CanCer-666: lymphomas

Lymphoma of the Skin Treatment

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There are many therapies available for skin lymphoma (often referred to as 'cutaneous lymphoma'). Your medical team will discuss all the options with you and will advise you which treatments they recommend. You can be more involved in these discussions and in making decisions about your treatment if you know how the treatments work, what they involve and what side effects they have. Cancer therapies can be highly individualized – your treatment may differ from what is described below. 
 
Chemotherapy 
<ul>
<li>Chemotherapy may be recommended if the skin lymphoma has spread. Drugs used for these lymphomas in the skin are not the same as drugs used for other skin cancers.</li>
<li>Some chemotherapy drugs are given as pills, to be taken by mouth. Others are given intravenously, through a needle in a vein (IV). Useful drugs include Acitretin, Chlorambucil, or Gemcitabine.</li>
<li>Radiation therapy to affected areas of the skin may be used at the same time.</li>
</ul>
External treatment of the skin 
<ul>
<li>Treatment of stages I and II may be a chemotherapy agent applied to the skin. For skin lymphomas, the main chemotherapy drug used on the skin is Nitrogen Mustard (Mechlorethamine) ointment.</li>
<li>Another treatment option for stages I or II can be ultraviolet light therapy (PUVA), using a drug (Psoralen) to make the lymphoma cells sensitive to the light.</li>
<li>External treatments for lymphomas of the skin are not the same as treatments used on other skin cancers.</li>
</ul>
Radiation Therapy 
<ul>
<li>Radiation therapy of the involved part of the skin is usually very effective.</li>
<li>Radiation therapy to the whole skin surface may be used if external skin treatments are not effective.</li>
</ul>
Surgery 
Surgery is not used to treat skin lymphomas, although a surgical biopsy (sample) of the area might be used to understand the stage of it. 
 
General Treatment Information 
 
In recent years, much progress has been made in treating skin lymphoma, and several newer types of treatment have come into use. Once a skin lymphoma is found and staged, your health care team will discuss your treatment options with you. The treatment options for a person with skin lymphoma depend on the kind of lymphoma and its stage, as well as other factors such as your overall health. Of course, no two patients are exactly alike, and treatment options are tailored to each patient’s situation. 
 
Several types of treatment can be used against skin lymphoma. These can generally be divided into: 
<ul>
<li>Treatments directed only at the skin</li>
<li>Treatments that can affect the whole body (systemic treatments)</li>
</ul>
Sometimes these 2 types of treatments are used together. 
 
Based on your treatment options, you may have different types of doctors on your treatment team. These doctors may include: 
<ul>
<li>A dermatologist: a doctor who treats diseases of the skin</li>
<li>A hematologist: a doctor who treats disorders of the blood, including lymphomas</li>
<li>A medical oncologist: a doctor who treats cancer with medicines</li>
<li>A radiation oncologist: a doctor who treats cancer with radiation therapy</li>
</ul>
Many other specialists may be involved in your care as well, including nurse practitioners, physician assistants, nurses, nutrition specialists, social workers, and other health professionals. 
 
It is important to discuss all of your treatment options and their possible side effects with your doctors to help make the decision that best fits your needs. It’s also very important to ask questions if there is anything you’re not sure about.</div>
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Lymphoma of the Skin Treatment

There are many therapies available for skin lymphoma (often referred to as 'cutaneous lymphoma'). Your medical team will discuss...

Skin Lymphoma Causes

ancorez lymphomas 8:53 PM

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No specific causes of skin lymphoma are known. Genetic damage to a person’s cells, or immune system suppression (such as caused by AIDS), may be risk factors. Certain specific skin conditions (plaque parapsoriasis, follicular mucinosis) can develop into skin lymphoma. 
 
Scientists now understand how certain changes in DNA can cause normal lymphocytes to become lymphoma cells. DNA is the chemical in each of our cells that makes up our genes – the instructions for how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than just how we look. 
 
Some genes contain instructions for controlling when our cells grow, divide into new cells, and die at the right time. Certain genes that help cells grow, divide, or live longer are called oncogenes. Others that slow down cell division or cause cells to die at the right time are called tumor suppressor genes. Cancers can be caused by DNA changes that turn on oncogenes or turn off tumor suppressor genes. 
 
The DNA in each human cell is packaged in 23 pairs of chromosomes. Changes in chromosomes are sometimes seen in skin lymphoma cells, but there is no single chromosome change that is common to all skin lymphomas. In some cases, part of one of the chromosomes is lost (known as a chromosomal deletion). Translocations, in which DNA from one chromosome breaks off and becomes attached to a different chromosome, are another type of change seen in some skin lymphomas. When these types of chromosome changes happen, oncogenes can be turned on or tumor suppressor genes can be turned off. 
 
Scientists are learning about the exact genes involved in this process and how they may cause lymphoma and other cancers. This information is being used to develop new tests for detecting and classifying certain types of non-Hodgkin lymphoma, as well as for developing new treatments. Even though researchers have found some of the key DNA changes that cause lymphoma, they still do not know why these changes occur. The immune system seems to play an important role in some cases of lymphoma. People with immune deficiencies (due to inherited conditions, drug treatment, organ transplants, or HIV infection) have a much greater chance of developing lymphoma than people without an immune deficiency. 
 
Statistics 
<ul>
<li>Skin lymphomas (T-cell or B-cell, mycosis fungoides, or Sezary syndrome) are very rare.</li>
<li>In the statistics below, only 5% of those diagnosed with Non-Hodgkin lymphoma will have skin lymphoma. In BC, that might be about 45 people each year. 
<ul>
<li>B.C. statistics for these cancers are included with Non-Hodgkin Lymphomas.</li>
<li>Canadian statistics are also grouped in with other Non-Hodgkin Lymphoma. Skin lymphomas are only a very small number of these cases.</li>
</ul>
</li>
</ul>
</div>
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Skin Lymphoma Causes

No specific causes of skin lymphoma are known. Genetic damage to a person’s cells, or immune system suppression (such as caused by AIDS...

