| Lymphoma |
| Classification and external resources |
|
Follicular lymphoma replacing a lymph node
|
| ICD-10 |
C81-C96 |
| ICD-9 |
202.8 |
| ICD-O: |
9590–9999 |
| MedlinePlus |
000580 000581 |
| MeSH |
D008223 |
Lymphoma is a group of blood cell tumors that develop from lymphocytes.[1] It is sometimes used to refer to just the cancerous ones rather than all tumors.[1] Symptoms may include: enlarged lymph nodes that are not generally painful, fevers, sweats, itchiness, weight loss and feeling tired among others.[2][3] The sweats are most common at night.[2][3]
There are two main types: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL),[4] with two others, multiple myeloma and immunoproliferative diseases, also included by the World Health Organization within the category.[5] Non-Hodgkin lymphoma makes up about 90% of cases and includes a large number of sub-types.[4][6] Lymphomas are part of the broader group of neoplasms called tumors of the hematopoietic and lymphoid tissues.[7]
Risk factors for HL include: infection with Epstein–Barr virus and having other in the family with the disease.[2] Risk factors for NHL include: autoimmune diseases, HIV/AIDS, infection with human T-lymphotropic virus, eating a large amount of meat and fat, as well as immunosuppressant medications and some pesticides.[3] They are usually diagnosed by blood, urine, or bone marrow testing.[3] A biopsy of a lymph node may also be useful.[2][3] Medical imaging then may be done to determine if and where the cancer has spread.[2][3] This spread can occur to many other organs including: lungs, liver, and brain.[2][3]
Treatment may involve some combination of chemotherapy, radiation therapy, targeted therapy and surgery.[2][3] In NHL the blood may become so thick with protein that a procedure called plasmapheresis is needed.[3] Watchful waiting may be appropriate for certain types.[3] Some types are curable.[4] The overall five-year survival rate in the United States for HL is 85%[8] while that for NHL is 69%.[9] Worldwide, lymphomas developed in 566,000 people in 2012 and caused 305,000 deaths.[5] They make up 3–4% of all cancers, making them as a group the 7th most common form.[5][10] In children they are the third most common cancer.[11] They occur more often in the developed world than the developing world.[5]
Contents
- 1 Signs and symptoms
- 2 Diagnosis
- 2.1 Hodgkin lymphoma
- 2.2 Non-Hodgkin lymphoma
- 2.3 WHO classification
- 2.4 Working formulation
- 2.5 Other
- 2.6 Subtypes
- 3 Staging
- 4 Treatment
- 4.1 Low-grade lymphomas
- 4.2 High-grade lymphomas
- 4.3 Palliative care
- 5 Prognosis
- 6 Epidemiology
- 7 History
- 8 Research directions
- 9 Other animals
- 10 References
- 11 External links
Signs and symptoms
Lymphoma and lymphatic system
Lymphoma presents with certain non-specific symptoms. If symptoms are persistent, lymphoma needs to be excluded medically.
- Lymphadenopathy[12][13] or swelling of lymph nodes – It is the primary presentation in lymphoma.
- B symptoms (systemic symptoms) – Can be associated with both Hodgkin's lymphoma and non-Hodgkin's lymphoma. They consist of:
- Fever[12][13]
- Night sweats[12][13]
- Weight loss[12][13]
- Other Symptoms :
- Loss of appetite or anorexia[13]
- Fatigue[12][13]
- Respiratory distress or dyspnea[13]
- Itching[12][13]
Diagnosis
Lymph node with mantle cell lymphoma (low power view, H&E)
Lymphoma is definitively diagnosed by a lymph node biopsy, meaning a partial or total excision of a lymph node that is then examined under the microscope.[14] This examination reveals histopathological features that may indicate lymphoma. After lymphoma is diagnosed, a variety of tests may be carried out to look for specific features characteristic of different types of lymphoma. These include:
- Immunophenotyping
- Flow cytometry
- FISH testing.
Several classification systems have existed for lymphoma. These systems use histological findings and other findings to divide lymphoma into different categories. The classification of lymphoma can affect treatment and prognosis. Classification systems generally classify lymphoma according to:
- Whether or not it is a Hodgkin lymphoma.
- Whether the cell that is replicating is a T cell or B cell.
- The site that the cell arises from.
