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مُساهمةموضوع: °l||l° Lymphomas ™ °l||l°   °l||l° Lymphomas ™ °l||l° Empty19/12/2009, 8:55 pm

LYMPHOMAS


Lymphomas are cancers of lymphocytes, which reside in the lymphatic
system and in blood-forming organs.
Lymphomas are cancers of a specific type of white blood cells known as lymphocytes. These cells help fight infections. Lymphomas can develop from either B or T lymphocytes. T lymphocytes are important in regulating the immune system and in fighting viral infections. B lymphocytes produce antibodies.
Lymphocytes move about to all parts of the body through the bloodstream and through a network of tubular channels called lymphatic vessels ).

Scattered throughout the network of lymphatic vessels are lymph nodes, which house collections of lymphocytes. Lymphocytes that become cancerous (lymphoma cells) may remain confined to a single lymph node or may spread to the bone marrow, the spleen, or virtually any other organ.
The two major types of lymphoma are Hodgkin lymphoma, previously known as Hodgkin's disease, and non-Hodgkin lymphoma. Non-Hodgkin lymphomas are more common than Hodgkin lymphoma. Burkitt's lymphoma and mycosis fungoides are subtypes of non-Hodgkin lymphomas.


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مُساهمةموضوع: رد: °l||l° Lymphomas ™ °l||l°   °l||l° Lymphomas ™ °l||l° Empty19/12/2009, 9:00 pm

Hodgkin Lymphoma



Hodgkin lymphoma is a type of lymphoma distinguished by the presence of a particular kind of cancer cell called a Reed-Sternberg cell.

  • The cause is unknown.
  • Lymph nodes enlarge but are not painful.
  • Other symptoms, such as muscle weakness, fever, and shortness of breath, develop depending on where the cancer cells are growing.
  • A lymph node biopsy is needed for diagnosis.
  • Chemotherapy and radiation therapy are used for treatment.
  • Most people are cured.

In the United States, about 8,000 new cases of Hodgkin lymphoma occur every year. The disease is more common in males than in females—about three men are affected for every two women. Hodgkin lymphoma rarely occurs before age 10. It is most common in people between the ages of 15 and 40 and in people older than 50.
The cause of Hodgkin lymphoma is unknown. There is strong evidence that, in some people, Epstein-Barr virus infection causes B lymphocytes to become cancerous and transform into Reed-Sternberg cells. Although there are some families in which more than one person has Hodgkin lymphoma, it is not contagious.
Symptoms
People with Hodgkin lymphoma usually become aware of one or more enlarged lymph nodes, most often in the neck but sometimes in the armpit or groin. Although usually painless, sometimes the enlarged lymph nodes may be painful for a few hours after a person drinks alcoholic beverages.
People with Hodgkin lymphoma sometimes experience fever, night sweats, and weight loss. They can also have itching and fatigue. Some people have Pel-Ebstein fever, an unusual pattern of high temperature for several days alternating with normal or below-normal temperature for days or weeks. Other symptoms may develop, depending on where the cancerous cells are growing. For example, enlargement of lymph nodes in the chest may partially narrow and irritate airways, resulting in a cough, chest discomfort, or shortness of breath. Enlargement of the spleen or lymph nodes in the abdomen may cause discomfort in the abdomen.


[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]