Risk Factors for Lymphoma of the Skin

ancorez lymphomas 8:38 PM

<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN28dc5_2-bsbCBATGeBokmOTRxn86wc8QpJW_NXb22uXaT_1urASt_jd0Zm1ItBZaYNbOo5Zl53LMANoyyLmay_GjW9AE8utv4DP8x_hqE1PDWaXlKPxsGx-sB8vk40uvrcycHKSUXBM/s1600/Risk+Factors+for+Lymphoma+of+the+Skin.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN28dc5_2-bsbCBATGeBokmOTRxn86wc8QpJW_NXb22uXaT_1urASt_jd0Zm1ItBZaYNbOo5Zl53LMANoyyLmay_GjW9AE8utv4DP8x_hqE1PDWaXlKPxsGx-sB8vk40uvrcycHKSUXBM/s200/Risk+Factors+for+Lymphoma+of+the+Skin.jpg" width="200" /></a>Lymphoma is a cancer of the lymph system, and most commonly affects lymph nodes in the neck, armpits and groin. But lymph cells are present in all organs of the body - including the skin. Lymphoma can therefore affect the skin as well. Skin lymphoma, also called Cutaneous T-cell Lymphoma (CTCL) is a rare type of non-Hodgkin lymphoma (NHL) that mainly affects the skin. 
 
In many ways this lymphoma is different from other more common types of lymphoma. The way it grows and spreads, the tests that are done, the treatment options are all distinct for lymphoma of the skin. A risk factor is anything that increases your chance of getting a disease like cancer. While most people with lymphoma of the skin may have some factors that make them more likely to get this disease (such as their age or gender), in most people there is no clear cause of the lymphoma. Having one or more risk factors doesn’t mean that you will develop this cancer. There are including the: 
<ul><li>Age: Age is an important risk factor for this disease, with most cases occurring in people in their 50s and 60s.</li>
<li>Gender and race: Most (but not all) types of skin lymphoma are more common in men than in women. Most also tend to be more common in African-Americans than in whites. The reasons for this are not known.</li>
<li>Infections: Infection with the human immunodeficiency virus (HIV), the virus that causes AIDS, may increase a person’s risk of skin lymphoma. In parts of Europe (but not in the United States), infection with Borrelia, the bacteria that causes Lyme disease, has also been linked with skin lymphomas. This link has only been reported in a small number of cases—most people with skin lymphoma have not had Lyme disease, and most people with Lyme disease do not develop lymphoma of the skin.</li>
<li>Weakened immune system: Skin lymphomas may be more common in people with acquired immunodeficiency syndrome (AIDS), who have a weakened immune system. They may also be more common in people who have had an organ transplant such as a heart, kidney or liver transplant. These people must take drugs that suppress their immune system, which may raise the risk of skin lymphoma or lymphomas in other areas of the body.</li>
</ul></div></div>

Risk Factors for Lymphoma of the Skin

Lymphoma is a cancer of the lymph system, and most commonly affects lymph nodes in the neck, armpits and groin. But lymph cells are present ...

Signs and Symptoms of Skin Lymphoma

ancorez lymphomas 12:41 PM

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Lymphoma is not difficult to diagnose once a patient and doctor begin to look for signs of cancer. However, Lymphoma can be something of a silent killer. Lymphomas of the skin can be seen and felt. They can appear as: 
<ul style="text-align: left;">
<li>Nodules or tumors (larger lumps or bumps under the skin)</li>
<li>Papules (small, pimple-like lesions)</li>
<li>Patches (flat lesions)</li>
<li>Plaques (thick, raised or lowered lesions)</li>
</ul>
The lesions are often itchy, scaly, and red to purple in color. The lymphoma might show up as more than one type of lesion and on different parts of the skin (often in areas not exposed to the sun). Some skin lymphomas appear as a rash over some or most of the body (known as erythroderma). Sometimes larger lesions may break open (ulcerate). 
 
Lymphoma symptoms are not specific to the disease. For this reason, it is very important that you tell your doctor during regular checkups about any symptoms that you might be experiencing including: 
 
Chest pain: Chest pain may occur if the lymphoma affects the thymus. 
 
Fatigue / Lack of energy: This can be related to many things but in combination with other symptoms might be significant. 
 
Lower back pain: Obviously, most back pain occurs for reasons apart from lymphoma. However, expanding lymph nodes may press on nerves and cause lower back pain. This type of pain should be considered in the presence of other symptoms. 
 
Night sweats: These will usually occur in conjunction with a fever. 
 
Rashes: Itchy skin (pruritis), rashes and lesions can be a sign of lymphoma, particularly cutaneous lymphoma. 
 
Recurring Fevers: Obviously, fever can be a sign of just about anything. When fever recurs for no apparent reason, especially in conjunction with other symptoms, it could be a sign of lymphoma. 
 
Swollen lymph nodes: Lymphoma may cause swelling of lymph nodes in the neck, chest, abdomen and on the skin. Lymph nodes in the neck frequently swell in cases of sinus infection or can be symptomatic of the flu. But if they persist for a long time or occur apart from other sickness they might be cause for concern. Lymph node swelling in the armpits or abdomen might be cause for more immediate concern. Lymphoma may also cause swelling in the chest area which may interfere with breathing. Lymphomas of the skin often appear as itchy red or purple lumps. Swollen lymph nodes are usually tender and painful to some degree. However, in the case of non-Hodgkin lymphoma, lymph nodes might swell and become firm without any evident pain. 
 
Unexplained weight loss: Sudden and unexpected weight loss of 10% or more of total body weight could be a cause for concern. 
 
Sore lymph nodes after drinking: Alchohol consumption puts stress on the lymphatic system which, along with the liver and kidneys, is part of the body's blood cleansing apparatus. If the lymph system is weakened by lymphoma, drinking may cause pain in the affected areas which means that lymph nodes may be sore after alcohol consumption.</div>
</div>

Signs and Symptoms of Skin Lymphoma

Lymphoma is not difficult to diagnose once a patient and doctor begin to look for signs of cancer. However, Lymphoma can be something of...

