Nervous System Lymphoma Page Literature Review Primary

¶ … Nervous System Lymphoma page literature review "Primary Central Nervous System Lymphoma The primary central nervous system lymphoma The primary central nervous system lymphoma is a cancer type that is very rare, and affects the central nervous system i.e. spinal cord, brain, brain coverings, optic nerves, or the eyes. The cancer being referred to as a lymphoma indicates that its cells are lymphocytes which are a white blood cell type.

Primary central nervous system lymphoma has no specific age group, but in most of the diagnosed cases, it is found in patients who are above 50 years. Immunosuppressed patients i.e. patients whose immune system has been reduced, like people living with AIDS or patients after organ transplant who are taking specific drugs, all seem to be more at risk of contracting this cancer Weinberg et al., 2005. There is poor prognosis for immunocompromised patients. Primary central nervous system lymphoma represents about 20% of lymphoma cases in HIV infections.

The Epstein-Barr virus infection is associated with primary central nervous system lymphoma. Rarely is there any association with Epstein-Barr virus infections with patients who are not HIV infected or have any immunodeficiency. Primary central nervous system lymphoma was described first in 1920s. It used to be referred to using various names back then including reticulum cell sarcoma, perithelial sarcoma, and microglioma. It started been recognized as a lymphoma from 1970s. Causes There is no known cause of the primary central nervous system lymphoma.

No one knows why lymphoma would involve an area that does not contain any lymphocytes. Researchers suggest this could be because of inflammation in the central nervous system. The lymphocytes that are cancerous might develop in other part of the body, but they get a receptor that pulls them to the central nervous system. Though, for patient with AIDS, the infection of Epstein-Barr virus triggers the lymphoma, the reasons are not understood.

Course of the disease Patients who suffer from primary central nervous system lymphoma usually have a variety of symptoms. These symptoms are dependent on the part of the central nervous system that is infected. If the brain is infected, a patient may suffer from headaches, have personality changes, drowsiness, memory problems, limb numbness, and walking difficulty. Patients, who get infected in the eyes, will first see floating spots, and this may progress and lead to eye sight loss Yoo, Lee, & Kwon-Chung, 1985.

Brain symptoms may come after or before the eye symptoms. Lack of immediate treatment may lead to progressive worsening of the cancer. The lymphoma cancer is not easily diagnosed as it does not infect other areas of the body. This means that symptoms that a person may have with other lymphoma forms may not be present in this cancer. Diagnosing and testing the disease The usual way for detecting the primary central nervous system lymphoma that affects the brain is by using an MRI scan.

Revelations of lymphoma of the eye is by using a detailed clinical examination. Diagnosis of this cancer is usually delayed. This is because the cancer is rare and normally will mimic other common ailments. To reach a final diagnosis, there is need to have opinions from several practitioners namely the ophthalmologist and a neurosurgeon.

As the disease can either affect the eyes and the brain, it is recommended that a patient who suffers from eye disease should see a neurosurgeon, and a person with brain disease be examined by an ophthalmologist. To get a definite diagnosis biopsy of the tissue is required. By a process referred to as vitrectomy, the biopsy is taken from the eye incase the eye is affected by the cancer. In the other cases, one can either get a spinal tap, or biopsy of the brain.

There are special times when both will be required. A pathologist who is familiar with the cancer should examine the biopsy Gaidano et al., 1997. The pathologist will then diagnose the biopsy and determine if the cancer is present. To establish the effects of the cancer, additional MRI scans, tissue biopsies, and eye examinations will be carried out as treatment progresses. Treating the disease There are many ongoing clinical trials, which are trying to establish the optimal treatment method for primary central nervous system lymphoma.

Though, surgery is required to diagnose the cancer, alone it is not effective for its treatment. The other options available for its treatment are radiotherapy and/or chemotherapy. Treating the cancer using radiotherapy only induces remission and they lymphoma recurs. Using higher or repeated doses of radiation, can lead to serious complications. These complications include retinal blood vessels leaking, and dementia. There are different challenges posed to the patient when chemotherapy is used.

Toxins in the blood are barred from getting to the eye and brain by barriers of tightly joined cells. These very cells are the limitations for using chemotherapy for the treatment of lymphoma. The barriers limit the chemotherapy drug amount that enters the central nervous system or the eye, when the drug is administered in the usual manner. The doses of chemotherapy administered to the patient should be very high and this increases the risk of the patient having the drug side effects.

Intrathecal chemotherapy is an option that can be used to ensure that the drug reaches the intended area in the normal doses. There is another alternative that requires to be administered when the patient is under anesthesia. This treatment is referred to as osmotic blood-brain barrier disruption, and it is available only in selected international centers. The treatment involves administration of a medicine initially, which will break the blood-brain barrier, and this allows for systematic chemotherapy doses to be administered.

All these methods can be combined with other local injections of the chemotherapy drug for the eye Ivers, Kim, & Sax, 2004. Such treatment is effective and well tolerated by the eye. This leads to clearing of the cancer cells. Conclusion A patient who suffered from central nervous system lymphoma had a poor outlook, but after effective treatments were introduced this changed. They can now live longer with these treatments.