Friday, June 26, 2015

Lyme to Lymphoma?


Many people, upon hearing my cancer diagnosis, have said, "Oh, so you never had Lyme?"  Indeed, I was so sick for so long it's hard to imagine that a tick bite could do that…

And of course, I think it's common for those diagnosed with cancer to wonder how it happened.  In general there are so many factors that each individual is exposed to in a lifetime it's hard to point at a single cause.  But this all started with a little tick bite!

So with that I felt compelled to ask the question,

Can Lyme disease cause cancer?

On this, opinions start to fly.  The one thing I know for sure is I got bit by a tick and ended up on chemotherapy.  Perfectly healthy one day, almost dead a year and a half later.

There are only 3 possible answers to this question:

1)  Coincidence - the tick bite happened at the same time as cancer, the two are not related
2)  Infection triggered cancer - in my case the lymph was involved from the start
3)  Disabled immune response allowed the cancer to grow

1) Coincidence 

Really?  I suppose bad luck happens, but twice at the same time? I see this as an easy out for an oncologist who specializes in treating cancer but has no need to understand what causes it…  or those who don't believe in Lyme disease.

2) Infection triggered cancer

a. In my case the Lyme infection entered the lymphatic system right from the start.  Almost three months after the initial bite and 2 weeks of antibiotics, I felt a swollen lymph gland under my arm. This is consistent with recent research that reveals that the bacteria that cause Lyme disease appear to hide out in the lymph nodes.  Although I was unknowingly having progressive neurological symptoms, this was the first sign that something was wrong. Then, following the first 6 months of the triple antibiotic treatment, the lymph nodes in my neck became visibly enlarged. The nodes continued to grow (along with severe weight loss) until my lymphoma diagnosis 9 months later.

b. Scientists know that certain viruses can trigger cancers.  But can a bacterial infection trigger cancer?  It turns out that there are at least two examples of Bacteria that can lead to cancer:
  • Helicobacter pylori         =>   Stomach cancer 
  • Chlamydia trachomatis   =>   Cervical cancer
In the latter example,"studies have not shown that chlamydia itself causes cancer, but it might work with HPV in a way that promotes cancer growth."  

3) Disabled immune response

"Having a compromised immune system, such as from HIV/AIDS or from having an organ transplant requiring medications to suppress the immune response, increases the risk of Hodgkin's lymphoma."

Throughout my illness it was clear that my immune and digestive systems were compromised. This is common in Lyme patients and happens for two reasons:

a. Lyme specifically acts to disable the immune system. This often results in autoimmune conditions such as chronic fatigue, fibromyalgia, and often leading to other more serious conditions like MS.

A recent study from UC Davis reveals how Lyme disease subverts the immune system;

The bacteria initially trigger a strong immune response in an infected animal, but findings from this study indicate that the bacteria soon cause structural abnormalities in “germinal centers” — sites in lymph nodes and other lymph tissues that are key to producing a long-term protective immune response.  The researchers found that following Borrelia burgdorferi infection, this process even prevented induction of strong immune responses to an influenza infection

b. Lyme treatment usually involves long-term antibiotic therapy - this may compound the Lyme's impact on immune function by killing off the "good bugs" in the digestive tract.  Emerging science is showing that the gut "microbiome" is critical to a healthy immune system.   (More on this later)


Examples of immune disorder and cancer

A good place to look for the connections between immune deficiency and cancer is HIV/AIDS.  According to cancer.org:

"...some types of cancer occur so often in people with AIDS that they are considered AIDS-defining conditions – that is, their presence in a person infected with HIV is a clear sign that full-blown AIDS has developed."


The cancers that define a person with HIV as having AIDS include:
  • Kaposi sarcoma
  • Non-Hodgkin lymphoma (especially primary central nervous system lymphoma)
  • Invasive cervical cancer
"Some other cancers are also more common in people with HIV or AIDS than people who are not infected, but the reasons for the increased risk aren’t clear. It may be that some of these cancers are able to develop and grow more quickly because of a weakened immune system brought on by the infection itself."

