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The incidence of non-Hodgkin lymphoma increases with age.

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It is further divided into several subtypes. Epstein-Barr virus-associated lymphoproliferative diseases are a group of benign, pre-malignant , and malignant diseases of lymphoid cells , i. The WHO classification, published in and updated in , [29] [30] is based upon the foundations laid within the "revised European-American lymphoma classification" REAL. This system groups lymphomas by cell type i. The five groups are shown in the table. Hodgkin lymphoma is considered separately within the WHO and preceding classifications, although it is recognized as being a tumor of, albeit markedly abnormal, lymphocytes of mature B cell lineage.

Of the many forms of lymphoma, some are categorized as indolent e. 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.

The Working formulation of 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 and B-cell lymphomas.

It was widely accepted at the time of its publication, but is now obsolete. In , the Revised European-American Lymphoma REAL classification applied immunophenotypic and genetic features in identifying distinct clinicopathologic entities among all the lymphomas except Hodgkin lymphoma. After a diagnosis and before treatment, a cancer is staged. This refers to determining if the cancer has spread, and if so, whether locally or to distant 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. In this staging system, I represents a localised disease contained within a lymph node group , II represents the presence of lymphoma in two or more lymph nodes groups, III represents spread of the lymphoma to lymph nodes groups on both sides of the diaphragm , and IV indicates spread to tissue outside the lymphatic system. Different suffixes imply involvement of different organs, for example S for the spleen and H for the liver.

Extra-lymphatic involvement is expressed with the letter E. In addition, the presence of B symptoms or their absence is expressed with B and A, respectively. CT scan or PET scan imaging modalities are used to stage a cancer. For other lymphomas CT scan is recommended for staging. Age and poor performance status are established poor prognostic factors, as well.

Mantle cell lymphoma: Notice the irregular nuclear contours of the medium-sized lymphoma cells and the presence of a pink histiocyte. Hodgkin lymphoma, nodular lymphocyte predominant low-power view : Notice the nodular architecture and the areas of "mottling". These diseases do not progress to cancer, may regress spontaneously and do not respond to, and do not require, chemotherapy or other lymphoma treatments. Prognoses and treatments are different for HL and between all the different forms of NHL, [46] and also depend 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 ] Burkitt lymphoma , for example, is a high-grade tumour known to double within days, and is highly responsive to treatment. Lymphomas may be curable if detected in early stages with modern treatment.

Pathophysiology of T-cell Subsets

Many low-grade lymphomas remain indolent for many years. Treatment of the nonsymptomatic 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. 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. Treatment of some other, more aggressive, forms of lymphoma [ which? A number of people are cured with first-line chemotherapy. Most relapses occur within the first two years, and the relapse risk drops significantly thereafter. Hodgkin lymphoma typically is treated with radiotherapy alone, as long as it is localized. Advanced Hodgkin disease requires systemic chemotherapy, sometimes combined with radiotherapy.

Encouragingly, a significant number of people who relapse after ABVD can still be salvaged by stem cell transplant. 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. Lymphoma is the most common form of hematological malignancy , or "blood cancer", in the developed world. Taken together, lymphomas represent 5.

According to the U. 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. Thomas Hodgkin published the first description of lymphoma in , specifically of the form named after him. The two types of lymphoma research are clinical or translational research and basic research.

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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. Hundreds of clinical trials are being planned or conducted at any given time. 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, [69] but can improve scientists' understanding of lymphoma and form the foundation for future, more effective treatments.

Chan, L. Quintanilla-Martinez, J. Ferry, and S.


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Dr. Ruan on Classifying T-cell Lymphomas

Khong, C. Pang, R. Liang, Y. Kwong, and W. Chan, W. Au, C. Wong et al. Chan, J. Zhang, A. Au, A. Pang, C. Choy, C. Chim, and Y. The incidence of T-cell lymphoma is variable around the world, with a higher incidence compared to B-cell lymphomas in the Asian basin. While the overall incidence of B-cell lymphomas has begun to decline in the United States, the incidence of T-cell lymphomas continues to rise. Over the last decade, a number of novel agents have been developed which target T-cell lymphomas and studies have identified novel genes and pathways associated with lymphomagenesis in T-cells.

Skip to main content Skip to table of contents. Advertisement Hide. T-Cell Lymphomas. Front Matter Pages i-xv. Histopathology and Classification of T-Cell Lymphomas. Pages Epidemiology and Prognosis of T-Cell Lymphoma.