Transcript The incidence of non-Hodgkin`s lymphoma (NHL)

Epidemiology
Etiology
Of Lymphoma
Dr.Azarm
Epidemiology
In the United States, approximately
55,000 new cases of non-Hodgkin’s
lymphoma are diagnosed annually,
and about 25,000 people die of the
disease each year.
Epidemiology
The incidence of non-Hodgkin's
lymphoma (NHL) has doubled over
the past two decades in the US and
most other westernized countries
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The annual incidence
of non-Hodgkin lymphoma has nearly
doubled over the last 55 years
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Up to 35 to 65 percent of
Poorly - differentiated
neoplasms of unknown
primary site may represent
cases of NHL
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0
0
0
Cancer in Men
0
0
0
0
0
0
Skin
Lymphoma
Bladder
Stomach
Blood
Lung
Colon
Rectum
Esophagus
Prostat
800
700
Cancer in Women
600
500
400
300
200
100
0
skin
Stomach
rectom
Lung
Blood
Breast
Lymphoma
Colon
Esophagus
Other
:Etiology
The etiology is unknown
- Genetic,
- Environmental,
- Infectious agents have been implicated.
- Familial clusters have been described, and
there may be a slightly higher risk of nonHodgkin’s lymphoma among siblings or
first-degree relatives of patients with
lymphoma or other hematologic
malignancies.
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Etiology:
Ultraviolet (UV) irradiation may cause
immunosuppression However,
studies that have especially
evaluated the possible role of UV light
in NHL have shown an increased risk
for outdoor occupations or exposure
to sunlight
Epstein-Barr virus:
It has been associated with Burkitt lymphoma.
EBV is persistent in over 95% of adults in
nasopharyngeal epithelium and B cells
Normally, EBV production is held back by
active cellular and humoral immune
mechanisms.
In immunodeficiency states, this balance may
be disrupted, and EBV-infected B cells begin
to proliferate.
Specific illnesses which are risk factors
for the development of gastrointestinal lymphoma include
Crohn's disease
Gastrointestinal nodular lymphoid hyperplasia
Helicobacter pylori-associated chronic gastritis
Celiac diseas
Ethiologic factors in NHL
_ TCR
_ Congenital Immunodeficiency s.
_ Aquaired. I . d.
_ Auto-immune disorders
_ Viral cofactors:
Epstein Barr Virus
HIV
HTLV-1
Herpes Virus
Helicobacter Pylori
_ Organ Transplantation
immunosuppression , and blood transfusion
transmission of viruses have been discussed Increased
incidence of NHL.
It has been reported among patients with: :
- Autoimmune congenital immune deficiency.
- Rheumatoid arthritis.
- Sjögren's syndrome.
- Systemic lupus erythematosus .
- immunosuppressive Therapy.
Chemotherapy and radiotherapy regimens in patients with
Hodgkin's disease.
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The insecticide chlordane,
significantly higher concentrations
were found in NHL cases than in
the sum controls in the same study
of chlordanes in the 27 NHL patients
was 180 ng/g lipid compared to 92.8
in the 17 surgical controls
Etiology:
:
Infections:
-Infection with HIV
Infection with human T-lymphocytic virus type 1 (HTLV-1)
-Infection with Epstein-Barr virus (EBV), one of the etiologic
factors in Infectous mononucleosis.
-A bacterium that lives in the digestive Helicobacter pylori
-Autoimmune disease
-Diseases requiring immune suppressive therapy, often used
following organ transplant.
-Inherited immunodeficiency diseases (severe combined
- immunodeficiency, ataxia telangiectasia,
MALIGNANCY due to EBV
Burkitt's lymphoma (NHL)
Hodgkin's disease
Nasopharyngeal carcinoma
T cell lymphoma
Nasal/nasal type angiocentric lymphoma
Oncogenic viruses :
The infection of cells by oncogenic viruses must be
considered to be a genetic lesion, since viruses
introduce foreign genes into their target cells.
Three distinct viruses are associated with the
pathogenesis of specific NHL subtypes .
-Epstein-Barr virus (EBV)
-Human T-cell lymphotropic virusI (HTLV-I)
-Human Herpes virus-8 (HHV-8)
-Simian virus 40
Simian virus 40
Simian virus-40 (SV-40) is a polyoma virus
with oncogenic potential in humans and
animals.
Its actions are thought to result from inactivation
of tumor suppressors p53
AIDS-related lymphomas:
(AIDS-NHL) are invariably derived from B-cells and
are classified into 3 main groups:
1- AIDS-related BL (AIDS-BL) .
2- AIDS-related DLBCL (AIDS-DLBCL).
3- AIDS-related body-cavity-based lymphomas
(AIDS-BCL) represent a rare additional type of AIDS-NHL.
Ultraviolet radiation,
previously demonstrated to have an
immunosuppressive effect, has also been
suggested as a possible risk factor for NHL
:Factors thought to increase risk of lymphoma include
Chemical exposures
- dioxins, PCBs,
pesticides, solvents, and fertilizer
Chronic infections- H pylori is strongly
Depressed immunity - such as caused by
immune-suppressing drugs used to prevent
rejection of organ transplants
People infected with the
hepatitis C virus (HCV)
are at an increased risk
of developing certain
lymphomas
Factors Associated with the development of Non-Hodgkin’s Lymphoma
1- Immune abnormalities:
Inherited disorders
Common variable immunodefeciency ,
Wiskott-Aldrich syndrome
Ataxia-telangictasia ,
X-linked lymphoprolifrative disorder
Acquired disorders:
Solid organ transplant recipients
Acquired immunodeficiency syndrome
Methotrexate therapy for autoimmune disorders
Rheumatoid arthritis , Sjogren’s syndrome , Hashimoto’s thyroiditis
2- Infectious agents:
Epestein – Barr Virus
Human T-cell lymphotropic virus type ! ,
Hepatitis C Virus,
Human herpes virus 8
Helicobacter pylori
3- Occupational and environmental exposure:
Herbicides,
Organic Solvents,
Hair dyes,
Ultraviolet light