Hodgkin lymphoma
Main article: Hodgkin lymphoma
Hodgkin lymphoma is one of the most commonly known types of lymphoma,[citation needed] and differs from other forms of lymphoma in its prognosis and several pathological characteristics. A division into Hodgkin and non-Hodgkin lymphomas is used in several formal classification systems. A Hodgkin lymphoma is marked by the presence of a type of cell called the Reed–Sternberg cell.[15][16]
Non-Hodgkin lymphoma
Non-Hodgkin lymphoma is more common than Hodgkin lymphoma. The incidence of non-Hodgkin lymphoma increases with age.
WHO classification
The current accepted definition is the WHO classification, published in 2001 and updated in 2008,[17][18] is the latest classification of lymphoma and is based upon the foundations laid within the "Revised European-American Lymphoma classification" (REAL). This system attempts to group lymphomas by cell type (i.e. the normal cell type that most resembles the tumor) and defining phenotypic, molecular or cytogenetic characteristics. There are three large groups: the B cell, T cell, and natural killer cell tumors. Other less common groups, are also recognized. Hodgkin lymphoma, although considered separately within the World Health Organization (and preceding) classifications, is now recognized as being a tumor of, albeit markedly abnormal, lymphocytes of mature B cell lineage.
Subtypes
Mature B-cell neoplasms
DNA-microarray analysis of Burkitt's lymphoma and diffuse large B-cell lymphoma (DLBCL) showing differences in gene expression patterns. Colors indicate levels of expression; green indicates genes that are underexpressed in lymphoma cells (as compared to normal cells), whereas red indicates genes that are overexpressed in lymphoma cells.
- Chronic lymphocytic leukemia/Small lymphocytic lymphoma
- B-cell prolymphocytic leukemia
- Lymphoplasmacytic lymphoma (such as Waldenström macroglobulinemia)
- Splenic marginal zone lymphoma
- Plasma cell neoplasms:
- Plasma cell myeloma (also known as multiple myeloma)
- Plasmacytoma
- Monoclonal immunoglobulin deposition diseases
- Heavy chain diseases
- Extranodal marginal zone B cell lymphoma, also called MALT lymphoma
- Nodal marginal zone B cell lymphoma (NMZL)
- Follicular lymphoma
- Mantle cell lymphoma
- Diffuse large B cell lymphoma
- Mediastinal (thymic) large B cell lymphoma
- Intravascular large B cell lymphoma
- Primary effusion lymphoma
- Burkitt lymphoma/leukemia
Mature T cell and natural killer (NK) cell neoplasms
- T cell prolymphocytic leukemia
- T cell large granular lymphocytic leukemia
- Aggressive NK cell leukemia
- Adult T cell leukemia/lymphoma
- Extranodal NK/T cell lymphoma, nasal type
- Enteropathy-type T cell lymphoma
- Hepatosplenic T cell lymphoma
- Blastic NK cell lymphoma
- Mycosis fungoides / Sezary syndrome
- Primary cutaneous CD30-positive T cell lymphoproliferative disorders
- Primary cutaneous anaplastic large cell lymphoma
- Lymphomatoid papulosis
- Angioimmunoblastic T cell lymphoma
- Peripheral T cell lymphoma, unspecified
- Anaplastic large cell lymphoma
Hodgkin Lymphoma
- Classical Hodgkin lymphomas:
- Nodular sclerosis
- Mixed cellularity
- Lymphocyte-rich
- Lymphocyte depleted or not depleted
- Nodular lymphocyte-predominant Hodgkin lymphoma
Immunodeficiency-associated lymphoproliferative disorders
- Associated with a primary immune disorder
- Associated with the Human Immunodeficiency Virus (HIV)
- Post-transplant
- Associated with methotrexate therapy
- Primary central nervous system lymphoma occurs most often in immuno-compromised patients, in particular those with AIDS, but it can occur in the immunocompetent as well. It has a poor prognosis, particularly in those with AIDS. Treatment can consist of corticosteroids, radiotherapy, and chemotherapy, often with methotrexate.
