This document provides an overview of non-Hodgkin's lymphoma, including its history, statistics, biology, classification and staging, symptoms, causes and risk factors, diagnosis, and treatment. Non-Hodgkin's lymphoma is cancer of the lymphatic system that begins in the lymphocytes and can spread throughout the body. It is the sixth and seventh most common cancer in men and women respectively, with over 54,000 new cases and 19,000 deaths estimated in 2004 in the United States. Diagnosis involves imaging tests and biopsy, while treatment options include chemotherapy, radiation, bone marrow transplantation, surgery, immunotherapy, and targeted therapies.

1. Non-Hodgkin’sNon-Hodgkin’s
LymphomaLymphoma
Michael HakimMichael Hakim
Bio 316Bio 316
August 5, 2004August 5, 2004

2. LymphomaLymphoma
 History and OverviewHistory and Overview
 StatisticsStatistics
 What it effects (biology)What it effects (biology)
 Classification and StagingClassification and Staging
 SymptomsSymptoms
 Causes and Risk FactorsCauses and Risk Factors
 Diagnosis and TreatmentDiagnosis and Treatment

3. Lymphoma’sLymphoma’s
Where They BeginWhere They Begin
 Lymphomas are aLymphomas are a
cancer of thecancer of the
lymphatic systemlymphatic system
• Lymphatic vesselsLymphatic vessels
• Lymph nodesLymph nodes
(underarms, groin,(underarms, groin,
neck, spleen,neck, spleen,
tonsils and bonetonsils and bone
marrow)marrow)

4. Lymphoma’sLymphoma’s
Where They BeginWhere They Begin
 The Lymphatic system is our bodiesThe Lymphatic system is our bodies
main fight against infectionmain fight against infection
 Lymphocytes (B-cell and T-cell)Lymphocytes (B-cell and T-cell)
• Carried through our lymphatic systemCarried through our lymphatic system
and help our bodies fight infectionand help our bodies fight infection
• Lymphocytes are carried through theLymphocytes are carried through the
lymph vessels as well as the bloodlymph vessels as well as the blood
stream, so cancer can start in nodes andstream, so cancer can start in nodes and
spread anywhere throughout the body.spread anywhere throughout the body.

5. Lymphatic SystemLymphatic System
American Medical
Association

6. Non-Hodgkin’s LymphomaNon-Hodgkin’s Lymphoma
StatisticsStatistics
for 2004for 2004
 54,370 new cases54,370 new cases
 19,410 deaths19,410 deaths
• In California Alone there are est. 5,550 newIn California Alone there are est. 5,550 new
cases and a Death rate of 1,730 (California hascases and a Death rate of 1,730 (California has
the highest incidence and Death rate for Non-the highest incidence and Death rate for Non-
Hodgkin’s LymphomaHodgkin’s Lymphoma
• Non-Hodgkin’s Lymphoma is the 6Non-Hodgkin’s Lymphoma is the 6thth
and 7and 7thth
most deadly cancers for men and womenmost deadly cancers for men and women
• Recent studies have shown that overweightRecent studies have shown that overweight
patients are more likely to die then thosepatients are more likely to die then those
patients who are in better shape.patients who are in better shape.

7. ClassificationClassification
 Usually classified by how the cellsUsually classified by how the cells
look under a microscope and howlook under a microscope and how
quickly they grow and spreadquickly they grow and spread
• Aggressive lymphomas (high-gradeAggressive lymphomas (high-grade
lymphomas)lymphomas)
• Indolent Lymphomas (low-gradeIndolent Lymphomas (low-grade
lymphomas)lymphomas)

8. Non-Hodgkin’s LymphomaNon-Hodgkin’s Lymphoma
StagingStaging
 Stage is the term used to describe theStage is the term used to describe the
extent of tumor that has spread throughextent of tumor that has spread through
the body( I and II are localized where asthe body( I and II are localized where as
III and IV are advanced.III and IV are advanced.
 Each stage is then divided into categoriesEach stage is then divided into categories
A, B, and EA, B, and E
• A: No systemic symptomsA: No systemic symptoms
• B: Systemic Symptoms such as fever, nightB: Systemic Symptoms such as fever, night
sweats and weight losssweats and weight loss
• E: Spreading of disease from lymph node toE: Spreading of disease from lymph node to
another organanother organ

9. StagingStaging

10. Non-Hodgkin’s LymphomaNon-Hodgkin’s Lymphoma
 Two main types of Non-Hodgkin’sTwo main types of Non-Hodgkin’s
Lymphoma:Lymphoma:
 B-Cell and T-Cell LymphomasB-Cell and T-Cell Lymphomas
•B-Cell lymphomas (80%)B-Cell lymphomas (80%)
•T-Cell lymphomas (15%)T-Cell lymphomas (15%)

