated with aIt is associated with a large mediastinal masslarge mediastinal mass (occurring in chest(occurring in chest cavity between thecavity between the lungs) and carries alungs) and carries a high risk for spreadinghigh risk for spreading to bone marrow, theto bone marrow, the brain, and other lymphbrain, and other lymph nodes.nodes.
    • 32. Clinical featuresClinical features • Peak incidence at 60 years. Can occur at any age.Peak incidence at 60 years. Can occur at any age. • Usually widespread at the time of diagnosis.Usually widespread at the time of diagnosis. • Discrete, painless, firm lymph nodal enlargement is theDiscrete, painless, firm lymph nodal enlargement is the most common presentation. Waldeyer’s ring andmost common presentation. Waldeyer’s ring and epitrochlear lymph nodes are frequently involved.epitrochlear lymph nodes are frequently involved. • B symptoms: night sweats, weight loss, fever are lessB symptoms: night sweats, weight loss, fever are less prominent.prominent. • Early involvement of extra lymphatic organ is a feature ofEarly involvement of extra lymphatic organ is a feature of NHL.NHL. • GIT, CNS, skin, thyroid are frequently involved.GIT, CNS, skin, thyroid are frequently involved. • Bone marrow involvement is common and early.Bone marrow involvement is common and early. • Involvement of liver and spleen results inInvolvement of liver and spleen results in hepatosplenomegaly.hepatosplenomegaly. • Bone involvement can manifest as pathological fractureBone involvement can manifest as pathological fracture with pain.with pain.
    • 33. ManagementManagement
    • 34. InvestigationsInvestigations • Lymph node biopsy.Lymph node biopsy. • Hemogram: Anemia, lymphocytosis in some patients,Hemogram: Anemia, lymphocytosis in some patients, leukemic phase develops in 20-40% of lymphocyticleukemic phase develops in 20-40% of lymphocytic patients.patients. • Bone marrow aspiration.Bone marrow aspiration. • Immunotyping of blood, lymph node, marrow lymphoidImmunotyping of blood, lymph node, marrow lymphoid cells.cells. • S.Uric acid.S.Uric acid. • X-Rays.X-Rays. • CT scans.CT scans. • Magnetic Resonance Imaging (MRI).Magnetic Resonance Imaging (MRI).
    • 35. T R E A T M E N T
    • 36. • Non-Hodgkin’s Lymphoma is usually treated byNon-Hodgkin’s Lymphoma is usually treated by a team of physicians including hematologists,a team of physicians including hematologists, medical oncologists and a radiation oncologist.medical oncologists and a radiation oncologist. • In some cases such as for Indolent lymphomas,In some cases such as for Indolent lymphomas, the Doctor may wait to start treatment until thethe Doctor may wait to start treatment until the patient starts showing symptoms, known aspatient starts showing symptoms, known as “watchful waiting”“watchful waiting”
    • 37. •Radiation therapy -uses high doses of X- rays, gamma rays, or other types of ionizing (damaging) radiation to kill cancer cells. It may be applied to the whole body or to a specific zone.
    • 38. •Chemotherapy is the use of cytotoxic (cell damaging) medicines to target and kill tumors. The drugs work by interrupting the DNA of fast- growing cells, preventing them from growing or reproducing.
    • 39. Chemotherapy regimenChemotherapy regimen • CHOP regimen- Cyclophophamide,CHOP regimen- Cyclophophamide, Hydroxunorubicin(adriamycin), OncovinHydroxunorubicin(adriamycin), Oncovin (vincristine), Prednisolone.(vincristine), Prednisolone.
    • 40. •Immunotherapy uses the body’s own immune system to attack and remove cancer cells. Doctors inject a patient with a special type of antibody, or cell marker, that binds to antigens on a cell’s surface. Antibody against CD20: Rituxan, Bexxar, Zevalin.
    • 41. •Bone marrow transplantation •For patients with very advanced disease, extremely high does of chemotherapy may be needed. This type of chemotherapy wipes out the body’s entire immune system, including the bone marrow that produces blood cells. So, patients need a bone marrow transplant in order to recover.
    • 42. • Survival Rates vary widely by cell type andSurvival Rates vary widely by cell type and staging.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%