Working formulation
Main article: Working formulation
First proposed in 1982, the Working formulation was a classification of non-Hodgkin lymphoma. It excluded the Hodgkin lymphomas and divided the remaining lymphomas into four grades (Low, Intermediate, High, and Miscellaneous) related to prognosis, with some further subdivisions based on the size and shape of affected cells. This purely histological classification included no information about cell surface markers, or genetics, and it made no distinction between T-cell lymphomas or B-cell lymphomas. It was widely accepted at the time of its publication but is now obsolete.[19] It is still used by some cancer agencies for compilation of lymphoma statistics and historical rate comparisons.[citation needed]
Other
- REAL. In the mid 1990s, the Revised European-American Lymphoma (REAL) Classification attempted to apply immunophenotypic and genetic features in identifying distinct clinicopathologic entities among all the lymphomas except Hodgkin's lymphoma.[20]
- ICD-O (codes 9590–9999, details at Archived June 27, 2004 at the Wayback Machine)
- ICD-10 (codes C81-C96, details at who.int)
Subtypes
There are many forms of lymphoma. Some forms of lymphoma are categorized as indolent (e.g. small lymphocytic lymphoma), compatible with a long life even without treatment, whereas other forms are aggressive (e.g. Burkitt's lymphoma), causing rapid deterioration and death. However, most of the aggressive lymphomas respond well to treatment and are curable. The prognosis therefore depends on the correct diagnosis and classification of the disease, which is established after examination of a biopsy by a pathologist (usually a hematopathologist).[21]
Lymphoma subtypes.[22]
| Lymphoma type |
Relative incidence[22] |
Histopathology[22] |
Immunophenotype |
Overall
5-year
survival |
Other comments[22] |
| Precursor T-cell leukemia/lymphoma |
40% of lymphomas in childhood. |
Lymphoblasts with irregular nuclear contours, condensed chromatin, small nucleoli and scant cytoplasm without granules. |
TdT, CD2, CD7 |
|
It often presents as a mediastinal mass because of involvement of the thymus. It is highly associated with NOTCH1 mutations. Most common in adolescent males. |
| Follicular lymphoma |
40% of lymphomas in adults |
Small "cleaved" cells (centrocytes) mixed with large activated cells (centroblasts). Usually nodular ("follicular") growth pattern |
CD10, surface Ig |
72–77%[23] |
Occurs in older adults. Usually involves lymph nodes, bone marrow and spleen. Associated with t(14;18) translocation overexpressing Bcl-2. Indolent |
| Diffuse large B cell lymphoma |
40 to 50% of lymphomas in adults |
Variable. Most resemble B cells of large germinal centers. Diffuse growth pattern. |
Variable expression of CD10 and surface Ig |
60%[24] |
Occurs in all ages, but most commonly in older adults. Often occurs outside lymph nodes. Aggressive. |
| Mantle cell lymphoma |
3 to 4% of lymphomas in adults |
Lymphocytes of small to intermediate size growing in diffuse pattern |
CD5 |
50%[25] to 70%[25] |
Occurs mainly in adult males. Usually involves lymph nodes, bone marrow, spleen and GI tract. Associated with t(11;14) translocation overexpressing cyclin D1. Moderately aggressive. |
| B-cell chronic lymphocytic leukemia/lymphoma |
3 to 4% of lymphomas in adults |
Small resting lymphocytes mixed with variable number of large activated cells. Lymph nodes are diffusely effaced |
CD5, surface immunoglobulin |
50%.[26] |
Occurs in older adults. Usually involves lymph nodes, bone marrow and spleen. Most patients have peripheral blood involvement. Indolent. |
| MALT lymphoma |
~5% of lymphomas in adults |
Variable cell size and differentiation. 40% show plasma cell differentiation. Homing of B cells to epithelium creates lymphoepithelial lesions. |
CD5, CD10, surface Ig |
|
Frequently occurs outside lymph nodes. Very indolent. May be cured by local excision. |
| Burkitt's lymphoma |
< 1% of lymphomas in the United States |
Round lymphoid cells of intermediate size with several nucleoli. Starry-sky appearance by diffuse spread with interspersed apoptosis. |
CD10, surface Ig |
50%[27] |
Endemic in Africa, sporadic elsewhere. More common in immunocompromised and in children. Often visceral involvement. Highly aggressive. |
| Mycosis fungoides |
Most common cutaneous lymphoid malignancy |
Usually small lymphoid cells with convoluted nuclei that often infiltrate the epidermis, creating Pautrier microabscesseses. |
CD4 |
75%[28] |
Localized or more generalized skin symptoms. Generally indolent. In a more aggressive variant, Sézary's disease, there is skin erythema and peripheral blood involvement. |
| Peripheral T-cell lymphoma-Not-Otherwise-Specified |
Most common T cell lymphoma |
Variable. Usually a mix small to large lymphoid cells with irregular nuclear contours. |
CD3 |
|
Probably consists of several rare tumor types. It is often disseminated and generally aggressive. |
| Nodular sclerosis form of Hodgkin lymphoma |
Most common type of Hodgkin's lymphoma |
Reed-Sternberg cell variants and inflammation. usually broad sclerotic bands that consists of collagen. |
CD15, CD30 |
|
Most common in young adults. It often arises in the mediastinum or cervical lymph nodes. |
| Mixed-cellularity subtype of Hodgkin lymphoma |
Second most common form of Hodgkin's lymphoma |
Many classic Reed-Sternberg cells and inflammation |
CD15, CD30 |
|
Most common in men. More likely to be diagnosed at advanced stages than the nodular sclerosis form. Epstein-Barr virus involved in 70% of cases. |
Staging