11. B-Cell Lymphoma (80%)B-Cell Lymphoma (80%)
 B-Cells help make antibodies, which areB-Cells help make antibodies, which are
proteins that attach to and help destroyproteins that attach to and help destroy
antigensantigens
 Lymphomas are caused when a mutationLymphomas are caused when a mutation
arises during the B-cell life cyclearises during the B-cell life cycle
 Various different lymphomas can occurVarious different lymphomas can occur
during several different stages of the cycleduring several different stages of the cycle
• Follicular lymphoma, which is a type of B-cellFollicular lymphoma, which is a type of B-cell
lymphoma is caused by a gene translocationlymphoma is caused by a gene translocation
which results in an over expressed gene calledwhich results in an over expressed gene called
BCL-2, which blocks apoptosis.BCL-2, which blocks apoptosis.

12. B-Cell CancersB-Cell Cancers

13. T-Cell Lymphoma (15%)T-Cell Lymphoma (15%)
 The T-cells are born from stem cells,The T-cells are born from stem cells,
similar to that of B-cells, but maturesimilar to that of B-cells, but mature
in the thymus.in the thymus.
 They help the immune system workThey help the immune system work
in a coordinated fashion.in a coordinated fashion.
• These types of lymphomas areThese types of lymphomas are
categorized by how the cell is affectedcategorized by how the cell is affected
 Anaplastic Large cell Lymphoma, t-cellAnaplastic Large cell Lymphoma, t-cell
lymphoma caused by a gene translocation inlymphoma caused by a gene translocation in
chromosome 5chromosome 5
Lymphoma.org

14. SymptomsSymptoms
 Painful Swelling of lymph nodesPainful Swelling of lymph nodes
located in the neck, underarm andlocated in the neck, underarm and
groin.groin.
 Unexplained FeverUnexplained Fever
 Night SweatsNight Sweats
 Constant FatigueConstant Fatigue
 Unexplained Weight lossUnexplained Weight loss
 Itchy SkinItchy Skin
Cancer Sourcebook

15. Causes and Risk FactorsCauses and Risk Factors
 The Exact causes are still unknownThe Exact causes are still unknown
• Higher risk for individuals who:Higher risk for individuals who:
 Exposed to chemicals such as pesticides orExposed to chemicals such as pesticides or
solventssolvents
 Infected w/ Epstein-Barr VirusInfected w/ Epstein-Barr Virus
 Family history of NHL (although noFamily history of NHL (although no
hereditary pattern has been established)hereditary pattern has been established)
 Infected w/ Human Immunodeficiency VirusInfected w/ Human Immunodeficiency Virus
(HIV)(HIV)
Lymphoma.org

16. DiagnosisDiagnosis
 X-RaysX-Rays
 CT scansCT scans
 Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI)
 BiopsyBiopsy
 LymphangiogramLymphangiogram
• Pictures of the lymphatic system takenPictures of the lymphatic system taken
w/ x-ray after a special dye is injectedw/ x-ray after a special dye is injected
to illuminate lymph nodes and vesselsto illuminate lymph nodes and vessels

17. TreatmentTreatment
 Non-Hodgkin’s Lymphoma is usuallyNon-Hodgkin’s Lymphoma is usually
treated by a team of physicians includingtreated by a team of physicians including
hematologists, medical oncologists and ahematologists, medical oncologists and a
radiation oncologist.radiation oncologist.
 In some cases such as for IndolentIn some cases such as for Indolent
lymphomas, the Doctor may wait to startlymphomas, the Doctor may wait to start
treatment until the patient starts showingtreatment until the patient starts showing
symptoms, known as “watchful waiting”symptoms, known as “watchful waiting”

18. Treatment OptionsTreatment Options
 ChemotherapyChemotherapy
 RadiationRadiation
 Bone Marrow TransplantationBone Marrow Transplantation
 SurgerySurgery
 Bortezomib (Velcade)Bortezomib (Velcade)
 ImmunotherapyImmunotherapy
 Using the bodies own immune systemUsing the bodies own immune system
combined with material made in a lab.combined with material made in a lab.

19. Survival RatesSurvival Rates
 Survival Rates vary widely by cellSurvival Rates vary widely by cell
type and staging.type and staging.
• 1 Year Survival Rate: 77%1 Year Survival Rate: 77%
• 5 Year Survival Rate: 56%5 Year Survival Rate: 56%
• 10 Year Survival Rate: 42%10 Year Survival Rate: 42%
Cancer.org

20. Any Questions?Any Questions?