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LYMPHOMAS - LYMPHOMAS Malignant lymphomas are cancers of...

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LYMPHOMAS Malignant lymphomas are cancers of the lymphoid system and include distinct entities defined by clinical, histologic, immunologic, molecular, and genetic characteristics. Based on histologic characteristics, lymphomas are divided into two major subgroups: Hodgkin’s disease and non-Hodgkin’s lymphoma. HODGKIN’S DISEASE The etiology of Hodgkin’s disease is unclear, but indirect evidence indicates a viral cause. Signs and symptoms of Hodgkin’s disease are distinctive—patients present with a slow, insidious, superficial lymphadenopathy with lymph (cervical, supraclavicular, mediastinal) nodes that are firm, rubbery, and freely movable. The disease spreads in a generally predictable manner to contiguous lymph nodes via lymphatic channels. Because of many histologic subtypes and ongoing biological, pathological, and clinical studies, classifying lymphomas is controversial. In 1999, the World Health Organization suggested a change in the subtyping of Hodgkin’s disease that would assist physicians in selecting treatment protocols. Treatment for Hodgkin’s disease may include radiation, a combination of radiation and chemotherapy, or chemotherapy alone. The cure rate for newly diagnosed cases is higher than 90%, making Hodgkin’s disease one of the most treatable forms of cancer. Bone marrow transplant or peripheral progenitor (stem) cell transplants with high-dose chemotherapy are recommended for patients who have relapsed/failed primary chemotherapy regimen. NON-HODGKIN’S LYMPHOMA Non-Hodgkin’s lymphoma is a malignancy of the B lymphocyte and T lymphocyte cell systems. Abnormal lymphocytes accumulate and form masses in lymph tissue such as the lymph nodes, spleen, or other organs. Malignant lymphocytes travel through the circulation to distant sites. Common extranodal sites include the lungs, liver, gastrointestinal tract, meninges, skin, and bones. Most patients with non-Hodgkin’s lymphoma fall into two broad categories related to their clinical features: the nodular indolent type, and the diffuse, aggressive lymphomas. Malignant lymphocytes accumulate in lymph nodes. If the normal follicular structure of the nodes remains intact, the lymphoma is called follicular or nodular. When malignant cells destroy the follicles, the lymphoma is considered diffuse. For treatment purposes, they may be separated into two categories: low-grade lymphoma and aggressive lymphoma (which includes intermediate-grade and high-grade lymphomas). Treatment for non-Hodgkin’s lymphomas may includes watching and waiting, radiation, chemotherapy (usually multiple combinations of antineoplastic agents), monoclonal antibodies (rituximab [Rituxan]), peripheral progenitor (stem) cell transplant or bone marrow transplant. With or without treatment, low-grade lymphomas can transform into a more aggressive lymphoma, or the tumor replaces the hematopoietic and lymphoid tissue, which leads to multiple systemic dysfunction and death. Intermediate- and high- grade lymphomas tend to be more responsive to treatment.
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