Non-Hodgkin's lymphoma is a cancer of the lymphatic system that can affect B-cells or T-cells. It is classified based on the type of cell and aggressiveness. Common symptoms include swollen lymph nodes, fever, night sweats, and unintended weight loss. While the exact causes are unknown, risk factors include chemical exposure, infections, and immunodeficiency. Diagnosis involves imaging tests and biopsy. Treatment options include chemotherapy, radiation, immunotherapy, and bone marrow transplants, with survival rates varying based on cell type and staging.

1. NON-
HODGKIN’
S
LYMPHOM
A
Oliveros francis!!!!!!!!!!!!!!!!!

2.  A heterogeneous group of B- and T-cell
malignancies that are diverse in cellular
origin, morphology, cytogenetic
abnormalities, response to treatment,
and prognosis
 Any of a large group of cancers of
lymphocytes (white blood cells).
NON-HODGKIN’S LYMPHOMA
(NHL):

3. chronic myeloid
leukaemia
(CML)
HAEMATOPOIETIC MALIGNANCIES
Polycythemia
vera
(PV)
Idiopathic
myelofibrosis
(MF)
Essential
thrombocythemia
(ET)
Acute myeloid
leukaemia
(AML)
Chronic myeloid
leukaemia
(CML)
Acute lymphatic
leukaemia
(ALL)
Chronic lymphatic
leukaemia
(CLL)
hairy cell
leukaemia
(HCL)
Hodgkin’s
lymphoma
Burkitt's lymphoma
cutaneous T-cell
lymphoma (CTCL)
Non-hodgkin’s
lymphoma
(NHL)
Myeloproliferative
diseases Leukaemias
Malignant
lymphomas

4. HAEMATOPOIETIC MALIGNANCIES
 Family of chronic
neoplastic
diseases
 Due to a clonal
disorder arising
at the level of the
pluripotent stem
cell
 Characterised by
abnormal
proliferation of 1
or more blood cell
lines
 Neoplastic
disease of a
haematopoietic
precursor cell
 Characterised by
replacement of
normal bone
marrow
 Often infiltration
into other organs
 Malignant clones
suppress normal
cell formation
 Neoplastic
disease of
lymphatic tissue
 Originates in
lymph node or
spleen
 Hodgkin’s (15%)
 non-Hodgkin’s
(85%)
Myeloproliferative
diseases
Malignant
lymphomas
Leukaemia

5. THE
LYMPHA
TIC
SYSTEM

6. Lymphatic TissueLymphatic Tissue
 Lymph nodes, spleen, liver, skin and the
respiratory, GI and GUT tract
 Lymphocytes undergo further proliferation and
differentiation in lymphoid tissue
 B-lymphocytes
tend to reside in lymph nodes & spleen
 T-lymphocytes
tend to circulate throughout the
lymphatic system

8. LYMPH NODE - NORMAL HISTOLOGY
afferent lymphatic vessel capsule
follicle (mainly B-
cells)
- germinal centre
- mantle zone
C
cortex
medulla
paracortex
efferent lymphatic vessel
artery
vein

10.  Incidence of 13.3/100,000 per year
 Predominates in the 40-70 years age
group
 most common neoplasm in the 20-
40 age group
 Incidence is rising
 150% growth over the past 30
years
 increasing by 4% annually since
1970’s
 Mortality rate is also rising
 2% rise per year
 third highest rise, exceeded only
by lung cancer in women and
malignant melanoma
NHL INCIDENCE

11. STAGING OF NHL

12. The Non-Hodgkin’s Lymphoma Pathologic Classification Project. Cancer. 1982;49:2112.
MODIFIED ANN ARBOR STAGING OF
NHL
Stage I Involvement of a single lymph node region
Stage II Involvement of ≥2 lymph node regions on the same
side of the diaphragm
Stage III Involvement of lymph node regions on both sides
of the diaphragm
Stage IV Multifocal involvement of ≥1 extralymphatic sites
± associated lymph nodes or isolated
extralymphatic
organ involvement with distant nodal involvement

15. CATEGORIES OF
NON-HODGKIN’S
LYMPHOMA

16. FOLLICULAR NON-
HODGKIN’S
LYMPHOMA
AGGRESSIVE NON-
HODGKIN’S
LYMPHOMA
INDOLENT NON-
HODGKIN’S
LYMPHOMA

17. B-CELL
LYMPHOMAS

18.  Diffuse Large B-Cell Lymphoma
(DLBLC). DLBCL is the most common
type of non-Hodgkins lymphoma,
accounting for about 30% of all NHL
cases. It is an aggressive, fast-growing
lymphoma that usually affects adults but
can also occur in children. DLBCL can
occur in lymph nodes or in organs outside
of the lymphatic system. DLBCL includes
several subtypes such as mediastinal
large B-cell lymphoma, intravascular
large B-cell lymphoma, and primary
effusion lymphoma.

