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Lymphoma

Definition: Lymphoma is a type of blood cancer that originates in the lymphatic system, the disease-fighting network spread throughout your body. It is characterized by the uncontrolled growth of lymphocytes, which are a type of white blood cell.

Types of Lymphoma:

  1. Hodgkin Lymphoma (HL): Marked by the presence of Reed-Sternberg cells.
  2. Non-Hodgkin Lymphoma (NHL): Includes a diverse group of cancers derived from either B, T, or NK lymphocytes.

Epidemiology:

  • NHL is more common than HL.
  • NHL can occur at any age, but the risk increases with age. HL is most common between ages 15-40 and above 55.

Pathophysiology:

  • HL: The Reed-Sternberg cells are usually derived from B lymphocytes that have become malignant.
  • NHL: Can originate from B, T, or NK cells, and its behavior ranges from slow-growing (indolent) to rapidly progressing (aggressive).

Clinical Presentation:

  • Painless swelling of lymph nodes in the neck, armpits, or groin.
  • Systemic ‘B’ symptoms: fever, night sweats, and weight loss.
  • Fatigue, itching, and coughing or breathlessness if the lymphoma is in the chest area.

Diagnosis:

  • Physical Examination: Palpation of peripheral lymph nodes, liver, and spleen.
  • Blood Tests: Complete blood count (CBC), lactate dehydrogenase (LDH), and ESR.
  • Imaging: CT, PET, or MRI scans to determine the extent of the disease.
  • Biopsy: Excisional biopsy of an enlarged lymph node for histological diagnosis.
  • Bone Marrow Biopsy: To check for spread to the bone marrow.

Management:

  • HL: Often curable with standard treatment protocols which may include chemotherapy, radiation therapy, or stem cell transplantation.
  • NHL: Treatment varies widely depending on the type and may include chemotherapy, immunotherapy, targeted therapy, radiation therapy, and stem cell transplantation.

Prognosis:

  • Prognosis depends on the type of lymphoma, stage, and biological characteristics. For example, HL has a high cure rate, while NHL’s prognosis varies widely with subtype.

Prevention:

  • There are no specific measures to prevent lymphoma. Risk factor modification, like avoiding known carcinogens and maintaining a healthy immune system, may be beneficial.

Conclusion: Lymphomas are a heterogeneous group of malignancies with varied presentations and outcomes. Medical students should focus on understanding the differences between HL and NHL, the significance of ‘B’ symptoms, and the basics of lymphoma management.

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