Non-hodgkin's%20lymphoma 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, follicular lymphoma, mantle cell lymphoma)
- Chromosomal deletions (eg chromosome 6q, chromosome 13q14)
- Chromosomal translocations (eg follicular lymphoma - 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