Today, about 1.5 million people worldwide living with malignant lymphoma, especially the type of LNH, and within a year approximately 300 thousand people die from this disease. From year to year, the number of patients with these diseases is also increasing. Just for illustration, the LNH incidence has increased 80 percent compared to 1970's figures. The data also show that this disease is more common in adults with the highest number in the range between the ages of 45 to 60 years. The older the age, the higher the risk of this disease. But in general, LNH can strike all ages, ranging from children to older people. In terms of gender, LNH cases more often found in men than wanita.Di Indonesia, lymphoma is the sixth type of cancer most often found (www.compas.com)
The lymphatic system is an important part of the immune system that plays a key role in the body's natural defenses against infection and cancer. Lymphatic fluid is a white liquid like milk that contains protein, fat, and lymphocytes (white blood cells) all of which flow throughout the body via the lymphatic vessels. There are two types of lymphocytes: B cells and T cells B cells help protect the body against bacteria by making antibodies that attack and destroy bacteria.
B. Definition of Malignant Lymphoma
Lymphoma (cancer of lymph nodes) is a form of malignancy of the lymphatic system cells such limforetikular B cells, T cells and thus the term histiocyte lymphoma malignum (malignant = malignant).
In normal conditions, cell lymphocytes is one of the body's defense system. While that is not normal lymphocytes (lymphoma) can be assembled in lymph nodes and cause swelling. Lymphocytes was not just circulating in the lymph vessels, these cells also circulate throughout the body in the blood vessels because that's lymphoma can also occur outside the lymph nodes. In this case, which is common in the spleen and bone marrow. Besides, can also arise in other organs such as stomach, liver, and brain.
There are two types of diseases including lymphoma malignum of Hodgkin's disease (PH) and non-Hodgkin lymphoma (LNH). Both have similar symptoms. The difference is differentiated based on anatomic pathology examination found where in PH Reed Sternberg cells, and the more aggressive nature of LNH
The cause must be made known. Four possible causes include: heredity, immune system disorders, viral or bacterial infections (HIV, the virus human T-cell leukemia / lymphoma (HTLV), Epstein-Barr virus (EBV), Helicobacter sp) and environmental toxins (herbicides, preservatives and chemical dyes).
E. Pathophysiology and Clinical
Abmormal tumor proliferation may provide suppression of damage or blockage of an organ that was attacked. Tumors can start in lymph nodes (nodal) lymph nodes or outside (extra nodal).
Symptoms of Lymphoma can arise physically rubbery lumps, easily moved (on the neck, armpit or groin). Gland enlargement can be started earlier with symptoms of weight loss, fever, night sweats. This can be immediately suspected of being lymphoma. But not every bump that occurred in the lymphatic system is a lymphoma. It could be the result of resistance lump lymph glands with a virus or possibly tuberculosis of lymph.
Some sufferers experience Pel-Ebstein fever, which the body temperature rises for a few days interspersed with normal temperature or below normal for several days or several weeks. Other symptoms may arise based on the location of the growth of lymphoma cells. There are three specific symptoms of lymphoma among others:
1.Demam prolonged with temperatures more than 38 oC
2.Sering night sweats
3.Kehilangan weight of more than 10% in 6 months
F. Pathology Classification
Lymphoma pathologic classification has changed over the years. In 1956 Rappaport classification was introduced. Rappaport divides lymphomas into nodular and diffuse types and subtypes based on cytologic examination. Modifications of these classifications continue until the year 1982 appeared the Working Formulation classification that divides into malignant lymphoma of low, medium and high based on clinical and pathological. Along with the advancement of immunology and genetics of the new classification appeared in 1982, known as the Revised European-American classification of lymphoid Neoplasms (REAL classification). Nevertheless, the Working Formulation classification is still the basic guideline for determining the diagnosis, treatment, and prognosis
Pathology Classification Based on the Working Formulation
Malignum lymphoma, small lymphocytic
Malignum lymphoma, follicular, predominantly small cleaved cell
Malignum lymphoma, follicular, mixed small cleaved cells and large
Malignum lymphoma, follicular, predominantly large cell
Lymphoma malignum, diffuse, small cell
Lymphoma malignum, diffuse, mixed small and large-sized cells
Lymphoma malignum, diffuse, large cell
Lymphoma malignum, large imunoblastik cells
Lymphoma malignum, cell limfoblastik
Lymphoma malignum, small cell noncleaved
G. Stadium malignant lymphoma
Lymphoma dissemination can be grouped into four stages. Stage I and II are often grouped together as the early stages of disease, while stage III and IV are grouped together as an advanced stage.
1.Stadium I: The spread of lymphoma found only in one group of lymph nodes.
2.Stadium II: The spread of Hodgkin attacked two or more groups of lymph nodes, but only on one side of the diaphragm, and the entire chest or abdomen.
3.Stadium III: Dissemination Lymphoma attacked two or more groups of lymph nodes, as well as on the chest and abdomen.
4.Stadium IV: The spread of lymphoma than in the lymph nodes in at least one other organs such as bone marrow, liver, lungs, or brain
H. Examination Diagnosis
Must be done to detect lymphoma biopsy of affected lymph nodes, to discover the existence of Reed-Sternberg cells. To detect Lymphoma require such examination X-rays, CT scans, PET scans, bone marrow biopsy and blood tests. Biopsy or staging is a way to get tissue samples to help doctors diagnose lymphoma. There are several types of biopsy for detecting malignant lymphoma:
1.Biopsi lymph nodes, tissues taken from the enlarged lymph nodes
2.Biopsi fine-needle aspiration, tissue is taken from the lymph nodes with a syringe. This is sometimes done to monitor response to treatment.
3.Biopsi bone marrow where the bone marrow taken from the pelvic bone to see if the lymphoma involved the bone marrow.
Non-Hodgkin's Lymphoma Treatment can be done in several ways, according to a diagnosis of multiple factors such as whether to have relapsed, stage number, age, body condition, needs and desires of patients. Broadly speaking healing occurs about 93%, making this disease as one of the most curable cancers.