Mantle cell lymphoma. Notice the irregular nuclear contours of the medium-sized lymphoma cells and the presence of a pink histiocyte. By immunohistochemistry the lymphoma cells expressed CD20, CD5 and Cyclin D1 (high power view, H&E)
Hodgkin lymphoma, nodular lymphocyte predominant (low power view). Notice the nodular architecture and the areas of "mottling".(H&E)
Hodgkin lymphoma, nodular lymphocyte predominant (high power view). Notice the presence of L&H cells, also known as "popcorn cells". (H&E)
Diagram showing common sites where lymphoma spreads
After a diagnosis and before treatment, a cancer is staged. This refers to deducing how far the cancer has spread, in local tissue and to other sites. Staging is reported as a grade between I (confined) and IV (spread). Staging is carried out because the stage of a cancer impacts its prognosis and treatment.[citation needed]
The Ann Arbor staging system is routinely used for staging of both HL and NHL. In this staging system, I represents a localized disease contained within a lymph node, II the presence of lymphoma in two or more lymph nodes, III spread of the lymphoma to both sides of the diaphragm, and IV to tissue outside a lymph node.[citation needed]
A CT scan or PET scan are imaging modalities used to stage a cancer.[citation needed]
Age and poor performance status is an established poor prognostic factor as well.[29]
Treatment
Prognosis and treatment is different for HL and between all the different forms of NHL,[30] and also depends on the grade of tumour, referring to how quickly a cancer replicates. Paradoxically, high-grade lymphomas are more readily treated and have better prognoses .[citation needed] A well-known example of a high-grade tumour is that of Burkitt's lymphoma, which is a high-grade tumour that has been known to double within days, but is readily treated. Lymphomas may be curable if detected in early stages with modern treatment.
Low-grade lymphomas
Many low-grade lymphomas remain indolent for many years. Treatment of the non-symptomatic patient is often avoided. In these forms of lymphoma, such as follicular lymphoma, watchful waiting is often the initial course of action. This is carried out because the harms and risks of treatment outweigh the benefits.[31] If a low-grade lymphoma is becoming symptomatic, radiotherapy or chemotherapy are the treatments of choice; although they do not cure the lymphoma, they can alleviate the symptoms, particularly painful lymphadenopathy. Patients with these types of lymphoma can live near-normal lifespans, but the disease is incurable. Some centers advocate the use of single agent rituximab in the treatment of follicular lymphoma rather than the wait and watch approach. Watchful waiting is not a good strategy for all patients, as it leads to significant distress and anxiety in some patients. It has been equated with watch and worry.[32]
High-grade lymphomas
Treatment of some other, more aggressive, forms of lymphoma[which?] can result in a cure in the majority of cases, but the prognosis for patients with a poor response to therapy is worse.[33] Treatment for these types of lymphoma typically consists of aggressive chemotherapy, including the CHOP or R-CHOP regimen. A number of people are cured with first line chemotherapy. Most patients relapse within the first two years, and the relapse risk drops significantly thereafter.[34] For people who relapse, high dose chemotherapy followed by autologous stem cell transplantation is a proven approach.[35]
Hodgkin lymphoma
Hodgkin lymphoma typically is treated with radiotherapy alone, as long as it is localized.[36]
Advanced Hodgkin disease requires systemic chemotherapy, sometimes combined with radiotherapy.[37] Chemotherapy used includes the ABVD regimen, which is commonly used in the Unted States. Other regimens used in the management of Hodgkin Lymphoma include BEACOPP and Stanford V. There is considerable controversy regarding the use of ABVD or BEACOPP. Briefly, both regimens are effective, but BEACOPP is associated with more toxicity. Encouragingly, a significant number of people who relapse after ABVD, can still be salvaged by stem cell transplant.[38]
Palliative care
Palliative care, a specialized medical care focused on the symptoms, pain, and stress of a serious illness, is recommended by multiple national cancer treatment guidelines as an accompaniment to curative treatments for people suffering from lymphoma.[39][40] It is used to address both the direct symptoms of lymphoma and many unwanted side-effects that arise from treatments.[41][42] Palliative care can be especially helpful for children who develop lymphoma, helping both children and their families deal with the physical and emotional symptoms of the disease.[41][43][44][45] For these reasons, palliative care is especially important for patients requiring bone marrow transplants.[46][47]
Prognosis
The lymph nodes where lymphoma most commonly develops
| 5-year relative survival by stage at diagnosis[48] |
| Stage at diagnosis |
5-year relative
survival (%) |
Percentage
of cases (%) |
| Localized (confined to primary site) |
82.1 |
27 |
| Regional (spread to regional lymph nodes) |
77.5 |
19 |
| Distant (cancer has metastasized) |
59.9 |
45 |
| Unknown (unstaged) |
67.5 |
9 |
Epidemiology
Age-standardized death from lymphomas and multiple myeloma per 100,000 inhabitants in 2004.[49]
no data
less than 1.8
1.8–3.6
3.6–5.4
5.4–7.2
7.2–9
9–10.8
10.8–12.6
12.6–14.4
14.4–16.2
16.2–18
18–19.8
more than 19.8
Lymphoma is the most common form of hematological malignancy, or "blood cancer", in the developed world.
