Non-Hodgkin's Lymphoma

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Questions to Ask Your Doctor About Your Cancer
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Risk Factors

Although scientists have studied the many cellular changes associated with lymphoma, no one really knows why such changes occur. It is likely that certain risk factors make individuals more prone to developing non-Hodgkin's lymphoma (NHL). Many factors - such as age and genetics - are probably beyond our control. Other factors, such as environmental or lifestyle-related variables, may be more correctable.

It is now known that all cancers, including lymphoma, begin as a mutation (change) in the genetic material - the DNA (deoxyribonucleic acid) - within certain cells. The external or internal causes of such change probably add up over a lifetime. DNA errors may occur in the form of translocations - damage produced when part of one chromosome becomes displaced and attached to another chromosome. Translocations disrupt the normal sequencing of the genes. As a result, oncogenes (cancer-promoting genes) on the chromosomes may be switched on, whereas tumor suppressors (cancer-preventing genes) may be switched off. These changes often occur in cases of lymphoma. Physicians test for these translocations to help diagnose the type of lymphoma, determine a patient's prognosis (outcome), and identify cancer recurrence.

Numerous risk factors may be responsible for DNA damage within the body's lymphocytes (specialized white blood cells). The risk factors now believed to have the strongest associations with lymphoma are:

• Age
• Sex
• Infections
• Medical Conditions
• Chemicals
• Genetics
• Cancer Therapy

Age
The rate of NHL increases exponentially with age between 20 and 79 years, and the rate of HD is highest in two age groups: young adults (age 15 - 40) and older adults (age 55+).

Sex
In general, both HD and NHL affect more men than women.

Infections
In addition, the chance of developing NHL is increased among people who have been exposed to:

• human T-lymphotrophic virus type I (HTLV-1);
• Epstein-Barr (EBV) virus;
• Helicobacter pylori, a bacteria that may infect the gastrointestinal tract and can cause lymphomas of the stomach;
• human immunodeficiency virus (HIV), the "AIDS" virus; and
• malaria, especially in areas of Africa, where Burkitt's lymphoma is common.

It is important to note that there is no evidence of infection in many HD and NHL patients, so its role in cancer development remains uncertain.

Medical Conditions
Specific medical conditions may make a person more likely to develop HD or NHL. In particular, HD and NHL are more common among people with a weakened immune system, such as those with:

• autoimmune disease (e.g., HIV/AIDS), disease caused by the body's immunologic attacks against its own tissues;
• inherited immune deficiency syndromes (e.g., ataxia telangiectasia); or
• organ transplants that require the use of immunosuppressant drugs.

Some experts believe that HD is caused by a complex deficiency in cellular immunity. Sucha deficiency may be due to chronic overstimulation by cytokines - substances that draw germ-fighting white blood cells to areas of infection.

Chemicals
The risk of NHL is increased among individuals exposed to chemicals such as

• benzene and certain other solvents,
• herbicides (weed killers),
• pesticides (insect killers), or
• the antiepileptic medicine phenytoin (Dilantin®), which can cause
  reversible overgrowth of lymphoid tissues.

Genetics
The rates of lymphoma and leukemia (e.g., chronic lymphocytic leukemia, CLL) are especially high in some Jewish populations, whereas Asian populations rarely develop CLL. Among first-degree relatives (parents, children, siblings) of CLL patients there is a two- to four-fold increased risk for this cancer.

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