What is Cutaneous T-cell Lymphoma?

Lymphoma is a type of cancer that attacks the lymph cells in the body. There are two different types of lymphoma, such as non-Hodgkin lymphoma, Hodgkin Lymphoma, and then there are various subtypes, which are cutaneous, peripheral, angioimmunoblastic and adult T-cell lymphomas. This article will focus on Cutaneous T-cell Lymphoma (CTCL); cutaneous refers to the skin and T-cell refers to certain types of lymphocytes of the immune system. This disease affects the skin, but it can also proliferate into other areas of the body such as the liver, bone marrow and lungs. T-cells are considered to be the "helper cells" of the immune system.

What causes Cutaneous T-cell Lymphoma?

It is believed that most T-cell lymphomas are caused by the body's response to antigens in the body which induces genetic mutations; the genetic changes induce rapid cell division. However, not too much is known about how this occurs. It is known that Adult T-cell Lymphoma (a type of leukemia) is caused by a virus called HTLV-1 which attacks the immune system.

The function of the lymph system is to filter out infectious organisms before they can enter into circulatory system. Lymphocytes (white blood cells) attack and destroy the bacteria that are foreign to the body. There are two main types of lymphocytes: T-cells are the killer and helper cells and B-cells are responsible for administering antibodies into the body. Cutaneous T-cell Lymphoma is believed to be caused from overproduction of the helper T-lymphocytes.

What are the symptoms of Cutaneous T-cell Lymphoma?

The symptoms of CTCL include:

Dark or light patches on the skin

Itchiness of the skin

Mushroom shaped tumors

Dry and scaly skin

Loss of skin integrity that can lead to infection

Hair loss

Depending on a person's skin coloring, the individual may have dark or light colored patches to form on the skin. Light skinned people are likely to have dark patches and dark skinned people will usually have light patches on the skin. The constant irritation and inflammation of CTCL may also cause hair loss anywhere on the body. These patches will be very itchy, dry and scaly; in time the patches may form in to mushroom shaped tumors. Parts of the skin, especially in the folds, may become thick, hard and cracked; the hard part is referred to as plaque. When cracks form on the skin, the integrity of the skin is compromised and very serious infections can occur.

As Cutaneous T-cell Lymphoma progresses, the cancer can metastasize to the lungs, liver and bone marrow, which will cause other symptoms related to appear related to the parts of the body that have been invaded by the cancer cells. For instance, if CTCL metastasizes to the liver, the person will develop symptoms associated with the liver such as jaundice and other related symptoms.

How is Cutaneous T-cell Lymphoma diagnosed and treated?

A physical examination will be done to check the lymph nodes for swelling and inflammation; the skin will be examined for the presence of patches of dark or light skin, plaques, cracks and other signs of skin breakdown. Because CTCL can mimic other skin disorders, the doctor will need to order certain tests to be done. One of the tests will involve taking a skin biopsy to look for cancer cells. Blood tests will be done to look for cutaneous lymphoma cells. When cancer spreads, it does so by entering into the circulatory and lymphatic systems. Other tests will consist of a CT scan and/or an MRI to look for signs of metastasis in other areas of the body.

Treatment for Cutaneous T-cell Lymphoma depends on whether the CTCL is localized to the skin or metastasized to other parts of the body. If the cancer is localized to the skin, treatment will likely involve photo-chemotherapy and a topical form of chemotherapy (Mustargen - also known as nitrogen mustard). Before photo-chemotherapy is administered, a drug is given to make the cancer cells vulnerable to the phototherapy. The cancer cells die when they are exposed to the light. This form of chemotherapy doesn't affect the internal organs.

When tumors are present, radiation therapy is the likely treatment. The radiation therapy is called total skin electron beam (TSEB) radiation. TSEB radiation kills tumors on the skin with the use of high energy electron particles. A person undergoing TSEB radiation may need to have it done over the course of a few months. Once remission has taken place, the topical chemotherapy application may be used.

When metastasis has occurred in patients with Cutaneous T-cell Lymphoma, the treatment will depend the patient's age and on which areas of the body that has been invaded by cutaneous cancer cells. A combination of chemotherapy, radiation therapy and medications are the most likely forms of treatment that will be used.

Conclusion

The survival rate for Cutaneous T-cell Lymphoma patients will largely depend on the stage of the cancer. A person who has no lymph node involvement or metastasis to the blood or internal organs may live for 12 years or more after being diagnosed. A person that has hardened plaques on the skin, and has skin tumors and the cancer cells have spread to the lymph nodes and the blood may survive about 5 years after diagnosis. If the cancer cells have spread to the internal organs, the person may live approximately 2 to 4 years after diagnosis.

Anyone who notices changes in their skin, such as the changes listed above, should see their physician as soon as possible. Even though the likelihood is very small, any suspicious changes in the skin should be brought to the attention of a medical professional.

Sources:

T-cell Lymphomas

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