2. Epidemiology Etiology Of Lymphoma Dr.Azarm

3. Epidemiology In the United States, approximately 55,000 new cases of non-Hodgkin ’ s lymphoma are diagnosed annually, and about 25,000 people die of the disease each year.

4. The incidence of non-Hodgkin's lymphoma (NHL) has doubled over the past two decades in the US and most other westernized countries Epidemiology Dr.Azarm

5. The annual incidence of non-Hodgkin lymphoma has nearly doubled over the last 55 years Dr.Azarm

6. Up to 35 to 65 percent of Poorly - differentiated neoplasms of unknown primary site may represent cases of NHL Dr.Azarm

9. Skin Stomach Lymphoma Lung Bladder Blood Colon Esophagus Rectum Prostat Cancer in Men

10. Cancer in Women skin Breast Stomach Lymphoma Blood Colon rectom Esophagus Lung Other

11. Etiology For most cases of non-Hodgkin’s lymphoma, the etiology is unknown, although genetic, environmental, and infectious agents have been implicated (Table 195–1). Familial clusters have been described, and there may be a slightly higher risk of non-Hodgkin’s lymphoma among siblings or first-degree relatives of patients with lymphoma or other hematologic malignancies. The etiology is unknown - Genetic, - Environmental, - Infectious agents have been implicated. - Familial clusters have been described, and there may be a slightly higher risk of non- Hodgkin’s lymphoma among siblings or first-degree relatives of patients with lymphoma or other hematologic malignancies. :Etiology Dr.Azarm

12. Ultraviolet (UV) irradiation may cause immunosuppression However, studies that have especially evaluated the possible role of UV light in NHL have shown an increased risk for outdoor occupations or exposure to sunlight Etiology:

13. Epstein-Barr virus: It has been associated with Burkitt lymphoma. EBV is persistent in over 95% of adults in nasopharyngeal epithelium and B cells Normally, EBV production is held back by active cellular and humoral immune mechanisms. In immunodeficiency states, this balance may be disrupted, and EBV-infected B cells begin to proliferate.

14. Specific illnesses which are risk factors for the development of gastrointestinal lymphoma include Crohn's disease Gastrointestinal nodular lymphoid hyperplasia Helicobacter pylori-associated chronic gastritis Celiac diseas

15. Ethiologic factors in NHL _ TCR _ Congenital Immunodeficiency s. _ Aquaired. I. d. _ Auto-immune disorders _ Viral cofactors: Epstein Barr Virus HIV HTLV-1 Herpes Virus Helicobacter Pylori _ Organ Transplantation

16. blood transfusion immunosuppression, and transmission of viruses have been discussed Increased incidence of NHL. It has been reported among patients with: : congenital immune deficiency. - Autoimmune Rheumatoid arthritis.- - Sjögren's syndrome.. - Systemic lupus erythematosus Therapy. - immunosuppressive Chemotherapy and radiotherapy regimens in patients with Hodgkin's disease. Dr.Azarm

17. The insecticide chlordane, significantly higher concentrations were found in NHL cases than in controls in the same study the sum of chlordanes in the 27 NHL patients was 180 ng/g lipid compared to 92.8 in the 17 surgical controls

19. Etiology: : Infections: -Infection with HIV Infection with human T-lymphocytic virus type 1 (HTLV-1) -Infection with Epstein-Barr virus (EBV), one of the etiologic factors in Infectous mononucleosis. -A bacterium that lives in the digestive Helicobacter pylori Helicobacter pylori -Autoimmune disease -Diseases requiring immune suppressive therapy, often used following organ transplant. -Inherited immunodeficiency diseases (severe combined immunodeficiency, ataxia telangiectasia, -

20. MALIGNANCY due to EBV Burkitt's lymphoma (NHL) Hodgkin's disease Nasopharyngeal carcinoma T cell lymphoma Nasal/nasal type angiocentric lymphoma

22. Oncogenic viruses : The infection of cells by oncogenic viruses must be considered to be a genetic lesion, since viruses introduce foreign genes into their target cells. Three distinct viruses are associated with the pathogenesis of specific NHL subtypes. -Epstein-Barr virus (EBV) -Human T-cell lymphotropic virusI (HTLV-I) -Human Herpes virus-8 (HHV-8) -Simian virus 40

23. Simian virus 40 Simian virus-40 (SV-40) is a polyoma virus with oncogenic potential in humans and animals. Its actions are thought to result from inactivation of tumor suppressors p53

24. AIDS-related lymphomas: (AIDS-NHL) are invariably derived from B-cells and are classified into 3 main groups: 1- AIDS-related BL (AIDS-BL). 2- AIDS-related DLBCL (AIDS-DLBCL). 3- AIDS-related body-cavity-based lymphomas (AIDS-BCL) represent a rare additional type of AIDS-NHL.

25. Ultraviolet radiation, previously demonstrated to have an immunosuppressive effect, has also been suggested as a possible risk factor for NHL

26. Factors thought to increase risk of lymphoma include: Chemical exposures -dioxins, PCBs, pesticides, solvents, and fertilizer Chronic infections -H pylori is strongly Depressed immunity - such as caused by immune-suppressing drugs used to prevent rejection of organ transplants

27. People infected with the hepatitis C virus (HCV) are at an increased risk of developing certain lymphomas

28. Factors Associated with the development of Non-Hodgkin’s Lymphoma 1- Immune abnormalities: Inherited disorders Common variable immunodefeciency, Wiskott-Aldrich syndrome Ataxia-telangictasia, X-linked lymphoprolifrative disorder Acquired disorders: Solid organ transplant recipients Acquired immunodeficiency syndrome Methotrexate therapy for autoimmune disorders Rheumatoid arthritis, Sjogren’s syndrome, Hashimoto’s thyroiditis 2- Infectious agents: Epestein – Barr Virus Human T-cell lymphotropic virus type !, Human herpes virus 8 Hepatitis C Virus, Helicobacter pylori 3- Occupational and environmental exposure: Herbicides, Organic Solvents, Hair dyes, Ultraviolet light