Epidemiology of Lymphoma in Saudi Arabia

Mr.Abdulaziz R. AlanziMedical Student, Al-Imam University

Riyadh – Saudi Arabia

Road Map

Definition

Classification

Risk Factors

Etiology

Prevalence – World Wide

Prevalence – Saudi Arabia

References

1. Harrison’s Principles of Internal Medicine Book 17th edition2. Kumar et al: Robbins Basic Pathology Book 8th edition3. World Health Organization (WHO) 4. Medscape Reference5. Surveillance Epidemiology and End Results (SEER)6. Cancer Center, University of Kansas7. Right Diagnosis

Definition

•Malignant tumors of lymphoid tissue, characterized by the abnormal proliferation of B or T cells in the lymphoid tissue.

Source: Kumar et al: Robbins Basic Pathology Book 8E

Lymphoma

Hodgkin’s lymphoma Non-Hodgkin’s lymphoma

Nodular lymphocyte-predominant

Hodgkin’s lymphoma

Classical Hodgkin’s lymphoma:

Nodular sclerosis HL

Lymphocyte-rich HL

Mixed cellularity HL

Lymphocyte- depleted HL

B cell lymphomas T/NK cell lymphomas

Precursor B celllymphoma

Mature B celllymphoma

Precursor T celllymphoma

Mature T/NK celllymphoma

The WHO classification (2001)

Source: World Health Organization (WHO)

Non-Hodgkin Lymphoma Hodgkin Lymphoma

More frequent involvement of multiple peripheral nodes

More often localized to a single axial group of nodes (cervical, mediastinal, para-aortic)

Noncontiguous spread Orderly spread by contiguity

Mesenteric nodes and Waldeyer ring commonly involved

Mesenteric nodes and Waldeyer ring rarely involved

Extranodal involvement common Extranodal involvement uncommon

Table 12-10. Clinical Differences Between Hodgkin and Non-Hodgkin Lymphomas

Source: Kumar et al: Robbins Basic Pathology Book 8E

Classification

• Age: The disease peaks at ages 15 to 40 and at 55 and older.• Exposure to environmental poisons, such as Agent Orange • Family history of the disease, although lymphoma has only a weak genetic

link• Gender: Hodgkin lymphoma is more common in males than females• History of infectious mononucleosis or Epstein-Barr virus• Prolonged use of human growth hormone • Weakened immune system, including infection with HIV

Source: http://www.kucancercenter.org/cancer-information/specialties-and-treatment/lymphoma/prevention

RF - Hodgkin Lymphoma

• Age: The likelihood of getting NHL increases as you get older. • Bacterial infection: Infection with Helicobacter pylori increases the risk of

lymphoma involving the stomach. • Gender: Non-Hodgkin lymphoma is more common in males than females.• Exposure to farming chemicals or fertilizers, chemicals used to dissolve

rubbers or glues, chemicals used to make rubber products, asbestos and arsenic increases the risk of developing NHL. • Weakened immune system: NHL is most common among those who have an

impaired immune system or a severe autoimmune disease. It also occurs among those who take medicines to suppress the immune system following an organ transplant. • Viral infection: Infection with Epstein-Barr virus or Human Immunodeficiency

Virus (HIV) increases the risk of developing NHL.

RF – Non-Hodgkin Lymphoma

Source: http://www.kucancercenter.org/cancer-information/specialties-and-treatment/lymphoma/prevention

Source: http://emedicine.medscape.com/article/201886-overview#aw2aab6b2b3

Etiology - Hodgkin Lymphoma

• EBV, may be involved in the pathogenesis. In as many as 50% of cases, the tumor cells are EBV-positive.

• Patients with HIV infection have a higher incidence of Hodgkin lymphoma compared with the population without HIV infection.

Infectious agents

• Approximately 1% of patients with Hodgkin lymphoma have a family history of the disease.

Genetic predisposition

• May have a protective effect against lymphomagenesis through mechanisms that may be independent of vitamin D

UV radiation exposure

Source: http://emedicine.medscape.com/article/201886-overview#aw2aab6b2b3

Etiology – Non-Hodgkin Lymphoma

• Epstein-Barr virus (EBV), Human T-cell leukemia virus type 1 (HTLV-1) , Hepatitis C virus (HCV), Kaposi sarcoma–associated herpesvirus (KSHV) , Helicobacter pylori infection.

Infectious agents

• The t(14;18)(q32;q21) translocation is the most common chromosomal abnormality associated with NHL.Chromosomal translocations

• chemicals (eg, pesticides, herbicides, solvents, organic chemicals, wood preservatives, dusts, hair dye), chemotherapy, and radiation exposure.

Environmental factors

• Congenital immunodeficiency states, AIDS, Celiac disease.Immunodeficiency states

• Sjögren syndrome and Hashimoto thyroiditis.Chronic inflammation

Etiology – Q

Which of these agents will not cause HL?• HIV Infection• Genetic predisposition• UV radiation• Non of the above

• Data taken from SEER (Surveillance Epidemiology and End Results) http://seer.cancer.gov• Prevelance includes any person alive on January 1, 2009

who had been diagnosed with lymphoma at any point prior to January 1, 2009 and includes persons with active disease and those who are cured of their disease.

Prevalence – World Wide

1- Non-Hodgkin Lymphoma 2- Hodgkin Lymphoma

Non-Hodgkin Lymphoma On January 1, 2009 , in US

Source: Surveillance Epidemiology and End Results (SEER) http://seer.cancer.gov/statfacts/html/nhl.html

Prevalence – World Wide

1- Non-Hodgkin Lymphoma: 484,336

252,111 men 232,225 women

Prevalence – World Wide

Source: Surveillance Epidemiology and End Results (SEER) http://seer.cancer.gov/statfacts/html/nhl.html

Hodgkin Lymphoma On January 1, 2009 , in US

2- Hodgkin Lymphoma: 174,908

90,425 men 84,483 women

Prevalence – World Wide

Which is More common?

Or

Hodgkin Non-Hodgkin

Source: Harrison’s Principles of Internal Medicine 17th edition

Figure: Relative Frequency of Lymphoid Malignancies

Prevalence – Saudi Arabia

Source: http://www.rightdiagnosis.com/n/non_hodgkins_lymphoma/stats-country.htm

Prevalence – Saudi Arabia

Prevalence – Saudi Arabia

Source: http://www.rightdiagnosis.com/n/non_hodgkins_lymphoma/stats-country.htm

://http . . . / /1503/15_3_2009_0600_0611.applications emro who int emhj pdf Source: WHO

Prevalence – Saudi Arabia

d0pa@hotmail.com@AbdulazizEnazi

:// . . /http imamu academia edu AbdulazizAlanzi

Thank You