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Lymphomas

What is it ?

Lymphoma is a cancer of the immune system that develops primarily in the lymph nodes and involves a particular type of white blood cell called lymphocytes. Lymph nodes are small, bean-shaped organs that branch out into the lymphatic system and are spread throughout the body. They contain cells of the immune system, especially lymphocytes, which are ready to react to possible external agents or aggressions.

When an error occurs in the manufacture of lymphocytes, it can lead to the production of an abnormal cell that is beyond control. This abnormal cell can have a very rapid multiplication capacity coupled with a survival capacity, which can lead to a tumor syndrome, lymphoma.

Types of cancer

Two types of lymphomas exist and are different both in their appearance than on their management:

Hodgkin lymphoma (HL)

HL is characterized by the presence of large atypical cells, the Reed-Sternberg cells. It is an uncommon cancer (0.5% of all cancers), but the most common in young adults.

Le Lymphome Non-Hodgkinien (LNH)

NHL represents 90% of lymphoma cases, with a median age of onset around 60 years. Some are said to be indolent, with a rather slow evolution but numerous relapses; as opposed to the so-called aggressive NHL, characterized by a rapid evolution and a cure rate around 60%.

What makes the difference

Therapeutic progress in the field of lymphoma management has been major in recent years, particularly with the advent of CAR-T cell therapy. This is possible from the third line for the 2 most frequent lymphomas, and soon possibly from the second line. It is important that patients be treated in centers that have access to such treatments as well as to innovative therapies, within the framework of clinical trials, in case of relapse.

The symptoms

illustration de ganglions gonflés

Persistent increased of one or more lymph nodes that may cause swelling in the affected area

(neck, sub-axillary, groin…)

Lymphomas can also develop in extra-ganglionic regions, notably within the lymphoid tissues associated with mucous membranes, or the spleen or bone marrow or any other organ (brain, testicle…), which can cause symptoms depending
on the precise location,such as : 

 

illustration d'une personne qui tousse et de postillons sortant de sa bouche

Cough

illustration d'un rouleau de papier toilette

Diarrhea

The patient may also have an altered general condition:

illustration d'une balance indiquant un poids très léger

Weight loss

illustration d'un oreiller e référant à la fatigue

Fatigue

image représentant un thermomètre avec un niveau de température élevé

Fever

(especially in the evening)

image représentant un homme allongé sur un coussin ayant des sueurs froides

Cold sweats

(especially at night)

The lymphoma may be revealed by rarer symptoms such as :

Unexplained itching

Pain in the lymph nodes after drinking alcohol

Risk factors

In the majority of cases, there is no identified causal element.

In the occupational setting, exposures to pesticides, organic solvents (benzene, chlorinated solvents, hair dyes), and wood dusts have often been associated with an increased risk of lymphoma. Since 2015, a decree has defined non-Hodgkin’s malignant lymphoma caused by pesticides as an occupational disease by the agricultural regime.

In the general environment, exposures to UV ionizing radiation, and dioxins are suspected of increasing the risk of lymphoma, but no causal link has been established.

Some infectious elements may be associated with the development of lymphoma, either through a direct oncological role (such as EBV or HTLV1), or a chronic antigenic stimulation (such as certain bacteria: Helicobacter Pylori or others).

The diagnosis

It is supported by a biopsy and an anatomopathological analysis. The initial extension work-up will then include a CT scan and/or PET scan, a biological work-up, and a pre-therapy work-up. In the context of chemotherapy treatment, a consultation for fertility preservation will be performed.

The treatments

The choice of treatment depends mainly on the type of lymphoma, the stage, the size of the lymph nodes, certain biological parameters, the general health of the patient, his or her age and, of course, the medical history. In about 30% of cases of indolent lymphoma, especially follicular lymphoma, the patient, if he/she does not present any symptoms, can be monitored without initiating any treatment, this is called therapeutic abstention.

In contrast, when treatment must be initiated for aggressive lymphoma, it will be based on chemotherapy in combination with immunotherapy. The chemotherapy will often be a combination of agents, administered through intravenous from an implantable chamber. In Hodgkin’s lymphoma, it is not uncommon to combine radiation therapy, which uses ionizing radiation to destroy the cancer cells, after 3 or 4 cycles of chemotherapy. In the case of relapse, management is evolving with more and more options based on immunotherapy and targeted therapy, although chemotherapy followed by autotransplantation is still an option in the first relapse.

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