Lymphoma (Non Hodgkin's Lymphoma)

Lymphoma is defined as a condition of cancer in the lymphatic cells (lymphocytes) of the immune system originated in lymph nodes. It represents a group of over 20 types of cancers. Since it is a cancer in the lymph nodes, it tends to begin with several places simultaneously and spread slowly or quickly to distant parts of body, depending to the grade of the cancer.
Lymphocytes are white blood cells in the lymph nodes and bone marrow.

Symptoms
1. Weight loss
Unintentional weight loss over 10% in a short period of time
2. Lumps
As the cancer had or have progressed to the lymph nodes depending to primary cancer.
3. Fever
Infection due to decrease function of the immune system
4. Excessive sweating
Required to change night-ware, it also one of the sign of cancer.
5. Itching
Due to hormone secreting by the malignant tumor.
6. Shortness of breath
If the cancer has spread to the lung
7. Anemia
As the cancer has influenced to the production of red blood cells
9. Loss of appetite
A common symptom of cancer
10. Pain
As a result of the malignant tumor has pressed on the nerves
10. Etc.

Causes and risk factors
Although the exact causes of lymphoma are unknown, but researchers suggested
1. Exposure to certain chemicals
Prolonged exposure to certain chemicals such as solvents, pesticides, herbicides increases risk of lymphoma
2. Certain diseases
Increased risk of lymphoma for people with stomach ulcers or gastritis caused by a kind of bacteria called H. pyelori.
3. HIV/AIDs
People with supression of immune system with HIV/AIDs are at risk to devleop lymphoma.
4. Chemotherapy
People who had previous chemotherapy with certain drugs used, are at risk to develop the disease.
5. Age
The risk of develop of lymphoma increases with age. T he average age of lymphomatic patients are 65 in all cases.
6. Family history
Risk of lymphoma increases if one your immediate relative has it.
7. Viral exposures
Exposure to certain virus are such as Epstein Barr, Hepatitis C, and SV-40 associated with increased risk of lymphoma.
8. Etc.


Grading
The Grade of lymphoma are depending to the tendency of spreading. Low grade cancers usually grow more slowly and are less likely to spread while high grade cancer indicates otherwise.

Staging
Stage I:
The disease is present in only one group of lymph nodes, or, more rarely, in a single organ that does not belong to the lymph system.

Stage II:
Cancer is found in two or more groups of lymph nodes on the same side as the diaphragm. (The diaphragm is a thin muscle below the lungs that helps in breathing and separates your chest from the abdomen). In addition, an organ not in the lymph system may be involved close to the involved nodes.

Stage III:
The disease is present in lymph node groups on both sides of the diaphragm, occasionally with the involvement of other adjacent organs. If the spleen is involved then the disease becomes stage III as well.

Stage IV:
Once the liver, the bone marrow or the lung substance becomes involved, the disease is in stage IV. The same is true if other organs are involved far away from involved nodes.

The letter B in the stage if the patient also affected by the B symptoms (Fever greater than 38°C, drenching night sweats and Unintentional weight loss of >10%). The letter A indicates otherwise
Letter E means the cancer has spread to another organ outside of the lymph . Letter S means spleen has been infected.



Diagnosis and tests
After recording the family history and physical exam, you doctor may order the below tests, if you are found to have some of the above symptoms such as enlaged lymph nodes, excessive night sweat, etc.
1. Blood test
Blood sample is taken from your vein to check the levels of red and white cells and platelets in your blood, and how well your body's organ is working.
2. Chest X ray
Chest X ray is a form of electromagnetic radiation to take image and check for any abnormality of the lung caused by the spreading of the lymphoma.
3. CT Scan (computerized tomography)
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the tumors abnormalities, such as spreading of cancer to the nearby structure and lymph nodes. CT scan can only review the existence of cancer ,but it can not tell it is a primary or secondary cancer.
4. MRI (magnetic resonance imaging)
MRI (magnetic resonance imaging) is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of the metastasis of cancer in the lymph nodes and surrounding areas.
5. Lumbar puncture
It is procedure to withdraw a sample of spinal fluid by a thin and tube-like needle. Sample then is examined under microscopy for any abnormal lymphoma cells.
6. Lymph nodes biopsy
In lymphoma biopsy, a sample of liver is taken by a thin, tube-like instrument to examine under microscopy to review the stage of the cancer.
7. Positron emission tomography (PET scan)
Positron emission tomography (PET scan) is a type of nuclear medicine imaging with the uses of small amounts of short-lived radioactive material, either injected into a vein, swallowed or inhaled as a gas which will appear in the area of the body being examined, where it gives off energy in the form of gamma rays detected by a camera of positron emission tomography that produces a three-dimensional image or picture of functional processes of the organs in the body.
8. Immunochistochemistry
Immunochistochemistry is type of the test which provides the pathologist information to determine the type of lymphoma by using antibodies that bind to those antigens.
9. Flow Cytometry
Flow Cytometry isw another type of test which allows the pathologist to examine certain cells by separate them with others with the use of laser light and a fluorescent dye
10. Etc.

