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

NON-Hodgkin's lymphoma

Who is involved?
With more than 11 600 new cases estimated in France in 2011, non-Hodgkin lymphomas are ranked 5th among the most common cancers. They affect men a little more often (54%) and are observed at any age, including in children and adolescents, but with increased frequency after 60-65 years.

Symptoms
The most common symptom is swelling of the lymph nodes at the neck, armpit or groin. Painless normally, swollen lymph nodes can train a gene or even a sore by exerting pressure on the surrounding tissues or organs.
It is common for the lymph nodes to be swollen, and this can be caused by other health problems, such as infection or flu. However, these lymph nodes are usually small in size. If they are swollen because of an infection, they may be susceptible or painful;
Rash or itchy skin (pruritus);
Unexplained fatigue


Some symptoms of non-Hodgkin's lymphoma are generalized and affect the whole body especially when the disease has already advanced:

Unexplained fever with a temperature above 38 °c, with no apparent cause, which can last for weeks;
Heavy night sweats that make sweating so abundant that sleepwear or sheets are wet and may need to be changed;
Unexplained weight loss that can reach a loss of more than 10% of body weight over a 6-month period.
 Non-Hodgkin's lymphoma can cause symptoms depending on the part of the body affected.

If non-Hodgkin's lymphoma affects the thorax, the person may have:

shortness of breath;
A cough.
If non-Hodgkin's lymphoma affects the abdomen, the person may have:

Difficulty in digesting
A mass or swelling in the abdomen
Abdominal tenderness, pain or discomfort;
Nausea or vomiting
Loss of appetite
spleen or liver swollen;
Anemia, due to chronic bleeding in the gut (gastrointestinal tract), as in the stomach or intestine.
If non-Hodgkin's lymphoma affects the brain (CNS lymphoma), the possible symptoms are:

Headaches

Difficulty thinking

Difficulty in moving parts of the body

Personality changes

Seizures.

If non-Hodgkin's lymphoma affects the bone marrow, the person may suffer:

Low numbers of blood cells

Constant or recurrent infections

More frequent bleeding or bruising.

Treatments

Lymphomas often react very well to treatment. The treatment options depend on the diagnosis and the evolution of the disease. A vigilant observation may suffice if the evolution of the disease is slow.

Chemotherapy

The chemo-therapeutic agents employed depend on the type of non-Hodgkin's lymphoma and its stage.

Biological therapy

Biological therapy can be administered to treat certain non-Hodgkin's lymphomas or associate with chemotherapy.

Radiotherapy

 External radiation therapy can treat areas affected by localized early lymphoma. It can also be associated with chemotherapy.

Surgery

 Surgery is used to remove a partial or full lymph node (biopsy) in order to diagnose lymphoma. More extensive surgery is rarely done to treat non-Hodgkin's lymphoma. We could remove the spleen (splenectomy) in some cases.

Stem cell transplant

A stem cell transplant (GCS) is possible in some cases, such as when lymphoma reappears after being treated or reacting to treatment.

It is important to have regular follow-up visits, especially in the first 2 years following treatment, since that is when the risk of recidivism is highest.

What is lymphoma?

Lymphoma is a cancer that develops from cells of the lymphatic system, lymphocytes. These cells that form part of the white blood cells participate in the immune defenses of the body. They circulate in the blood and are also grouped in the lymph nodes.

For reasons that are not yet fully understood, these cells become abnormal and multiply in an anarchic way: they become cancerous or lymphoma.

Lymphoma appears most often in a group of lymph nodes (ganglionic lymphoma) or, more rarely, in another organ (stomach, intestine, skin, brain, etc.). It can spread through the lymphatic system or the blood system to any tissue or organ.

The term hemopathy malignant is also used to qualify lymphomas.

What is the difference between NON-Hodgkin's lymphoma and Hodgkin's lymphoma? 

