Non-Hodgkin's lymphoma (NHL) is a cancerous overproduction of lymphocytes, which are cells that are a part of the body’s immune system. T-cell lymphoma is a type of non-Hodgkin's lymphoma that accounts for 15 percent of all non-Hodgkin's lymphomas. The other 85 percent of non-Hodgkin's lymphomas are B-cell lymphomas.
Definition & Facts
Non-Hodgkin's lymphomas are typically found in the lymph nodes (or sometimes in the spleen and bone marrow) and can metastasize or spread throughout the entire body. Lymphomas cause tumors, which hinder the normal function of organs. T cells are one of two types of lymphocytes that may develop cancer. The American Cancer Society categorizes a number of different cancers as subtypes of T-cell lymphomas.
- Precursor T-lymphoblastic lymphoma/leukemia. This is an aggressive cancer that straddles the line between lymphoma and leukemia depending upon the quantity of cancerous tissue in the bone marrow.
- Peripheral T-cell lymphomas. These include cutaneous T-cell lymphoma and subcutaneous T-cell lymphoma, enteropathy-associated T-cell lymphoma, anaplastic large-cell lymphoma, angioimmunoblastic T-cell lymphoma, and peripheral T-cell lymphoma not otherwise specified. Mycosis fungoides and Sézary disease are two types of cutaneous T-cell lymphoma.
Symptoms & Complaints
Associated symptoms of growth of cancer in the lymph nodes include swollen lymph nodes. Lymphoma of the abdomen usually produces fluid buildup which elicits nausea, vomiting, bloating, and other forms of abdominal pain.
Less commonly, when lymphoma develops in the skin, it will appear as an itchy, red or purple lump or nodule directly under the skin.
Many but not all T-cell lymphoma patients experience symptoms of general illness that include the following: fever, chest pain, anemia, fatigue, loss of appetite, night sweats, unexplained weight loss, overall sense of malaise, and shortness of breath.
Because there are so many different types of T-cell lymphoma, the causes of T-cell lymphoma are not uniform or conclusive. Nevertheless, age (those over 60) and race (white) are two demographic risk factors for non-Hodgkin's lymphomas generally. In addition, the Epstein-Barr virus infection may contribute to peripheral T-cell lymphomas.
Exposure to environmental toxicants (pesticides and herbicides, specifically) and radiation exposure (such as in the cases of those exposed to nuclear attacks) are also associated with heightened risk of developing T-cell lymphoma.
Autoimmune diseases (Celiac disease, Sjögren’s syndrome), and weakened immune systems generally may also make one susceptible to developing a T-cell lymphoma. HIV and genetic disorders affecting the integrity of the immune system may also play a role in causing T-cell lymphoma.
Diagnosis & Tests
As with any suspected illness, diagnosis will involve an intake of a patient's medical history and family history as well as his or her presentation of symptoms. A physical examination will ensue as will blood tests.
Biopsy of any area that is posing pain or possesses a lump is necessary for diagnosis. This involves removing a piece of tissue from the body for laboratory test analysis at the microscopic level to look for signs of cancer.
Imaging studies such as X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, ultrasounds, will be conducted and show the body's tissues in varying levels of detail to detect the presence of abnormal tissues and possible metastasis.
Cancer staging involves assessing the level of metastasis and aggressiveness of the cancer and is useful in guiding treatment approaches.
Treatment & Therapy
Many healthcare professionals beyond a primary care provider and oncologist will be involved in a patient’s care. Hematologists—doctors who treat blood diseases; radiation oncologists—doctors who use radiation to treat cancers; dermatologists; nurses and nurse practitioners; social workers; psychiatrists; nutritionists may form a team that can offer the best care to a patient.
Common therapies that are generally used to treat T-cell lymphomas include chemotherapy, immunotherapy, targeted therapy, radiation therapy, stem cell transplants, and, in some cases, surgery. Which types of therapies will be used depends upon the kind of T-cell lymphoma the patient has and how it has been staged.
Adult T-cell leukemia/lymphomas are slow-growing and therefore a watchful waiting approach is adopted. However, if treatment is deemed necessary, a chemotherapy regimen called CHOP may be administered. It consists of the following drugs: cyclophosphamidem, hydroxydaunorubicin, oncovin, and prednisone.
For cutaneous T-cell lymphoma, topical treatments that focus on treating the skin or systemic treatments that focus on treating the entire body may be utilized. The use of topical anti-itch creams and moisturizers may also be necessary for symptom abatement of certain types of cutaneous T-cell lymphoma. Photopheresis is sometimes employed as a systemic treatment. This is a procedure in which a patient's blood is removed from the body, its lymphocytes are irradiated, and then it is transfused back into the body all through a catheter.
Enteropathy-associated T-cell lymphoma may benefit from CHOP chemotherapy as well as surgery to remove parts of the intestines that are cancerous in order to avoid a potentially life-threatening gastrointestinal obstruction.
Prevention & Prophylaxis
To the extent that this group of cancers strikes those who have had a viral infection such as the Epstein-Barr virus more often than those who have not, one should avoid the means by which this viral infection is transmitted by practicing proper hygiene and not sharing eating utensils with those suspected of having the virus.