Lymphoma

Lymphoma, known as a tumor of the lymph nodes, is a disease in which blood cells produced by the bone marrow that is called lymphocytes accumulate in organs or tissues. Generally, the factors that cause lymphoma are not known clearly. Uncontrollable proliferation and mutation of cell nuclei in DNA cause lymphoma. Although rare, lymphoma disease is observed in some family members.

In Liv Hospital Hematology Clinic, with specialist physicians and equipped infrastructure Technologies, we serve a personalized programs formed for the diagnosis, examination and treatment process of lymphoma disease, , and a safe and high quality health service. In the process carried out in coordination with radiation oncology and medical oncology branches, a high rate of success is achieved in the treatment of many diseases that are of great importance for human life.

What is Lymphoma? Why does it happen?

Lymphoma is a tumor of the lymph nodes. It is a disease in which the blood cell called lymphocyte produced in the bone marrow accumulates in a wide variety of organs or tissues, primarily in the lymph nodes. The cause of lymphoma in most cases is unknown. DNA changes, called “mutations" in the cell nucleus make the cell proliferation uncontrollable. Very rarely, lymphoma can be observed in members of some families. Lymphomas are divided into two categories: Hodgkin lymphomas and non-Hodgkin lymphomas. There are approximately 50 types of lymphomas. Even if it is the same type, lymphoma may develop in different organs between patients. Therefore, the approach that is still valid in our country, which is to exemplify and identify with the experiences of patients or their relatives suffering from the same disease, is not correct.

 

At what age does lymphoma occur the most?

The probability of developing lymphoma increases with age. It is rare in children. Hodgkin's lymphoma usually occurs in early adulthood (15-40 years) or late adulthood (over 55 years).  Non-Hodgkin's lymphoma frequently develops in the elderly, and it is rare under the age of 15.

 

Who is at risk for lymphoma?

Non-Hodgkin's lymphoma is usually seen in developed countries such as America, Australia, New Zealand and Europe. Lymphoma can develop in everyone. But some people are a little more at risk.

People at high risk for lymphoma;

• Obesity
• Patients with autoimmune disease: Connective tissue diseases such as rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome are the most typical examples.
• Patients using immunosuppressive drugs: for example, transplant patients are at risk of developing lymphoma.
• Some infections increase the risk of lymphoma.

 

What are the symptoms of lymphoma?

• Since lymphoma can develop in almost every tissue and organ, it can show symptoms associated with organ damage. But most often patients with lymph node enlargement consult a physician.
• Lymph node enlargement: It is usually noticed as a swelling in the neck, armpit or groin areas. Painless swellings suggest lymphoma.
• Abdominal distension, pain: This is associated with spleen growth. If the pain is spreading to the back and waist, it may be related to the compression of the abdominal lymph nodes.
• Unexplained fever
• Unexpectedly rapid weight loss
• Significant excessive sweating at night
• Unexplained rash-free itch
• Severe dry cough, shortness of breath: It can develop due to compression by lymph nodes that grow on the trachea.
• Unexplained, usually puffy rashes on the skin
• Fatigue, exhaustion, headache, nerve damage-associated limb movement impairments (paralysis)

 

What are the types of lymphoma?

It is known that today, there are about 50 types of lymphoma diseases detected. Since it can develop in different organs from patient to patient, the presence of this type of disease in family members is not considered as a determining factor in the detection process. The probability of developing lymphomas, which are divided into two as Hodgkin and non-Hodgkin lymphomas, increases with aging.
 

How is Lymphoma diagnosed?

The diagnosis of lymphoma comes to the mind of the physician who examines the patient. Definitive diagnosis is made by microscopic examination of a sample from the tissue where the tumor cells accumulate by a pathologist, in conjunction with the information and opinion provided by the physician who examines the patient in the clinic. Since there are many types of lymphomas, determining the type of lymphoma requires significant knowledge, experience and laboratory work. Sometimes the name of the lymphoma might not be specified; in this case, a biopsy may be necessary. The physician and the pathologist evaluate the patient's complaints and findings together in the clinic. This is a condition that patients do not like and often misunderstand as a lack of skill in diagnosis. After a lymphoma diagnosis is made by the pathology laboratory, a staging procedure is performed in the clinic in order to determine the spread of the disease to determine the tumor burden or biological behavior. Staging is performed either by radiological evaluation of the whole body, called PET-CT, or by imaging the neck, abdomen, groin and rib cage by computerized tomography or magnetic resonance imaging. Some blood tests are performed to investigate the presence of organ damage and infectious disease screening. Generally, bone marrow samples are also taken.
 

Should every lymph node swelling suggest lymphoma?

Of course, not every lymph node swelling is associated with lymphoma. Lymph nodes collect waste molecules and cells in the body. They also houses immune cells. Hence, the most plausible explanations are especially viral or bacterial infections. Painful lymph nodes are usually not associated with lymphoma. Soft and mobile lymph node swelling in the groin area, under the jaw, behind the ears are usually not malignant.

Other conditions that enlarge the lymph node;

•  Infection (eg. swelling of the lymph nodes in the throat area in case of tonsil infections): Tuberculosis, brucellosis, fungal infections, HIV)
•  Rheumatic diseases
•  Allergic reactions
•  Substance accumulation
•  Leukemia
•  Cancer spread (metastasis)

 

What is the treatment process for lymphoma?

