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Lymphoma – Manila Bulletin

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IF SYMPTOMS PERSIST

“So we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day.” – 2 Corinthians 4:16 The Holy Bible, English Standard Version

Dr. Jose Pujalte, Jr.

Broadcast journalist Cesar Apolinario died of an uncommon cancer last year.Amid the shock and sadness was another question mark, “What is lymphoma?”. We have been oriented to organs when it comes to tumors, so we easily recognize lung, breast, brain cancer, and so on. But lymphoma? Flummoxed. To understand it, we return to its origin – the lymphatic system, which is again unfamiliar to most as the network of tubes transporting a clear fluid called “lymph,” essential to the body’s immune system. It is not all obscure thankfully since we use “kulani” often enough to refer to swollen or inflamed lymph nodes. Aside from these, the other parts of the lymphatic system are the bone marrow, thymus, tonsils, and spleen. The bone marrow found in the inner part of bones form our red blood cells (erythrocytes), white blood cells (lymphocytes), and platelets. Lymphocytes are formed in the other organs mentioned above and they are further subdivided to T-cells (that directly kill infected cells in the body) and B-cells(that fight bacteria and viruses by making antibodies). B-cells can also inhibit tumor development by producing antibodies.

Causes & Risk Factors. While the exact cause of lymphoma is unknown, family history, previous chemo and radiotherapy and phenytoin treatment have been implicated. As in any cancer, the rogue cell – in this case, the lymphocyte – undergoes genetic mutation and multiplies without control as the lymphoma. MayoClinic.com identifies risk factors as being male, having a suppressed immune system and a history of getting any of these infections: HIV, TB, HH-8 (human herpes-8), EBV (Epstein-Barr virus), Helicobacter pylori (bacterial), and HCV (hepatitis C virus).

Types and Signs & Symptoms. Two main subtypes are known: 1) Hodgkin lymphoma– seen in younger patients between 20 and 40 years old with the involved nodes localized or grouped; diagnosis is made earlier; and 2) Non-Hodgkin lymphoma (NHL) – seen in patients between 65 and 75 years old and over 60 types of lymphoma are NHLs; spreads to more than one nodal group and it is usually diagnosed already in an advanced stage. Generally, a lymphoma patient presents with:

  • Lymphadenopathy – painless swelling of the lymph nodes in the armpits, groin, or neck.
  • Unexplained, sudden weight loss (10% of body mass in less than 6 months).
  • Fever, low-grade.
  • Itchy skin.
  • Night sweats.
  • lassitude (chronic fatigue).

Diagnosis.The doctor to visit and trust is the hematologist-oncologist. The good doctor will request any or all the following: lymph node biopsy, bone marrow biopsy, complete blood count, and specific blood exams such as LDH (lactate dehydrogenase, estimates lymphoma activity in the body). Suggested imaging includes CT (computed tomography) and PET (positron emission tomography) scans. The cancer is staged (Lugano) into limited (Stage I, II) and advanced (Stage III, IV).

Treatment. Before treatment, women of child-bearing age should see a fertility specialist (men could visit a sperm bank). Treatment options in lymphoma are radiation therapy, chemotherapy, immunotherapy, stem cell transplant, and antibody drug therapy. For Hodgkin lymphoma treated early, the 5-year survival is at 86% (NHL, 71%).

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