Taken together, lymphomas represent 5.3% of all cancers (excluding simple basal cell and squamous cell skin cancers) in the United States and 55.6% of all blood cancers.[50]
According to the U.S. National Institutes of Health, lymphomas account for about five percent of all cases of cancer in the United States, and Hodgkin's lymphoma in particular accounts for less than one percent of all cases of cancer in the United States.
Because the whole system is part of the body's immune system, patients with a weakened immune system such as from HIV infection or from certain drugs or medication also have a higher incidence of lymphoma.[51]
History
Thomas Hodgkin published the first description of lymphoma in 1832, specifically of the form named after him, Hodgkin's lymphoma.[52] Since then, many other forms of lymphoma have been described, grouped under several proposed classifications. The 1982 Working formulation became very popular. It introduced the category non-Hodgkin lymphoma, divided into 16 diseases. However, because these lymphomas have little in common with each other, the NHL label is of limited usefulness for doctors or patients and is slowly being abandoned. The latest classification by the WHO (2008) lists 70 forms of lymphoma divided into four broad groups.[17]
As an alternative to the American Lakes-Butler classification, in the early 1970s, Karl Lennert of Kiel, Germany, proposed a new system of classifying lymphomas based on cellular morphology and their relationship to cells of the normal peripheral lymphoid system.[53]
Research directions
Significant research into the causes, prevalence, diagnosis, treatment, and prognosis of lymphoma is being performed. Hundreds of clinical trials are being planned or conducted at any given time.[54] Studies may focus on effective means of treatment, better ways of treating the disease, improving the quality of life for patients, or appropriate care in remission or after cures.
In general, there are two types of lymphoma research: clinical or translational research and basic research. Clinical/translational research focuses on studying the disease in a defined and generally immediately patient-applicable way, such as testing a new drug in patients. By contrast, basic science research studies the disease process at a distance, such as seeing whether a suspected carcinogen can cause healthy cells to turn into lymphoma cells in the laboratory or how the DNA changes inside lymphoma cells as the disease progresses. The results from basic research studies are generally less immediately useful to patients with the disease[55] but can improve scientists' understanding of lymphoma and form the foundation for future, more effective treatments.
Other animals
Main article: Lymphoma in animals
For a discussion of lymphoma in animals other than humans see the above link.
References
- ^ a b Taylor, Elizabeth J. (2000). Dorland's Illustrated medical dictionary. (29th ed.). Philadelphia: Saunders. p. 1038. ISBN 0721662544.
- ^ a b c d e f g "General Information About Adult Hodgkin Lymphoma". National Cancer Institute. 2014-04-23. Retrieved 20 June 2014.
- ^ a b c d e f g h i j "General Information About Adult Non-Hodgkin Lymphoma". National Cancer Institute. 2014-04-25. Retrieved 20 June 2014.
- ^ a b c The Lymphoma Guide Information for Patients and Caregivers. Leukemia and Lymphoma Society. 2013. Retrieved 20 June 2014.
- ^ a b c d World Cancer Report 2014. World Health Organization. 2014. pp. Chapter 5.13. ISBN 9283204298.
- ^ "Lymphoma". NCI. Retrieved 13 June 2014.
- ^ Vardiman, JW; Thiele, J; Arber, DA; Brunning, RD; Borowitz, MJ; Porwit, A; Harris, NL; Le Beau, MM; Hellström-Lindberg, E; Tefferi, A; Bloomfield, CD (Jul 30, 2009). "The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes.". Blood 114 (5): 937–51. doi:10.1182/blood-2009-03-209262. PMID 19357394.
