Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, MD
 8 March 2006

WHAT IS A LYMPHOMA?

            This past week a very dear friend passed away from a disease called mantle cell lymphoma.  Many of his concerned acquaintances inquired about what is a lymphoma.  One was a delightful very bright twelve year old girl who wanted to know why we couldn’t do anything to save him.  I answered her as below:

            I first told her that the human body is made up of cells of many different kinds.  She said  she knew that.  I then explained that one kind of cell is called a lymphocyte.  I told her that lymphocytes were cells that protected the body from foreign invaders such as bacterial of fungal infections.  I explained that some lymphocytes called B-cells make something called an antibody that attaches to bacteria to mark them for destruction.  Other lymphocytes called T-cells then eat up the antibody marked bacteria and kill them.  I explained that these two types of lymphocytes are very important in protecting the body from infection.  The little girl said that she didn’t know that.

            I then explained how smart the cells in our body were.  Normally, they know enough to grow when they need to and not grow further when their job is done.  For example, when a baby is born, it has a very tiny hand.  As the baby grows up, its hand gets bigger and bigger until it is an adult.  The cells in the baby’s hand know enough to grow to an adult size and then stop growing.  This is true for all parts of the baby’s body.  Imagine what would happen if a baby’s parts didn’t know enough to stop growing at the right time.  Alternatively, imagine what might happen if one part of a body grew uncontrollably.  I explained to her that something called a malignancy (or cancer) is exactly that.  One type of cell in the body begins to grow uncontrollably and to no useful purpose.  The little girl said that she didn’t know that.

            I then explained that a lymphoma is a disease in which one particular type of lymphocyte begins to grow uncontrollably.  Normally, this kind of lymphocyte would make antibodies to help fight infections.  But in the case of a lymphoma, not only do the cells grow uncontrollably, but they don’t function at all.  They take up more and more of the body’s energy and food and waste it doing nothing.  Thus, the rest of the body doesn’t get enough to eat and other bodily functions begin to fail.  Most importantly, those lymphocytes whose job it is to make antibodies to protect the body get crowded out by all those useless lymphoma cells and the body’s immune protection system is lost.  Then an infection occurs and the body is not able to combat it and the person dies.  I explained to the little girl that this is what happened to our friend.

            She looked very puzzled at that point and asked why we couldn’t give him medicine to make him better.  I explained that if the condition is found early enough, sometimes we can use medicines that will kill the lymphoma lymphocytes.  Unfortunately, these same medicines also kill the normal body-protecting lymphocytes to a certain degree.  I explained that sometimes these medicines are as bad as the disease because they also kill the lymphocytes that protect the body.  Thus, medicine to treat this condition is a very risky business.  I explained to her that unfortunately our friend was already very sick and infected when his lymphoma was diagnosed.  It was too late to use any medication to treat the lymphoma and he passed away.

            I explained to her that lymphomas are not the only cancers that we have problems with.  There are cancers of the lung, of the stomach, of the liver, of the intestine, of the brain, and on, and on.  To this time, we have very few medicines that will cure any kind of cancer.  Research is continuing to find cures for cancer but we just don’t have the job done yet.

            This beautiful child then said, “Maybe someday I will grow up and help find a cure for these diseases so my friends won’t die from them, too.”   And maybe she will.  The healthcare profession needs all the help that we can get from bright minds like hers.