Non-Hodgkin lymphomas and Hodgkin's lymphoma are the two main types of cancer in the lymphatic system. Hodgkin's lymphoma, also known as Hodgkin's disease, is the first form of the disease to be identified. It was the Doctor Thomas Hodgkin who described it in 1832. It is particularly characterized by the presence of special abnormal cells, the Sternberg cells. As opposed to this form, all other lymphomas are called non-Hodgkin lymphomas. 

What is NON-Hodgkin's lymphoma?

Non-Hodgkin's lymphoma (NHL) is a cancer that develops from cells of the lymphatic system, lymphocytes. This is a type of white blood cells involved in the body's defense reactions.

Non-Hodgkin's lymphoma most often appears in a group of lymph nodes (ganglionic lymphoma) or, more rarely, in another organ such as the stomach, intestine, skin or brain (extra-ganglionic lymphoma). It can spread through the lymphatic system or the blood system to any tissue or organ.

Non-Hodgkin lymphomas are a group of many diseases that differ in the appearance of their cells when examined microscopically, how they are developed, and their impact on the organism. The NHL is defined by the type of cells involved (B lymphocytes or T lymphocytes), the rate of evolution of the tumor (the grade) and the extension of the lymphoma in the body (the stage). Depending on the grade, there are two groups of non-Hodgkin lymphomas: indolent lymphomas that have a slow evolution and aggressive lymphomas that evolve rapidly.

From diagnosis to treatment proposal

The diagnosis of non-Hodgkin lymphomas includes clinical examination and blood tests. It is established by the Anatomo-pathological examination of a ganglion taken from the patient. A scanner is performed at the neck, thorax, abdomen and pelvis to determine the number and size of the affected ganglia. A bone marrow examination is often necessary. Additional examinations may be prescribed in some cases (examination of cerebrospinal fluid, other imaging tests, etc.).

The results of these tests allow you to propose a treatment adapted to your situation, depending on the type of lymphoma, its grade, its stage, your general condition and any contraindications to the treatments. At a multi-disciplinary consultation meeting, several doctors of different specialties come together to discuss the best possible treatments in your case. They are based for this on recommendations of good practice. They can also offer you to participate in a clinical trial.

The treatments

The management of non-Hodgkin lymphomas is mainly based on chemotherapy. This treatment uses an association of anticancer drugs that act throughout the body on cancer cells. Chemotherapy is often associated with monoclonal antibody treatment. We speak in this case of Immunochimiothérapie. It is currently the reference treatment for non-Hodgkin ganglion lymphomas.

Depending on the situation, treatment may involve radiation therapy or hematopoietic stem cell transplantation. In some cases of indolent lymphoma, therapeutic forbearance may be proposed.

Side effects differ depending on the treatment. They are explained to you by the Doctor who follows you and who makes sure they are taken care of.

Infertility, transient or definitive, may occur in men at the end of certain chemotherapy. Before getting started, it is essential to discuss with the medical team the possibilities of sperm conservation. Possibilities for the conservation of oocytes or embryos may be considered for women treated with pelvic radiation therapy.

Additional care and support can be implemented to deal with the possible consequences of the disease and its treatments: fatigue, pain, need for psychological support, social problems, etc. Such care, called support care, is provided by various professionals (psychologist, social worker, etc.) who, depending on the case, practice in a health facility, in hospitalization at home, in consultation with the city, in the context of a Health Network, Patient association, etc.


The Monitoring

After the treatments, regular and prolonged follow-up must be put in place over several years. It's based on medical consultations, blood tests and scanners. The timetable and duration of this follow-up are adapted on a case by case basis by the specialized team who carried out the treatment, in liaison with the attending physician.

In the case of aggressive non-Hodgkin lymphomas, i.e. fast-changing, the treatment allows a complete cure for more than half of the patients. In the case of non-Hodgkin indolent lymphomas, in other words slow-changing, more remissions are discussed: all symptoms and detectable signs of the disease have disappeared. These remissions may last a long time, however relapses are frequent.