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Lymphomas
Lymphomas
What is it?
Lymphoma is the most common haematological malignancy (malignant tumours of blood cells) and the third most common cancer in children. It is a cancer of the lymphatic system and develops when an error occurs during the production of lymphocytes, leading to the production of abnormal cells. These cells can proliferate in two ways: by dividing more rapidly than normal lymphocytes or by living longer than them. Like healthy lymphocytes, cancerous lymphocytes develop in various parts of the body, including the lymph nodes, spleen, bone marrow and other organs. There are two main types of cancer of the lymphatic system: Hodgkin lymphoma (Hodgkin’s disease) and non-Hodgkin lymphoma (NHL).
Symptoms
Signs and symptoms are all the disorders observed and reported by the patient that may be related to the disease.
For example, swollen lymph nodes, whether painful or not, are a common sign of lymphoma. Lymph nodes are generally swollen in the neck or armpits, but many patients may also have swollen lymph nodes in other parts of the body, causing various symptoms. Thus, swollen lymph nodes in the groin may cause heavy legs and swollen ankles, while swollen lymph nodes in the abdomen may cause abdominal discomfort, back pain or bloating. The signs of extranodal lymphoma may vary depending on the part of the body where the tumour develops. This is why lymphoma in the stomach may sometimes cause symptoms similar to those of an ulcer, such as pain and internal bleeding. More rarely, some patients with lymphoma may not have swollen lymph nodes.
Certain unusual symptoms observed by the patient may also indicate the possible presence of the disease. The symptoms of lymphoma most often include chills, fever, profuse sweating (often at night), unexplained weight loss, reduced energy, itching or other symptoms caused by swollen lymph nodes.
These symptoms are not specific, and most people who experience them do not have lymphoma. However, in the case of persistent symptoms, it is important to consult a doctor to make sure that lymphoma is not present. Serious diseases do not disappear overnight; they persist.
Types
Non-Hodgkin lymphomas
NHL is not a single disease but rather a group of at least 30 closely related cancers that affect the lymphatic system. Although the different forms of NHL have features in common, particularly their lymphatic origin, they differ in their appearance under the microscope, their molecular characteristics, their growth pattern and their impact on the body.
NHLs are divided into two main subtypes:
- B-cell lymphomas (which develop from abnormal B lymphocytes)
- T-cell lymphomas (which develop from abnormal T lymphocytes).
The exact causes of NHL are unknown. Doctors are often unable to explain why one person develops NHL while another does not. What is known is that lymphomas are not caused by an accident and cannot be contracted through contact with someone who has the disease.
Hodgkin lymphomas
Hodgkin’s disease (sometimes called Hodgkin lymphoma) accounts for 15% of all lymphomas and 1% of all cancers. It occurs in approximately 3 or 4 people per 100,000 each year. This rate has not changed for several decades. It most commonly affects adolescents or young adults (aged 15 to 35) or people aged between 45 and 50.
Hodgkin’s disease is one of the cancers with the highest cure rates: a cure can be achieved in more than 80% of cases through radiotherapy, chemotherapy or a combination of these two treatments.
Although the cause of Hodgkin’s disease remains unknown, environmental and genetic factors, as well as infectious agents, may be involved in its development. In both Hodgkin’s disease and non-Hodgkin lymphoma, several aspects of the tumour need to be assessed before determining the best treatment option.
The overall prognosis is good because the vast majority of patients can be cured. However, it depends on various factors: the patient’s age, the extent of the disease, the impact of the disease on the patient’s general health (general symptoms, inflammation), the size of the tumour mass and, above all, the response to initial treatment.
Treatment
Lymphoma is one of the diseases that can be treated effectively, and patients can be cured through modern treatments such as chemotherapy, radiotherapy and immunotherapy. The response to treatment of the different types of lymphoma depends on the type and stage of the lymphoma, as well as on a number of other factors.
For example, localised diffuse large B-cell lymphoma, which accounts for one-third of cases of this type of large B-cell lymphoma, can be cured in 80% of cases. Extensive follicular lymphoma is more difficult to cure but remains compatible with prolonged survival.
Many patients treated for NHL receive chemotherapy, radiotherapy or biological therapy, or a combination of all these treatments. An autologous or allogeneic stem cell transplant is sometimes necessary. Except in exceptional cases, surgery is only performed during the diagnosis of lymphoma.
Doctors may also decide not to prescribe immediate treatment for a patient with non-Hodgkin lymphoma. The patient continues to live normally as long as NHL symptoms are absent. They consult their doctor regularly for follow-up visits and laboratory and medical imaging examinations. Watchful waiting may be considered for certain forms of follicular lymphoma or other indolent lymphomas (low-grade malignancy). As soon as the patient begins to show signs of disease progression, treatment is initiated.
Ongoing research is making considerable efforts to assess the efficacy of new medicines and treatment combinations. At the same time, researchers are working to develop new protocols to minimise the short- and medium-term toxicity of these treatments. Treatment for non-Hodgkin lymphoma is progressing rapidly, and many promising new treatments are currently under investigation.