Non-Hodgkin's lymphoma cancer treatment

non-Hodgkin lymphoma cancer treatment

Non-Hodgkin's lymphoma is the most common lymphatic cancer, and it appears in many extra-lymphatic types, and its diagnosis and treatment requires the best and most skilled hands of Turkish doctors.

What is lymphoma?

The concept of lymphoma is derived from the cells affected by the disease, which are lymphocytes (a type of white blood cell), especially type B lymphocytes (therefore, they are classified as blood cancers), where the section lymph refers to lymphocytes and suffix oma in the sense of tumor, that is, lymphocyte tumor.
Lymphomas usually develop when a change or mutation occurs within lymphocytes, causing the abnormal (neoplastic) cell to multiply faster than normal lymphocytes or to live longer and not undergo programmed cell death (Apoptosis).
Cancerous lymphocytes can travel through the blood and lymph system and spread and grow in many parts of the body, including the lymph nodes, spleen, bone marrow and many other organs.
 
Lymphomas are divided into two main categories:
Hodgkin's lymphoma (It was called Hodgkin's disease):  It includes certain cell types characteristic of this disease (we will mention them later).
Non-Hodgkin lymphoma: It is the most common, and includes all tumors that do not fall under the classification of Hodgkin lymphoma.
Each type spreads, divides and responds to treatment differently, so it is necessary to know which type the patient has to develop the optimal treatment plan, whether for Hodgkin's tumors or non-Hodgkin's tumors.

Overview of the lymphatic system and lymphocytes

Before we talk about the pathological or cancerous state of the cells and the lymphatic system, we will mention an overview of the normal physiological state of the lymphatic system and lymphocytes.
 

The lymphatic system is an important part of the immune system in the human body and it rids the body of many toxins and eliminates many pathogens that attack the body.
The lymphatic system consists of the lymph, lymph vessels, lymph nodes, bone marrow, spleen, thymus gland, and amygdala.

Picture of the lymphatic system in the human body and a section of the lymph node
Overview of the lymphatic system to facilitate understanding of non-Hodgkin's lymphoma

 
 B and T lymphocytes arise from the bone marrow (which is a primary lymphoid organ) and are initially precursors and then develop into mature lymphocytes in the same bone marrow for type B, while T cells develop in thymus.
The mature B cells then migrate to the lymph nodes (secondary lymphoid organs) where they gather as follicles in the lymph node cortex.
Mature T cells congregate in the paracortex.
 
On the surface of B lymphocytes, there are protein complexes called CD (cluster of differentiation) with different numbers that act as markers that identify the body's cells and help it distinguish different types of cells.
B cells in the normal state express CD20 and CD45.
 
In the event that an antigen is attached to the surface of the B cell, this cell activates, and some of it develops into plasma cells that secrete IgM immunoglobulins, which are usually found in the middle of the lymph nodes in the so-called medulla, and from them what goes to the center of the lymphatic follicle and develops into a centroblast The centroblast that divides and multiplies and forms what is known as the germ center, where a rearrangement occurs in the immunoglobulin genes of these cells and become centrocytes, some of which secrete IgA and others IgG.
 
The centrocytes then differentiate into either plasma cells or memory cells, and the latter circulates in the blood, where part of it remains, or settles in the spleen or in the mucosa-associated lymphoid tissue known as MALT.
While the development and differentiation of T lymphocytes begins in the thymic gland.
Mature cells express either CD4, in this case, helper T cells, or CD8, called killer or suppressor T cells.

Non-Hodgkin's Lymphoma

Non-Hodgkin's lymphoma is a type of hematological neoplasm that specifically affects lymphocytes, and is known as NHL for short.
It is the other most common type of lymphoma, as it is the seventh most common adult cancer in the world.
The incidence of this cancer is estimated at about 72,000 cases annually, with the number expected to increase significantly in the coming years.
 
Non-Hodgkin's Lymphoma cancer is not a single disease as some think, but a group of diseases affecting lymphocytes, as it was estimated that there are more than 86 types of Non-Hodgkin's Lymphoma.

How do doctors distinguish Hodgkin's lymphoma from non-Hodgkin's lymphoma?

