Cutaneous T-Cell Lymphoma

T-cell lymphoma is a type of cancer that involves the T-cells (a type of white blood cell that is a part of the immune system and develops from the stem cells in the bone marrow). They can be slow-growing or aggressive. Cutaneous T-cell lymphoma is one of the most common forms of T-cell lymphoma. They usually affect the skin but can also involve the blood, lymph nodes, and other internal organs. Dry skin, severe itching, a red rash, and enlarged lymph nodes often accompany it. Cutaneous T-cell lymphoma (CTCL) affects men more than women above the age of 40 years. Most CTCLs grow slowly and aren't dangerous or life-threatening. Though CTCL cannot be cured, doctors can provide a wide range of treatment options, such as topical medications, immunotherapy, radiation therapy, photochemotherapy, and chemotherapy, to ease symptoms.  

This informative blog will discuss everything you need to know about cutaneous T-cell lymphoma to keep you well-informed.  

What is Cutaneous T-cell Lymphoma?

Cutaneous T-cell lymphoma is a group of rare blood cancers that affects the largest organ in the body, the skin. It starts in the blood cells known as T-lymphocytes, which are white blood cells responsible for fighting infections in the body. 

Cutaneous T-cell lymphomas cause prominent, itchy, scaly rashes (pruritus) or patches (lesions). This cancer is also known as the lymphoma of the skin, which is a type of non-Hodgkin lymphoma. It is usually a non-contagious and slow-growing cancer, but for some, it may grow aggressively.  

What Are the Types of Cutaneous T-cell Lymphomas?

The two most common subtypes of cutaneous T-cell lymphoma are as follows:

Mycosis Fungoides

• This is the most common type of CTCL that accounts for 50% of all cases. 
• It is a slow-growing cancer that usually affects the skin, but 10% of the time, it may spread to your lymph nodes and other internal organs like the liver, kidneys, and lungs.  

Sezary Syndrome 

• This is the second most common type of CTLC, accounting for 15% of all cases. 
• Here, the cancerous lymphocytes are seen in the skin and bloodstream.
• You may experience widespread skin redness.
• This is an aggressive and fast-growing form of lymphoma.  

What Causes Cutaneous T-cell Lymphomas? 

The exact cause of cutaneous T-cell lymphoma remains unknown, but there could be two main possibilities. These include:

• Acquired Genetic Mutation: Some gene changes can predispose you to develop CTCL. 
• Infections: Your immune system may overreact when there is an infection, which causes your bone marrow to produce more lymphocytes. Abnormal DNA mutations affect the key genes in lymphocytes, causing lymphoma.  

What Are the Symptoms Associated with Cutaneous T-cell Lymphomas?

The symptoms of CTLC depend on the stage of the lymphoma. Although you may observe similar symptoms for both types of CTLCs, they may differ depending on the different stages. 

Stage I

• Dry red, scaly bumps or patches on the skin.
• Lymph nodes are normal and are not swollen or inflamed. 

Stage II

• Dry, red, scaly patches or plaques (thick lesions) cover at least 80% of the skin surface.
• The lesion may be 1 cm or more in width.
• There are a few Sezary cells in the blood.
• Lymph nodes may be enlarged but do not contain cancer cells within them. 

Stage III

• Most of the skin is affected with dry, red scaly lesions.
• Lymph nodes may be slightly swollen but do not contain cancer cells. 

Stage IV

• Almost the entire skin surface may be covered with dry, itchy, scaly plaques or patches 
• There may be many Sezary cells in the blood
• Lymph nodes are enlarged with cancer cells within them
• The cancer spreads to other internal organs like the liver, lungs, and kidneys. 

How is Cutaneous T-cell Lymphoma Diagnosed?

If you notice any scaly skin patches or lesions, consult a dermatologist (a doctor specializing in diagnosing and treating conditions related to the skin, hair, and nails) for further evaluation. Your doctor will analyze your medical history and conduct a physical examination. 

They may order the following diagnostic tests to confirm CTLC and rule out other skin conditions:

Blood Tests

Your doctor will check the blood count, especially the lymphocytes, and the presence of any infections. 

Biopsy

They may take a small sample of your skin tissue and study it under a microscope. Your doctor may also recommend lymph node biopsies if needed.  

Imaging Studies

Your doctor may recommend imaging tests, such as CT (Computed Tomography) scan and PET (Positron Emission Tomography) scan, to evaluate your lymph nodes and other organs. 

Cancer Staging

Your doctor may use a staging system to determine the severity of the lymphoma. It is based on four factors:

• Tumor Size (T) - Measures how much skin is affected.
• Lymph Nodes (N) - This measures the amount of lymphoma in your lymph nodes.
• Metastasis (M) - This evaluates if the tumor has spread to other organs. 
• Blood (B) - This measures the amount of lymphoma cells in your blood.  

How is Cutaneous T-cell Lymphoma Treated?

Based on the diagnosis, your doctor may recommend any one of the following treatment options:

Topical Treatment

• These include topical skin creams or ointments such as retinoids, corticosteroids, or targeted therapy. 

Phototherapy

• This is used for early-stage disease where the doctor uses UV-A or UV-B light to kill the cancer cells.  

Extracorporeal Photophoresis (ECP)

• This treatment involves UV light and psoralen.
• Your doctor will draw your blood sample and mix the white blood cells with psoralen.
• This makes the cells vulnerable to UV light.
• The cells are then exposed to UV light, which kills the cancer cells. 

Radiation Therapy

• Your doctor will target cancer cells with X-ray radiation that slows the cancer cell growth or kills the cells. 

Immunotherapy 

• Your doctor will boost your immune system with specialized man-made or blood substances.  

Chemotherapy 

• Your doctor may administer special drugs in oral pills or IV injections or directly apply ointments or gels to the affected area.  

Can You Prevent Cutaneous T-cell Lymphomas?

You can adopt the following preventive measures to strengthen your immune system to reduce your likelihood of developing CTLC:

• Try to quit smoking 
• Make sure you are up-to-date on vaccines 
• Maintain a healthy weight 
• Eat a healthy, well-balanced, nutritious diet 
• Avoid alcohol
• Exercise regularly
• Get enough sleep
• Maintain personal hygiene
• Reduce your stress levels through relaxation techniques 
• Moisturize your skin well
• Prevent excess sun exposure 
• Don't scratch your skin

Conclusion 

CTLC is a group of rare blood cancers that affects your skin. You may experience a persistent red, scaly skin patch or lesion that may be extremely dry and itchy. This may be due to a genetic mutation. However, the exact cause is unknown. Your doctor can clinically evaluate your rash and consider several diagnostic tests before confirming the disease and ruling out other skin conditions. Once the diagnosis is confirmed, your doctor may ease symptoms with various treatment options.