19.  Follicular Lymphoma
(FLs). Follicular
lymphoma is the second
most common type
lymphoma, accounting for
about 20% of all NHL
cases. It is usually
indolent (slow growing)
but about half of follicular
lymphomas transform
over time into the
aggressive diffuse large
B-cell lymphoma.

20.  Mantle Cell Lymphoma.
Mantle cell lymphoma is an aggressive
type of lymphoma that represent about
7% of NHL cases. It is a difficult type of
lymphoma to treat and often does not
respond to chemotherapy. It is found in
lymph nodes, the spleen, bone marrow,
and gastrointestinal system. Mantle cell
lymphoma usually develops in men over
age 60.

21. Small
Lymphocytic
Lymphoma (SLL).
SLL is an indolent
type of lymphoma
that is closely
related to B-cell
chronic
lymphocytic
leukemia (CLL). It
accounts for about
5% of NHL cases.

22.  Marginal Zone
Lymphomas (MZL).
MZLs are categorized
depending on where the
lymphoma is located.
Mucosa-associated
lymphoid tissue
lymphomas (MALT)
usually involve the
gastrointestinal tract,
thyroid, lungs, saliva
glands, or skin. MALT is
often associated with a
history of an
autoimmune disorder
(such as Sjogren
syndrome in the salivary
glands or Hashimoto's
thyroiditis in the thyroid
gland).

23.  Lymphoplasmacytic
Lymphoma.
Lymphoplasmacytic
lymphoma, also called
Waldenstrom's
macroglobulinemia or
immunocytoma, is a rare
type of lymphoma
accounting for about 1%
of NHL cases. It usually
affects older adults and
most often involves bone
marrow, lymph nodes,
and spleen.

24.  Primary Central Nervous System Lymphoma.
This lymphoma involves the brain and spinal cord.
Although it is generally rare, it is common in
people who have AIDS.

25.  Burkitt's Lymphoma.
This is one of the most
common types of
childhood NHL,
accounting for about
40% of NHL pediatric
cases in the United
States. It usually starts
in the abdomen and
spreads to other organs,
including the brain. In
African children, it
often involves facial
bones and is associated
with Epstein-Barr
infection.

26.  Lymphoblastic Lymphoma.
This lymphoma is also
common in children,
accounting for about 25%
of NHL pediatric cases,
most often boys. It is
associated with a large
mediastinal mass
(occurring in chest cavity
between the lungs) and
carries a high risk for
spreading to bone marrow,
the brain, and other lymph
nodes.

27. PATHOGENESIS

28. Malignant transformation of
either the T or B cells
Differentiation in the peripheral
lymphoid tissues
Predisposing
•Gender
•Race
•Family History
•Infections
•Immune System Deficiency
Disorders
•Autoimmune Disorders
•Chemical Exposure
•Radiation Exposure
•Lifestyle Factors
Precipitating
•Unknown
(idiopathic)

29. T lumphocytes proliferate on antigenic
stimulation and migrate into follicles,
where they intact in B lymphocytes
These activated follicles becme
germinal centers, containing
macrophages, follicular dendrite
cells and maturing T and B cells
Develops in any
lymphoid tissues (lymph
nodes

30. Spreads to various lymphoid
tissues throughout the body,
especially the liver, spleen and
bone marrow
Non-hodgkin’s
lymphoma
Group of tumors will
develop

31. Most common:
•painless
enlargement of one
or more lymph
node, usually in the
neck, armpits, or
groin. (painless,
superficial
lymphadenopathy)
•Usually
asymptomatic
Systemic B Sx:
•Drenching night
sweats
•Unexplained
weight loss
•Fever
•Severe itching

34. PREVENTION
and
Management

35. •Resting your stomach and being alert for signs of
dehydration
•Gentle exercise along with adequate intake of fluids
and a diet that is high in fruits, vegetables, and fiber.
•Get extra rest while you are receiving chemotherapy
or radiation therapy.
•Change your diet, rinsing your mouth with liquid
medicines, and putting a baking soda paste or
nonprescription medicine on mouth sores.
•If you find you have trouble sleeping, having a
regular bedtime, getting some exercise during the
day, avoiding naps, and using other tips to relieve
sleep problems may help you sleep more easily.

36.  You may be able to reduce your stress by expressing
your feelings to others. Learning relaxation
techniques may also help you reduce your stress.
 Adapting to your body image changes may involve
talking openly about your concerns with your partner
and discussing your feelings with your doctor. Your
doctor may also be able to refer you to organizations
that can offer additional support and information.
 To prevent weight loss and conserve your strength, it
is important to eat well during treatment for cancer.
 If pain occurs, many treatments are available to
relieve it. If your doctor has given you instructions or
medicines to treat pain, be sure to follow them. You
may use home treatment for pain to improve your
physical and mental well-being. Be sure to discuss
any home treatment you use for pain with your
doctor.