It can be distinguished by the location of the tumor and its accompanying symptoms, but the main difference on which the diagnosis is based is seen in the microscopic arena, where in Hodgkin's lymphoma there are neoplastic cells called Reed-Sternberg cells with a distinctive appearance that looks like an owl's eye.
Helps distinguish also that Hodgkin's Lymphoma It arises mostly in the lymph nodes and is rarely seen outside these nodes, unlike non-Hodgkin's lymphoma, which is often seen outside the lymphatic system.
 
In Non-Hodgkin's Lymphoma, there is a change or mutation (for several reasons we will mention later) in the genes of lymphocytes, where these cells become not subject to programmed cell death and divide randomly, and the immune system cannot control the division of these cells, giving these random divisions Nonfunctional tumor cells.
These cells can grow in any organ of the body and symptoms vary depending on the affected organ.

Types of Non-Hodgkin's Lymphoma

As we mentioned, Non-Hodgkin's lymphoma has many types (more than 86 types), but to facilitate understanding and classification of the disease, Non-Hodgkin's lymphoma cancer types have been placed in two main types:

B-cell lymphoma

This lymphoma constitutes about 85% of non-Hodgkin's lymphoma cases, and it is either slow-growing indolent or fast-growing aggressive and includes different types, including:

Diffuse Large B Cell Lymphoma

It is the most common type of lymphoma from B-lymphocyte lymphoma, which accounts for approximately 22%, and it is in one out of every three cases diagnosed with Non-Hodgkin's lymphoma.
It is characterized by being rapidly growing, and it affects the elderly more, especially those in their sixties, and usually appears as a mass in the abdomen, chest, or lymph nodes and gives metastases to multiple sites such as the liver, digestive tract, and even the brain, spinal cord and thyroid gland.
Symptoms are often B symptoms, and may be asymptomatic at first.
 
It is highly responsive to treatment and treatable despite its rapid growth and delivery to metastases.
There are many types of lymphoma, B lymphocytes, and we mention only one of them due to its importance, which is Primary mediastinal B lymphoma It often appears in young women behind the sternum and can cause respiratory symptoms due to pressure on the adjacent structures, or even cause swelling of the face and neck when it presses on the superior vena cava.

Follicular lymphoma

It is the most common slow-growing lymphoma, indolent, with 1 in 5 patients diagnosed with Non-Hodgkin's lymphoma, and the average age of infection is in the sixties.
The tumor arises in the lymph nodes and bone marrow, and this type of lymphoma is a chronic disease that is often incurable, as patients live for many years despite having this lymphoma.
This lymphoma can progress to diffuse large B-cell lymphoma.

Chronic lymphocytic leukemia (CLL/SLL)

They are almost the same disease, as they arise at the expense of small lymphocytes, but the difference is in the place of origin of the rum, where CLL arises in the blood and the greater marrow, while SLL arises in the lymph nodes and spleen.
Treating them is difficult, but the patient often lives for long periods.

Burkitt Lymphoma

It is a rare, fast-growing type of non-Hodgkin's lymphoma, named after the doctor who first described it in children in sub-Saharan Africa.
It has three under types:
  • Burkitt Endemic: As we mentioned, it is spread in children and adolescents in Africa and is often associated with infection with the Epstein-Barr virus, and it often affects their jaw and facial bones, and it can also arise in the intestines, kidneys and other organs.
    Photo of an African boy with Burkitt lymphoma in the jaw
    Picture showing endemic Burkitt's lymphoma, which is widespread in Africa in young and young and can cause serious facial disfigurements

  • Sporadic isolated brookite: They are isolated cases that appear in different parts of the world, and here they often arise in the abdomen.
  • Immunodeficiency-associated Burkitt: It is associated with acquired immunodeficiency syndrome (AIDS).
Brockett's lymphoma under the microscope looks like a starry sky at night, due to the presence of Tingible bodies, which are large microbes that have devoured the tumor cells.

It needs immediate and intensive treatment due to its rapid spread and growth, although half of the patients recover after intensive chemotherapy.

We note the characteristic microscopic appearance of Burkitt's lymphoma and the presence of Tingible bodies (white spots)
We note the characteristic microscopic appearance of Burkitt's lymphoma and the presence of Tingible bodies (white spots), which are large macrophages that have devoured the neoplastic cells.

