Rheumatoid Arthritis Patients Have a Higher Risk of Developing Cancer

Persons with rheumatoid arthritis have daily struggles with severe pain and movement. Another serious downfall of the disorder is that these patients are more susceptible to develop cancer.

The association between rheumatoid arthritis (RA) and cancer is not completely clear. Some studies show an increased risk of cancer in people with rheumatoid arthritis (RA) while others show a decreased risk. But the picture becomes clearer when researchers look at specific cancer types.
Lymphoma. The strongest evidence of a link appears to be between lymphoma -- the most common type of blood cancer -- and severe rheumatoid arthritis (RA). Researchers from Sweden examined data from nearly 75,000 RA patients, 378 of whom had lymphoma. The researchers assessed risk for three different levels of disease activity (low, moderate, and severe) and found that people with moderate disease activity were eight times more likely to have lymphoma than those who had low disease activity, while those with severe disease activity were 70 times more likely.
More support for a connection comes from a review of 21 published studies, including the Swedish study and 13 others that tried to determine whether there was a link between lymphoma and rheumatoid arthritis (RA). The findings, reported recently in Arthritis Research & Therapy,showed that overall, people with rheumatoid arthritis (RA) were twice as likely as the general population to develop lymphoma, particularly Hodgkin's lymphoma (one of the most curable types of cancer when detected early).
Lung cancer. The same review also reported that lung cancer was observed more often in people with rheumatoid arthritis (RA). Based on data from 12 studies, people with rheumatoid arthritis (RA) were 63% more likely to develop lung cancer than the general population.
Cancer at other sites. In addition, the authors of the review reported a potentially reduced risk of colorectal cancer among people with rheumatoid arthritis (RA) -- possibly due to their increased use of nonsteroidal antiinflammatory drugs (NSAIDs) and COX-2 inhibitors. The researchers also reported a slightly reduced risk of breast cancer.
What's Behind the Link? An important question that remains unanswered is whether people with rheumatoid arthritis (RA) are more prone to develop certain cancers than others or if the medications they take could be responsible for the increased risk.
In the Swedish study, more than 70% of people with rheumatoid arthritis (RA) had taken traditional disease-modifying antirheumatic drugs, or DMARDs, such as methotrexate (Rheumatrex, Trexall). However, the only DMARD linked to an increased risk of lymphoma was azathioprine (Imuran) -- a treatment that is rarely used today. There was also no link between NSAIDs like aspirin and ibuprofen (Advil and others).
One encouraging finding was that people who frequently used corticosteroids for inflamed joints had a lower risk of lymphoma, a result that suggests anti-inflammatory drugs could possibly protect against lymphoma.

Kimme L. Hyrich,M.D.,Arthritis Research UK Epidemiology Unit at University of Manchester discusses the risk of rheumatoid arthritis patients.

All RA patients should be regularly tested for cancer.  All health care professionals should be aware of this risk and write orders so they can be screened. If you know anyone with RA please ask and encourage them to be tested.  Early detection can save a life.

http://www.johnshopkinshealthalerts.com/reports/arthritis/3308-1.html

Lyphomas

Lymphoma is when cancer invades the lymphoid cells.  They are usually seen as a solid tumor in the lyphoid cells.

The two main categories for lymphoma are Hodgkin's lymphoma and non-Hodgkin's lymphoma.  Since there was so many lymphomas that have nothing in common they developed a new classification called WHO.  There are four major categories and 70 different lymphomas divided under the four categories. The four major categories are as follows.

Follicular lymphoma in the Bone Marrow

A.  Mature T cell and natural killer (NK) cell neoplasms

B.  Mature B cell neoplasms

C. Hodgkin lymphoma

E. Immunodeficiency-associated lymphoproliferative disorders

 

The Symptoms of Lymphoma are the following:

*weight loss

*abnormal amount of white cells in urine

*lymphdenopathy 

* fever of no indicated reason

What lab tests are ordered in diagnosing Lymphoma?

