what is lymphoma

What is lymphoma?



Lymphomas are cancers of the lymphatic system. They represent the most common malignant hemopathy, or nearly half of the blood cancers. These are heterogeneous diseases, with more than 80 subtypes of lymphomas, which makes diagnosis difficult and requires different supports.

They are divided into approximately 80% non-Hodgkin's lymphoma (NHL) and 20% Hodgkin lymphoma (LH). Lymphomas can affect all ages (including in children), are mainly ganglion but can touch (only or accompany) all organs. There is no prevention or screening. The incidence has doubled in 30 years, with 14,000 new cases in France each year (figures 2015)


Lymphoma
Lymphomas are tumors of the lymphatic system. The lymphatic system ensures the defense of the organism. It is made up of cells (lymphocytes) of the lymph nodes, spleen, tonsils but is also present in all organs (especially bone marrow, intestine, glands). Lymphoma can develop from one of the two large lymphocyte families: B lymphocytes or T lymphocytes.

Lymphoma Lymphatic System

As with most tumors, the exact cause of lymphoma is not known. It is known, however, that people whose immune defenses are weakened (after treatment or in different diseases) have a higher risk of developing lymphoma. Some viruses may promote the appearance of lymphoma, but this is not a contagious disease in any case.

There are about 12 000 new cases of lymphoma each year in France. It is one of the tumors whose incidence increased in the years 1970-1990, with some stabilization in the years 2000. The causes of this increase are not accurately known, but environmental factors are suspected (dioxins, pesticides...).

Lymphomas-Evolution-NHL

Revealing signs of lymphoma

This is most often the development of a lump at the level of a ganglion (neck, armpit or groin) or organ. Sometimes the disease is manifested by a loss of weight, fever, sweat or a great fatigue.

The diagnosis

The diagnosis of lymphoma is not always easy, far from it. It is the treating physician who thinks about the signs described to him or the data of his clinical examination or other examinations (e.g. blood tests, X-rays or ultrasound).

In any case, it is the microscopic examination of the tumor that will confirm the diagnosis. This requires a surgical procedure to allow the removal of the tumor, this is called a biopsy. This is an intervention usually benign, readily done under local anesthesia if the tumor reaches a superficial ganglion (neck, armpits, groins) but which can be a heavier intervention if there is a need to take a ganglion in the Chest or abdomen. In some cases, the biopsy can be done with a special needle during a scan.

The examination under the microscope, called histological examination, makes it possible to diagnose but also to specify the type of lymphoma. The precise knowledge of the type of lymphoma is important because the treatment depends on it, sometimes it requires, in difficult cases, to take the advice of several doctors specialized in the interpretation of these samples. The biopsy also allows to preserve a frozen fragment of the ganglion that can be used for subsequent biological studies.

There are indeed several dozen types of lymphoma listed in a classification. The classification currently used is the World Health Organization (WHO) classification. This classification is based on the appearance of the tumor (histology), the type B or T of the diseased cells (immunological phenotype of lymphoma) and the genetic anomalies of tumor cells (determined by the study of chromosomes or genes).

Before treatment

The treatment will be decided only after examinations which will allow to judge the extension of the lymphoma and the repercussion of it on the general condition of the patient. These tests include at least blood tests, a chest and abdomen scan – now most often coupled with positron emission tomography or TEP – and bone marrow sampling (medullary biopsy). Other tests are sometimes necessary (in particular a lumbar puncture, a fibroscopy...). The results of these tests allow to know the prognostic factors that will determine the evolution of the disease and help in the choice of treatment.

Other tests are often needed to look for contraindications to certain treatments. This is the case for cardiac exams. Semen conservation is readily available to men who have a subsequent desire for paternity and for whom the treatment envisaged may entail a risk of sterility.

Generally, the treatment is done by repeated intravenous infusions also is proposed the implantation of an infusion device which will allow the easy administration of the treatment.

The treatment

Treatment should be done under the guidance of a specialized physician who will decide on the treatment plan based on the type of lymphoma, the patient's age and the prognostic factors. This decision is usually made at a meeting of several competent doctors in the field of lymphoma: this is the multidisciplinary consultation meeting (RCP). It is also during this meeting that the decision is made to propose to the patient the participation in a clinical trial.

The treatment of lymphomas is mainly based on chemotherapy, but in some cases a therapeutic intensification with autografting, radiotherapy, monoclonal antibody injections will be proposed.

While in some cases standard treatments have been defined on previous experience and clinical trial results, in most cases there are still many questions about the best treatment strategy, the possibility To use new drugs, the quality of life of patients under this treatment and the medium and long-term side effects of treatments. In these many situations patients are offered to participate in a therapeutic trial. It is through these therapeutic trials that it is possible to judge the progress made in the treatment of lymphomas.

The Monitoring

During the treatment, the patient is reviewed regularly by the medical team to monitor the side effects of the treatments. Examinations made at the onset of the disease (blood sample, scanner or toe-scanner, biopsy) are renewed at regular intervals to judge the efficacy of the treatments. The purpose of these is usually to obtain, at the end of the treatment, the total disappearance of the signs of the disease, one can then speak of "complete remission". However, it is common to have a few anomalies on this date, especially on the scanner, which is referred to as "complete uncertain remission".

Thereafter, once the remission is obtained, monitoring is necessary. It is intended to detect a possible relapse of lymphoma, which does not necessarily manifest in the same way as the first time. It includes regular consultations and reviews that vary depending on the case. Frequent at the beginning, these controls are spaced as the risk decreases.