How is Lymphoma of the Skin Diagnosed?

ancorez lymphomas 12:13 PM

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A lymphoma diagnosis is not difficult to determine once a patient and doctor begin to look for signs of cancer. However, lymphoma can be something of a silent killer. Symptoms are frequently minor or nonexistent in the early stages. Furthermore, lymphoma symptoms mimic symptoms of common sickness that are familiar and not necessarily threatening to most patients. 
 
Because this type of lymphoma affects the skin, it is often noticed fairly quickly. But the actual diagnosis of skin lymphoma might be delayed because the symptoms often resemble other, more common skin problems. The diagnosis of skin lymphoma can only be confirmed with tests such as biopsies (described below). 
 
1. Biopsy 
 
A biopsy is a procedure in which a doctor removes a sample of body tissue for viewing under a microscope or other lab tests. A biopsy is needed to diagnose lymphoma of the skin. 
 
1.a. Lymph Node Biopsies 
 
Skin lymphomas often spread to lymph nodes, so your doctor may recommend a lymph node biopsy to help confirm the diagnosis or to help determine how widespread the lymphoma is. This is more likely to be done if the doctor detects enlarged lymph nodes, either during a physical exam or with imaging tests (such as a CT scan). 
 
Fine needle aspiration (FNA) biopsy: In an FNA biopsy, the doctor uses a very thin, hollow needle attached to a syringe to withdraw (aspirate) a small amount of tissue from a tumor. If an enlarged node is near the surface of the body, the doctor can aim the needle while feeling it. If the enlarged node is deep inside the body, the doctor can guide the needle while viewing it with ultrasound or a CT scan (see “Imaging tests”). An FNA does not require surgery, but in some cases it cannot remove enough tissue to make a definite diagnosis of lymphoma. But advances in lab tests (discussed later in this section) and the growing experience of many doctors with FNA have improved the accuracy of this procedure. Some doctors will use FNA in patients already diagnosed with lymphoma of the skin to confirm that an enlarged lymph node also contains lymphoma. 
 
Excisional or incisional lymph node biopsy: This is the most common type of lymph node biopsy. In this procedure, a surgeon cuts through the skin to remove either the entire lymph node (excisional biopsy) or a small part of a large tumor (incisional biopsy). If the node is near the skin surface, this is a simple operation that can often be done with local anesthesia. But if the node is inside the chest or abdomen, the patient will be asleep or deeply sedated during the biopsy. Removing a lymph node almost always provides enough tissue to diagnose the exact type of lymphoma. This type of biopsy is preferred by most doctors, if it can be done without too much discomfort to the patient. 
 
1.b. Skin Biopsies 
 
There are several types of skin biopsies, and the doctor’s choice is based on each person’s situation. Usually a skin biopsy is done by a dermatologist. 
 
Incisional and excisional skin biopsies: For these types of biopsies, a surgical knife is used to cut through the full thickness of skin. An incisional biopsy removes only part of the tumor, while an excisional biopsy removes the entire tumor. The piece of skin is removed for testing, and the edges of the wound are sewn together. These biopsies are usually done using a local anesthetic (numbing medicine). 
 
Punch biopsy: For a punch biopsy, the doctor uses a tool that looks like a tiny round cookie cutter (usually a little more than 1/8 inch across). Once the skin is numbed with a local anesthetic, the doctor rotates the punch biopsy tool on the surface of the skin until it cuts through all the layers of the skin. Often the biopsy site is closed with a stitch. 
 
1.c. Other Types of Biopsies 
 
These procedures may sometimes be done to confirm a diagnosis of lymphoma, but they are more often done to help stage (determine the extent of) a lymphoma that has already been diagnosed. 
 
Lumbar puncture (spinal tap): This test looks for lymphoma cells in the cerebrospinal fluid (CSF), which is the liquid that bathes the brain and spinal cord. Most people with skin lymphoma will not need this test. But doctors may order it if a person has symptoms that suggest the lymphoma may have reached the brain. 
 
Bone marrow aspiration and biopsy: These procedures are sometimes done after lymphoma has been diagnosed to help determine if it has reached the bone marrow. The two tests are often done at the same time. The samples are usually taken from the back of the pelvic (hip) bone, but in some cases they may be taken from the sternum (breast bone) or other bones. 
 
In bone marrow aspiration, you lie on a table (either on your side or on your belly). The doctor cleans the skin over the hip and then numbs the area and the surface of the bone with local anesthetic. This may cause a brief stinging or burning sensation. A thin, hollow needle is then inserted into the bone and a syringe is used to suck out a small amount of liquid bone marrow (about 1 teaspoon). Even with the anesthetic, most patients still have some brief pain when the marrow is removed. 
 
A bone marrow biopsy is usually done just after the aspiration. A small piece of bone and marrow is removed with a slightly larger needle that is twisted as it is pushed down into the bone. The biopsy may also cause some brief pain. Once the biopsy is done, pressure will be applied to the site to help stop any bleeding. 
 
2. Blood Tests 
 
Blood tests are used to measure the amounts of certain types of cells and chemicals in the blood. They are not used to diagnose lymphoma, but they can sometimes help determine how advanced the lymphoma is. They may also be done during certain types of treatment (such as chemotherapy) to monitor how well the bone marrow and other organs are functioning. 
 
Blood chemistry tests: These tests look at how well the kidneys and liver are working. Results of another blood test that measures levels of lactate dehydrogenase (LDH) will often be abnormally high in the blood of patients with widespread lymphoma. The level goes up when larger amounts of lymphoma are present. 
 
Complete blood count (CBC): This test measures the levels of different cells in the blood, such as the red blood cells, the white blood cells, and the platelets. The CBC is often done with a differential (or “diff”) which counts the numbers of different types of white blood cells. If a person’s blood counts are low, it might mean that the lymphoma is growing in the bone marrow and crowding out normal blood cell production. 
 
