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368 CHAPTER 12 Possible Causes of Lymphoma At some point, many people who are diagnosed with lymphoma become focused on the question “Why did this happen to me?” Wanting to understand what caused a catastrophic illness is natural and may be a universal drive. But for most people with lymphoma, this is not yet a question that can be easily answered. We still don’t know enough about what causes the disease. Eventually, for most of us with lymphoma, what caused the illness becomes somewhat immaterial: what really matters is dealing with the disease as best we can. And I think it’s important for all of us who have been diagnosed with lymphoma to remember that we didn’t choose to get this disease. Still, pondering from time to time about what could have caused our illness is inescapable. Although a clear-cut cause for most occurrences of lymphoma remains elusive, this chapter explores some of the factors that may be involved in promoting the development, or pathogenesis, of lymphoma. If you have turned to this chapter first, please take a quick look at Chapters 9, 10, and 11 before going any further. You need to understand something about the different types of lymphoma and the nature of cells and the immune system before you can understand how various factors might interact to cause lymphoma. Environmental Factors The ultimate cause of all the different kinds of lymphoma is an alteration in gene expression (see Chapter 9). There may be a mutation in some gene that causes its protein product to be abnormal. Or there may be a mutation that disrupts gene regulation, so that more or less of a normal protein is made than appropriate. In many lymphomas, these abnormalities in gene Possible Causes of Lymphoma 369 V expression result from disruptions of chromosomes, particularly translocations . In many cases, chromosomal translocations may result from random chance—in other words, plain bad luck, helped along by the DNA shuffling that is a part of the normal process of lymphocyte development. In other cases, they may result from some sort of “environmental insult”—something a person was exposed to increased the probability that chromosomal breakage and inappropriate recombination would occur. In this case, a specific environmental insult may be associated with the disruption of a specific chromosome and hence a specific version of lymphoma. This chapter is concerned with environmental factors that may cause the sorts of cellular mutations that can lead to a person developing lymphoma. The term environmental factors can be used to mean different things. Some people would restrict the term to pollutants or other toxins found in air, food, and water. Others would include substances people might encounter at work or aspects of their lifestyle, such as sunbathing, diet, exercise, or smoking. In this chapter, I use the broadest possible definition of environmen‑ tal factors to include everything a person might be exposed to. The possible roles of viruses, diet, environmental toxins, and disruption of the immune system are explored. Any lymphoma is likely the result of a combination of factors. For example, a weakened immune system might be ineffective at controlling certain viral infections, making it more likely that one could develop a form of lymphoma in which viral infection is involved. And, of course, the converse is also true—certain viruses, such as HIV, profoundly suppress the immune system. In searching for the possible causes of one’s own illness (as opposed to general information about factors that tend to enhance the probability of developing the disease), there are many pitfalls for the unwary, and it’s important to remember that statistical data apply to large populations of people rather than to individuals. Shortly after I was diagnosed with lymphoma, I read that celiac disease was linked to NHL. Having had a celiaclike syndrome as a baby, I wondered if this was connected to my later development of NHL. I also wondered why none of my doctors inquired about this possible link. It was not until much later that I realized that celiac disease is linked to enteropathy-associated T-cell lymphoma—a completely different disease than the primary mediastinal large B-cell lymphoma with which I was diagnosed. U 370 Understanding Lymphoma It’s painfully easy to jump to this sort of conclusion and to make connections that may be erroneous. Unless you have a form of lymphoma that has been clearly linked to a specific cause—such as adult T-cell leukemia/lymphoma...


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