Lymphoma of Breast
Lymphoma of Breast is an uncommon lymphoma that is mostly observed in older women, though a wide age category of women may be affected. Microscopic pathology image showing marginal zone B cell lymphoma.
What are the other Names for this Condition? (Also known as/Synonyms)
- Breast Lymphoma
- Lymphoma of Mammary Gland
- Malignant Lymphoma of Breast
What is Lymphoma of Breast? (Definition/Background Information)
- Lymphoma of Breast is an uncommon lymphoma that is mostly observed in older women, though a wide age category of women may be affected
- The condition may be primary (very uncommon) or secondary (more common):
- Primary Lymphoma of Breast: This type of lymphoma first involves the breast and later can involve other parts of the body including the lymph nodes and bone marrow
- Secondary Lymphoma of Breast: This type of lymphoma involves other parts of the body first, such as peripheral blood, lymph nodes, bone marrow, and other organs; breast involvement occurs later
- Lymphoma of Breast can either be a B-cell lymphoma or a T-cell lymphoma. B-cell lymphomas are far more common than T-cell lymphomas
- There are various (histological) subtypes of Breast Lymphomas and some of these include:
- Diffuse large B-cell lymphoma of breast: Over 50% of the cases belong to this subtype
- MALT lymphoma of breast: A little less than 50% of the cases belong to this subtype
- Follicular lymphoma of breast
- Burkitt lymphoma of breast
- Lymphoma of Breast may be associated with autoimmune disorders. It can be present as a mass in the breast and cause thickening of the breast with pain. Other general signs and symptoms, such as anemia, fatigue, and appetite loss, may also be seen
- Chemotherapy, surgery, radiation therapy, and other treatment measures may be used for treating Lymphoma of Breast based on the assessment of the physician
- The prognosis depends on many factors including the subtype and stage of lymphoma, progression of the condition, response to treatment, and overall health of the individual. In general, the prognosis of Lymphoma of Breast is guarded
General information on lymphoma and lymphocytes:
- Lymphoma is a type of cancer stemming from uncontrollably dividing lymphocytes (type of white blood cells). There are two types of lymphomas:
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
- Lymphocytes are the main white blood cells found in the lymph, which is the fluid of the lymphatic system; just as blood is the fluid of the circulatory system. Lymphocytes are made in bone marrow, and can develop into either B-cells or T-cells
- Lymph results from filtration of blood as it travels to and from tissues. Lymph is colorless because it lacks red blood cells; instead, it contains lymphocytes. It is central to the immune system
- There are 3 different kinds of lymphocytes:
- T-lymphocytes or T cells: They help combat infections and abnormalities within the cells (cell-mediated immunity). They fight viruses and cancerous cells
- B-lymphocytes or B cells: They produce antibodies that are bodily defense proteins, which target foreign invaders outside the cells (humoral immunity). They fight bacterial cells, cell fragments, and other immunogenic elements
- Natural killer cells or NK cells: They perform diverse functions related to both cell-mediated and humoral immunity. They also scout for cancer cells, a process called immune surveillance
Who gets Lymphoma of Breast? (Age and Sex Distribution)
- Lymphoma of Breast is an infrequent condition that generally affects older women; studies show that the average age at diagnosis is between 55-60 years
- The condition can occur at any age though, and a wide age range of 17-95 years is noted
- Both males and females can be affected; although, this condition is highly infrequent in males
- It can occur worldwide and all races and ethnic groups may be affected
- The subtype Burkitt lymphoma of breast is more common in Africa than other parts of the world
What are the Risk Factors for Lymphoma of Breast? (Predisposing Factors)
No specific risk factors have been identified for Lymphoma of Breast. However, the condition is known to be associated with the following factors:
- Autoimmune disorders
- Advanced age; older individuals commonly have a higher risk
- Individuals with weak immune system (due to various health conditions)
Besides the above, the following general factors may contribute towards lymphoma formation and development:
- Family history of immune disease
- The presence of any systemic disease
- Exposure to radiation and industrial chemicals
- Viruses (in some rare cases); Epstein-Barr virus infection
- X-ray, CT scan exposure
- Profession involving radiation exposure, which may include nuclear plant workers, pilots, astronauts, etc.
- Certain medications and drugs
International Prognostic Index: According to some scientists, the International Prognostic Index may not be very helpful in evaluating Breast Lymphoma. However, some scientists believe that it is helpful in some cases, to determine the prognosis.