- ^ "Hodgkin Lymphoma—SEER Stat Fact Sheets". Seer.cancer.gov. Retrieved 2012-08-26.
- ^ "SEER Stat Fact Sheets: Non-Hodgkin Lymphoma". NCI. Retrieved 18 June 2014.
- ^ Marcus, Robert (2013). Lymphoma : pathology, diagnosis and treatment (Second ed.). p. 1. ISBN 9781107010598.
- ^ Tepper, John E. Niederhuber, James O. Armitage, James H. Doroshow, Michael B. Kastan, Joel E. (2014). "Childhood lymphoma". Abeloff's clinical oncology (Fifth ed.). p. Chapter 97. ISBN 1455728659.
- ^ a b c d e f "About Lymphoma". Lymphoma Research Foundation. Retrieved 22 December 2012.
- ^ a b c d e f g h "Warning Signs of Lymphoma — First Signs of Lymphoma". Lymphoma.about.com. Retrieved 2012-12-01.
- ^ Mallick, Indranil. "How Is Lymphoma Diagnosed?". lymphoma.about.com. Retrieved 22 December 2012.
- ^ National Cancer Institute, "Hodgkin Lymphoma", http://www.cancer.gov/cancertopics/types/hodgkin, accessed on 2013-08-05
- ^ National Cancer Institute. "What You Need To Know About Hodgkin Lymphoma". U.S. Dept of Health and Human Services, (online at http://www.cancer.gov/cancertopics/wyntk/hodgkin.pdf), pg 4.
- ^ a b Swerdlow, Steven H.; International Agency for Research on Cancer; World Health Organization (2008). WHO classification of tumours of haematopoietic and lymphoid tissues. World Health Organization classification of tumours 2 (4th ed.). International Agency for Research on Cancer. ISBN 9789283224310.
- ^ Jaffe, Elaine Sarkin (2001). Pathology & Genetics: Tumours of Haematopoietic and Lymphoid Tissues. WHO classification of tumours, pathology and genetics series 3. IARC. ISBN 978-92-832-2411-2.
- ^ Clarke CA, Glaser SL, Dorfman and Dorfwoman RF, Bracci PM, Eberle E, Holly EA (January 2004). "Expert review of non-Hodgkin lymphomas in a population-based cancer registry: reliability of diagnosis and subtype classifications". Cancer Epidemiol. Bio-markers Prev. 13 (1): 138–43. doi:10.1158/1055-9965.EPI-03-0250. PMID 14744745.
- ^ Non-Hodgkin Lymphoma at eMedicine
- ^ Wagman LD. (2008). "Principles of Surgical Oncology". In Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ. Cancer Management: A Multidisciplinary Approach (11th ed.). CMPMedica. ISBN 9781891483622.
- ^ a b c d and others (2007). Robbins basic pathology (8th ed.). Philadelphia: Saunders/Elsevier. pp. Table 12–8. ISBN 1-4160-2973-7.
- ^ Lymphoma, Follicular at eMedicine
- ^ Turgeon, Mary Louise (2005). Clinical Hematology: Theory and Procedures 936 (4 ed.). Lippincott Williams & Wilkins. pp. 285–6. ISBN 978-0-7817-5007-3.
- ^ a b
- 50% for limited stage, according to: Leitch HA, Gascoyne RD, Chhanabhai M, Voss NJ, Klasa R, Connors JM; Gascoyne; Chhanabhai; Voss; Klasa; Connors (October 2003). "Limited-stage mantle-cell lymphoma". Ann. Oncol. 14 (10): 1555–61. doi:10.1093/annonc/mdg414. PMID 14504058.
- 70% for advanced stage, according to most recent values in: Herrmann A, Hoster E, Zwingers T et al. (February 2009). "Improvement of overall survival in advanced stage mantle cell lymphoma". J. Clin. Oncol. 27 (4): 511–8. doi:10.1200/JCO.2008.16.8435. PMID 19075279.
- ^ "Chronic Leukemias". The Merck Manual of Geriatrics.
- ^ Diviné M, Casassus P, Koscielny S et al. (December 2005). "Burkitt lymphoma in adults: a prospective study of 72 patients treated with an adapted pediatric LMB protocol". Ann. Oncol. 16 (12): 1928–35. doi:10.1093/annonc/mdi403. PMID 16284057.
- ^ Kirova YM, Piedbois Y, Haddad E et al. (May 1999). "Radiotherapy in the management of mycosis fungoides: indications, results, prognosis. Twenty years experience". Radiother Oncol 51 (2): 147–51. doi:10.1016/S0167-8140(99)00050-X. PMID 10435806.