3. Imaging Tests 
 
For skin lymphomas, imaging tests are not always needed for patients with only a few skin lesions, but they are often done in patients with a lot of skin involvement or if lymphoma cells are found in the lymph nodes or blood. 
 
Chest x-ray: An x-ray of the chest may be done to look for enlarged lymph nodes in this area. 
 
Computed tomography (CT) scan: The CT scan is a type of x-ray test that produces detailed, cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into detailed images of the part of your body that is being studied. Unlike a regular x-ray, CT scans can show the detail in soft tissues (such as internal organs). This scan can help tell if any lymph nodes or organs in your body are enlarged. 
 
A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken. Before the test, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You may also receive an IV line through which a different kind of contrast dye (IV contrast) is injected. 
 
The injection can cause some flushing (redness and warm feeling). A few people are allergic to the dye and get hives or, rarely, have more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have any allergies or have ever had a reaction to any contrast material used for x-rays. 
 
Magnetic resonance imaging (MRI) scan: Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed by the body and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body. A contrast material called gadolinium is often injected into a vein before the scan to better see details. The contrast material usually does not cause allergic reactions. 
 
MRI scans are very helpful in looking at the brain and spinal cord, but they are not often used to evaluate skin lymphomas unless a CT scan can’t be done for some reason. MRI scans take longer than CT scans – often up to an hour. You may have to lie inside a narrow tube, which is confining and can be distressing to some people. Newer, more open MRI machines may be another option. The MRI machine makes loud buzzing and clicking noises that you may find disturbing. Some places provide headphones or earplugs to help block this out. 
 
Positron emission tomography (PET) scan: For a PET scan, a radioactive substance (usually a type of sugar related to glucose, known as FDG) is injected into the blood. The amount of radioactivity used is very low. Because cancer cells in the body grow quickly, they absorb large amounts of the radioactive sugar. After about an hour, you will be moved onto a table in the PET scanner. You lie on the table for about 30 minutes while a special camera creates a picture of areas of radioactivity in the body. The picture is not finely detailed like a CT or MRI scan, but it can look for possible areas of lymphoma in all areas of the body at once. 
 
PET scans can help tell if an enlarged lymph node contains lymphoma or is benign. It can also help spot small areas that might be lymphoma, even if the area looks normal on a CT scan. PET scans can also be used to tell if a lymphoma is responding to treatment. Some doctors will repeat the PET scan after 1 or 2 courses of chemotherapy. If the chemotherapy is working, the abnormal areas will no longer take up the radioactive sugar. Some newer machines are able to perform both a PET and CT scan at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT. 
 
Ultrasound: Ultrasound uses sound waves and their echoes to produce a picture of internal organs or masses. For this test, a small, microphone-like instrument called a transducer is placed on the skin (which is first lubricated with a gel). It gives off sound waves and picks up the echoes as they bounce off the organs. The echoes are converted by a computer into a black and white image that is displayed on a screen. 
 
Ultrasound can be used to look at lymph nodes near the surface of the body or to look inside your abdomen for enlarged lymph nodes or organs such as the liver and spleen. (It can’t be used to look at organs or lymph nodes in the chest because the ribs block the sound waves.) It is sometimes used to help guide a biopsy needle into an enlarged lymph node. This is an easy test to have done, and it uses no radiation. You simply lie on a table, and a technician moves the transducer over the part of your body being looked at 
 
4. Lab Tests of Biopsy or Blood Samples 
 
These tests may be done on biopsy samples or, in some cases, blood samples to help diagnose lymphoma and determine what type it is. Pathologists can sometimes tell which kind of lymphoma a patient has by just looking at the cells under a microscope, but usually these other types of tests are needed to confirm the diagnosis. 
 
Cytogenetics: This technique allows doctors to evaluate the chromosomes (long strands of DNA) in the lymphoma cells. The cells are looked at under a microscope to see if the chromosomes have any translocations (where part of one chromosome has broken off and is now attached to another chromosome), as happens in certain types of lymphoma. Some lymphoma cells may have too many chromosomes, too few chromosomes, or other chromosome abnormalities. These changes can help identify the type of lymphoma. Cytogenetic testing usually takes about 2 to 3 weeks because the lymphoma cells must be grown in lab dishes for a couple of weeks before their chromosomes can be viewed under the microscope. 
 
Flow cytometry: For this test, a sample of cells is treated with special antibodies that stick to the cells only if certain substances are present on their surfaces. The cells are then passed in front of a laser beam. If the cells now have antibodies attached to them, the laser will cause them to give off light, which can be measured and analyzed by a computer. Groups of cells can be separated and counted by these methods. 
 
This is the most commonly used test for immunophenotyping – classifying lymphoma cells according to the substances (antigens) on their surfaces. Different types of lymphocytes have different antigens on their surface. These antigens may also change as each cell matures. Flow cytometry can help determine whether a biopsy sample contains lymphoma, some other cancer, or a non-cancerous disease. It has also become very useful in helping doctors determine the exact type of lymphoma so that they can select the best treatment. 
 
Immunohistochemistry: In this test, a part of the biopsy sample is treated with special antibodies (man-made versions of immune system proteins) that attach to cells only if specific molecules are on their surface or inside the cells. These antibodies cause color changes, which can be seen under a microscope. This test can be used to help diagnose lymphoma and tell what type it is. 
 
Molecular genetic tests: In this test, a part of the biopsy sample is treated with special antibodies (man-made versions of immune system proteins) that attach to cells only if specific molecules are on their surface or inside the cells. These antibodies cause color changes, which can be seen under a microscope. This test can be used to help diagnose lymphoma and tell what type it is. 
 