Prevention
A. How to avoid
1. Practice safe sex
HIV/AIDs can cause weakened immune system that allow the cells in the lymph nodes to grow with being checked, that can lead to lymphoma.

2. Infection
Prolonged infection cause of cancers are still under further studies, but infection caused by weakened immune system may be a cause of lymphoma.

3. Exposure to radiation
Exposure to radiation increases the risk of lymphoma. Risk of lymphoma increases many times for people lived near the nuclear accident.

4. Avoid Exposing to certain chemicals
Prolonged exposure to certain chemicals such as solvents, pesticides, herbicides increases risk of lymphoma.

5. Etc.

B. Diet
1. Grapes
Resveratrol found in the grape triggers the anti-cancer process in cell and tissue in animal study.
2. Garlic
An analysis of several case-controlled studies in Europe suggests an inverse association between garlic consumption and risk of common cancers.
3. Soy
In laboratory studies, saponins have shown the ability to inhibit the reproduction of cancer cells and slow the growth of tumors in several different tissues.
4. Tomato
Many studies showed that antioxidant lycopene in tomato inhibits cancer cell growth and exhibit apoptosis, causing cell death.
5. Cruciferous vegetables
In a study conducted by University of Leicester researchers and recently presented at the National Cancer Research Conference in Britain found that cruciferous vegetables contains a naturally compound indole-3-carbinol (I3C) which could be a powerful cancer fighter when used in combination with chemotherapy drugs.
6. Etc.

C. Nutritional supplements
1. Antioxidants
Antioxidants such free radical scavengers vitamin A, C, E enhance the immune system against the forming of free radicals and prevent the alternation of cell DNA cause of abnormal cell growth.
2. Vitamin D
In a study presented at the annual meeting of the American Society of Hematology in New Orleans, researcher found that the amount of vitamin D in patients being treated for diffuse large B-cell lymphoma was strongly associated with cancer progression and overall survival.
3. Flavonoids
In a study of flavonoids intake in human, The researchers found that flavonoids’ anticancer property has been proposed to exist via prevention of the formation of cancer-causing metabolites, inhibition of tumor cell proliferation, and stimulation of programmed tumor cell self-destruction (apoptosis).
4. Quercetin
Quercetin is a type of phytochemical, also known as a flavonoid. In cell culture or animal studies, researchers found that quercetin has activity against some types of cancer cells and suggested it may be potential benefits in treating cancer.
5. Lycopene and 1,25-dihydroxyvitamin D3
In a study of Lycopene and 1,25-dihydroxyvitamin D3 cooperate in the inhibition of cell cycle progression and induction of differentiation in HL-60 leukemic cells, researchers found that The combination of low concentrations of lycopene with 1,25-dihydroxyvitamin D3 exhibited a synergistic effect on cell proliferation and differentiation and an additive effect on cell cycle progression. Such synergistic antiproliferative and differentiating effects of lycopene and other compounds found in the diet and in plasma may suggest the inclusion of the carotenoid in the diet as a cancer-preventive measure.

6. Etc.

Treatments
A. In conventional medicine
Treatment of lymphoma are depended on the grades and types
A.1. Indolent lymphomas
Indolent lymphoma is a type of slow grow cancer, with no symptoms in early stage, but by the time it is diagnosed, the diseases in general have spread to distant parts of the body. It is considered a curable lymphoma.
Because of its incurable nature, the aims of the treatment is to control the symptoms with chemotherapy and radiotherapy. Once the symptoms are controlled, the treatments stop.
1. Wait and see approach
If there is no symptom, no treatment. Many studies found that it is a best treatment, there is no evidence that the use chemo and radio therapy can produce any benefits in the early stage of Indolent lymphoma.

