Lymphoma describes a group of cancers that affect the lymphatic system, which is part of the body's immune defense system. This type of cancer may develop when lymphocytes are not produced properly, causing abnormal cells to accumulate either by duplicating faster or living longer than normal. When these abnormal cells accumulate, they displace normal lymphocytes.
Cancerous lymphocytes, like healthy lymphocytes, are able to grow in many areas of the body, including the spleen, lymph nodes, bone marrow or blood. Since lymph tissue is found throughout the body, the cancer cells may spread to other organs and tissues.
AIDS-related lymphoma occurs when cancer cells are present in the lymph system of a patients who has AIDS (acquired immune deficiency syndrome).
AIDS is caused by HIV (human immunodeficiency virus), which attacks and weakens the immune system. HIV and AIDS patients have an increased risk of developing infections, lymphoma and other types of cancer. In most cases, a person with HIV infection who develops lymphoma is subsequently diagnosed with AIDS. Sometimes people are diagnosed with AIDS and AIDS-related lymphoma at the same time.
AIDS patients can develop either of the two types of lymphoma -
Hodgkin's disease lymphoma or non-Hodgkin's lymphoma. However, non-Hodgkin's lymphoma is more common among AIDS patients. Non-Hodgkin's lymphoma affects about 20% of HIV/AIDS patients.
Patients who have AIDS-related lymphoma respond differently to treatment than lymphoma patients who do not have AIDS. This is because AIDS-related lymphoma usually grows faster and spreads more quickly than non-AIDS-related lymphoma.
Treatment of AIDS-related lymphoma combines cancer treatment (chemotherapy, radiation therapy or high-dose chemotherapy with stem cell transplant) with treatment for AIDS (highly active antiretroviral therapy).
Prognosis and treatment depends on the stage of the cancer, the number of CD4 lymphocytes (type of white blood cell), whether the patient has ever had AIDS-related infections, as well as the patient's ability to perform daily activities of living.
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Lymph: Lymph is colorless, watery fluid that travels through the lymph system, carrying white blood cells called lymphocytes. Lymphocytes fight against infections and destroy tumors (abnormal tissue growth).
Lymph vessels: The lymph vessels are a network of thin tubes that collect lymph from different body parts and return it to the bloodstream.
Lymph nodes: The lymph nodes are small, bean-shaped structures that are located along the lymph vessels throughout the body. Clusters of lymph nodes are located under the arm, as well as near the pelvis, neck, abdomen and groin. The lymph nodes filter the lymph to help fight infection and disease.
Spleen: The spleen is an organ located on the left side of the abdomen. The spleen produces lymphocytes, stores blood cells and destroys old blood cells.
Thymus: The thymus is an organ located in the chest, behind the breastbone. Lymphocytes mature and reproduce in the thymus.
Tonsils: The tonsils are two small masses of lymph tissue at the back of the throat, which produce lymphocytes.
Bone marrow: The bone marrow is soft, spongy tissue in the center of large bones. The bone marrow produces white blood cells, red blood cells and platelets.
AIDS-related lymphoma may be classified as "E," for extranodal, or "S," for spleen. If the cancer is extranodal, the cancer is present in an area or organ other than the lymph nodes, or it has spread via lymph vessels to tissues beyond, but close to, the major lymphatic areas. When cancer is described as "S," this means the cancer is present in the spleen.
Stage I: Stage I is subdivided into Stage I and Stage IE. Stage I occurs when cancer is present in one lymph node group. Stage IE occurs when cancer is present in an area or organ other than the lymph nodes.
Stage II: Stage II is subdivided into Stage II and Stage IIE. Stage II occurs when cancer is found in two or more lymph node groups on the same side of the diaphragm (muscle below the lungs that aids in breathing). Stage IIE occurs when cancer is present in an area or organ, in addition to the lymph nodes near that area. At this stage, the cancer may have also spread to other lymph node groups on the same side of the diaphragm.
Stage III: Stage III is subdivided into Stage III, Stage IIIE, Stage IIIS or Stage IIIS+E. Stage III occurs when cancer is found in lymph node groups on both sides of the diaphragm. Stage IIIE occurs when cancer is present in lymph node groups on both sides of the diaphragm, as well as in an area or organ other than the lymph nodes. Stage IIIS occurs when cancer is present in lymph node groups on both sides of the diaphragm and in the spleen. Stage IIIS+E occurs when cancer is present in lymph node groups on both sides of the diaphragm, in an area or organ other than the lymph nodes and in the spleen.
Stage IV: During stage IV, cancer is either found throughout one or more organs (other than the lymph nodes) and possibly in lymph nodes nearby, or cancer is present in one organ (other than the lymph nodes), as well as lymph nodes far away from that organ.
Once a patient is diagnosed with AIDS-related lymphoma, additional tests are performed to determine whether cancer cells have spread throughout the lymph system or to other parts of the body. This process is called staging. The test results will help the healthcare provider determine the stage of the disease, which is important to plan treatment. In most cases, AIDS-related lymphoma is advanced (cancer cells have spread throughout the body) by the time it is diagnosed.
Computerized tomography (CT) scan: A computerized tomography (CT) scan may be performed to detect abnormal tissue growth in the body. The CT scan provides detailed images of the internal organs and tissues. During the procedure, a dye may be injected into the vein or taken orally to help make the organs and tissues more visible.
Positron emission tomography (PET) scan: A positron emission tomography (PET) scan may be performed to detect malignant (cancerous) tumor cells in the body. A small amount of radioisotope compound is injected into a vein to help make the tissues and organs more visible. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Malignant tumor cells appear brighter in the image because they are more active and consume more glucose than normal cells.
Magnetic resonance imaging (MRI): A magnetic resonance imaging (MRI) test provides a series of detailed pictures of the internal organs and tissues. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. People with heart pacemakers, metal implants, artificial heart valves and other surgically implanted structures cannot be scanned with an MRI because of the risk that the magnet may move the metal parts of these structures.
Bone marrow biopsy: A bone marrow biopsy may be performed to determine if cancer cells are present. During the procedure, a small piece of bone and bone marrow are removed after inserting a needle into the hipbone or breastbone. Then a pathologist views both the samples under a microscope to look for signs of cancer.
Lumbar puncture: A lumbar puncture (spinal tap) may be performed to determine if the cancer has spread to the cerebrospinal fluid (CSF). During the procedure, a needle is inserted into the lower back and a small sample of CSF is removed from the spinal column. The sample is then analyzed under a microscope for signs of cancer.