Non-hodgkin's%20lymphoma Signs and Symptoms

Signs and Symptoms

Introduction

The most common hematologic cancer
B-cell non-Hodgkin's lymphoma (NHL) are 80-85% more common than T-cell/natural killer (NK) cell NHLs (15-20%)
Advances in molecular genetics allowed better understanding of the pathophysiology and further identification of the different subtypes of NHL
NHL subtypes are based on the malignant cell's morphology; genetic features, immunohistological characteristics and stage of maturation

Definition

A heterogenous group of lymphoproliferative malignancies formed by either B-cells or T-cell/NK cells

Etiology

Causes of Non-Hodgkin's Lymphoma (NHL)

Genetic aberrations and lesions
- p53 tumor suppressor gene deletions/alterations [eg Burkitt lymphoma (BL), follicular lymphoma (FL), mantle cell lymphoma (MCL)]
- Chromosomal deletions (eg chromosome 6q, chromosome 13q14)
- Chromosomal translocations (eg FL - t[14;18][q32;q21], MCL - t[11;14][q13;q32])

Oncogenic viruses (eg Epstein-Barr virus, Human T-cell lymphotropic virus I, Human Herpes virus-8)

Signs and Symptoms

Clinical Evaluation

Assess patient’s performance status based on the clinical presentation
Systemic B-cell symptoms
- Present in aggressive types of NHLs
- Fever
- Night sweats
- Weight loss

Indolent types of NHL
- Splenomegaly
- Hepatomegaly
- Lymphadenopathy
- Cytopenia

Nonspecific signs and symptoms
- Skin rash
- Generalized fatigue
- Fever of unknown origin
- Pleural effusion
- Pruritus
- Malaise
- Ascites

Lymphoma with gastrointestinal tract involvement
- Anorexia
- Weight loss
- Bloatedness
- Pallor
- Nausea/vomiting
- Abdominal pain
- Early satiety
- Intestinal bleeding

Lymphoma with central nervous system involvement
- Headache
- Blurred vision
- Paralysis
- Dizziness
- Seizures
- Focal neurologic symptoms

Adult T-cell leukemia/lymphoma
- Lymphadenopathy
- Fatigue
- Anorexia
- Splenomegaly
- CNS involvement
- Pulmonary complications
- Skin eruptions
- Abdominal pain
- Hepatomegaly
- Bone marrow involvement

Burkitt lymphoma
- Bone marrow (70%) involvement
- Leptomeningeal CNS involvement (40%)

Extranodal NK/T-cell lymphomas (ENKL), nasal type
- Nasal obstruction
- Nasal bleeding secondary to mass lesion
- Elevated lactate dehydrogenase (LDH) levels

Risk Factors

Acquired immunosuppression (previous organ/bone marrow/stem cell transplant, HIV, AIDS)
Congenital immunodeficiency syndromes
Old age
Positive family history of NHL
Positive medical history of Hodgkin lymphoma
Chemical exposures [pesticides, wood dust, epoxy glue, organic solvents, medication (eg Methotrexate, TNF-α inhibitors)]
Radiation exposure

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