The International Prognostic Index, for aggressive non-Hodgkin lymphoma, lists a few factors that determine the overall risk:
- Age over 60 years
- Elevated level of serum lactate dehydrogenase - LDH (a type of enzyme)
- Performance status, i.e. the overall health condition of the individual, which could range from being fully active (low risk) to being completely disabled (very high risk)
- Individual, who have already suffered from lymphoma, or other types of blood cancers, may have a relapse or a recurrence
- Presence of an immunodeficiency syndrome, like AIDS, is a high risk factor
- Those infected with Epstein-Barr virus are also prone to this lymphoma type
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Lymphoma of Breast? (Etiology)
Lymphocytes are a type of white blood cells that are responsible for providing immunity in the human body. B-cells and T-cells are the two different types of lymphocytes. When under certain circumstances, the lymphocytes grow and multiply abnormally, it leads to a condition called as lymphoma, which is a most common type of cancer. There are 2 types of lymphoma:
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
The cause of Lymphoma of Breast is unknown. There may be certain genetic defects, such as translocation, which is a juxtaposition of regions of the chromosomes. This may result in:
- Change of regulatory elements of certain cancer-causing genes called as oncogenes, which can lead to increased production of their mRNA (overexpression), thus increasing their protein levels
- Exchange of protein coding regions of gene, giving rise to new proteins that can stimulate the inappropriate growth of cells
It is believed that the abnormal development of lymphocytes gives rise to cancerous cells leading to the formation of this condition. Nevertheless, how this occurs and the factors that cause it remain under investigation.
What are the Signs and Symptoms of Lymphoma of Breast?
The signs and symptoms depend on whether it is a primary condition or a secondary condition. In a majority of primary lymphomas, if the tumor is small, it may be usually asymptomatic and individuals will not have any significant symptoms. The symptoms also depend upon the extent of lymphoma involvement in other parts of the body.
The signs and symptoms of Lymphoma of Breast may include:
- Presence of a mass/lump in the breast or underarm area; the average tumor size noted is around 3.5 cm
- The tumors may present as slowly enlarging painless mass
- Breast pain may occur in some cases
- Thickening or swelling of part of the breast; change in the size or shape of the breast
- Unintentional weight loss; changes in appetite
- Fatigue and weakness, headache
- Anemia (low red blood cell count)
- Frequent infections
- Low blood pressure
In most cases, apart from the breast, there will be an involvement of other organs; the signs and symptoms may be based on the specific organs that are affected.
How is Lymphoma of Breast Diagnosed?
Lymphoma of Breast diagnosis is generally performed by obtaining biopsy samples from the affected region of the breast and examining them under a microscope to detect the cancerous cells. There are other tests and procedures that could help in the diagnosis and these include:
- A thorough physical examination and a complete medical history, which is very important
- Breast exam, where the physician checks for any lumps or unusual signs in the breasts
- Blood tests that may include:
- Complete blood cell count (CBC) blood test
- Absolute lymphocyte count on peripheral blood
- Liver function blood test (LFT)
- Lactate dehydrogenase (LDH) blood test
- Tissue biopsy from the breast:
- A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
- Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
- Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, flow cytometric analysis and very rarely, electron microscopic studies, to assist in the diagnosis
- The biopsy may be performed through any of the following procedures:
- Fine needle aspiration biopsy (FNAB): A device called a cannula is used to extract tissue or fluid from the breast, or surrounding lymph nodes
- Breast core biopsy of the tumor
- Breast open biopsy of the tumor
- Radiological imaging may be performed specific to location of the involved organ, and to determine the extent of lymphoma in the body including:
- Mammogram: Screening mammograms are commonly used to detect possible signs of breast tumor, in women with no apparent symptoms
- Breast ultrasound: An ultrasound can help identify whether a lump is a fluid-filled cyst (non-cancerous) or a solid mass (which may be cancerous or benign)
- Plain x-ray of the chest
- Computerized tomography (CT) scan of the chest
- Vascular radiological studies
- Whole body bone scan
- Whole body CT-PET scans to determine how far the lymphoma has spread, by checking the size and metabolic rate (a reflection of uncontrolled growth) of lymph nodes, throughout the body. This can also help determine, if the cancer has spread to other organ systems
- Brain MRIs are used if neurological symptoms are present, which can help determine if the cancer has spread to the brain, or to tissues that cover the brain
- Bone marrow aspiration and biopsy is performed and sent to a laboratory for a pathological examination, to determine if the bone marrow is involved. Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, histochemical stains, molecular testing, and very rarely electron microscopic studies. However, a bone marrow biopsy is not needed in the early stages of the condition
