Episode 84. Lymphoma with Professor Stephen Opat (Part 2)
Lymphoma is a clonal neoplastic proliferation of lymphoid cells (B cells, T cells and NK cells) and is the sixth most common malignancy reported in this country which makes it the most common hematologic malignancy with over 5000 cases diagnosed each year in Australia putting lifetime risk at 1 in 50.
There are over 70 different types of lymphoma which are divided into 2 main groups: Hodgkin's lymphoma accounts for 10% of cases and non-Hodgkin's lymphoma accounts for 90% of cases.
Hodgkin's lymphoma named after Thomas Hodgkin (1832) is more common in men, and tends to occur at a younger age than non-Hodgkin's lymphoma with a bimodal age distribution but the average age at diagnosis of 39 years and involves lymph nodes frequently on just one side of the body usually above the diaphragm. The tumour cell is referred to as the Reed Sternberg cell which is a bi or multi-nucleated B cell comprising characteristically just 1% of the lymphoma mass. Just to make this nomenclature interesting there is classic Hodgkins which make up about 95 % of cases and of which nodular sclerosing comprises about 70 % and mixed cellularity 20-25 % and non-classic Hodgkins is characterised by nodular lymphocytic predominant pathology.
Non-Hodgkin's lymphoma can occur at any age and although the median age at diagnosis is 67 years it is one of the more common cancers among children, teens and young adults, none the less the risk of developing NHL increases throughout life and more than half the patients with NHL are 65 years or older at diagnosis. It is also more common amongst men and those with autoimmune diseases or a family history of hematologic malignancies. Presentations often involve the finding of involved lymph nodes on either side of the diaphragm. 85% of non-Hodgkin lymphomas are B cells in origin, and 15% are T cells. The most common the B cell non-Hodgkin lymphomas are diffuse large B cells -accounting for 37% of NHL cases, followed by follicular 29%, Malt 9% and Mantle cells 7%.
This is a complex and vast subject with a number of environmental factors and associated diseases influencing the fascinating pathogenesis of lymphoma which goes to the heart of B cell biology and our immune systems’ task of fighting for our lives against antigen invaders. There are a host of treatment options available with new emerging therapies at the cutting edge of medicine and it was a privilege to have a conversation with Professor Stephen OPAT -and to journey for a short time into his world of haematology. Stephen is the professor and director of clinical haematology at MMC and has a special interest in lymphoma, chronic leukaemia, cancer genomics and disorders of metabolism. I found Stevens’ conversation incredibly insightful and welcome you to this podcast:
References:
www.melbournehaematology.com.au
www.uptodate.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.