lymphoma prognosis |Lymphomas: General

Lymphomas: General



Lymphoma is a cancer of the lymphatic system, the main element of the body's immune system. It's a disease that involves cells in the white blood cell family, called lymphocytes. It is therefore important to understand how the immune system and the lymphatic system work to apprehend what is Hodgkin's lymphoma and its therapeutic management.

Lymphoma
Lymphoma is the most common of hemic (diseases of the blood and lymphatic system). It is a cancer of the lymphatic system that develops when an error occurs at the level of the manufacture of lymphocytes, leading to the production of abnormal cells. These can proliferate in two ways: by dividing faster and/or living longer than normal lymphocytes. Cancerous lymphocytes, such as healthy lymphocytes, can develop in various parts of the organism, especially in the organs of the lymphatic system such as lymph nodes, spleen, bone marrow but also in all other Organs.

There are two main types of cancers of the lymphatic system:
Hodgkin's lymphoma or Hodgkin's lymphoma (LH), subject to this guide and described in the following chapter;
Non-Hodgkin lymphomas (NHL).
Lymphomas not Hodgkin in a nutshell
Non-Hodgkin lymphomas (NHL) are cancers that affect the lymphatic system; They do not form a single disease, but a group of many closely related diseases. Although the different forms of NHL have commonalities, especially their lymphatic origin, they differ by the appearance of their cells when they are observed microscopically, their immunological and molecular characteristics, their Development and their impact on the organism. For patients, this results in symptoms, evolution and response to treatments that will be different depending on the form of NHL that they are afflicted with.
Non-Hodgkin's lymphoma: key points
What is NON-Hodgkin's lymphoma?
Non-Hodgkin's lymphoma 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.

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.

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 anatomopathologic examination of a lymph node 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
You are supported by a team that specializes in an institution that is licensed to treat cancers. This team works in a regular relationship with your attending physician. Depending on your situation, several professionals may be involved: hematologist, medical oncologist and radiotherapist, pathologist, nurse, psychologist, social worker, etc.

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.