- ^ International Prognostic Index N Engl J Med. 1993;329(14):987-94
- ^ Sweetenham JW (November 2009). "Treatment of lymphoblastic lymphoma in adults". Oncology (Williston Park, N.Y.) 23 (12): 1015–20. PMID 20017283.
- ^ Elphee EE (May 2008). "Understanding the concept of uncertainty in patients with indolent lymphoma". Oncol Nurs Forum 35 (3): 449–54. doi:10.1188/08.ONF.449-454. PMID 18467294.
- ^ http://www.ncbi.nlm.nih.gov/pubmed/24602759
- ^ Bernstein SH, Burack WR; Burack (2009). "The incidence, natural history, biology, and treatment of transformed lymphomas". Hematology Am Soc Hematol Educ Program 2009: 532–41. doi:10.1182/asheducation-2009.1.532. PMID 20008238.
- ^ Jenkins, EC (Jan 1972). "Wire-loop application of liquid emulsion to slides for autoradiography in light microscopy.". Stain technology 47 (1): 23–6. doi:10.3109/10520297209116530. PMID 4550425.
- ^ Philip, T; Guglielmi, C; Hagenbeek, A; Somers, R; Van der Lelie, H; Bron, D; Sonneveld, P; Gisselbrecht, C; Cahn, JY; Harousseau, JL (Dec 7, 1995). "Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma.". The New England journal of medicine 333 (23): 1540–5. doi:10.1056/nejm199512073332305. PMID 7477169.
- ^ Martin NE, Ng AK; Ng (November 2009). "Good things come in small packages: low-dose radiation as palliation for indolent non-Hodgkin lymphomas". Leuk. Lymphoma 50 (11): 1765–72. doi:10.3109/10428190903186510. PMID 19883306.
- ^ Kuruvilla J (2009). "Standard therapy of advanced Hodgkin lymphoma". Hematology Am Soc Hematol Educ Program 2009: 497–506. doi:10.1182/asheducation-2009.1.497. PMID 20008235.
- ^ http://www.ncbi.nlm.nih.gov/pubmed/21774708
- ^ Ferrell B, Connor SR, Cordes A, Dahlin CM, Fine PG, Hutton N et al. (2007). "The national agenda for quality palliative care: the National Consensus Project and the National Quality Forum". J Pain Symptom Manage 33 (6): 737–44. doi:10.1016/j.jpainsymman.2007.02.024. PMID 17531914.
- ^ *The American Society of Clinical Oncology made this recommendation based on various cancers. See American Society of Clinical Oncology, Five Things Physicians and Patients Should Question, Choosing Wisely: an initiative of the ABIM Foundation (American Society of Clinical Oncology), retrieved August 14, 2012
- ^ a b Higginson IJ, Evans CJ; Evans (2010). "What is the evidence that palliative care teams improve outcomes for cancer patients and their families?". Cancer J 16 (5): 423–35. doi:10.1097/PPO.0b013e3181f684e5. PMID 20890138.
- ^ "Palliative Care: It's for Caregivers Too, Says Study". Retrieved 2014-08-21.
- ^ Heath JA, Clarke NE, Donath SM, McCarthy M, Anderson VA, Wolfe J; Clarke; Donath; McCarthy; Anderson; Wolfe (2010). "Symptoms and suffering at the end of life in children with cancer: an Australian perspective". Med J Aust 192 (2): 71–5. PMID 20078405.
- ^ Schmidt P, Otto M, Hechler T, Metzing S, Wolfe J, Zernikow B; Otto; Hechler; Metzing; Wolfe; Zernikow (2013). "Did increased availability of pediatric palliative care lead to improved palliative care outcomes in children with cancer?". J Palliat Med 16 (9): 1034–9. doi:10.1089/jpm.2013.0014. PMID 23901834.
- ^ Tang ST, Chang WC, Chen JS, Wang HM, Shen WC, Li CY et al. (2013). "Course and predictors of depressive symptoms among family caregivers of terminally ill cancer patients until their death". Psychooncology 22 (6): 1312–8. doi:10.1002/pon.3141. PMID 22836818.
- ^ Chung HM, Lyckholm LJ, Smith TJ; Lyckholm; Smith (2009). "Palliative care in BMT". Bone Marrow Transplant 43 (4): 265–73. doi:10.1038/bmt.2008.436. PMID 19151797.
- ^ "Providing Palliative Care to Family Caregivers Throughout the Bone Marrow Transplantation Trajectory". Retrieved 2014-08-21.
