Research Paper Sample on Non-Hodgkin's Lymphoma and PTCL

Lymphoma is a cancer of the lymphatic system. It is divided into Hodgkins lymphoma (HL) which makes up 10 percent of all lymphoma cases and non-Hodgkin's lymphoma (NHL) (Armitage et al., 2017). It attacks lymphocytes which are a type of white blood cells but are classified explicitly according to the immune cells affected. The two broad categories of NHL are B-cell lymphomas which develop from abnormal B-lymphocytes and accounts for 85 percent of all NHL, and T/NK-cell lymphomas resulting from abnormal T-lymphocytes found in the thymus gland (American Cancer Society, 2015). Peripheral T-cell lymphomas (PTCL) belongs to the T-cell non-Hodgkin lymphomas (NHLs) subdivision and carry a poor prognosis (Foss et al., 2011).

Non- Hodgkin lymphoma represents a broad spectrum of illnesses that differ from the most aggressive to the most indolent malignancies. These malignancies arise from lymphocytes that are at various stages of development, and the characteristics of the specific lymphoma subtype depend on which cell they originate from. NHL majorly develops in the lymphoid tissues such as the spleen, lymph nodes, and bone marrow but can occur in almost any tissue. Evens and Blum (2015) notes that NHL rates doubled between 1970 and 1990 but have since stabilized yet increases have been more pronounced in males, whites, the elderly, and those with extranodal sites diagnosis.

According to Evens and Blum (2015), NHL prevalence in the United States is 50 percent higher in men as compared to women, and this trend is seen in other countries as well. Evens and Blum (2015) argue that NHL incidences vary by race with non-Hispanics at a higher rate than blacks, Asian islanders, and Hispanics with NHL types such as peripheral T-cell lymphoma (PTCL), Sezary syndrome, and mycosis fungoides being more common among whites than in blacks. According to American cancer society (2017), NHL accounts for 4 percent of all cancers in the United States responsible for approximately 72,240 people diagnosed per year with men leading with 40,080 and women 32,160 cases, and 20,140 reported deaths every year.

Hodgkins lymphoma (HL), on the other hand, is less common and treatable as compared to NHL as there are only 8,260 new cases and 1,070 deaths reported every year in the united states (American cancer society, 2017). The survival rates for HL patients stand at 86 percent and has improved in the past few years because of advanced treatment options (American cancer society, 2017). The survival rates depend on the patients age and the stage of HL.

When a person has lymphoma, some of the white blood cells undergo abnormal division and lacks resting time as typical white blood cell do. Because of this, there is continuous division before maturity, production of more white blood cells that do not die naturally and fail to fight infections. They start to collect abnormally and cause swelling in lymph nodes, spleen, or bone marrow then grows into tumors. The patient may experience a build-up of cancerous lymphocyte tumors in other parts of the body. NHL starts at the lymph nodes area and spread through the lymphatic system or bloodstream to tissues and organs outside the lymph nodes such as brain, skin, sinuses, and stomach, a process called extranodal spread. It spreads through stages where at stage I, the cancer is either in one lymph node area or has invaded one extralymphatic organ or site. It spreads to 2 or more lymph node sites. It then spreads all over the body past the lymph nodes.

There are several predisposing factors of NHL. For example, congenital and acquired states of immunosuppression increase NHL risk. These conditions include Wiskott-Aldrich syndrome, X-linked lymphoproliferative syndrome, and severe combined immunodeficiency. Acquired immunodeficiency states such as HIV infection also increases the risk of NHL and is attributed to deficient immune surveillance of oncogenic herpesviruses, such as human herpesvirus 8 and defective immune regulation. Treatment drugs such as immunosuppressive and chemotherapy or radiation are susceptible to NHL. Several viruses such Epstein-Barr Virus, hepatitis C virus (HCV), human T-cell lymphotrophic virus (HTLV-1), and Kaposi sarcoma-associated herpesvirus play a role in the pathogenesis of NHL. Furthermore, lifestyle factors have contributed to the prevalence of NHL. For example, red meat and fish are associated with risk because meat modulates the immune response (Evens & Blum, 2015). Other diets known to predispose one to NHL include fats such as trans fatty acids, animals, and saturated fats.

NHL manifests itself in the body through a range of signs and symptoms. However, some NHL patients do not experience any symptoms and may be initially detected by a physician when the tumor has enlarged, and trigger symptoms or a doctor can detect it during a routine physical examination. The most common sign is enlarged lymph nodes in the neck, groin, or armpit. Some patients may experience some enlarged lymph nodes near the ears or elbow, severe or frequent fever, skin rashes, and feel tired most of the time. Easy bruising or bleeding, loss of appetite, numbness or tingling in hands and feet, night sweats that soak sheets and clothing, headaches, blurry vision, and drop in weight are indications of NHL. These signs and symptoms depend on the location of the tumor in the body, but a patient is advised to see a doctor if they persist and impact on the life of a person.