The type of treatment varies according to the type of lymphoma. Some types of non-Hodgkin's lymphoma have a quiet course. It can be monitored for years without treatment. If it is observed to become aggressive, then treatment will begin.
 

Treatment types

• Chemotherapy: It is the administration of multiple tumor cell killer drugs together at predetermined times and numbers.
• Radiotherapy: It is generally preferred if the tumor cell mass is very large (10 cm at the time of diagnosis). Following chemotherapy, radioactive irradiation is performed.
• Bone marrow transplantation

Drugs used in clinical trials

In general, treatment is administered in accordance with widely accepted treatment guidelines in the world. In other words, when Hodgkin's lymphoma is diagnosed, the same treatment is applied in almost every country in the world. Following the new diagnosis, imaging is usually repeated in the 3rd-4th month to control the response to the first-line treatment. If the tumor mass has shrunk by less than 50%, it is considered not to have achieved a good response. In this case, treatment modalities in which multiple drugs are used together in higher doses are used. If response to this treatment, which is called second-line treatment, is reduced tumor burden, even if partial, high-dose chemotherapy is administered. High-dose chemotherapy is supported by intravenous administration of previously stored blood stem cells to the patient to regenerate bone marrow. This form of treatment is called autologous stem cell transplant or bone marrow transplant with its former name. Sometimes patients are given medications based on clinical trials that have not yet proven efficacy.

Is lymphoma a type of tumor that should be feared?

In general, lymphoma is not a type of tumor that should be feared. In the last 10–15 years, there have been positive advances in the treatment of lymphomas. Drugs used in chemotherapy are drugs that kill cells without differentiating diseased cells from healthy ones. Therefore, rapidly proliferating cells such as gastrointestinal tract epithelium cells and hair follicle cells are also adversely affected, in addition to tumor cells. In recent years, drugs acting against a molecule on the tumor cells have been developed. In lymphoma types carrying the target molecule, they are usually used in combination with chemotherapy, rather than on their own. Again, a large number of drugs with demonstrably improved efficacy that were developed based on disease development mechanisms are increasingly being licensed.
 

What awaits the patient after lymphoma treatment is completed?

There is a response ratio to treatment depending on the type of lymphoma. Of course, the patient's physical ability to handle the treatment is also important for giving full doses. Many types of lymphoma with a complete response are closely monitored, especially during the first two years. Blood tests and disease recurrence controls are carried out once in 3 to 6 months.  In case the disease recurs, the type and dose of chemotherapy is selected by taking into account the period of recurrence (first year or later), stage, new biopsy sample, comorbidities (hypertension, heart disease, diabetes) and age. Some patients may even be recommended a bone marrow transplant plan from other people.
 

At what age does lymphoma develop?

The age limit in lymphoma was determined as adult period (15-40) and late adulthood (over 55 years old) in Hodgkin cases. The disease, which is rare in children, emerges as non-Hodgkin lymphoma in the elderly. The risk of lymphoma under the age of 15 is low.

What are the symptoms of lymphoma?

Lymphoma is a disease that can develop in almost every organ and tissue. For this reason, the probability of symptoms in the relevant organ is high. The disease, which is usually observed in the form of adenoids; shows symptoms as such:

• Swelling in the areas where the lymph nodes are located, such as the armpit, neck, and groin area,
• Unexplained fever,
• Abdominal swelling and pain spreading to the back and waist area,
• Unexplained rash without itching,
• Sudden weight loss,
• Severe shortness of breath and dry cough,
• Loss of movement in the limbs and partial paralysis due to nerve damage,
• Unexplained red and raised rashes on the skin,
• Night sweats,
• Tiredness and exhaustion.

 

What factors increase the risk of lymphoma?

Lymphoma can develop in anyone. However, there are some situations where the risk of development is higher;

• Patients at risk of autoimmune diseases (such as Systemic Lupus Erythematosus, Rheumatoid Arthritis, Sjögren's Syndrome)
• Excess weight,
• Patients using immunosuppressive drugs (transplanted patients can be given as an example)
• Some infections.

 

How is lymphoma diagnosed?

For the diagnosis of lymphoma, first of all, a comprehensive physician examination is required. In the final diagnosis stage, an examination is made under the microscope with a sample taken from the tissues containing the tumor cells. After this examination, many laboratory studies are performed to diagnose lymphoma. In some patients, a re-biopsy may be required in the process of clarifying the diagnosis. The patient's complaints and current findings are an important guide in the evaluation process.
 

What is lymphoma staging?

In line with the results obtained from the pathology laboratory, the examination carried out to determine the biological behaviour of the tumor is called staging. With the radiological evaluation called PET-CT, regions such as the abdomen, groin, rib cage and neck are examined together with imaging techniques such as MR and CT. In addition to the examination, some blood tests are used to detect infectious diseases and organ damage. During the process, a sample is taken from the bone marrow.
 

How is lymphoma treated?

Lymphoma treatment varies from person to person. The reason for this is that some types of lymphoma have a calm course, while others are at risk of developing aggressively. In the treatment of aggressive lymphomas, methods such as chemotherapy, radiotherapy and bone marrow transplantation are used. Bone marrow transplantation is the transfer of previously stored stem cells to the patient via vascular access with high-dose chemotherapy in order to regenerate bone.