non Hodgkin lymphoma treatment and management protocol. treatment guideline and paradigm shift. contains more test regarding new trends in NHL management regarding adult and pared iatric disease and extent. current practice in various centers. short term knowldge of nhl natural history and staging.

1. Non-Hodgkin’s
Lymphoma
Michael Hakim
Bio 316
August 5, 2004

2. Lymphoma
 History and Overview
 Statistics
 What it effects (biology)
 Classification and Staging
 Symptoms
 Causes and Risk Factors
 Diagnosis and Treatment

3. Lymphoma’s
Where They Begin
 Lymphomas are a
cancer of the
lymphatic system
• Lymphatic vessels
• Lymph nodes
(underarms, groin,
neck, spleen,
tonsils and bone
marrow)

4. Lymphoma’s
Where They Begin
 The Lymphatic system is our bodies
main fight against infection
 Lymphocytes (B-cell and T-cell)
• Carried through our lymphatic system
and help our bodies fight infection
• Lymphocytes are carried through the
lymph vessels as well as the blood
stream, so cancer can start in nodes
and spread anywhere throughout the
body.

5. Lymphatic System
American Medical
Association

6. Non-Hodgkin’s Lymphoma
Statistics
for 2004
 54,370 new cases
 19,410 deaths
• In California Alone there are est. 5,550 new
cases and a Death rate of 1,730 (California has
the highest incidence and Death rate for Non-
Hodgkin’s Lymphoma
• Non-Hodgkin’s Lymphoma is the 6th and 7th
most deadly cancers for men and women
• Recent studies have shown that overweight
patients are more likely to die then those
patients who are in better shape.

7. Classification
 Usually classified by how the cells
look under a microscope and how
quickly they grow and spread
• Aggressive lymphomas (high-grade
lymphomas)
• Indolent Lymphomas (low-grade
lymphomas)

8. Non-Hodgkin’s Lymphoma
Staging
 Stage is the term used to describe the
extent of tumor that has spread through
the body( I and II are localized where as
III and IV are advanced.
 Each stage is then divided into categories
A, B, and E
• A: No systemic symptoms
• B: Systemic Symptoms such as fever, night
sweats and weight loss
• E: Spreading of disease from lymph node to
another organ

9. Staging

10. Non-Hodgkin’s Lymphoma
 Two main types of Non-Hodgkin’s
Lymphoma:
B-Cell and T-Cell Lymphomas
•B-Cell lymphomas (80%)
•T-Cell lymphomas (15%)

11. B-Cell Lymphoma (80%)
 B-Cells help make antibodies, which are
proteins that attach to and help destroy
antigens
 Lymphomas are caused when a mutation
arises during the B-cell life cycle
 Various different lymphomas can occur
during several different stages of the cycle
• Follicular lymphoma, which is a type of B-cell
lymphoma is caused by a gene translocation
which results in an over expressed gene called
BCL-2, which blocks apoptosis.

12. B-Cell Cancers

13. T-Cell Lymphoma (15%)
 The T-cells are born from stem cells,
similar to that of B-cells, but mature
in the thymus.
 They help the immune system work
in a coordinated fashion.
• These types of lymphomas are
categorized by how the cell is affected
 Anaplastic Large cell Lymphoma, t-cell
lymphoma caused by a gene translocation in
chromosome 5
Lymphoma.org

14. Symptoms
 Painful Swelling of lymph nodes
located in the neck, underarm and
groin.
 Unexplained Fever
 Night Sweats
 Constant Fatigue
 Unexplained Weight loss
 Itchy Skin
Cancer Sourcebook

15. Causes and Risk Factors
 The Exact causes are still unknown
• Higher risk for individuals who:
 Exposed to chemicals such as pesticides or
solvents
 Infected w/ Epstein-Barr Virus
 Family history of NHL (although no
hereditary pattern has been established)
 Infected w/ Human Immunodeficiency Virus
(HIV)
Lymphoma.org

16. Diagnosis
 X-Rays
 CT scans
 Magnetic Resonance Imaging (MRI)
 Biopsy
 Lymphangiogram
• Pictures of the lymphatic system taken
w/ x-ray after a special dye is injected
to illuminate lymph nodes and vessels

17. Treatment
 Non-Hodgkin’s Lymphoma is usually
treated by a team of physicians including
hematologists, medical oncologists and a
radiation oncologist.
 In some cases such as for Indolent
lymphomas, the Doctor may wait to start
treatment until the patient starts showing
symptoms, known as “watchful waiting”

18. Treatment Options
 Chemotherapy
 Radiation
 Bone Marrow Transplantation
 Surgery
 Bortezomib (Velcade)
 Immunotherapy
 Using the bodies own immune system
combined with material made in a lab.

19. Survival Rates
 Survival Rates vary widely by cell
type and staging.
• 1 Year Survival Rate: 77%
• 5 Year Survival Rate: 56%
• 10 Year Survival Rate: 42%
Cancer.org

20. Any Questions?