- ^ [1] Data from the USA 1999–2006, All Races, Both Sexes: Altekruse SF, Kosary CL, Krapcho M, Neyman N, Aminou R, Waldron W, Ruhl J, Howlader N, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Cronin K, Chen HS, Feuer EJ, Stinchcomb DG, Edwards BK (eds). SEER Cancer Statistics Review, 1975–2007, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER web site, 2010.
- ^ "WHO Disease and injury country estimates". World Health Organization. 2009. Retrieved Nov 11, 2009.
- ^ Horner MJ, Ries LAG, Krapcho M, Neyman N, et al. (eds). "SEER Cancer Statistics Review, 1975–2006". Surveillance Epidemiology and End Results (SEER). Bethesda, MD: National Cancer Institute. Retrieved 3 November 2009. "Table 1.4: Age-Adjusted SEER Incidence and U.S. Death Rates and 5-Year Relative Survival Rates By Primary Cancer Site, Sex and Time Period"
- ^ Tran, H; Nourse J; Hall S; Green M; Griffiths L; Gandhi MK. (Sep 2008). "Immunodeficiency-associated lymphomas". Blood Reviews 22 (5): 261–281. doi:10.1016/j.blre.2008.03.009. PMID 18456377.
- ^ Hellman, Samuel; Mauch, P.M. Ed. (1999). Hodgkin's Disease. Chapter 1: Lippincott Williams & Wilkins. p. 5. ISBN 0-7817-1502-4.
- ^ Feller, Alfred C.; Diebold, Jacques (2004). Histopathology of Nodal and Extranodal Non-Hodgkin's Lymphomas (3rd ed.). Springer. ISBN 978-3-540-63801-8.
- ^ http://www.clinicaltrials.gov/ct2/results?term=lymphoma
- ^ "Understanding Clinical Trials for Blood Cancers". Leukemia and Lymphoma Society. Retrieved 19 May 2010.
External links
|
Healthcare science – Surgery – General surgery
|
|
| Neck |
|
|
| Esophagus / Stomach |
- Resection
- Esophageal cancer
- Stomach cancer
- Bariatric surgery
- Repair
|
|
| Abdomen (non-GI) |
|
|
Liver / Pancreas /
Gallbladder / Biliary tract |
- Liver transplantation
- Cirrhosis
- Hepatitis
- PBC
- PSC
- Resection
- HCC
- Metastatic liver disease
- Resection
- Whipple procedure (Pancreatic cancer)
- Cholecystectomy
|
|
| Small intestine |
- Resection
- due to bowel infarction and / or small bowel obstruction - Intussusception
- Crohn's disease
- Meckel's diverticulum
- Meconium ileus (due to Cystic fibrosis)
- Small intestine cancer
- Volvulus
- Diversion - Ileostomy
- Loop ileostomy
- Small bowel obstruction
- Perforation / Sepsis
|
|
| Colon |
- Appendectomy
- Resection
- Abdominoperineal resection
- Lower anterior resection
- Colectomy
- Hemicolectomy
- due to obstruction and / or perforation / threatened perforation and / or malignancy
- Toxic megacolon (due to IBD)
- Colorectal cancer
- Hirschsprung's disease
- Inguinal hernia
- Intussusception
- Trauma
- Volvulus
- Adhesions (due to previous surgery)
- Diversion - Colostomy
- Hartmann's operation
- Large bowel obstruction
- Peritonitis
- Diverticulitis
|
|
|
Differential diagnoses of Arthritis in children
|
|
| Inflammatory |
| Idiopathic |
- Juvenile idiopathic arthritis
|
|
| Inflammatory disease |
- Inflammatory bowel disease, Sarcoidosis, Cystic fibrosis, Autoimmune hepatitis
|
|
| Hematological malignancy |
- Acute lymphoblastic leukemia, Lymphoma
|
|
| Malignancy |
|
|
| Reactive |
- post-streptococcal, Rheumatic fever, postenteric, post-viral
|
|
| Infection |
- Septic arthritis, Osteomyelitis, Tuberculosis, Lyme arthritis
|
|
|
| Mechanical |
|
|
| Tumours of cartilage bone or muscle |
| Benign |
- Osteoid osteoma, Pigmented villonodular synovitis, Hemangioma
|
|
| Malignant |
- Synovial sarcoma, Rhabdomyosarcoma, Ewing's sarcoma
|
|
|
| Psychological |
- Idiopathic pain syndromes
- Local
- Complex regional pain syndrome/Reflex sympathetic dystrophy
- Generalized
- Fibromyalgia
|
|