37. T
R
E
A
T
M
E
N
T

38. •Radiation therapy
-uses high doses of X-
rays, gamma rays, or
other types of ionizing
(damaging) radiation
to kill cancer cells. It
may be applied to the
whole body or to a
specific zone.

39. •Chemotherapy is the
use of cytotoxic (cell
damaging) medicines
to target and kill
tumors. The drugs
work by interrupting
the DNA of fast-
growing cells,
preventing them from
growing or
reproducing.

40. •Immunotherapy uses
the body’s own
immune system to
attack and remove
cancer cells. Doctors
inject a patient with a
special type of
antibody, or cell
marker, that binds to
antigens on a cell’s
surface.

41. •Bone marrow
transplantation
•For patients with very
advanced disease,
extremely high does of
chemotherapy may be
needed. This type of
chemotherapy wipes out
the body’s entire immune
system, including the bone
marrow that produces blood
cells. So, patients need a
bone marrow transplant in
order to recover.

42.  History and Overview
 Statistics
 What it effects (biology)
 Classification and Staging
 Symptoms
 Causes and Risk Factors
 Diagnosis and Treatment

43.  Lymphomas are a cancer of
the lymphatic system
Lymphatic vessels
Lymph nodes
(underarms, groin,
neck, spleen, tonsils
and bone marrow)

44.  The Lymphatic system is our bodies main fight against
infection
 Lymphocytes (B-cell and T-cell)
 Carried through our lymphatic system and help our bodies
fight infection
 Lymphocytes are carried through the lymph vessels as well
as the blood stream, so cancer can start in nodes and
spread anywhere throughout the body.

45. •American Medical
Association

46.  54,370 new cases
 19,410 deaths
In California Alone there are est. 5,550 new cases
and a Death rate of 1,730 (California has the
highest incidence and Death rate for Non-Hodgkin’s
Lymphoma
Non-Hodgkin’s Lymphoma is the 6th
and 7th
most
deadly cancers for men and women
Recent studies have shown that overweight patients
are more likely to die then those patients who are in
better shape.

47.  Usually classified by how the cells look under a
microscope and how quickly they grow and spread
 Aggressive lymphomas (high-grade lymphomas)
 Indolent Lymphomas (low-grade lymphomas)

48.  Stage is the term used to describe the extent of
tumor that has spread through the body( I and
II are localized where as III and IV are
advanced.
 Each stage is then divided into categories A, B,
and E
A: No systemic symptoms
B: Systemic Symptoms such as fever, night sweats
and weight loss
E: Spreading of disease from lymph node to another
organ

50.  Two main types of Non-Hodgkin’s Lymphoma:
B-Cell and T-Cell Lymphomas
B-Cell lymphomas (80%)
T-Cell lymphomas (15%)

51.  B-Cells help make antibodies, which are
proteins that attach to and help destroy
antigens
 Lymphomas are caused when a mutation
arises during the B-cell life cycle
 Various different lymphomas can occur during
several different stages of the cycle
Follicular lymphoma, which is a type of B-cell
lymphoma is caused by a gene translocation which
results in an over expressed gene called BCL-2,
which blocks apoptosis.

53.  The T-cells are born from stem cells, similar to that of
B-cells, but mature in the thymus.
 They help the immune system work in a coordinated
fashion.
 These types of lymphomas are categorized by how the cell is
affected
 Anaplastic Large cell Lymphoma, t-cell lymphoma caused by a
gene translocation in chromosome 5

54.  Painful Swelling of lymph nodes located in the neck,
underarm and groin.
 Unexplained Fever
 Night Sweats
 Constant Fatigue
 Unexplained Weight loss
 Itchy Skin

55.  The Exact causes are still unknown
 Higher risk for individuals who:
 Exposed to chemicals such as pesticides or solvents
 Infected w/ Epstein-Barr Virus
 Family history of NHL (although no hereditary pattern has been
established)
 Infected w/ Human Immunodeficiency Virus (HIV)

56.  X-Rays
 CT scans
 Magnetic Resonance Imaging (MRI)
 Biopsy
 Lymphangiogram
 Pictures of the lymphatic system taken w/ x-ray after a
special dye is injected to illuminate lymph nodes and
vessels

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

58.  Chemotherapy
 Radiation
 Bone Marrow Transplantation
 Surgery
 Bortezomib (Velcade)
 Immunotherapy
 Using the bodies own immune system combined with material
made in a lab.

59.  Survival Rates vary widely by cell type and staging.
 1 Year Survival Rate: 77%
 5 Year Survival Rate: 56%
 10 Year Survival Rate: 42%