Explaining David Quessenberry's Unique Lymphoma

Sophomore Houston Texans offensive tackle David Quessenberry has been dealt the challenge of his life – fighting against cancer. Specifically, Quessenberry is now locked in a battle with lymphoma, or cancer of the lymphatic system. The lymphatic system, which is a collection of organs, lymph nodes, lymph ducts, and lymph vessels within the body’s circulatory network, is the most critical component of the human immune system. Without the lymphatic system to produce white blood cells and filter out bacteria, even athletes in peak physical condition can quickly succumb to miniscule infections and diseases. Lymphoma’s tendency – and in fact the tendency of cancer in general – to compromise the body’s ability to keep itself healthy is why lymphoma can cause so many devastating secondary and tertiary medical issues throughout the body.

Lymphoma generally comes under two major distinctions – Hodgkin’s disease and non-Hodgkin lymphomas. Non-Hodgkin lymphomas, or NHLs, are more common than Hodgkin’s disease, and there are several types of NHLs within that subcategory. To get a better idea of what lymphomas actually are, I turned to the U.S. National Library of Medicine.

Non-Hodgkin lymphomas begin when a type of white blood cell, called a T cell or B cell, becomes abnormal. The cell divides again and again, making more and more abnormal cells. These abnormal cells can spread to almost any other part of the body. Most of the time, doctors don't know why a person gets non-Hodgkin lymphoma. You are at increased risk if you have a weakened immune system or have certain types of infections.

Non-Hodgkin lymphoma can cause many symptoms, such as

• Swollen, painless lymph nodes in the neck, armpits or groin
• Unexplained weight loss
• Fever
• Soaking night sweats
• Coughing, trouble breathing or chest pain
• Weakness and tiredness that don't go away
• Pain, swelling or a feeling of fullness in the abdomen

Your doctor will diagnose lymphoma with a physical exam, blood tests, a chest x-ray, and a biopsy. Treatments include chemotherapy, radiation therapy, targeted therapy, biological therapy, or therapy to remove proteins from the blood. Targeted therapy uses substances that attack cancer cells without harming normal cells. Biologic therapy boosts your body's own ability to fight cancer. If you don't have symptoms, you may not need treatment right away. This is called watchful waiting.

Roughly 85% of all non-Hodgkins lymphomas are of the B-cell variety, while T-cell lymphomas like the one Quessenberry is fighting make up the remaining 15%. The specific T-cell lymphoma that Quessenberry has been diagnosed with, T-lymphoblastic lymphoma, is an even smaller subset of patients.

This disease accounts for about 1% of all lymphomas. It can be considered either a lymphoma or leukemia, depending on how much of the bone marrow is involved (leukemias have more bone marrow involvement). The cancer cells are small-to-medium sized, immature T-cells.

This lymphoma often starts in the thymus (see the image below). This is where many T cells are made. This lymphoma can develop into a large tumor in the mediastinum (the area in the middle of the chest and behind the breast bone). If the tumor presses on the windpipe (trachea) that carries air into the lungs, it can cause trouble breathing. The tumor can also press on or even block the superior vena cava (the large vein that returns blood to the heart from the arms and head), which can make the arms and face swell.

Patients are most often young adults, with males being affected more often than females.

This lymphoma is fast-growing, but if it hasn’t spread to the bone marrow when it is first diagnosed, the chance of cure with chemotherapy is quite good.

Despite being a fast-growing form of lymphoma, T-lymphoblastic lymphoma is very curable. In a trial study conducted on 45 T-LBL patients between June 1989 and December 1998, a virtual lifetime of medical advancements ago, a staggering 93% of patients went into complete remission (100% of stage I-III patients and 89% of stage IV patients). Estimates for continuous complete remission and disease-free survival  at seven years were 65% and 62%, respectively. Taking into account the huge strides that the medical community has made in cancer treatment since 1998, I fully expect that number to be much higher in 2014.

There has been no indication on just how far along Quessenberry’s lymphoma was before his diagnosis, but I am confident that Houston’s world class medical facilities will give him the best care he could ever hope for. Without more information, it is hard to really guess at any sort of prognosis, nor would I ever want to write about such a thing, but if anyone is tough enough to beat this, it is David Quessenberry. As a rookie, "Quess" had his truck stolen by human smugglers and missed his entire first season due to a broken foot, but he never let his misfortune get the best of him. I anticipate that same warrior’s mentality will serve him well in the most important fight of his life.

For information on how you can help others in their struggle against lymphoma, visit the Leukemia and Lymphoma Society. Don’t have any spare income to give? Not to worry, there is something you can donate that is far more valuable than any currency – your blood.

Just heard about Q. Prayers to him & his family. Want to help all with blood cancers? Pls donate blood. Shortages are very hard on patients.

— Stephanie Stradley (@StephStradley) June 10, 2014

Want to help MDA patients specifically? Where to donate blood: http://t.co/wbQmnm0rNL @MDAndersonNews Holly Hall location easy, close to NRG

— Stephanie Stradley (@StephStradley) June 10, 2014

I think I speak for everyone at BRB when I say that we send our prayers to the Quessenberry family. Give ‘em hell, David.