Diagnosis
Doctors suspect Hodgkin lymphoma when a person with no apparent infection develops persistent and painless enlargement of lymph nodes that lasts for several weeks. The suspicion is stronger when lymph node enlargement is accompanied by fever, night sweats, and weight loss. Rapid and painful enlargement of lymph nodes—which may occur when a person has a cold or infection—is not typical of Hodgkin lymphoma. Sometimes enlarged lymph nodes deep within the chest or abdomen are found unexpectedly on a chest x-ray or computed tomography (CT) scan done for another reason.
Abnormalities in blood cell counts and other blood tests may provide supportive evidence. However, to make the diagnosis, doctors must perform a biopsy of an affected lymph node to see if it is abnormal and if Reed-Sternberg cells are present. Reed-Sternberg cells are large cancerous cells that have more than one nucleus. Their distinctive appearance can be seen when a biopsy specimen of lymph node tissue is examined under a microscope.
The type of biopsy depends on which node is enlarged and how much tissue is needed. Doctors must remove enough tissue to be able to distinguish Hodgkin lymphoma from other disorders that can cause lymph node enlargement, including non-Hodgkin lymphomas, infections, or other cancers.
The best way to obtain enough tissue is with an excisional biopsy. A small incision is made to remove a piece of the lymph node. Occasionally, when an enlarged lymph node is close to the body's surface, a sufficient amount of tissue can be obtained by inserting a hollow needle through the skin and into the lymph node (needle biopsy). When an enlarged lymph node is deep inside the abdomen or chest, surgery may be needed to obtain a piece of tissue.
Staging
Before treatment is started, doctors must determine how extensively the lymphoma has spread—the stage of the disease. The choice of treatment and the prognosis are based on the stage. An initial examination may detect only a single enlarged lymph node, but procedures to find if and where the lymphoma has spread (staging) may detect considerably more disease.


The disease is classified into four stages based on the extent of its spread (I, II, III, IV; the higher the number, the more the lymphoma has spread). The four stages are subdivided, based on the absence (A) or presence (B) of one or more of the following symptoms:

  • Unexplained fever (more than 100° F [about 37.5° C] for 3 consecutive days)
  • Night sweats
  • Unexplained loss of more than 10% of body weight in the preceding 6 months

For example, a person with a stage II lymphoma who has experienced night sweats is said to have stage IIB Hodgkin lymphoma.
Several procedures are used to stage or assess Hodgkin lymphoma. Basic blood tests, including tests of liver and kidney function, along with chest x-rays and computed tomography (CT) scans of the chest, abdomen, and pelvis are standard. CT scans are quite accurate in detecting enlarged lymph nodes or spread of the lymphoma to the liver and other organs.
Positron emission tomography (PET) scanning is the most sensitive technique for determining the stage of Hodgkin lymphoma and for evaluating the person's response to treatment. Because living tissue can be identified on a PET scan, doctors can use this imaging technique to distinguish scar tissue from active Hodgkin lymphoma after the person has undergone treatment (although PET scanning is not always accurate because inflammation can appear on PET scans). Most people with Hodgkin lymphoma do not need surgery to determine whether the disorder has spread to the abdomen, because all people receive chemotherapy, which treats the lymphoma no matter where it is located.

[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]


Treatment and Prognosis
With chemotherapy, with or without radiation therapy, most people who have Hodgkin lymphoma can be cured.
Chemotherapy is used for all stages of disease. Doctors usually use more than one chemotherapy drug. Several combinations may be used. Involved field radiation therapy (radiation therapy delivered only to the affected areas of the body, avoiding exposing unaffected areas to radiation) may be added after chemotherapy. Treatments are usually given on an outpatient basis over about 4 weeks.
More than 80% of people with stage I or stage II disease are cured with chemotherapy followed by involved field radiation therapy. The cure rate of people with stage III disease ranges from 70 to 80%. Cure rates for people with stage IV disease, while not as high, are above 50%.
Although chemotherapy greatly improves the chances for a cure, side effects can be serious. The drugs may cause temporary or permanent infertility, an increased risk of infection, potential damage to other organs, such as the heart or lungs, and reversible hair loss. After involved field radiation, there is an increased risk of cancer, such as lung, breast, or stomach cancer, occurring 10 or more years after treatment in organs that were in the radiation field. Non-Hodgkin lymphomas may develop in some people many years after successful treatment for Hodgkin lymphoma, regardless of the treatment used.
A person who has a remission (the disease under control) after initial treatment but then relapses (lymphoma cells reappear) may still be cured with second-line treatment. The cure rate for people who relapse is at least 50%. Among people who relapse in the first 12 months after initial treatment, cure rates are somewhat lower, whereas the rates for people who relapse later tend to be somewhat higher. People who relapse after initial treatment generally are treated with a “salvage” chemotherapy regimen followed by high-dose chemotherapy. Autologous stem cell transplantation, which involves using the person's own stem cells , may be done after high-dose chemotherapy. High-dose chemotherapy with stem cell transplantation is generally a safe procedure, with less than a 1 to 2% risk of death related to the treatment.
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Non-Hodgkin Lymphomas



