B and T-cell lymphomas
What are they?
B and T- cell lymphomas (also known as non-Hodgkin lymphomas ) are cancers of the lymphatic system. The lymphatic system forms part of the immune system. It contains specialised white blood cells called lymphocytes that help protect the body from infection and disease. Lymphomas arise when developing B and T-lymphocytes undergo a malignant change, and multiply in an uncontrolled way. These abnormal lymphocytes, called lymphoma cells, form collections of cancer cells called tumours, in lymph nodes (glands) and other parts of the body.
The majority of lymphomas (around 80 per cent) arise in developing B-lymphocytes (B-cell lymphomas). The remainder arise in developing T-lymphocytes (T-cell lymphomas).
How common are they?
Each year in Australia around 3,500 people are diagnosed with type of B-cell or T-cell lymphoma* making them the most common type of blood cancer diagnosed. Overall, they represent the sixth most common type of cancer in men, and the fifth most common type of cancer in women.
Who gets lymphomas?
Lymphomas can occur at any age but they are more common in adults over the age of 50 years, who account for over 70 per cent of all cases. Around 40 children (0-14 years) in Australia are diagnosed with lymphoma each year. Lymphomas occur more frequently in men than in women.
What causes lymphomas?
In most cases the exact cause of lymphomas remains unknown but they are thought to result from damage to one or more of the genes that normally control the development of blood cells. Research is going on all the time into possible causes of this damage and it is thought the alterations in the immune system may play a role in some cases. People with a weakened immune system (immunosuppressed) due to an inherited immune deficiency disease, HIV infection, and drugs taken to prevent rejection of a transplanted organ, all have an increased chance of developing lymphoma. Certain viruses such as the Epstein Barr virus, the virus that causes glandular fever, may be involved, particularly in people who are immunosuppressed. The bacteria helicobacter pylori is associated with a rare type of lymphoma called MALT lymphoma which usually affects the lining of the stomach wall.
What are the symptoms?
Some people don't have any symptoms when they are first diagnosed with lymphoma and the disease is picked up during a routine chest x-ray.
The most common symptom of lymphoma is a firm, usually painless swelling of a lymph node (swollen glands), usually in the neck, under the arms or in the groin.
Other symptoms may include:
- recurrent fevers
- excessive sweating at night
- unintentional weight loss
- persistent fatigue and lack of energy
- generalised itching
Sometimes lymphoma starts in the lymph nodes in deeper parts of the body like those found in the abdomen (causing bloating), or the lymph nodes in the chest (causing coughing, discomfort in the chest and difficulty breathing). When it is first diagnosed, it is common for lymphoma to be found in several different sites in the body at once. It can spread to any organ and may involve the spleen, liver, brain and spinal cord (central nervous system) and bone marrow.
How are they diagnosed?
B and T-cell lymphomas are diagnosed by examining cells from an affected lymph node.
How are they treated?
Treatment varies depending the exact type of B or T-cell lymphoma you have, where it has spread in your body and how fast it is likely to grow. Your age and your general health are also taken into account.
There are 30 different types of B and T-cell lymphomas, many of which affect the body in different ways, and respond differently to treatment. Some lymphomas grow quickly and need to be treated as soon as they are diagnosed. Others grow more slowly and do not need to be treated straightaway.
Both the grade of your lymphoma and whether it belongs to the B-Cell or T-cell group can be determined by examining the cells from your lymph node biopsy under a microscope in the laboratory.
Below you will find some examples of B-cell and T-cell lymphomas. The more common types are written in bold text.
|Diffuse large B-cell lymphoma||Peripheral T-cell lymphoma|
|Follicular lymphoma||Mycosis fungoides|
|Extranodal marginal zone B-cell lymphoma (also called mucosa-associated lymphatic tissue lymphoma or MALT lymphoma)||Sezary syndrome|
|Chronic lymphocytic leukaemia/small lymphocytic leukaemia||Angio-immunoblastic T-cell lymphoma|
|Mantle cell lymphoma||Anaplastic large cell lymphoma|
|Mediastinal (thymic) large B-cell lymphoma||Precursor T-lymphocyte leukaemia/lymphoma|
|Waldenstrom’s macroglobulinaemia (also called Lymphoplasmacytic lymphoma)|
|Nodal marginal zone B-cell lymphoma|
|Splenic marginal zone lymphoma|
Chemotherapy is usually given as a combination of drugs, in several cycles (or courses) of treatment with a rest period of a few weeks in between each cycle. Chemotherapy may be given in either tablet form or intravenously, into a vein in your hand or arm, or through a special line called a central venous catheter inserted before you start treatment.
It may also be injected intrathecally , directly into the fluid that surrounds the brain and spinal cord, to treat disease in this area.
Improved results have been achieved by combining chemotherapy with monoclonal antibodies for example rituximab (Mabthera ®). This drug works by deliberately targeting abnormal lymphocytes, allowing chemotherapy to be delivered directly to the lymphoma cells without causing harmful side effects to other parts of the body.
Occasionally, a stem cell transplant is given, providing some people with a better chance of cure or long-term control of their disease. It is generally only suitable in some situations where the lymphoma has come back (relapsed) or is at high risk of relapse, and where it doesn't respond well to standard (conventional) treatment.
Slow-growing (indolent) lymphomas
In these cases the doctor may recommend regular checkups to carefully monitor your health. If this type of lymphoma is limited to a small group of lymph nodes radiotherapy alone may be able to cure or control it for a very long time. In some situations chemotherapy is given, either in tablet form or intravenously. This is usually very effective and puts many people with slow-growing lymphomas into remission that lasts a long time.
Fast-growing (aggressive) lymphoma
Fast-growing lymphomas respond well to chemotherapy and radiotherapy and can often be cured.
Side effects of treatment
All treatments can cause side effects. The type and severity however will vary between individuals, depending on the type of treatment used and how an individual responds to it. In general, more intensive treatment is associated with more severe side-effects. It is important to report any symptoms you are having to your doctor or nurse. In most cases they can be treated and are reversible.
Possible side effects of chemotherapy include:
- feeling sick - nausea and/or vomiting
- feeling tired and weak
- a drop in blood counts, especially white cells (with increased susceptibility to infection)
- hair loss and thinning
- mouth problems such as mucositis or ulcers
- diarrhoea or constipation
- skin problems such as dryness, rash or sensitivity to sunlight.
Radiotherapy can cause similar side effects to those caused by chemotherapy including nausea and vomiting, hair loss and fatigue. In general however the type of side effects seen with radiotherapy depends on the area of the body which has been treated. Skin reactions are common.
Your doctor and nurse will discuss with you the possible side-effects of any treatments you need and how they can be managed.
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