5. Medical History and Physical Exam 
 
Usually the first step is for your doctor to take your medical history. The doctor probably will ask when the changes in your skin first appeared, whether they have changed in size or appearance, and whether they are itchy or painful. You may be asked if you have any other symptoms, like fever or weight loss. Because skin lymphomas can be hard to tell apart from allergies and other causes of rashes, you might also be asked if you have recently been exposed to something that could be causing your skin problems, such as if you are taking a new medicine or are using a new laundry detergent. 
 
During the physical exam, your doctor will note the size, shape, color, and texture of any area(s) of skin in question. The rest of your body will be checked for other areas of skin involvement. The doctor may also feel the lymph nodes (small, bean-sized collections of immune cells) under the skin in the neck, underarm, or groin, as lymphomas can sometimes cause lymph nodes to become enlarged. If you are being seen by your primary doctor and skin lymphoma or another type of skin cancer is suspected, you may be referred to a dermatologist (a doctor who treats skin diseases), who will look at the skin more closely. 
 </div>
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How is Lymphoma of the Skin Diagnosed?

A lymphoma diagnosis is not difficult to determine once a patient and doctor begin to look for signs of cancer. However, lymphoma can be...

Cutaneous B-Cell Lymphoma (CBCL)

ancorez lymphomas 2:15 AM

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Cutaneous lymphomas represent a unique group of lymphomas and are the second most frequent extranodal lymphomas. They can be defined as lymphoproliferative skin infiltrates of T-cell, B-cell, or natural killer cell lineage, which primarily occur in and remain confined to the skin in most patients, without detectable extracutaneous manifestations at diagnosis. 
 
B-cell lymphomas account for the majority of nodal lymphomas, whereas primary cutaneous B-cell lymphomas (CBCLs) represent 20-25% of all cutaneous lymphomas. Because CBCLs have an overall favorable prognosis, proper recognition is vital for appropriate therapy and to avoid overtreatment in most cases. The tumor type and the extent of cutaneous involvement are the 2 most relevant prognostic factors in primary CBCL. 
 
Types of Cutaneous B-Cell Lymphoma 
 
Primary Cutaneous Diffuse Large B-cell Lymphoma is less common than other CBCLs, but is usually more aggressive (fast-growing), developing over weeks or months. This lymphoma usually appears as red or bluish-red lesions on the lower legs, although lesions can occur on any part of the body. The lesions frequently grow into large tumors that extend deep into the body. The lesions may become open sores and spread outside the skin more frequently than the slow-growing CBCLs. 
 
Intravascular Large B-Cell Lymphoma describes a group of very rare lymphomas, including intravascular large B-cell lymphoma, T-cell rich large B-cell lymphoma, plasmablastic lymphoma, and anaplastic B-cell lymphoma. Although these lymphomas usually appear on the head, trunk, and extremities, they are almost always systemic lymphomas with cutaneous symptoms and thus do not truly fit among the CBCLs. 
 
Primary Cutaneous Follicle Center Lymphoma is the most common type of CBCL. These skin lymphomas develop slowly over months or years. They usually appear on the head, neck, or trunk of the body as single or multiple tumors or nodules with a pink or reddish appearance. 
 
Primary Cutaneous Marginal Zone B-cell Lymphoma (MALT-Type) is the second most common form of CBCL. This slow-growing lymphoma appears as pink or red lesions, nodules, and/or tumors, most commonly found on the extremities, although they can occur anywhere on the body. 
 
Treatment and Management for Cutaneous B-Cell Lymphoma 
 
Overtreatment in follicle center lymphoma (FCL) and marginal zone B-cell lymphoma (MZL) must be avoided because cutaneous B-cell lymphomas (CBCLs) have a much better prognosis than their nodal counterparts. Aggressive systemic treatment regimens are suitable only for diffuse large B-cell lymphoma (DLBCL) and for patients with extracutaneous spread. Treatment follows standard regimens for primary nodal lymphomas in these patients, as in B-cell lymphoma. The treatment of primary cutaneous lymphomas associated with an excellent prognosis depends on whether the patient has a solitary lesion or multiple lesions. 
 
First-line treatments for solitary lesions include surgical excision, antibiotics, and radiotherapy. Antibiotics and radiotherapy, but not surgical excision, are also first-line treatments for multiple lesions. Antibiotic treatment consists of doxycycline at 100 mg twice daily for 3 weeks or pulse therapy with cefotaxime in Borrelia -associated cases. Radiotherapy may include the following: 
<ul>
<li>20-100 kV Orthovolt therapy 1-4 times per week, to a total dose of up to 15-20 Gy</li>
<li>Extended-field irradiation at 30 Gy (4 fractions of 2.5 Gy/wk)</li>
<li>Localized-field irradiation as either a boost after extended-field irradiation or as definitive treatment</li>
<li>Energies of 45 kV x-ray filtered by 0.55 aluminum for small-depth lesions and higher energies (≤100 kV) for deeper lesions; radiation dose varies from 30-40 Gy (fractions of 2 Gy/wk)</li>
</ul>
Second-line treatments for solitary lesions include the following: 
<ul>
<li>Intralesional glucocorticosteroids</li>
<li>Intralesional rituximab: Injections 2-3 times weekly; single doses of 1-3 mL of stock solution (10 mg mL-1) or 3 times a week with 3 mL of stem solution (at 10 mg/mL); therapy repeated 6 times every 26 days</li>
<li>Intralesional interferon alfa: 3 and 9 million U subcutaneously (weekly basis) or 9 million U 3 times a week</li>
</ul>
Second-line treatments for multiple lesions include the following: 
<ul>
<li>Intralesional interferon alfa: 3 and 9 million U subcutaneously (weekly basis) or 9 million U 3 times a week</li>
<li>Intralesional rituximab: Injections 2-3 times weekly; single doses of 1-3 mL of stock solution (10 mg mL-1) or 3 times a week with 3 mL of stem solution (at 10 mg/mL); therapy repeated 6 times every 26 days</li>
<li>Intravenous rituximab: 375 mg/m2 weekly for 4 weeks</li>
</ul>
The treatment of primary cutaneous lymphomas associated with a poor prognosis (ie, DLBCL, intravascular lymphoma) is shown below (also see B-Cell Lymphoma). First-line treatment for isolated or grouped lesions includes the following: 
<ul>
<li>Radiotherapy: 20-100 kV Orthovolt therapy 1-4 times per week, to a total dose of up to 15-20 Gy ; extended-field irradiation at 30 Gy (4 fractions of 2.5 Gy/wk); localized-field irradiation as either a boost after extended-field irradiation or as definitive treatment; energies of 45 kV x-ray filtered by 0.55 aluminium for small depth lesions and higher energies (≤100 kV) for deeper lesions; radiation dose varies from 30-40 Gy (fractions of 2 Gy/wk)</li>
<li>Surgical excisions</li>
</ul>
First-line therapies for multiple lesions include the following: 
<ul>
<li>Monochemotherapy: Liposomal doxorubicin or pegylated liposomal doxorubicin at 20-40 mg/m2 intravenously every 2-4 weeks</li>
<li>Polychemotherapy: CHOP (cyclophosphamide, hydroxydaunorubicin, Oncovin [vincristine], and prednisone) regimen</li>
</ul>
Second-line therapy for multiple lesions is polychemotherapy (as above) plus rituximab. 
 