Mantle Cell Lymphoma

It is a rare type of non-Hodgkin's lymphoma, originating in the mantle zone and is often fast growing (it can be slow growing).
Often this lymphoma is not diagnosed until late stages and is often difficult to treat and cure.
There is an increase in the synthesis of the protein Cyclin D, which makes it easy to diagnose with a biopsy.

Marginal Zone Lymphoma MZL

It is slow growing and often appears after the age of sixty and is divided into three types:
  • Marginal Outward Nodal Extra-Nodal MZL: the most common, It arises in areas outside the lymph nodes and often in MALT where this type can be called MALT lymphoma, and it is either gastric or extra-infectious, this type appears with a medical history of chronic infection (Pylori,
  • Marginal Streptococcus Nodal MZL: They originate in the lymph nodes or bone marrow.
  • Splenic MZL: They originate in the spleen, blood, or bone marrow.

Lymphoplasmacytic Non-Hodgkin's Lymphoma

They usually arise in the bone marrow, lymph nodes, and spleen.
It is characterized by the secretion of immunoglobulins by tumor cells called immunoglobulins M, which accumulate in the blood at high levels. This accumulation leads to an increase in the thickness and viscosity of the blood. Waldenstrom Macroglobulinemia.

T . non-Hodgkin's lymphoma

Approximately 7% are non-Hodgkin's lymphoma cases and have many types, but they are rare.
For convenience, it is divided into two parts, depending on the degree of differentiation of the T cells from which the tumor arises:

T-lymphocytic leukemia

It is rare and arises at the expense of T cells in its initial stages, and it first arises in the thymus gland and grows to large sizes that can affect breathing and cause swelling in the face and neck.
The disease is rapidly spreading and growing, but responds well to chemotherapy and is curable if detected early.

Peripheral T-cell lymphoma

They arise at the expense of more mature T cells, a general term that includes many subtypes depending on where the tumor originates, and we will mention them briefly:
  • Anaplastic Large Cell Lymphoma: ALCL can be systemic (occurring all over the body) or cutaneous (limited to the skin). Systemic ALCL is usually at an advanced stage when diagnosed and is fast-growing.
    The systemic type is further categorized into two types based on ALK (Anaplastic Lymphoma Kinase) positivity or negativity. Systemic ALCL responds well to treatment, especially ALK-positive disease, but ALK-negative patients may require more aggressive treatments, and relapse occurs more frequently than ALK-positive disease. .
  • Angioimmunoblastic T-cell lymphoma: It is a rare, severe type that accounts for about seven percent of all patients with T-cell lymphoma in the United States.
    Most patients are middle-aged to elderly and are diagnosed at an advanced stage, and there is some evidence that AITL develops from a persistent immune response possibly due to an underlying viral infection (eg Epstein-Barr virus).
    Initial symptoms often include fever, night sweats, rash, itching, some autoimmune disorders such as autoimmune hemolytic anemia and immune thrombocytopenia and with elevated levels of gamma globulin in the blood.
  • Cutaneous T-cell Lymphoma: It is a general term that includes several under slow-growing types, most of which are specific to the skin, and one of these types is Mycosis Fungoides, which is the most common type and is characterized by the presence of papules, plaques, and itchy skin lesions on the course of the body. Another type is Sézary syndrome, which affects the blood and skin and appears as itchy red skin. Severely in most parts of the body, tumor T cells can also be seen, called Sézary cells.
  • Lymphoblastic lymphoma: It is rare and arises from lymphoblasts and is more common than T-cell blastocysts.
 
There are many other types, but they are not mentioned due to the lack of importance.

