lymphoma prognosis | Lymphomas: better and better treated cancers

Lymphomas: better and better treated cancers

Lymphoma
Lymphomas are part of the cancer of the lymphatic system. They develop from lymphocytes (T or B), a type of white blood cells present in different organs. Two types are mainly distinguished: Hodgkin and not Hodgkin.
Lymphomas are currently the sixth most common cancer. For twenty-five years, it has been estimated that their incidence has doubled.
This increase is linked to the ageing of the population but also to certain environmental factors (pesticides, radiations...). Fortunately, the chances of lymphoma healing have also increased dramatically.


Forms
1. Hodgkin and non-Hodgkin lymphomas
2. Different forms of non-Hodgkin lymphomas
Hodgkin and non-Hodgkin lymphomas
What is a cancer cell?
Our cells divide to ensure the growth and renewal of the tissues of our organism. This process is orchestrated, in each cell, by a set of genes. A cancer cell is a cell that has undergone a genetic accident. The dividing process can then become uncontrollable: the cells multiply in an anarchic manner, and the resulting cells will in turn multiply in excess. In some cases, these cells become immortal and this accumulation of abnormal cells creates the malignant tumor.

Hodgkin lymphomas
Hodgkin's lymphoma (or Hodgkin's lymphoma) is a special form of lymphoma. It was first described in 1832 by Thomas Hodgkin, an English physician who had observed microscopically the presence of a cell of abnormally large size (Sternberg cell), characteristic of this type of cancer. In Belgium, about 250 new cases of Hodgkin lymphoma are diagnosed each year.

Non-Hodgkin lymphomas
In addition to Hodgkin lymphomas, there are many other lymphomas related to the proliferation of other cell types. They are grouped under the name "Non-Hodgkin lymphomas". This heterogeneous set comprises about 30 different lymphomas. Each has its own characteristics. To facilitate their management, non-Hodgkin lymphomas are classified into different groups.

The lymphomas that derive are distinguished:

of very immature cells, found in the bone marrow,
of mature cells, lying in the blood or lymph nodes.
Lymphomas are also distinguished:

B lymphocytes, which produce our antibodies,
T lymphocytes, which do not produce antibodies but also play an important role in immunity.

Symptoms
What are the symptoms of lymphoma?
swollen lymph nodes: one of the first signs
In about two-thirds of the cases, lymphoma is manifested by the swelling of a lymph node, palpable in the neck, armpit or groin. It can also manifest itself by an increase in the volume of the spleen, organ considered a "large" ganglion. Usually these swellings are painless. Any swelling of the lymph nodes is obviously not due to lymphoma. It is most often related to an infection. But if ganglionic swelling persists beyond a month, it is advisable to consult a specialist.

Manifestations within the lymphoid tissue
In one-third of patients, lymphoma does not appear in a ganglion but in another part of the lymphatic system. It can develop in lymphoid tissues of the stomach, lungs, thyroid or skin, for example. Lymphoma can then be manifested by a mass in the stomach, a respiratory problem or an eczema. But once again, all of these symptoms usually have another less severe cause.

Other lymphoma Symptoms
Lymphoma can also cause general symptoms:

Episodes of Fever,
Significant weight loss,
Strong fatigue for no apparent reason,
Very abundant nocturnal perspirations (requiring changing pajamas).
It also happens that lymphoma is not manifested by any of these symptoms and is accidentally discovered, for example during a blood test.


Diagnosis
How to diagnose lymphoma?
Blood tests
A blood sample is often the first step in the case of swollen lymph nodes or other unexplained symptoms. It does not allow the diagnosis of lymphoma alone but gives indications of a possible infectious cause (e.g. mononucleosis), responsible for the lymph node swelling. If the biopsy of a ganglion confirms the presence of lymphoma, more in-depth blood tests will be requested.

Biopsy of lymph node or lymphoid tissue
If lymphoma is suspected, microscopic analysis of the cells should always be performed. A piece of the lymph node or suspected lymphoid tissue is taken for analysis (biopsy). Antigenic and genetic tests complete the biopsy. They confirm that the cell is well cancerous and identify the cells – B or T lymphocytes – that cause the disease.

Bone marrow biopsy
If lymphoma is diagnosed, further examinations, such as bone marrow biopsy, are performed to better identify the extent of the disease (possible invasion of the bone marrow by cancer cells). After a local anesthesia, the doctor takes a little bone marrow into the pelvic bone, pelvic bone with a special hollow needle. The bone marrow is then examined microscopically and analyzed by more thorough tests.

CT-Scanner
Computed tomography or CT-scanner (tomography) allows to obtain detailed images of the organs. In Lymphomas, the CT-scan is primarily used to explore the thoracic cavity and abdomen. It allows to examine most of the deep and peripheral ganglia, but also the state of different organs, like the liver.

PET-CT
Today, the CT is often combined with an examination that evaluates tissue activity, PET (positron emission tomography). The PET-CT thus allows to obtain both morphological and functional images of the tissues. It has become an indispensable tool in evaluating the extension of lymphomas.

Evolution
1. Evolution and prognosis of lymphomas
2. Hodgkin or non-Hodgkin lymphomas: what prognosis?
Evolution and prognosis of lymphomas
How to evaluate the extension and prognosis of lymphomas?
The ANN Arbor classification is used to evaluate the extension of Hodgkin and non-Hodgkin lymphomas.

Stage I: The disease is limited to a single ganglionic zone or a single organ.
Stage II: The disease invaded at least two ganglion zones but on the same side of the diaphragm.
Stage III: The disease invaded ganglion areas located on either side of the diaphragm.
Stage IV: The disease has spread to other organs such as the lungs, liver, bone marrow or skin.
These four stages are usually supplemented by the letter A or B. A means that the patient has no general symptoms. B means that the patient has one or more general symptoms such as:

A temperature above 38 °c,
A slimming of more than 10% of the body weight in six months,
Very abundant night sweating.
The classification in stages allows to evaluate the extension and prognosis of lymphomas. It plays a central role in the choice of treatment.