Treatments Under Investigation 
 
Many treatments at various stages of drug development are currently being tested in clinical trials and for relapsed or refractory CBCL, including panobinostat, lenalidomide, bendamustine, and others. It is critical to remember that today’s scientific research is continuously evolving. Treatment options may change as new treatments are discovered and current treatments are improved. Therefore, it is important that patients check with LRF or with their physician for any treatment updates that may have recently emerged. 
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Cutaneous B-Cell Lymphoma (CBCL)

Cutaneous lymphomas represent a unique group of lymphomas and are the second most frequent extranodal lymphomas. They can be defined as ...

Cutaneous T-cell lymphoma (CTCL)

ancorez lymphomas 1:47 AM

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Lymphomas are tumours of the lymph nodes and lymphatic system. Extranodal lymphomas are tumours that occur in organs or tissues outside of the lymphatic system. When lymphomas occur in the skin with no evidence of disease anywhere else at the time of diagnosis, they are called ‘primary’ cutaneous lymphomas. There are many different types of primary cutaneous lymphomas but they can be broadly divided into two categories, cutaneous T-cell lymphomas and cutaneous B-cell lymphomas. Of all primary cutaneous lymphomas, 65% are of the T-cell type. 
 
Types of Cutaneous T-Cell Lymphoma 
 
CTCL describes many different disorders with various symptoms, outcomes, and treatment considerations. The two most common types are mycosis fungoides and Sézary syndrome. 
 
Mycosis fungoides: Mycosis fungoides is the most common type of CTCL, with approximately 16,000 to 20,000 cases across the United States, accounting for half of all CTCLs. The disease looks different in each patient, with skin symptoms that can appear as patches, plaques, or tumors. Patches are usually flat, possibly scaly, and look like a rash; plaques are thicker, raised, usually itchy lesions that are often mistaken for eczema, psoriasis, or dermatitis; and tumors are raised bumps, which may or may not ulcerate. It is possible to have more than one type of lesion. 
 
A medical history, physical exam, and skin biopsy are essential for diagnosis. A physician will examine lymph nodes, order various blood tests, and may conduct other screening tests, such as a chest x-ray or a computed axial tomography (CAT) scan. Scans are usually not needed for those with the earliest stages of the disease. Mycosis fungoides is difficult to diagnose in its early stages because the symptoms and skin biopsy findings are similar to those of other skin conditions. 
 
Sezary syndrome: Sezary syndrome is an advanced, variant form of mycosis fungoides, which is characterized by the presence of lymphoma cells in the blood. Extensive thin, red, itchy rashes usually cover over 80 percent of the body. In certain patients, patches and tumors appear. Patients may also experience changes in the nails, hair, or eyelids, or have enlarged lymph nodes. 
 
Many of the same procedures used to diagnose and stage other types of cutaneous T-cell lymphomas are used in Sézary syndrome. In addition, a series of imaging tests may be needed to determine if the cancer has spread to the lymph nodes or other organs (although that uncommonly occurs). These tests may include a CAT scan, a positron emission tomography (PET) scan, and/or a magnetic resonance imaging (MRI) scan. A bone marrow biopsy may also be done, but is usually not necessary. 
 
Causes of Cutaneous T-Cell Lymphoma 
 
The causes of CTCL are unknown. Like other cancers, it’s not infectious and can't be passed on to other people. 
 
Symptoms of Cutaneous T-Cell Lymphoma 
 
The symptoms of CTCL will depend on the stage it is at when you are diagnosed. In the very early stage, CTCL can look like skin conditions such as eczema or psoriasis. There are red, rash-like patches on the skin. The skin may be scaly and the patches are sometimes raised (plaques). Itching is a common symptom. There may be one or more lumps (tumours) on the skin and some people may have swollen lymph nodes. In the advanced stage, large areas of skin are affected. The skin is very red, scaly and itchy, and it may be painful. It's often swollen and looks thicker in parts. 
 
How Cutaneous T-Cell Lymphoma is Diagnosed? 
 
The diagnosis is made by removing a small piece of affected skin (skin biopsy) and examining it under a microscope for abnormal cells. You can have this done under local anaesthetic. Your doctor will also carry out a full examination of your skin and lymph nodes. You will have blood tests taken to check if there are any abnormal lymphocytes present. 
 
Some people may also have scans such as a CT (computerised tomography) scan or a MRI (magnetic resonance imaging) scan to check that the lymphoma hasn't spread. If your lymph nodes are swollen, you may have a biopsy or have them removed so they can be examined under a microscope for lymphoma cells. Occasionally a sample of the bone marrow may be taken (bone marrow biopsy) and examined under the microscope. 
 