Causes and risk factors for non-Hodgkin lymphoma 

The cause of non-Hodgkin's lymphoma has not yet been clearly established.
As we mentioned earlier, the mechanism of cancer formation through different genetic mutations in the genes of lymphocytes is agreed upon, but no real and clear reason for the emergence of these mutations has been discovered.
There are some risk factors that often have a role in the emergence of these mutations in non-Hodgkin's lymphoma patients, including:
  • patient age: The older the patient, the higher the incidence of Non-Hodgkin's lymphoma, as more than a third of cases were diagnosed in the elderly over 75 years.
  • Gender: Where there is a slight tendency for infection to occur in males more than in females.
  • Sweat: It is believed that whites have a tendency to develop non-Hodgkin lymphoma more than blacks, but this belief needs more detailed studies.
  • Previous family story: The incidence of Non-Hodgkin's lymphoma increases when there is an infection among first-degree relatives (brother, father, son...).
  • Obesity Recent studies have shown that obese people have an increased risk of some types of Hodgkin lymphoma.
  • hereditary autoimmune disease: Such as hypogammaglobulinemia or Wiscott-Aldrich syndrome.
  • History of previous exposure to radiation: Such as those who underwent previous radiotherapy or, rarely, survivors of nuclear and chemical disasters.
  • Autoimmune diseases: Such as rheumatic fever, Sjögren's disease, systemic lupus erythematosus (SLE) or celiac disease are all conditioned by non-Hodgkin's lymphoma, and AIDS, caused by HIV, can also play a role in this cancer.
  • Epstein-Barr virus (EBV) and human T-lymphotrophic virus type I: It has been proven that they have a significant role in the occurrence of genetic mutations in patients with non-Hodgkin lymphoma.
  • Chronic infections: Such as infection caused by Helicobacter pylori, hepatitis virus and Chlamydia psittaci.

Symptoms and signs

Symptoms and signs of non-Hodgkin lymphoma vary greatly, due to the presence of many types and the possibility of cancer arising in almost any organ of the body.
Lymphoma may not have any symptoms until the tumor has grown to a certain size.
The most common presentation in patients with non-Hodgkin's lymphoma is Painless swelling of the lymph nodes Especially in the cervical, axillary and groin lymph nodes.
Other symptoms include:
  • Profuse night sweats.
  • Unexplained weight loss.
  • Rash or skin lumps with itchy skin around the whole body.
  • Unexplained fever.
  • Constant feeling of tiredness and fatigue.
  • Increasing the possibility of bleeding such as nosebleeds and heavy menstruation.
  • Feeling of breathlessness.
  • Feeling full after eating a small amount of food.
  • Frequent infections.
Symptoms (night sweats, weight loss, fever) are called B symptoms.
Some other lymphomas depend on the place of transmission of non-Hodgkin's lymphoma and are often mechanical symptoms, so intestinal obstruction occurs if it moves to the digestive system, or there is a lack of blood cell formation in the case of bone metastases, and it may also cause compression of the spinal cord if there is a metastasis next to it.

Diagnosis of Non-Hodgkin's Lymphoma in Turkey

Diagnostic and investigative methods have developed significantly in Turkey, especially in the field of cancer
Non-Hodgkin's lymphoma patients often present with an enlarged lymph node history and sometimes some other symptoms, but the lymph nodes enlarge for other reasons that are more common than Non-Hodgkin's Lymphoma and the most common infection.
Diagnosis depends mainly on the doctor's skill and experience, and many costly procedures can be dispensed with if the diagnosis is directed in the right direction.
First, the clinical history must be taken in detail, and then a clinical examination of the patient is conducted, and then moved to other, more specific procedures.
To facilitate the diagnosis, the following can be done:
  • Photography of all kinds: Such as ultrasound, CT, positron emission tomography (PET-Scan), simple chest radiograph, and magnetic resonance imaging (MRI).
  • Blood tests: Complete blood count (CBC), blood chemical tests, and titration of specific enzymes can be done if a certain type of Non-Hodgkin's lymphoma is suspected.
  • Bone Scan.
  • biopsy: It is the most important and most accurate diagnostic method, but it is not requested until after other causes and their types are denied bone marrow biopsy.

Interim assessment of non-Hodgkin's lymphoma

The same classification is used in the classification of Hodgkin's Lymphoma and he Lugano classification.

Staged classification of non-Hodgkin's lymphoma (Lugano classification)
The staging of non-Hodgkin's lymphoma (Lugano's classification) depends on the number and location of affected nodes as well as proximal and distal metastases.

Non-Hodgkin's Lymphoma Treatment in Turkey

depends choice Non-Hodgkin's lymphoma treatment It depends on several factors, including the patient's symptoms, the type and stage of non-Hodgkin's lymphoma.

