Friday, January 28, 2011

Friday" If I Had..." /Video:Non-Hodgkin's lymphoma

Friday If I Had.......
Once a week the blog will post a video in a series deemed "If I Had."
These videos cover numerous disorders and diseases.
Physicians share what they would do "IF they Had..." the disease in the topic video.

Today the topic is:
If I Had Night Sweats And An Enlarged Painless Lymph Node In My Neck -
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Studies have shown that patients with hepatitis C have a 20% to 30% increased risk of developing non-Hodgkin's lymphoma and a 3-fold higher risk of developing Waldenstrom's macroglobulinemia, a low-grade lymphoma.
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Dr. Jonathan W. Friedberg, M.D, University of Rochester Medical Center
At the American Society of Hematology meeting in San Francisco, we spoke with Dr. Jonathan Friedberg, who is Associate Professor and Chief, Department of Medicine at the University of Rochester School of Medicine. Dr. Friedberg is also Associate Professor at the James P. Wilmot Cancer Center.
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How many stages are there in non-Hodgkin's lymphoma?
Every weekday, a CNNHealth expert doctor answers a viewer question.
On Wednesdays, it's Dr. Otis Brawley, chief medical officer at theAmerican Cancer Society.
Question asked by Paula Holman-Yorba of San Bernardino, California

How many stages are there in non-Hodgkin's lymphoma?
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Expert answer
Two weeks ago, Paula asked about staging of non-Hodgkin's lymphoma.
We discussed cancer staging in general.
This week, we discuss lymphoma and its staging and prognosis.
Lymphoma is cancer of the lymphatic system, which is an important part of the immune system. The lymphatic system consists of conduits or tubes throughout the body with filters called lymph nodes along the path. The system carries a clear fluid with immune fighting cells such as lymphocytes.

Lymphoma is a disease that is increasing in incidence in the Western world. Common risk factors include exposure to:

• ionizing radiation;
• certain chemicals such as benzene, insecticides, or herbicides; and
• some viruses such as HIV, HTLV 1 and 2.

There is also evidence that people with immune diseases such as rheumatoid arthritis, systemic lupus erythematosus (SLE, or lupus), or celiac sprue are at higher risk of developing lymphoma. Patients with immune hyperstimulation from H. pylori infection of the stomach or hepatitis C are also at increased risk of certain types of lymphoma.

The appropriate treatment and the prognosis for a lymphoma patient are related to a combination of the type of lymphoma and stage of disease. The type of tumor is determined by a pathologist's microscopic examination of a biopsy of the tumor.

There are two major types of lymphoma: the Hodgkin's lymphomas and the non-Hodgkins lymphomas. HL spreads primarily through the ducts of the lymph system. NHL spreads more through blood vessels. There are five subtypes of HD and more than two dozen types of NHL.
These NHL are categorized into three groups: the indolent, intermediate and aggressive.
The stage or degree of spread of the disease is determined by the physical examination and radiologic imaging. A TNM stage, discussed last week, is determined and usually translated into what is known as the Ann Arbor staging system with Cotswolds modifications.
This is the overall or summary stage, in brief:

• Stage I - Lymphoma involving a single lymph node region (I) or a single node and the organ next to it.

• Stage II - Involvement of two or more lymph node regions in the chest or two or more in the abdomen or the area of the retroperitoneum (low back). There can be direct extension of lymphoma from the lymph node chain into an adjacent organ.

• Stage III - Involvement of lymph node in the abdomen and the chest or the retroperitoneum and the chest. Involvement of the spleen, which is located in the left upper abdomen, is stage III disease.

• Stage IV - Diffuse or disseminated lymphoma involving one or more organs or tissues without associated lymphatic involvement.

Patients with stage I or stage II disease are then further stratified for treatment purposes into favorable and unfavorable prognosis disease, based upon the presence or absence of certain clinical features, such as age and B symptoms (weight loss, fevers, night sweats, and large volume of disease in the chest).

Laboratory studies are done to determine the type of cancerous cells. There are drugs specific to the treatment of what are known as B cell lymphomas. B cell positive versus T cell positive or other laboratory markers can also be used to predict patterns of spread and patterns of invasion of a lymphoma.

The appropriate treatment of a lymphoma varies by the type of tumor and by the stage. Stage I and II lymphomas can often be treated with radiation alone. They are of limited size and spread, such that they can be illuminated by one radiation beam. Stage III and IV lymphomas generally must be treated with a series of chemotherapy drugs active in lymphoma. Type of tumor is very important, as indolent lymphoma usually presents as widely spread or stage IV disease, but can often be appropriately watched, and treatment can sometimes be deferred for a decade or more. On the other hand, the aggressive lymphomas can be a medical emergency requiring immediate treatment.