Treatment Options for Cutaneous T-Cell Lymphoma 
 
The treatment you have will depend on the stage of the CTCL. Different treatments can be used and you may have a combination of them. Your specialist will discuss the treatment options with you. In early CTCL, treatments given directly to the skin are usually used. This includes steroid cream, chemotherapy cream (topical chemotherapy), PUVA or radiotherapy. These are explained below. 
 
If CTCL is advanced or isn't responding to other treatments, systemic treatments are used. Chemotherapy (see below) or drugs called biological therapies are given directly into your bloodstream and can treat the whole body (systemic). You may also be given treatments directly to the skin. 
 
Alemtuzumab (Mabcampath®): This drug is a monoclonal antibody. Monoclonal antibodies recognise and stick to certain proteins on the surface of some cancer cells. This can trigger the immune system to attack the cancer cells and cause them to destroy themselves. Alemtuzumab, usually called Campath, is generally given when CTCL has come back after other treatments have already been tried. 
 
Bexarotene: Bexarotene (Targretin®) belongs to a group of drugs called retinoids. It can be taken daily as a capsule to treat CTCL that has come back after other treatments have been tried. Bexarotene can be given along with other treatments such as PUVA. 
 
Chemotherapy: If CTCL is advanced or is not responding to other treatments, chemotherapy by injection into a vein, or as a tablet, may be given to help control it. Low doses of a drug called methotrexate or another drug called chlorambucil can be given as tablets to treat early disease. In advanced disease you may be given a single drug or sometimes a combination of drugs, usually by injection into a vein. Chemotherapy drugs that may be used are gemcitabine, pentostatin or liposomal doxorubicin. 
 
Creams to the skin (topical treatments): Steroid cream applied to the skin may be the only treatment needed for early stage CTCL. Chemotherapy creams may be used. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is also given as a cream that can be applied to the affected skin. You'll need to make sure you only put the cream on the area where you've been told to apply it and you must wear gloves to protect your hands. 
 
Your doctor, a nurse or a pharmacist will explain this to you. It's important to follow the instructions they give you carefully. Some people may have a reaction to the cream. Let your doctor know if you have any side effects, such as redness or a burning sensation in the area. 
 
Extra-corporeal photopheresis (ECP): ECP is only used in advanced disease when the majority of the skin is affected and very red, and there are lymphoma cells in the blood. This treatment is only available in some specialist centres. ECP is a systemic (treats the whole body) type of PUVA treatment. Blood is removed from your body by connecting you to a special machine. The blood is then treated with ultraviolet light and drugs that become active when exposed to light. The treated blood is then returned to the body. Your doctor or nurse will give you more information about this treatment. 
 
Interferon: Interferon is a protein that occurs naturally in the body. It is sometimes injected just under the skin (subcutaneously) to boost the body’s own immune system to control the lymphoma. It may be given on its own or with other treatments, such as PUVA or bexarotene. The most common side effects of interferon are tiredness, aches and pains, fever and a low mood. 
 
PUVA treatment: PUVA (sometimes known as photochemotherapy) is an effective treatment for early CTCL, especially for treating plaques (raised red patches). It involves taking a drug called psoralen (P), which makes your skin sensitive to ultraviolet light (UVA). Once the drug has had time to collect in your skin, you go into an enclosed air-conditioned cabinet to have the ultraviolet light treatment. 
 
You may have this done a few times a week, with treatments reducing as skin symptoms improve. Treatment with PUVA is sometimes continued when the symptoms have gone away. This is done to help keep CTCL in remission (when there are no signs of the disease). 
 
This treatment tans the skin and can cause early ageing of the skin. Sometimes the skin may become red, like mild sunburn. Over the period of your treatment, you'll need to be careful not to expose your skin to extra ultraviolet light from the sun. Exposure to ultraviolet light can increase the risk of developing other types of skin cancer. The number of treatments you have with PUVA is limited to reduce the risk of this happening, and your skin is carefully monitored. Your doctor or specialist nurse can discuss this with you further. We have more information on taking care of your skin in the sun. 
 
Psoralen makes the eyes more sensitive to ultraviolet light, so you will need to wear protective glasses for around 12 hours from the time the drug is taken. The psoralen tablets can make you feel sick. If this happens you can be given anti-sickness (anti-emetic) drugs or it may be possible to be prescribed a different tablet. Other possible side effects of PUVA include itching, dizziness and headaches. 
 
Radiotherapy: Radiotherapy is the use of high-energy rays to destroy cancer cells. It's an effective treatment for early CTCL, when there are small areas of affected skin in the one area. It can also be used to ease skin symptoms when CTCL is advanced. The side effects are redness of the skin and hair loss in the area being treated. 
 
Total electron beam therapy (EBT): This is a type of radiotherapy. It can be used to treat larger areas of CTCL, that haven’t spread below the skin surface. The treatment can be repeated if necessary. It's only available at some specialist centres. 
 
The side effects are mainly skin changes and hair loss in the area of skin that's being treated. Sweat glands in treated areas may no longer work. The extent of side effects will depend on the size of the area treated. 
 
UVB therapy: UVB light (ultraviolet light from wavelength B) can help slow down the growth of skin cells and may be used to treat CTCL. The treatment is delivered in a similar way to PUVA, using an air-conditioned cabinet containing ultraviolet lights. However, you don’t need to take a drug to make your skin more sensitive to light. Treatment may be given a few times a week. 
 
UVB therapy causes similar skin side effects to PUVA. Because ultraviolet light increases the risk of other types of skin cancer, you will also need to avoid exposing the skin to extra UV light from the sun. Your doctor or specialist nurse can discuss this with you further. 
 
Treatments Under Investigation 
 
Many treatments at various stages of drug development are currently being tested in clinical trials and for various stages of CTCL, including everolimus (Afinitor), lenalidomide (Revlimid), brentuximab vedotin (Adcetris), panobinostat, forodesine, APO866, KW0761, and others. It is critical to remember that today's scientific research is continuously evolving. Treatment options may change as new treatments are discovered and current treatments are improved. Therefore, it is important that patients check with LRF or with their physician for any treatment updates that may have recently emerged.</div>
</div>

Cutaneous T-cell lymphoma (CTCL)

Lymphomas are tumours of the lymph nodes and lymphatic system. Extranodal lymphomas are tumours that occur in organs or tissues outside ...