It is not always necessary to resort to treatment if non-Hodgkin's lymphoma is diagnosed, as it can be monitored if there are no symptoms or the patient's life is not affected.
Among the most common treatments in Turkey:

Chemotherapy for non-Hodgkin's lymphoma

It is the most common treatment for non-Hodgkin's lymphoma, and it has developed Chemotherapy in Turkey Significantly until it became one of the leading countries in the field of chemical processing.
Chemical drugs target any cell that is constantly dividing in the body, including cancer cells, but as a result, they have many side effects. Cancer cells are not the only ones that regenerate quickly and constantly in the body (hair, skin, blood…).
Treatment is usually given in the form of drug combinations between several drugs to get a better result, and it includes many combinations Chemotherapy For non-Hodgkin's lymphoma, the monoclonal antibody rituximab (Rituxan), which is usually abbreviated with the letter R and placed at the beginning or end of the abbreviation for a co-administration, such as R-CHOP or CHOP-R consisting of cyclophosphamide, doxorubicin, vincristine, prednisone.

Intrathecal (into the spinal canal or subarachnoid space) chemotherapy may also be used to treat primary lymphomas that originate in the testicles or sinuses, diffuse large B-cell lymphoma, Burkitt's lymphoma, lymphoblastic lymphoma or some T-cell lymphomas. Aggressive (rapidly growing), given to reduce the spread of lymphoma cells to the brain and spinal cord.

Intrathecal injection of chemotherapy drugs into the spinal canal or subarachnoid space (the Ommaya Reservoir is the area where the cerebrospinal fluid drains).
 Intrathecal injection of chemotherapy drugs into the spinal canal or subarachnoid space (the Ommaya Reservoir is the area where the cerebrospinal fluid drains).

Immune lymphoma treatment protocol

The field Immunotherapy in Turkey It has expanded significantly in recent times and new generations of drugs and synthetic molecules have appeared to reduce collateral damage, and that Study Immunotherapy methods are still being developed.
Immunotherapy is based mainly on strengthening the human body's natural immunity or using synthetic antibodies to eliminate deformed cancerous cells. The most common of these methods are:

Monoclonal antibodies

They are synthetic proteins that attack cells with certain markers, which greatly reduces side effects, including:

  • Antibodies that target the CD20 antigen: CD20 is a protein found on the surface of B cells. These drugs include rituximab (Rituxan), obinutuzumab (Gaziva), ofatumab (Azera) and ibritumumab tuxitan (Zevalin).
  • Tet antibody targeting CD30 antigen: It is a protein found on the surface of T cells. An example of this drug is brentuximab vedotin (Adcetris).
  • Antibodies that target the CD52 antigen: It is a protein found on the surface of T cells, and a drug that targets this antigen is alemtuzumab.

Chimeric Antigen Receptor (CAR) T cells

This method is considered a quantum leap in the treatment of Non-Hodgkin's lymphoma and is still Study List about this method.
Here, T cells are taken from a person's blood and modified in the laboratory to have specific receptors on their surface. These chimeric receptors can attach to proteins on the surface of cancerous lymphoma cells, and this binding enables the T cells to destroy tumor cells.

Targeted non-Hodgkin's lymphoma treatment

Non-Hodgkin's Lymphoma Cancer Awareness Month

An estimated 81,560 people in the United States will be diagnosed with non-Hodgkin's lymphoma in 2023, according to the National Cancer Institute.
Hodgkin's and non-Hodgkin's lymphomas can occur in children, adults, and at any age.
September is Leukemia and Lymphoma Awareness Month as it spreads awareness campaigns and urges people to get regular checkups, and shows that the disease is treatable.

Why should I choose treatment in Turkey?

Turkey is distinguished by the presence of the best hospitals equipped with advanced technologies and a medical staff who has successfully performed this type of operation a large number of times.
Recently, Turkey has become one of the leading countries in the field of medical tourism in the world, due to the provision of appropriate treatment with advanced centers and low cost.
Bimaristan Medical Center It is your first choice For treatment in Turkey.
We guide you to the best expert specialists in all departments.
We facilitate the language of communication between you and everyone through specialized Arab doctors who will help you communicate with your doctor.
We help you in securing the appropriate treatment and high-end service in the most modern hospitals and medical centers in Turkey.
We provide our services extensively and precisely.
We accompany you step by step towards recovery.
Free consultations around the clock.
don't hesitate toContact usBimaristan, your family center in Turkey.


Sources:

  1. Lymphoma.org
  2. Cancer.gov
  3. NHS.UK
  4. LLS.org
  5. Cancer.org
  6. leukaemia.org

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