2. Chemotherapy
a. Chemotherapy is most use to treat with advance stage of indolent lymphomas, as it has spread to a distant parts of the body by using drugs, such as chlorambucil, with or without steroid agent, prednisone, melphalan, etc. taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells.
b. Side effects
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigue
b.5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Etc.

c. Biological therapy
By enhancing the body's own immune or hormonal system to kill cancer cells, while leaving healthy cells relatively intact with the use of antibodies to attack cancer cells or block their activities or interrupting the hormonal or chemical pathways of the cancers with certain drugs composed of small molecules .
b. Side effects
b.1. Allergic reactions,
b. 2. Difficulty breathing, swelling,
b. 3. Nausea,
b.4. Fever or chills, and
b. 5. Dizziness and fatigue
b.6. Etc

d. Radiotherapy
By using high-energy x-rays or other types of radiation, radiation therapy kills lung cancer cells and keep them from growing or regrowing. Depending to stage or grade there are two types of radiation therapy.
a. External radiation
By using a machine outside the body to send direct high-energy x-rays or other types of radiation toward the cancer.
b. Internal radiation
By placing a radioactive substance direct into or near the cancer by a medical instrument with the aim to kill nearby cancer cells.
c. Side effects
c.1.. Fatigue
c.2. Chest pain
c.3. Heart problem
c.4. Short of breath
c.5. Skin discoloration or pinkness, irritation.
c.6. Etc.

e. Radioimmunotherapy
a. In radioimmunotherapy, a tumor-killing dose of a radioactive substance made by identical immune cells that are all clones of a unique parent cell to target and bind selectively to malignant tumor when injected into the body with an aim to kill the cancer cells and prevent damage to the normal cells
b. Side effects
b.1.Fever
b.2. Low blood pressure,
b.3. Diarrhea, and
b.4. Decreased red cell counts
b.5. Etc.

f. Etc.

A.2. High Grade lymphomas
Cancer of high grade lymphomas spread rapidly and steady then indolent lymphomas, if left untreated, it can fatal in a few months but in many cases, it can be cured with intensive therapy.
1. Chemotherapy
a. Chemotherapy is most use to treat with advance stage of indolent lymphomas, as it has spread to a distant parts of the body by using drugs and combination of drugs of cyclophosphamide, doxorubicin (doxorubicin hydrochloride), vincristine (Oncovin) and prednisolone (a steroid), taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells. The duration of the intensive treatments is depending to the grade of cancer, the higher the grades, the time of treatment are longer
b. Side effects
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigue
b.5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Low white cell and platelet counts
b.9. Mouth ulcer
b.10. Etc.

2. Biological therapy
a, By enhancing the body's own immune or hormonal system to kill cancer cells, while leaving healthy cells relatively intact with the use of antibodies to attack cancer cells or block their activities or interrupting the hormonal or chemical pathways of the cancers with certain drugs composed of small molecules. Two groups of biological agents (purine analogues and rituximab) found to be very active in use of treating high grade lymphoma.
b. Side effects
b.1. Allergic reactions,
b. 2. Difficulty breathing, swelling,
b. 3. Nausea,
b.4. Fever or chills, and
b. 5. Dizziness and fatigue
b.6. Etc

3. Radiotherapy
Radiotherapy is used mostly in combination with chemotherapy to treat localized types of high grade lymphoma
a. By using high-energy x-rays or other types of radiation, radiation therapy kills lung cancer cells and keep them from growing or regrowing. Depending to stage or grade there are two types of radiation therapy.
a. External radiation
By using a machine outside the body to send direct high-energy x-rays or other types of radiation toward the cancer.
b. Internal radiation
By placing a radioactive substance direct into or near the cancer by a medical instrument with the aim to kill nearby cancer cells.
c. Side effects
c.1.. Fatigue
c.2. Chest pain
c.3. Heart problem
c.4. Short of breath
c.5. Skin discoloration or pinkness, irritation.
c.6. Etc.