Non-Hodgkin lymphomas are a diverse group of cancers that develop in B or T lymphocytes.

  • Often, lymph nodes in the neck, under the arms, or in the groin enlarge rapidly and painlessly.
  • People may have pain or shortness of breath or other symptoms when enlarged lymph nodes press on organs.
  • A lymph node biopsy is needed for diagnosis.
  • Treatment may involve radiation therapy, chemotherapy, monoclonal antibodies, or a combination.
  • Most people are cured or survive for many years.

This group of cancers is actually more than 20 different diseases, which have distinct appearances under the microscope, different cell patterns, and different clinical courses. Most non-Hodgkin lymphomas (85%) are from B cells. Less than 15% develop from T cells. Non-Hodgkin lymphoma is more common than Hodgkin lymphoma. In the United States, about 65,000 new cases are diagnosed every year, and the number of new cases is increasing, especially among older people and people whose immune system is not functioning normally. People who have had organ transplants and some people who have been infected with the human immunodeficiency virus (HIV) are at risk of developing non-Hodgkin lymphoma.
Although the cause of non-Hodgkin lymphomas is not known, evidence strongly supports a role for viruses in some of the less common types. A rare type of rapidly progressive non-Hodgkin lymphoma, which occurs in southern Japan and the Caribbean, may result from infection with human T-cell lymphotropic virus 1 (HTLV-1), a retrovirus similar to HIV. The Epstein-Barr virus is associated with many cases of Burkitt's lymphoma, another type of non-Hodgkin lymphoma.







Unusual Non-Hodgkin Lymphomas

Mycosis fungoides is a rare, persistent, very slow-growing non-Hodgkin lymphoma. Most people who develop it are older than 50. It originates from mature T lymphocytes and first affects the skin. Mycosis fungoides starts so subtly and grows so slowly that it may not be noticed initially. It causes a long-lasting, itchy rash—sometimes a small area of thickened, itchy skin that later develops nodules and slowly spreads. In some people, it develops into a form of leukemia (Sézary syndrome). In other people, it progresses to the lymph nodes and internal organs. Even with a biopsy, doctors have trouble diagnosing this disease in its early stages. However, later in the course of the disease, a biopsy shows lymphoma cells in the skin.

The thickened areas of skin are treated with a form of radiation called electron beam or with sunlight and corticosteroids applied to the skin. [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]Some Trade Names
See Mechlorethamine
applied directly to the skin can help reduce the itching and size of the affected areas. Interferon drugs can also reduce symptoms. If the disease spreads to lymph nodes and other organs, chemotherapy may be needed. On average, people live 7 to 10 years after the diagnosis is made, but survival varies widely depending on how far the cancer has spread. Treatment does not cure the disease, but it slows it down even further.

Burkitt's lymphoma is a very fast-growing non-Hodgkin lymphoma that originates from B lymphocytes. Burkitt's lymphoma can develop at any age, but it is most common in children and young adults, particularly males. Unlike other lymphomas, Burkitt's lymphoma has a specific geographic distribution: It is most common in central Africa and rare in the United States. Infection with Epstein-Barr virus is associated with Burkitt's lymphoma. It is more common in people who have AIDS.