During diagnosis, the doctor performs a physical examination by checking for swollen lymph nodes under the chin, neck, tonsil area, elbows, armpits, and groin. The physician also reviews the swelling caused by swollen lymph nodes in the chest or abdomen as well as any enlarged internal organs. Furthermore, the physician asks the patient for any pain experienced, paralysis or weakness as a result of pressure exerted by swollen lymph nodes on the spinal code or nerves. If the doctor suspects lymphoma, other tests are done to confirm the diagnosis. Biopsy tests such as chest x-rays, blood tests, bone marrow evaluation, and other imaging tests and scans are crucial in diagnosis. Imaging tests such as CT (computed tomography) scan, PET (positron emission tomography) scan, and MRI (magnetic resonance imaging) create chest and abdomen pictures to see if there is any lymphoma swelling in the lymph nodes, spleen, liver, or lungs.

Diagnosis is based on sufficient biopsy sample reviewed by a qualified hematopathologist. A sample from an excisional biopsy of the swollen lymph node or a tumor in another organ is appropriate, but a cutting-needle biopsy sample is used. During diagnosis, fine-needle aspiration or cytology from an effusion is inappropriate. Evens & Blum (2015) observe that a sufficient amount of tissue should be extracted to facilitate immunohistochemical and genetic studies as this increases the chance of a pathologist reaching a precise diagnosis. After the examination of a biopsy sample, a pathologist develops a report which an oncologist uses together with results of other diagnostic tests to confirm a diagnosis. It is occasionally hard to make an accurate pathologic diagnosis and classification of specific lymphoma type. If the pathologist is uncertain of the biopsy results, a lymphoma pathologist or hematopathologist can review the results because accuracy in diagnosis is vital in treatment planning.

There are many effective treatment options that a doctor can use but has to take into consideration many factors so that the treatment plan works. For example, the doctor has to determine the type of NHL, stage, location, and category of the disease. Other deciding factors include lymphoma growth rate, lactate dehydrogenase (LDH) and beta-2 microglobulin (B2M) proteins in the blood of the patient, and blood levels of LDH, and the patients overall health and age. The available treatment options include watch and wait for some NHL types, drug therapy, radiation therapy, stem cell transplantation and chemotherapy. The primary treatment type for NHL is chemotherapy administered in cycles lasting between six to 10 months but can cause harm to healthy cells tasked with forming blood in the bone marrow (Bolick & Reuter-Rice, 2012). Because of this, white blood cells and red blood cells count drops and may require blood cell transfusion which treats chemotherapy side effects. Drug combinations used to treat NHL depend on the stage of treatment and type of NHL. These drugs include Rituxan which kills some types of cancer.

Stem cell transplantation treats both NH and NHL. Factors such as treatment received, a subtype of the disease, stage, and the patients physical ability determine the need for stem cell transplant. Despite this, stem cell transplant can be an additional treatment for some patients but not an option for everyone. Autologous Stem Cell Transplantation frequently used than Allogeneic Stem Cell Transplantation are the types used in treating lymphomas lymphoma patients (Quesenberry & Castillo, 2013). Autologous stem cell transplantation helps the body in supplying new blood cells after chemotherapy. Allogeneic Stem Cell Transplantation involves the use of donor stem cells.

On the other hand, similar therapies used in B-cell lymphomas are essential in treating PTCLs. Treatment options include anthracycline-based combination chemotherapy, adriamycin, cyclophosphamide, vincristine bleomycin methotrexate and decadron (mBACOD), methyl-GAG, and cyclophosphamide vincristine and prednisone (CVP). Others include denileukin ditox and purine and pyrimidine analogues (Foss et al., 2011).

In conclusion, lymphoma is cancer that attacks the lymphatic system and is broadly divided into NHL and HL. The categories of NHL are B-cell lymphomas which develop from abnormal B-lymphocytes and T/NK-cell lymphomas. Peripheral T-cell lymphomas (PTCL) belongs to the T-cell non-Hodgkin lymphomas (NHL). Some of the general signs and symptoms include fever, swelling of lymph nodes, loss of weight, and fatigue. The primary form of diagnosis is biopsy tests such as chest x-rays, blood tests, bone marrow evaluation, and other imaging tests and scans. A professional hematopathologist carefully reviews the results of the biopsy. After diagnosis, the patient undergoes chemotherapy which is the main treatment option for lymphomas.

References

American Cancer Society (2017). View All Types of Cancers. Retrieved from https://www.cancer.org/cancer/all-cancer-types.html#alpha-P.

Armitage, J. O., Gascoyne, R. D., Lunning, M. A., & Cavalli, F. (2017). Non-Hodgkin lymphoma. The Lancet, 298-310.

Bolick, B. N., & Reuter-Rice, K. (2012). Pediatric Acute Care: A Guide for Interprofessional Practice. Burlington, MA: Jones & Bartlett Learning.

Evens, A. M., & Blum, K. A. (2015). Non-Hodgkin Lymphoma: Pathology, Imaging, And Current Therapy (Vol. 165). Cham, Switzerland: Springer.

Foss, F. M., Zinzani, P. L., Vose, J. M., Gascoyne, R. D., Rosen, S. T., & Tobinai, K. (2011). Peripheral T-cell lymphoma. Blood, 117(25), 6756-6767.

Quesenberry, P. J., & Castillo, J. J. (2013). Non-Hodgkin Lymphoma Prognostic Factors and Targets. New York, NY: Springer New York.