non hodgkin's lymphoma | Non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma

Non-Hodgkin (NHL) lymphomas are cancers of the immune system, and more specifically, of the lymphatic system. In France, they are the 6th most frequent cancers, with about 11 600 new cases per year. They affect men a little more often (54%) and are observed at any age, but with an increased frequency after 60-65 years. Thanks to therapeutic advances, many cures are now possible.

The disease
In an NHL, lymphocytes, a variety of white blood cells with a major role in immunity, are produced in too large a quantity and their lifespan is longer than normal. These abnormal lymphocytes are the cause of tumors that develop, at the expense of healthy cells, in the lymph nodes (ganglionic lymphoma) or in the lymphoid tissue found in most organs (extra lymphoma lymph nodes). The tumor can spread through the organism through the circulation of abnormal lymphocytes in the lymph. There are two main types of NHL: B-Cell lymphomas, the most numerous (85%), developing from abnormal B lymphocytes, and T-cell lymphomas, developing from abnormal T lymphocytes.

What are the signs of the disease?
It is possible to feel persistent swelling in the superficial ganglia of the neck or armpits, without it being associated with pain or inflammation. When the deep ganglia are affected, their swelling causes compression phenomena that can be felt, for example at the leg level, like a heaviness. The liver or spleen can increase in volume. Digestive or nervous system signs may occur when the NHL is located outside the lymph nodes, in the stomach or brain. The general condition of the patient can be affected with access to fever, night sweats or unexplained weight loss.

The diagnosis
• During the clinical review, the Doctor palpates the areas where the swollen glands can be located: Under the chin, in the neck, in the tonsil area, above the shoulders, at the elbows, under the armpits and in the groin. It also examines the abdomen, which may have swelling as a result of reaching organs or deep ganglia.

• A biopsy is used to confirm the presence of lymphoma and to specify its type. The biopsy consists of taking a sample on a ganglion or more rarely on an organ (spleen, liver, bone marrow, lung...), to analyze it under a microscope.

• During the extension checkup, the doctor searches for all the locations of the disease. Medical imaging tests such as CT scan, chest x-ray, abdominal ultrasound, or pet (positron emission tomography) can be used to determine the eventual expansion of the NHL. A blood test can reveal anomalies on the different types of blood cells, red cells, white blood cells and platelets and also helps to determine whether the liver, kidneys or other organs are affected. The doctor may request a bone marrow examination as well as an examination of the cerebrospinal fluid that surrounds the spinal cord and brain.

• A general health check is carried out. All these exams are complementary and help to specify the type of lymphoma, its extent and stage of advancement, and to adapt the treatments in the most optimal way

Therapeutic Responses

Each patient and lymphoma respond differently to the treatments indicated: this is the therapeutic response.

• Lymphoma can be stable at the end of a treatment: it does not evolve adversely but does not show any signs of improvement.

• In some cases lymphoma is refractory. The tumor grows or the disease changes adversely despite the treatments.

• indolent lymphomas respond well to treatments, but often re-offend or relapse. After an improvement has been observed, the signs of the disease are reappearing or worsening, which justifies new treatments.

• Remission is common in the case of aggressive lymphomas. A long period of remission, complete and without interruption, brings the patient closer to healing and a long-term medical follow-up remains necessary.

Your follow up

During the treatment phase, the medical team provides regular monitoring of your condition based on clinical examinations, blood balances and medical imaging results. This is necessary in order to evaluate your body's response to the treatment and possibly decide to adjust the medications or doses. After treatment, regular and prolonged follow-up over several years is also indispensable. It allows to detect possible late side effects of treatments and especially to be attentive to the risks of recurrence of the disease. You must pay attention to certain signs such as fever, digestive disorders (constipation or diarrhea), lesions in the mouth or throat, pain or swelling of the lymph nodes, and then let your doctor in.

Lexicon

Monoclonal antibody: A molecule of targeted therapy that specifically blocks, at the level of cancer cells, a biochemical mechanism leading to their proliferation.

Chemotherapy: Alternating periods of treatment and rest periods.

Lymph nodes: small organs grouped in clusters or chain-linked which participate in the functioning of the lymphatic system.

Lymphocytes: Cells made in the bone marrow. They attack viruses, bacteria but also abnormal or cancerous cells. B lymphocytes, which produce antibodies and T lymphocytes, are distinguished from the more diverse roles.

Remission: When the characteristic signs of the disease regress. A partial remission is declared when the tumor size is reduced by half. In complete remission, the tests no longer reveal cancer cells.

Lymphatic system: A system that participates in the immune system of the body's defense against infections and other diseases. Consisting of vessels, tissues and organs, the lymphatic system manufactures and transports lymphocytes in the lymph.

The evolution of the disease

The grade characterizes the rate of evolution of the disease. Aggressive lymphomas, representing 50 to 60% of NHL, are rapidly evolving. The indolent NHL, due to slower progression do not necessarily require therapeutic management. They represent 40 to 50% of the NHL. The stage refers to the extension of the disease in the organism. The ANN Arbor classification is used for the ganglion NHL. In stages I and II, the disease is located in one or more ganglion groups. In stages III and IV, the NHL is considered to be disseminated.  It extends, at stage IV, outside the ganglion groups to reach organs such as the liver, bone marrow or lungs. Rarer, lymphomas taking birth outside the lymph nodes (extra ganglion) are classified differently.

The treatments

The treatments that are offered to you have been designed according to the characteristics of lymphoma (type, grade, stage of evolution) but also according to your general health condition. The different options are prescribed alone or associated with each other. Combining multiple medications helps to increase the effectiveness of the treatment while reducing the doses of each and minimizing their side effects.

• Therapeutic forbearance is warranted for certain forms of indolent, slow-moving or low-spread lymphoma. The doctors then decide not to apply treatment immediately after the diagnosis while maintaining regular follow-up.

• Chemotherapy uses drugs that destroy cancer cells or prevent their growth. The reference protocols combine several medications and generally apply in successive cures. Medications are in the form of tablets (oral intake) or injectable products, intravenously, intramuscularly or subcutaneously.

• Radiotherapy uses powerful X-ray doses directed to the tumor area to locally destroy cancer cells. Following heavy treatment with chemotherapy or radiotherapy a bone marrow transplant can be considered, a treatment called "consolidation".

• Immunotherapy treatments take advantage of medications that stimulate the patient's immune system to direct it against cancer cells. These immunotherapeutics include Radio-immunotherapy, interferons and monoclonal antibodies