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Thursday, April 17, 2014
Does Pulmonary Sarcoidosis Lead to Lymphoma or One of Its Other Forms?
Good morning Doctor - Regarding Sarcoidosis and long-term monitoring. Does Pulmonary Sarcoidosis lead to Lymphoma or one of its other forms? Outside of the regular checkups with our General Practitioner, is there anything we should be looking out for?
This is a good question and a common concern among sarcoidosis patients.
Many patients with sarcoidosis have enlarged lymph nodes, and the immune cells located in the lymph nodes are very active, causing people to feel fatigue or even weight loss. Thus, sarcoidosis can present in a similar way to lymphoma. More than one research study has suggested that the risk of certain cancers, including lymphoma, is increased in sarcoidosis patients. However, for every study showing increased risk of cancer, there is another showing no difference in the risk of cancer overall in sarcoidosis patients. This may be related to studies involving different patient populations or perhaps the studies are too small. It would be necessary to follow thousands of patients for many years to answer this question unambiguously.
Some cases of sarcoidosis appear to be triggered by the presence of a malignancy. For instance, some patients with lung, testicular or breast cancer can have a "sarcoidosis-like" reaction in nearby tissues. This is one reason why experts encourage a biopsy to prove sarcoidosis. We check the biopsy material to make sure it is not caused by a cancer or infection. Even after the diagnosis of sarcoidosis is established, doctors also watch for unusual findings that may be a sign of malignancy. For instance, an enlarging tissue mass in the lungs on x-ray despite effective treatment for sarcoidosis should raise concerns about malignancy and might lead to a biopsy of the tissue. This is one reason why a regular x-ray (at least once a year) is recommended for patients with sarcoidosis.
Other than routine chest x-rays and examinations (at least once a year), there is no specific cancer screening process for sarcoidosis patients. Depending on if you are male or female, the usual cancer screening (e.g., PAP/pelvic exams, mammography, prostate exams, colonoscopy, etc.) is recommended for sarcoidosis patients. Your primary care doctor will help you with routine cancer screening. To reduce your risk of cancer, you are also encouraged to avoid smoking, excess alcohol use or sun exposure.
Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University