The international prognostic index (IPI) is used to determine prognosis for patients with lymphoma. The index takes into account the the type of lymphoma, stage of disease, and what markers or genes are expressed in the tumor. As a whole, lymphoma is one of the most treatable of malignancies. While the prognosis for many of the lymphomas can be very good, there are some lymphomas that are very difficult to treat.
Ask experts a question
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Hepatitis C may play a role in ocular adnexal non-Hodgkin lymphoma
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Arch Ophthalmol.
Posted on October 25, 2010
2010;128(10):1295-1299.
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The prevalence of hepatitis C infection may be relevant to ocular adnexal non-Hodgkin lymphoma, and hepatitis C may influence the initial appearance of the disease, a study said.
In the retrospective comparative study, medical records of 129 patients with ocular adnexal non-Hodgkin lymphoma were reviewed.
The prevalence of hepatitis C virus (HCV) infection among the patients was 17.8%, and seropositivity for infection was significantly associated with extraorbital lymphoma at the onset, the study said.
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A high prevalence of mucosa-associated lymphoid tissue disease (79.8%) was also noted.
Ninety-nine patients who underwent radiotherapy and chemotherapy achieved complete remission, while 23.6% of patients with HCV-seronegative status and 21.7% of patients with HCV-seropositive status relapsed.
"However, the overall and disease-free survival of the infected patients are not statistically different than that of patients who are not infected," the authors said.

Surrogate markers of B cell non-Hodgkin's lymphoma in patients with hepatitis C virus-related cryoglobulinaemia vasculitis

Author: Geri, G., Terrier, B., Semoun, O., Saadoun, D., Sene, D., Charlotte, F., Merle-Beral, H., Musset, L., Resche-Rigon, M., Cacoub, P.Publication: Annals of the Rheumatic DiseasesVolume: 69, Issue: 12, Pages: 2177 to 2180
Date: Saturday, November 20, 2010
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Objective
To evaluate clinical and biological surrogate markers associated with the presence of B cell non-Hodgkin's lymphoma= (B-NHL) in patients with hepatitis C virus (HCV) with mixed cryoglobulinaemia (MC) vasculitis.
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Methods
A total of 104 patients with HCV-MC vasculitis (including 20 with B-NHL) were included. The main clinical and biological markers associated with the presence of B-NHL were evaluated.
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Results
Patients with B-NHL compared to those without showed higher rates of poor general status (40% vs 16.7%; p=0.032), purpura (90% vs 66.7%; p=0.05), renal (50% vs 28.6%; p=0.11) and cardiac involvement (15% vs 0%; p=0.0006), higher cryoglobulin levels (1.44 g/litre vs 0.67 g/litre; p=0.0004), and lower C4 (0.025 g/litre vs 0.06 g/litre; p=0.001) and -globulin levels (5.3 g/litre vs 13.3 g/litre; p less then 0.0001). The free light chain / ratio was more frequently abnormal in patients with than without B-NHL (64.3% vs 33.3%, p=0.10). On multivariate analysis, only -globulin level was associated with the presence of B-NHL (OR 0.77 (95% CI –0.44 to –0.13), p=0.0006). The optimal cut-off value for -globulin level was 9 g/litre, with sensitivity, specificity, positive and negative predictive values for the presence of B-NHL of 75%, 82%, 50% and 93%, respectively
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Conclusions
In patients with HCV-MC, a low -globulin level (less then 9 g/litre) is strongly associated with the presence of B-NHL.
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Reuters) - People infected with hepatitis B virus are around twice as likely to develop non-Hodgkin lymphoma, reported on Aug 3, 2010 .

Hepatitis B was already known to cause liver cancer and some scientists had suspected it might cause lymphoma, too. The study, published in Lancet Oncology, confirms this.
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Hepatitis C is also linked to lymphoma.

The blood cancer is not common and widespread vaccination against the viruses is unlikely to affect non-Hodgkin lymphoma rates much, the researchers noted. But it may be possible to treat the virus and help non-Hodgkin lymphoma patients, they said.
Dr. Eric Engels of the U.S. National Cancer Institute and Sun Ha Jee of Yonsei University in Seoul studied the records of more than 600,000 people in South Korea, where hepatitis B was extremely common before a vaccination campaign began in 1995.

Of these, 53,000 or about 9 percent had evidence of hepatitis B infection. After 14 years, rates of non-Hodgkin lymphoma were more common among the infected people -- 19.4 cases per 100,000 people compared to 12.3 per 100,000 who did not have hepatitis B.
Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation, according to the U.S. Centers for Disease Control and Prevention. The various hepatitis viruses are not closely related -- the word hepatitis means inflammation of the liver.
An estimated 350 million people worldwide are infected with hepatitis B virus, which causes 340,000 cases of liver cancer a year and kills between 500,000 and 1.2 million people a year.
Researchers think both hepatitis B and C may cause lymphoma by overstimulating the immune system as it tries to fight off the liver infection.
(Reporting by Maggie Fox, editing by Alan Elsner)
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