Hodgkins lymphoma is among those other cancers listed as more likely to develop in people with HIV than in people who are not infected. In these cases:

Some of these cancers have been linked to infections with different viruses. These viruses can cause cancer in people with and without HIV, but the risk might be higher in people with HIV because their immune systems are less able to control the viral growth. For example, anal cancer and some mouth and throat cancers are linked to infection with HPV, the same virus that causes cervical cancer. Liver cancer is known to be more common in people infected with the hepatitis B or C viruses. Some types of lymphoma have been linked with viral infections as well.

Hmm.  In my case, tests revealed that I may have a past infection with Epstein-Barr virus (EBV) (mononucleosis)  that has been linked to Hodgkins.


Documented links between Lyme and cancer

It turns out there are medical references discussing possible links between Lyme disease and various cancers.  According to cancer.org, primary cutaneous marginal-zone B-cell lymphoma is sometimes linked to an infection with Borrelia, the germ that causes Lyme disease.  And several medical references are listed on lymeneteurope.org linking Lyme Disease and Various Forms of Lymphoma.  More medical references are listed below.


Conclusions

So while all this information does not "prove" anything, there are several factors that could lead to the conclusion that a tick bite ultimately led to my cancer.  Lyme disease, immune suppression, antibiotics, Epstein-barr virus, and other documented cases...

It is possible that I had Hodgkins disease lurking in my system, and my healthy body was keeping it at bay.  Or the Lyme infection somehow triggered a malignancy in the lymphatic system. Or the Lyme infection re-activated EBVvirus and triggered Hodgkins that took advantage of a compromised immune system.  Certainly more research is warranted, as Lyme has become an epidemic around the world and in many cases can be life threatening.

I am not a doctor, nor am I qualified to make medical conclusions, but the evidence seems fairly clear.  Although I know coincidences can happen,

in this case I'm going with a combination of (2) and (3) above…

Yes, Lyme disease can result in cancer.





References:

From American Cancer Society website, cancer.org:
From lymeneteurope:

From Mayo Clinic:

From UC Davis:

Lyme disease subverts immune system, prevents future protection

Lyme disease bacteria take cover in lymph nodes

Reference: Suppression of Long-Lived Humoral Immunity Following Borrelia burgdorferi Infection
Rebecca A. Elsner, Christine J. Hastey, Kimberly J. Olsen, Nicole Baumgarth  Published: July 2, 2015DOI: 10.1371/journal.ppat.1004976


From PubMed: National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM):