Other laboratory tests that may be useful include:

• Complete Blood Count (CBC) – may be ordered to rule out non-lymphoma conditions (such as leukemia) and/or to see if anemia is present. A CBC can determine if the platelet count and/or white blood cell count are low, which may indicate that lymphoma is present in the bone marrow.
• Bone marrow biopsy and examination – used to evaluate the cells present in the bone marrow. The presence of abnormal lymphoid cells and/or lymphoid aggregates may be seen with lymphoma.
• Blood smear – used to evaluate the quality of red and white blood cells and platelets as well as abnormal cells (lymphocytes), if present. 
• Immunophenotyping can identify the cells involved by testing for the presence or absence of certain markers on the membrane of the cells or inside the cells. These commonly used markers are called clusters of differentiation (CD) and are listed numerically. By developing a list of the CDs present on the cells, it is possible to classify the cells. This test can be done by several different methods, including flow cytometry and immunohistochemistry.
• Cytogenetics – an evaluation of the chromosomes in the nucleus of cancer cells to determine if pieces of the chromosomes have moved (translocation). This is rarely used for lymphomas. 
• Molecular genetic analysis – evaluating the cancer cell's DNA for genetic changes, particularly to determine whether all of the cells belong to a single clone.
• If it is thought that lymphoma has spread (metastasized) to other areas of the body, analysis of cerebrospinal fluid or other body fluids may be performed. 
• Beta-2 microglobulin – this test may be used to help predict the prognosis. I there are increased levels of the B2 microglobulin it is indicator of a problem, but not used as a diagnostic tool

Non-laboratory tests
Primarily used to help stage and monitor lymphoma. They include:

• Physical examination
• Computed tomography (CT) scans
• Positron emission tomography (PET) scan
• Chest X-ray
• Exploratory surgery (occasionally necessary)
• Magnetic Resonance Imaging (MRI)

You can read more at labsonline.org

Four types of Treatment for Lyphoma 

They are Chemotherapy and treated with the drug Rituxan.

RITUXAN^® (Rituximab) is indicated for the treatment of patients with:

• Previously untreated follicular, CD20-positive, B-cell NHL in combination with first-line chemotherapy and, in patients achieving a complete or partial response to RITUXAN in combination with chemotherapy, as single-agent maintenance therapy
• Non-progressing (including stable disease), low-grade, CD20-positive, B-cell NHL, as a single agent, after first-line CVP chemotherapy
• Previously untreated diffuse large B-cell, CD20-positive NHL in combination with CHOP or other anthracycline-based chemotherapy regimens
• Relapsed or refractory, low-grade or follicular, CD20-positive, B-cell NHL as a single agent

People with serious infections should not receive RITUXAN.

Important Safety Information

• RITUXAN can cause serious side effects that can lead to death, including infusion reactions, tumor lysis syndrome (TLS; kidney failure due to fast breakdown of cancer cells), severe skin and mouth reactions, and progressive multifocal leukoencephalopathy (PML; a rare, serious brain infection).
• RITUXAN has also been associated with serious and life-threatening side effects, including the return of active hepatitis B virus infection with sudden and serious liver problems including liver failure, and death, other serious infections that can lead to death, heart problems, kidney problems, and stomach and serious bowel problems including blockage and tears in the bowel that can sometimes lead to death.
• The most common side effects of RITUXAN seen in patients with non-Hodgkin's lymphoma were infusion reactions, fever, chills, low white blood cells, infections, body aches, and tiredness. Before starting treatment with RITUXAN it is important to talk to your doctor about your medical history.
• Tell your doctor about any side effect that bothers you or that does not go away. These are not all of the possible side effects with RITUXAN. For more information, ask your doctor.

Please see full Prescribing Information, including Medication Guide.

CVP=cyclophosphamide, vincristine, and prednisone or prednisolone; CHOP=cyclophosphamide, doxorubicin, vincristine, and prednisone. Got to website:   http//:www.rituxan.com

When a person is in treatment with Chemotherapy they will have to have blood drawn for a complete blood counts.  Chemo can cause the white cell count and platelet to decrease.  Your white has to be at least 2000 to receive chemo.  If it is not then you have to wait another day to be treated.