- Flow cytometry to identify cells as they flow through an instrument, called a flow cytometer. Flow cytometry measures the number and percentage of cells in a blood sample, and cell characteristics such as size, shape, and the presence of biomarkers on the cell surface. This method helps to sub-classify the condition and also to detect residual levels of disease after treatment. This tool can help in diagnosing relapse and restart treatment as needed
- Fluorescence in situ hybridization (FISH): It is a test performed on the blood or bone marrow cells to detect chromosome changes (cytogenetic analysis) in blood cancer cells. The test helps in identifying genetic abnormalities that may not be evident with an examination of cells under a microscope
- Immunophenotyping to identify a specific type of cell in a sample, which can help determine the best treatment course to be followed
- Exploratory laparoscopy (diagnostic laparoscopy) may be required, if gastrointestinal symptoms are present. In this procedure, the abdomen is examined using a minimally-invasive technique, and a tissue biopsy and tissue for culture obtained. Minimally-invasive approaches help decrease complications and the length of stay at the hospital. A diagnostic laparoscopy is also helpful in staging of the tumor. Nevertheless, this procedure is not very much used
- Polymerase chain reaction (PCR): It is used to measure the presence of certain biomarkers in blood or bone marrow cells. The test is ultrasensitive and detects extremely low amounts of biomarkers remaining in blood, which can be missed by cytogenetic methods, such as FISH, karyotype, or flow cytometry. PCR allows a more sensitive follow-up of patients in remission and can help determine whether additional treatment is necessary
Note: Differential diagnoses, to eliminate other tumor types are often considered, before arriving at a definitive diagnosis.
The primary type of Breast Lymphoma is much rarer than secondary type of Breast Lymphoma. In order to define the lymphoma as Primary Lymphoma of Breast, the following diagnostic criteria should be considered:
- The lymphoma should arise in the breast tissue or surrounding breast tissue
- There should be no other tissue involvement at the time of diagnosis, other than the breast
- Individuals should not have a pervious history of lymphoma
- Axillary nodes on the same side as the Breast Lymphoma may be involved
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Lymphoma of Breast?
The complications due to Lymphoma of Breast may include:
- Involvement of local and distant organs: It can lead to systemic or disseminated disease in some cases
- Loss of function of the organ/area to which cancer has spread due to systemic involvement
- Weakened immune system (or immunosuppression) can be a complication, which can become more severe during treatment. Due to this, individuals are more vulnerable to infections; there is an increased risk of developing serious complications from such infections
- Occasionally, the tumor can transform into a more aggressive form or subtype of lymphoma
There may be complications related to chemotherapy used in treating the condition, which may include:
- Side effects such as dizziness, vomiting, appetite loss, mouth ulcers, and hair loss
- By damaging healthy cells, the individual is more open or vulnerable to secondary infections
- The treatment can also cause infertility in men and women. Hence, measures to protect the individual’s fertility must be considered, before starting chemotherapy
The treatment measures can also give rise to secondary cancers, such as skin cancer.
How is Lymphoma of Breast Treated?
A combination of measures may be used to treat Lymphoma of Breast. The treatment also depends upon the stage, overall health, age, and subtype of lymphoma.
- Chemotherapy: This approach uses a combination of drugs to kill the cancerous cells and can be used in patients, for all stages of the tumor
- There can be severe side effects including fatigue, nausea, hair loss, anemia, high risk of infection, and drug-specific reactions
- Many lymphomas can be resistant to chemotherapy. It can also damage healthy cells
- Chemotherapy can be administered as a pill, liquid, shot, or intravenously
Note: Men and women in child-bearing age would greatly benefit from counseling regarding fertility issues. Some chemotherapy agents can cause infertility in both men and women. There can be permanent damage to the testicles and ovaries, harming their ability to produce sperms or ova. In men, sperm banking can be considered before initiating therapy. In women, in many cases, due to urgency of starting chemotherapy, it is often difficult to perform ovum banking. However, if there is sufficient time prior to chemotherapy, ovum banking may be performed. The healthcare provider may help assess the risk-benefit analysis, depending upon each individual’s specific circumstances.
- Surgical removal of the lymphoma from the breast, which may be performed through the following procedures:
- Lumpectomy: Least invasive breast cancer surgery, in which the tumor, as well as a small portion of the surrounding tissue, is removed
- Mastectomy: Surgery to remove all of the affected breast tissue
However, it is important to note that surgery is infrequently used as a treatment modality for Lymphoma of Breast.