Lymphoma of the Skin

ancorez lymphomas 1:14 AM

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Lymphoma is a cancer of the lymph system, and most commonly affects lymph nodes in the neck, armpits and groin. But lymph cells are present in all organs of the body - including the skin. Lymphoma can therefore affect the skin as well. Skin lymphoma, also called Cutaneous T-cell Lymphoma (CTCL) is a rare type of non-Hodgkin lymphoma (NHL) that mainly affects the skin. There are 2 main types of lymphomas: 
<ul>
<li>Hodgkin lymphoma (also called as Hodgkin’s lymphoma, Hodgkin disease, or Hodgkin’s disease)</li>
<li>Non-Hodgkin lymphoma (also called as non-Hodgkin’s lymphoma, NHL, or sometimes just lymphoma), which contains all other lymphomas, including all skin lymphomas</li>
</ul>
 
Lymphoid Tissue and Lymph System 
 
Lymphoid tissue is found throughout the body and contains several types of immune system cells that work together to help the body fight infections. The lymph system (also known as the lymphatic system) is made up of lymphoid tissue, lymph vessels, and a clear fluid called lymph. 
 
Lymphoid tissue 
 
Most lymphocytes are in lymph nodes, which are small, bean-sized collections of immune cells throughout the body. Lymph nodes are connected to each other by narrow tubes similar to blood vessels called lymphatics (or lymph vessels). Lymph vessels carry a colorless, watery fluid (lymph) that contains lymphocytes. Along with the lymph nodes, collections of lymphocytes can be found in many other places in the body, including the: 
<ul>
<li>Adenoids and tonsils</li>
<li>Bone marrow</li>
<li>Digestive tract</li>
<li>Skin</li>
<li>Spleen</li>
<li>Thymus</li>
<li>Other organs</li>
</ul>
Lymphomas can start in any part of the body that contains lymphoid tissue. 
 
Lymphocytes 
 
B lymphocytes: B cells normally help protect the body against germs (bacteria or viruses) by making proteins called antibodies. The antibodies attach to the germs and attract other immune system cells that then surround and digest the antibody-coated germs. Antibodies also attract certain blood proteins that can kill bacteria. 
 
T lymphocytes: There are several types of T cells, each with a specialized job. Some T cells help protect the body against viruses, fungi, and some bacteria. For example, they recognize virus-infected cells and destroy them. T cells can also release substances called cytokines that attract other types of white blood cells, which then digest the infected cells. Some types of T cells help boost or slow the activity of other immune system cells. 
 
Both types of lymphocytes can develop into lymphoma cells. Overall, B-cell lymphomas are much more common than T-cell lymphomas in the United States. In the skin, though, T-cell lymphomas are more common than B-cell lymphomas. Different types of lymphoma can develop from each type of lymphocyte. 
 
This information is important because for each type of lymphoma, the cancer cells tend to resemble a particular type of normal lymphocyte at a certain stage of development. Figuring out the type of lymphoma a person has helps determine treatment options.</div>
</div>

Lymphoma of the Skin

Lymphoma is a cancer of the lymph system, and most commonly affects lymph nodes in the neck, armpits and groin. But lymph cells are pres...

Definition and Description of Lymphoma

Gaptek_ancorez lymphomas 2:18 AM

<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;"><h1>Definition</h1><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHY_e4i4qquebCcSbcZOvwth0BlAH2Dx9dLuGAmFLtjggYwAsMoPruj29vB-jk5WfsPgtTwaVcIl299MtVzo8iXpl15rRXFeZTXVjQiq5dWKYJ745n-cIs0cDvrSrutuiDTB5ZgNSVImau/s1600/Definition+and+Description+of+Lymphoma.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="158" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHY_e4i4qquebCcSbcZOvwth0BlAH2Dx9dLuGAmFLtjggYwAsMoPruj29vB-jk5WfsPgtTwaVcIl299MtVzo8iXpl15rRXFeZTXVjQiq5dWKYJ745n-cIs0cDvrSrutuiDTB5ZgNSVImau/s200/Definition+and+Description+of+Lymphoma.jpg" width="200" /></a> 
Lymphoma is the name of a diverse group of <a href="http://cancer-666.blogspot.com/">cancer</a>s of the lymphatic system, a connecting network of glands, organs and vessels whose principle cell is the lymphocyte. 
 
What is the lymph system? 
 
The lymph system is an interconnected network of thin tubes and nodes that carries white blood cells. These cells fight infections and are vitally important for our well-being. You can read more about the lymph system in the article - What is the lymph system?. So when a lymphocyte (a type of white blood cell) that is a part of the lymph system becomes cancerous, it may grow and multiply to form a lymphoma. 
 
<h2>Description</h2> 
Cancer cells are the descendants of a single normal cell in which genetic errors, or mutations, have occurred. These errors cause the cancer cells to over- or under-produce proteins that abnormally affect the cell's behavior - causing these cells divide too fast or fail to die when they should. 
 
Cancer cells are typically clonal meaning that the descendent cells share the defects of the parent cell, but they can acquire additional mutations. 
 
The malignant behavior, such as how aggressive or slow growing it might be, is determined by the cell type, the kinds of mutations, and sometimes the host environment. 
 
There are as many kinds of cancers as there are cell types: skin, lung cancer, and blood cell cancers, etc. In cells, genetic errors occur in the basic building blocks of DNA called genes. These errors might occur randomly when the cell divides, or they may result from exposure to environmental toxins called carcinogens - meaning able to cause cancer.</div></div>

Definition and Description of Lymphoma

Definition Lymphoma is the name of a diverse group of cancer s of the lymphatic system, a connecting network of glands, organs and vessels...

CanCer-666