Burkitt's lymphoma grows and spreads quickly, often to the bone marrow, blood, and central nervous system. When it spreads, weakness and fatigue often develop. Large numbers of lymphoma cells may accumulate in the lymph nodes and organs of the abdomen, causing swelling. Lymphoma cells may invade the small intestine, resulting in blockage or bleeding. The neck and jaw may swell, sometimes painfully. To make the diagnosis, doctors do a biopsy of the abnormal tissue and order procedures to stage the disease.

Without treatment, Burkitt's lymphoma is rapidly fatal. Rarely, surgery may be needed to remove parts of the intestine that are blocked or bleeding or have ruptured. Intensive chemotherapy, which includes chemotherapy to the fluid surrounding the brain and spinal cord to prevent spread to these areas, can cure 70 to 80% of people.





Symptoms
The first symptom is often rapid and usually painless enlargement of lymph nodes in the neck, under the arms, or in the groin. Enlarged lymph nodes within the chest may press against airways, causing cough and difficulty in breathing. Deep lymph nodes within the abdomen may press against various organs, causing loss of appetite, constipation, abdominal pain, or progressive swelling of the legs.
Since some lymphomas can appear in the bloodstream and bone marrow, people can develop symptoms related to too few red blood cells, white blood cells, or platelets. Too few red blood cells can cause anemia, leading to fatigue, shortness of breath, and pale skin. Too few white blood cells can lead to infections. Too few platelets may lead to increased bruising or bleeding. Non-Hodgkin lymphomas also commonly invade the bone marrow, digestive tract, skin, and occasionally the nervous system, causing various symptoms. Some people have persistent fever without an evident cause, the so-called fever of unknown origin. This type of fever commonly reflects an advanced stage of disease.





Did You Know...



  • Non-Hodgkin lymphomas are actually a group of more than 20 different diseases.






In children, the first symptoms—anemia, rashes, and neurologic symptoms, such as weakness and abnormal sensation—are likely to be caused by infiltration of lymphoma cells into the bone marrow, blood, skin, intestine, brain, and spinal cord. Lymph nodes that become enlarged are usually deep ones, leading to

  • Accumulation of fluid around the lungs, which causes difficulty in breathing
  • Pressure on the intestine, which causes loss of appetite or vomiting
  • Blocked lymph vessels, which causes fluid retention, most noticeably in the arms and legs

[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]

Diagnosis and Classification
Doctors do a biopsy of an enlarged lymph node to diagnose non-Hodgkin lymphomas and to distinguish them from Hodgkin lymphoma and other disorders that cause enlarged lymph nodes.
Although more than 20 different disorders can be called non-Hodgkin lymphomas, doctors sometimes group them into two broad categories.


Indolent lymphomas are characterized by

  • A long survival period (many years)
  • Rapid response to many treatments
  • Lack of cure when standard therapies are used



Aggressive lymphomas are characterized by

  • Rapid progression without therapy
  • High rates of cure with standard chemotherapy

Although non-Hodgkin lymphomas are usually diseases of middle-aged and older people, children and young adults may develop lymphomas, and lymphomas that develop in children and young adults are commonly aggressive subtypes.
Staging
Many people with non-Hodgkin lymphomas have disease that has spread at the time of diagnosis. In only 10 to 30% of people, the disease is limited to one region. People with these lymphomas undergo similar staging procedures as people with Hodgkin lymphoma . In addition, a bone marrow biopsy is almost always done.