1.Borrelia and subsequent risk of solid tumors and hematologic malignancies in Sweden.
Chang CM, Landgren O, Koshiol J, Björkholm M, Löve TJ, Kristinsson SY.
Int J Cancer. 2012 Nov 1;131(9):2208-9. doi: 10.1002/ijc.27483. Epub 2012 Mar 15. No abstract available.
PMID: 22322900 [PubMed - indexed for MEDLINE]
Related citations
2.Risk of malignancy associated with Lyme disease: still up in the air.
Stricker RB, Johnson L.
Int J Cancer. 2012 Dec 1;131(11):2717; author reply 2718. doi: 10.1002/ijc.27559. Epub 2012 Apr 16. No abstract available.
PMID: 22461012 [PubMed - indexed for MEDLINE]
Related citations
3.Neuroborreliosis and CNS lymphoma: what is the nexus?
Saggese CE, Cecotti L, Lazzarino de Lorenzo LG.
Neurol Sci. 2013 Dec;34(12):2253-4. doi: 10.1007/s10072-013-1492-8. Epub 2013 Aug 10. No abstract available.
PMID: 23934519 [PubMed - indexed for MEDLINE]
Related citations
4.Borrelia infection and risk of non-Hodgkin lymphoma.
Schöllkopf C, Melbye M, Munksgaard L, Smedby KE, Rostgaard K, Glimelius B, Chang ET, Roos G, Hansen M, Adami HO, Hjalgrim H.
Blood. 2008 Jun 15;111(12):5524-9. doi: 10.1182/blood-2007-08-109611. Epub 2008 Apr 18.
PMID: 18424667 [PubMed - indexed for MEDLINE] Free PMC Article
Related citations
5.Borrelia burgdorferi-associated primary cutaneous marginal-zone B-cell lymphoma: a case report.
Monari P, Farisoglio C, Calzavara Pinton PG.
Dermatology. 2007;215(3):229-32.
PMID: 17823520 [PubMed - indexed for MEDLINE]
Related citations
6.Lyme neuroborreliosis mimicking primary CNS lymphoma.
Walther EU, Seelos K, Bise K, Mayer M, Straube A.
Eur Neurol. 2004;51(1):43-5. Epub 2003 Nov 21. No abstract available.
PMID: 14639029 [PubMed - indexed for MEDLINE]
Related citations
7.Interaction of Borrelia burgdorferi sensu lato with Epstein-Barr virus in lymphoblastoid cells.
Hulínská D, Roubalová K, Schramlová J.
Folia Biol (Praha). 2003;49(1):40-8.
PMID: 12630667 [PubMed - indexed for MEDLINE]
Related citations
8.[Infectious causes of non-Hodgkin lymphomas].
Munksgaard L, Hjalgrim H, Melbye M.
Ugeskr Laeger. 2002 Dec 9;164(50):5927-32. Review. Danish.
PMID: 12553112 [PubMed - indexed for MEDLINE]
Related citations
9.[Occurrence of angioimmunoblastic T-cell lymphoma six months after onset of Lyme disease].
Hatanaka K, Miyagishima T, Kamata T, Nakagawa M, Miura Y, Arai S, Kishimoto A, Kamishima Y, Shibata M, Choi GH, Kudo M, Okabe M, Tsukamoto T, Miyamoto K.
Rinsho Ketsueki. 2000 Dec;41(12):1273-6. Japanese.
PMID: 11201153 [PubMed - indexed for MEDLINE]
Related citations
10.Exploring the causes of cutaneous B-cell lymphoma: we should learn from the Lyme disease experience.
Naldi L, Minelli C.
Dermatology. 2000;201(4):353-5.
PMID: 11146350 [PubMed - indexed for MEDLINE]
Related citations
11.Incidence patterns of lyme disease and cutaneous B-cell non-Hodgkin's lymphoma in the United States.
Munksgaard L, Frisch M, Melbye M, Hjalgrim H.
Dermatology. 2000;201(4):351-2.
PMID: 11146349 [PubMed - indexed for MEDLINE]
Related citations
12.Borrelia burgdorferi-associated cutaneous marginal zone lymphoma: a clinicopathological study of two cases illustrating the temporal progression of B. burgdorferi-associated B-cell proliferation in the skin.
Goodlad JR, Davidson MM, Hollowood K, Batstone P, Ho-Yen DO.
Histopathology. 2000 Dec;37(6):501-8.
PMID: 11122431 [PubMed - indexed for MEDLINE]
Related citations
13.Positive serology for Lyme disease borrelias in primary cutaneous B-cell lymphoma: a study in 22 patients; is it a fortuitous finding?
Jelić S, Filipović-Ljesković I.
Hematol Oncol. 1999 Sep;17(3):107-16.
PMID: 10641031 [PubMed - indexed for MEDLINE]
Related citations
14.Borrelial lymphocytoma--a historical case.
Sonck CE, Viljanen M, Hirsimäki P, Söderström KO, Ekfors TO.
APMIS. 1998 Oct;106(10):947-52.
PMID: 9833696 [PubMed - indexed for MEDLINE]
Related citations
15.Borrelia burgdorferi-associated cutaneous B cell lymphoma: clinical and immunohistologic characterization of four cases.
Garbe C, Stein H, Dienemann D, Orfanos CE.
J Am Acad Dermatol. 1991 Apr;24(4):584-90.
PMID: 2033136 [PubMed - indexed for MEDLINE]
Related citations






No comments:

Post a Comment

Note: Only a member of this blog may post a comment.