- Radiation: Radiation therapy is the use of high-energy radiation waves to kill cancer cells, by destroying their DNA
- This treatment modality is generally used for early stage lymphomas. It is most commonly used in combination with chemotherapy
- The radiation may be administered by a machine placed outside the body, or by placing a radioactive material inside the body
- The side effects of radiation therapy include nausea, vomiting, fatigue, pain, risk of cancer later in life, and risk of heart disease
- Radiation can damage healthy cells in addition to cancer cells, causing further complications
- Supportive treatment: Steroids, blood transfusions, anti-nausea medications, and antibiotics, may be used as supportive therapy. In combination with other treatment measures, these can help combat the symptoms of immunodeficiency
- Undertaking treatment of underlying conditions/disorders, as warranted
- If Breast Lymphoma is not fully responsive to treatment, or if the chance of recurrence is high, then bone marrow transplantation or stem cell transplantation can be considered
- In order to prevent infections because the immune system is weakened by the lymphoma or by its treatment, the patient is kept in an isolated ward and treated with appropriate antibiotics
- Nowadays targeted therapies are being developed that can selectively kill the cancer cells. Many of them are in the stage of clinical trials
- Clinical trials: There may be some newer treatment options, currently on clinical trials, which can be considered for some patients depending on their respective risk factors
Your healthcare provider will determine the best course of treatment depending on your individual circumstances. Also, follow-up care with regular screening and check-ups are important post-treatment.
How can Lymphoma of Breast be Prevented?
Currently, it is not possible to prevent Lymphoma of Breast. However, controlling certain factors my help lower one’s risk for the condition.
- Healthy diet and exercise, as well as avoidance of unnecessary exposure to chemicals, may help decrease its risk
- Avoiding smoking
- Undertaking appropriate and early treatment of any condition that affects the breast, including any autoimmune disorders
- Using appropriate protective gear while working with x-rays and other radioactive source
- In order to avoid a relapse, or be prepared for a recurrence, the entire diagnosis, treatment process, drugs administered, etc. should be well-documented and follow-up measures initiated
Regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are mandatory. Often several years of active vigilance are crucial and necessary.
What is the Prognosis of Lymphoma of Breast? (Outcomes/Resolutions)
- Lymphoma of Breast is a slow-growing malignancy with a generally good prognosis with early diagnosis and treatment
- The prognosis is mainly dependent upon the tumor stage and lymphoma subtype. Also, primary lymphomas have better prognoses than secondary or recurrent lymphomas
- In general, the prognosis depends upon a set of several factors, which include:
- Stage of tumor: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
- Overall health of the individual: Individuals with overall excellent health have better prognosis compared with those with poor health
- Age of the individual: Older individuals generally have poorer prognosis than younger individuals
- The size of the tumor: Individuals with small-sized tumors fare better than those with large-sized tumors
- Individuals with bulky disease have a poorer prognosis
- Involvement of vital organs may complicate the condition
- The surgical respectability of the tumor (meaning, if the tumor can be removed completely) - it is a rare option
- Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have worse prognosis compared to tumors that do not recur
- Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond to treatment
- Progression of the condition makes the outcome worse (progressive Breast Lymphoma)
- The combination chemotherapy drugs used, may have some severe side effects (such as cardio-toxicity). This chiefly impacts the elderly adults, or those who are already affected by other medical conditions. Tolerance to the chemotherapy sessions is a positive influencing factor
- Progression to bone marrow failure is usually associated with short survival
Additional and Relevant Useful Information for Lymphoma of Breast:
- Treatment for Lymphoma of Breast can cause physical and emotional distress; supportive care and encouragement, help positively and can bring a measure of relief to the patients
The following article link will help you understand leukemia and lymphoma (blood cancer):
What are some Useful Resources for Additional Information?
Lymphoma Research Foundation (LRF)
115 Broadway, Suite 1301, New York, NY 10006
Phone: (212) 349-2910
Fax: (212) 349-2886
Leukemia & Lymphoma Society (LLS)
1311 Mamaroneck Ave., Suite 310 White Plains, NY 10605
Phone: (914) 949-5213
Toll-Free: (800) 955-4572
Fax: (914) 949-6691
National Cancer Institute (NCI)
U.S. National Institutes of Health
Public Inquiries Office
Building 31, Room 10A03
31 Center Drive, MSC 8322 Bethesda, MD 20892-2580
Phone: (301) 435-3848
Toll-Free: (800) 422-6237
TTY: (800) 332-8615
American Cancer Society (ACS)
1599 Clifton Road, NE Atlanta, GA 30329-4251
Toll-Free: (800) 227-2345
TTY: (866) 228-4327
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http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Lymphomanon-Hodgkin/TypesofNHL/DiffuselargeB-cell.aspx#DynamicJumpMenuManager_6_Anchor_3 (accessed on 02/05/16)
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Helpful Peer-Reviewed Medical Articles:
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