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
- Usually present in aggressive types of NHLs
- Fever
- Night sweats
- Weight loss

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

Nonspecific signs and symptoms
- Skin rash
- Generalized fatigue
- Fever
- 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, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (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

New treatment option now available for patients with HR+/HER2- aBC/MBC, PIK3CA mutations

31 Mar 2021

At the recent webinar entitled Pik Me Up: Mutation Matters, Consultant Medical Oncologist Dr Senthil Rajappa discussed the role of PI3Kα-specific inhibitor alpelisib (TREZILENT^®, Novartis) in managing patients with HR+/HER2- aBC/MBC and PIK3CA mutations while Senior Consultant Pathologist Professor Dr Pathmanathan Rajadurai explained the process of detecting PIK3CA mutations in patients.

The changing treatment landscape for premenopausal women with advanced breast cancer: Focus on ribociclib

Dr. Wong Seng Weng, Dr. Lee Guek Eng, 19 Mar 2021

In Singapore, advanced breast cancer (aBC) is the leading cause of cancer death in women 30–49 years of age. For premenopausal women diagnosed with hormone receptor (HR)-positive, HER2-negative BC, cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors provide new hope. Currently, ribociclib is the only CDK4/6 inhibitor studied in the first-line setting for premenopausal women with HR+/HER2- aBC, in the phase III MONALEESA-7 trial. Two experts, Dr Wong Seng Weng, Medical Director & Consultant Medical Oncologist at The Cancer Centre, Paragon Medical & Mount Elizabeth Novena Specialist Centre, and Dr Lee Guek Eng, Senior Consultant & Specialist in Medical Oncology at Icon Cancer Centre and Program Director of the Young Women Cancer Program, weigh in with their views on managing premenopausal women with aBC.

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Dr Raghav Sundar, 09 Sep 2019

Overall survival (OS) is currently the primary criteria in assessing the efficacy of a cancer treatment. Dr Raghav Sundar, a consultant medical oncologist at the National University Hospital, Singapore, details the crucial role played by tumour response in evaluating treatment efficacy, with a focus on the multiple kinase inhibitor lenvatinib in the treatment of hepatocellular carcinoma (HCC).