4. Radioimmunotherapy
a. In radioimmunotherapy, antibodies armed with radioactive antibodies are also used to target and bind selectively to malignant tumor when injected into the body with an aim to kill the cancer cells and prevent damage to the normal cells
b. Side effects
b.1. Fever
b.2. Low blood pressure,
b.3. Diarrhea, and
b.4. Decreased red cell counts
b.5. Etc.

5. CNS prophylaxis
a. Since some types of high grade lymphoma have a tendency to spread to the central nervous system, therefore, chemo and radio therapies treatment may be recommended to include the CNS even with no indication of their presence, with the injections of drugs into the fluid of brain and spinal cord (Chemo) with or without the use of radiotherapy.
b. Side effects
Side effects of radiotherapy and chemotherapy applied

B. Herbal medicine
1. Asparagus Cochinchinensis
In vitro studies researchers found that curcumin acts as a weak phytoestrogen, exhibits neuroprotective, antiproliferative and preventative effects against cancer

2. Devil's Claw
The extract of Harpagophytum procumbens, commonly known as devil's claw,
In vitro studies, researchers found that cat's claw demonstrated anticancer effects against several cancer cell lines and has been reported to be effective in the treatment of lymphoma cancer, according to a study conducted by K. S. Wilson, M.D., which was published in the journal "Current Oncology" in August 2009.

3. Turmeric
In a study conducted by S. Uddin and colleagues at the Department of Human Cancer Genomic Research at King Faisal Specialist Hospital and Research Center in Saudi Arabia. researchers found that Curcumin in turmeric may inhibit the proliferation of lymphoma cancer by modulating cell cycling and inducing apoptosis.

4. Garlic
An analysis of several case-controlled studies in Europe suggests an inverse association between garlic consumption and risk of common cancers.

5. Green tea
In some clinical studies researchers suggested that the polyphenols in green tea, may play an important role in the prevention of cancer by killing cancerous cells and stoppimg their progression.

6. Etc.


C. Traditional Chinese medicine
1. Huang Qi
In study of Astragalus-Based Chinese Herbs and Platinum-Based Chemotherapy for Advanced Non–Small-Cell Lung Cancer: Meta-Analysis of Randomized Trials, researchers found that astragalus may increase effectiveness of platinum-based chemotherapy when combined with chemotherapy. These results require confirmation with rigorously controlled trials.
According to the American Cancer Society, the substances, licochalcone-A, licocoumarone and glabridin, which are present in licorice root, may prevent mutations in the DNA and kill existing cancer

2. Yi Yi Ren
About 20 years ago, a young physician named Dr. Da-Peng Li observed that people in China who ate coix seed as a dietary staple had a surprisingly low incidence of cancer. Research in test tubes, animals and humans by Zhejiang Kanglaite Pharmaceutical Company indicated that The drug from the seed's oil, Kanglaite has been shown to induce apoptosis, or programmed cell death, in various kinds of human tumors, and has a powerful effect on angiogenesis (the formation of new blood vessels to feed the tumor).


3. Long Kui
Long Kui is also known as wonderberry. The bitter, cold, slightly sweet and toxic herb has been used in TCM as diuretic and antipyretic and to treat acute kidney inflammation, chronic bronchitis, throat cancer, larynx Cancer, uterus cancer as it clears heat, eliminates toxin, improve urination by enhancing the function of liver, kidney and stomach channels. A study was done at the College of Environmental and Chemical Engineering at the Yanshan University in Hebei, China, researcher found that the tumor growth inhibition of long kui polysaccarides might correlate with the reduction of TNF-alpha level of blood serum, which resulted in a massive necrosis (accidental death of cells) in tumor tissues and the up-regulation of Bax and down-regulation of Bcl-2 and mutant p53 gene expression, which triggered apoptosis in tumor cells.

4. Bai Hua She She Cao
Bai Hua She She Cao is also known as spreading hedyotis, The bitter, sweet and cold herb has been used in TCM as anti-bacteria, anti-inflammation, anti-tumor, anti-virus agent and to treat snakebite and enhances immune system as it clears heat, drains dampness, expels toxins and resolves abscesses by enhancing the functions of liver, stomach, large intestine channels.
The Sanjiv Kumar YADAV, Shao Chin LEE(Yong Loo Lin School of Medicine, National University of Singapore researcher results showed that the ethanol extract from Bai Hua She She Cao effectively evokes cancer cell apoptosis, possibly through burst-mediated caspase activation.

6. Etc.
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