Treatment and Prognosis
For some people with indolent lymphomas, treatment is not needed. Almost everyone else benefits from treatment. For people with aggressive lymphomas, cure is possible. For people with indolent lymphomas, treatment, when needed, extends life and relieves symptoms for many years. The likelihood of a cure or long-term survival depends on the type of non-Hodgkin lymphoma and the stage when treatment starts. It is somewhat of a paradox that indolent lymphomas usually respond readily to treatment by going into remission (in which the disease is under control), often followed by long-term survival, but the disease usually is not cured. In contrast, aggressive non-Hodgkin lymphomas, which usually require very intensive treatment to achieve remission, have a good chance of being cured.
Stage I and II Non-Hodgkin Lymphomas: People with indolent lymphomas who have very limited disease (stages I and II) are often treated with radiation therapy limited to the site of the lymphoma and adjacent areas. With this approach, most people do not have a disease recurrence in the irradiated area. Non-Hodgkin lymphomas can recur elsewhere in the body as long as 10 years after treatment, so people require long-term monitoring. People with aggressive lymphomas at a very early stage need to be treated with combination chemotherapy and sometimes radiation therapy. With this approach, 70 to 90% of people are cured.
Stage III and IV Non-Hodgkin Lymphomas: Almost all people with indolent lymphomas have stage III or IV disease. They do not always require treatment initially, but they are monitored for evidence of lymphoma progression, which could signal a need for therapy, sometimes years after the initial diagnosis. There is no evidence that early treatment extends survival in people with indolent lymphomas at more advanced stages. If the disease begins to progress, there are many treatment choices.
It is not known which treatment option is best initially, so the choice of treatment is influenced by the extent of disease and the person's symptoms. Treatment may include therapy with monoclonal antibodies ([ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]Some Trade Names
RITUXAN
) alone or chemotherapy with or without [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]Some Trade Names
RITUXAN
. These antibodies are given intravenously. Sometimes, the monoclonal antibodies are modified so that they can carry radioactive particles or toxic chemicals directly to the cancer cells in different parts of the body. Treatment usually produces a remission. The average length of remission ranges from 2 years to more than 5 years. When [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]Some Trade Names
RITUXAN
is combined with chemotherapy, the results of remission are better. The roles of maintenance chemotherapy (chemotherapy given after the initial treatment to help prevent relapse) and combined chemotherapy plus radioimmunotherapy are being studied.
A decision about treatment after a relapse (in which lymphoma cells reappear) depends on the extent of the disease and the symptoms. If non-Hodgkin lymphoma relapses, a type of radiation therapy called radioimmunotherapy is an option. After an initial relapse, remissions tend to become shorter.
For people with aggressive stage III or IV non-Hodgkin lymphomas, combinations of chemotherapy drugs are given promptly, often together with [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]Some Trade Names
RITUXAN
. Many potentially effective combinations of chemotherapy drugs are available. Combinations of chemotherapy drugs are often given names created by using single letters from each of the drugs that are included. For example, one of the oldest and still one of the most commonly used combinations is known as CHOP ([ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]Some Trade Names
LYOPHILIZED CYTOXAN
, [hydroxy][ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]Some Trade Names
DOXIL
, vincristine [Oncovin], and prednisone). [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]Some Trade Names
RITUXAN
has been shown to improve the outcome of CHOP and is now routinely added to the combination (R-CHOP). More than 70% of people with aggressive non-Hodgkin lymphomas at an advanced stage are cured with R-CHOP chemotherapy. Newer combinations of drugs are being studied. Chemotherapy, which often causes different types of blood cells to decrease in number, is sometimes better tolerated if special proteins (called growth factors) are also given to stimulate growth and development of blood cells.
Relapse: Chemotherapy at usual doses is of very limited value when relapse occurs. Many people who have a relapse of an aggressive lymphoma receive high doses of chemotherapy drugs combined with autologous stem cell transplantation, involving the person's own stem cells ). With this type of treatment, up to 50% of people may be cured. Sometimes stem cells from a sibling or even an unrelated donor (allogeneic transplant) can be used, but this type of transplantation has a greater risk of complications.
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والله ياعز عيوني صارت عليهم غشاوة وانا اقر

لكن موضوع جدا قيم مشكور على التعب
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danyasaad كتب:
والله ياعز عيوني صارت عليهم غشاوة وانا اقر

لكن موضوع جدا قيم مشكور على التعب

هههههههههه

هذا موضوع متكامل لا ترهقي عيونك

وإنما حبة حبة تقرأ وهذا الموضوع بالذات أعجبني كتيرا

فهو له علاقة بمنهجنا الدراسي

تقبلي تحياتي
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