3 Lymphoma Cancer of the lymphatic system Lymphoma is differentiated by the type of cell that multiplies and how the cancer presents itselfTwo main groups: Hodkgin’s disease and NHLUS prevalence (HD) = 3 cases/100,000 (incidence ↓)US prevalence (NHL)=16 cases/100,000 (incidence↑)
4 Hodgkin vs. Non-Hodgkin Ly. Non-Hodgkin's LymphomasHodgkin's LymphomaAverage age is about 67. Average age is 27.7 with two age peaks, the major one between 15 and 24 with a lesser peak after age 55.AgeMen 2.12% Women 1.79%Men 0.23% Women 0.20%Lifetime prevalenceAbout 85% of all lymphomasAbout 15% of all lymphomasOccurrence
5 Hodgkin vs. Non-Hodgkin Ly. Non-Hodgkin's LymphomasHodgkin's LymphomaLN above the collar bone. In NHL it is also more likely to appear in the mesenteric nodes in the abdomen.The disease occurs in the chest cavity in less than 40% of patients. (An exception, lymphoblastic lymphoma, which is seen most often in young people, is likely to first appear in the chest.) Extra-nodular disease in about 23% of patients. Slow-growing lymphomas are common in the liver and bone marrow.LN above the collar bone. In Hodgkin's it is also more likely to appear in the chest cavity (mediastinum), particularly in younger patients. Only about 15% to 20% of cases are below the diaphragm.Extra-nodular disease in about 4% of cases.Location
6 Hodgkin vs. Non-Hodgkin Ly. Non-Hodgkin's LymphomasHodgkin's LymphomaB-Lymphocytes (>90%), T-Lymphocytes or Natural Killer (NK) CellsB-Lymphocytes characterized by the Reed-Sternberg CellAffected Lymph CellsLess likely than HL to have systemic ("B") symptoms (27%) at the time of diagnosis.More likely (40%) to have systemic ("B") symptoms at the time of diagnosis.SymptomsMore likely than HD to be diagnosed in stage IV (36%) but this will vary by NHL subtype. The Non-Hodgkin's lymphomas are less predictable in their course than Hodgkin's and they are more apt to spreadLess likely to be diagnosed in stage IV (10%).Hodgkin's disease usually progresses slowly (or aggressively) in an orderly way from one lymph node region to the next.If it spreads below the diaphragm, it usually reaches the spleen first; the disease then may spread to the liver and bone marrow. If the disease starts in the nodes in the middle of the chest, it may spread outward to the chest wall and areas around the heart and lungs.Progression
8 H&N LymphomaLymphoma is the second most common primary malignancy occurring in the head and neck, and incidence of aggressive non-Hodgkin lymphoma is rising in young and middle-aged patients.25% of all extra-nodal lymphomas occur in the head and neck, and 8% of supraclavicular fine-needle aspirates are diagnosed as lymphoma.REAL classification (Revised European American Lymphoid neoplasm) : indolent, aggressive and Hodgkin disease
13 Procedures Fiberoscopy- NPH, larynx FNA-C from neck mass Excisional/Incisional BxDiagnostic TE(Bone marrow, LP, liver, explorative laparotomy…)
14 Ann Arbor Lymphoma staging Stage I - Involvement of a single LN region/ lymphoid structureStage II - Involvement of 2 or more LN regions on the same side of the diaphragm or localized contiguous involvement of only one extra-lymphatic site and LN regionStage III - Involvement of LN regions or lymphoid structures on both sides of the diaphragmStage IV - Disseminated involvement of one or more extra- lymphatic organs with or without LN involvement and/or involvement of the bone marrow or liver
15 Chemotherapy – major modality Radiotherapy Surgery ??? Relapse !!! TreatmentChemotherapy – major modalityRadiotherapySurgery ???Relapse !!!
16 Chemotherapy Hodgkin disease – - MOPP (mechlorethamine [nitrogen mustard], vincristine, procarbazine, and prednisolone)[2% post-Rx ALL, infertility]- ABVD (doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine)- For advanced disease : BEACOPP (cyclophosphamide, doxorubicin, etoposide, procarbazine, prednisolone, vincristine, and bleomycin with granulocyte colony-stimulating factor)
17 Chemotherapy Non-Hodgkin Lymphoma: CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone)Purine analogues
18 Other procedures Stem cell transplantation IL-2 Recomninat INF-α Bone marrow transplantation?
19 RadiotherapyMantle field includes the submandibular, cervical, supraclavicular, infraclavicular, axillary, mediastinal, and hilar lymph nodesIt can be extended to cover the Waldeyer ring and the skull base with lateral portals for lymphomas involving the skull baseCombined= Chemo + Radio
20 Surgical treatmentExcision of necrotic tissue may be necessary in nasal NK/T-cell lymphomaMALT lymphomas are often treated surgically with or without local radiotherapyLymphomas of the CNS and skull base are treated with surgical decompression when necessary