Lymphoma: what is lymphatic cancer? Swollen glands?

Definition: what is a lymphoma?

A lymphoma is a blood cancer that affects the lymphatic system, guarantor of the immune system. The lymphatic system is made up of lymphocytes, cells with a major role in the functioning of the immune system. A uncontrolled proliferation of lymphoid cells is the cause of lymphoma, from the lymph nodes or another lymphoid organ such as the spleen or liver For example. These cancerous tumors grow in different organs containing lymphoid tissueand in particular the lymph nodes, tonsils, small intestine lining, spleen, liver, bone marrow, the lungs and the thymus. It exists 2 types of lymphoma : Hodgkin lymphoma, also called Hodgkin’s disease (20% of cases), and the non-Hodgkin’s lymphoma (80% of cases).

Hodgkin lymphoma: 20% of lymphomas

Hodgkin’s lymphoma is marked by the presence, in the affected organ, of a particular tumor cell “Sternberg cell”. THE Hodgkin’s lymphoma mainly affects adolescents (100 cases per year with a ratio of 1.2 boys for 1 girl) and the young adults aged 20 to 40. This form of cancer of the lymphatic system is classified into four stages, depending on the degree of involvement, which is an indicator for the treatment decision: from stage I (affecting a single lymph node group) to stage IV (affecting one or several viscera). It’s a aggressive cancer but whose cure rate exceeds 80% of cases.

Non-Hodgkin lymphoma: 80% of lymphomas

Non-Hodgkin’s lymphoma is about 5 times more common than Hodgkin’s lymphoma. This malignancy develops at the expense of a line of lymphoid cells. The cancer cells involved are distinct from the cell involved in Hodgkin’s disease. Malignant non-Hodgkin lymphomas can develop from B lymphocytes, which is the case in 85% of cases, or from T lymphocytes in 15% of cases. Many sub-categories derive from it, and the common characteristics are affects adults usually after 50 years and to present with lymphadenopathy, swollen lymph nodes, enlarged spleen and liver. The biopsy of a lymph node and analysis of the sample is necessary to make the diagnosis and characterize the type of lymphoma, which will guide the treatment.

Non-Hodgkin’s large B-cell lymphoma

Malignant non-Hodgkin lymphomas can develop from B lymphocytes, which is the case in 85% of cases, or from T lymphocytes in 15% of cases. Depending on their degree of malignancy, type B non-Hodgkin’s lymphomas are classified into two large groups: indolent non-Hodgkin’s lymphoma (low malignancy) and aggressive non-Hodgkin’s lymphoma (high malignancy).

Mantle cell lymphoma

Mantle cell lymphoma, or mantle cell lymphoma, is one of the non-Hodgkin’s lymphomas, more particularly in men over 50. “It presents in an indolent form with often digestive involvement but it is more serious”, explains Dr. Pauline Brice of the hematology department at Saint-Louis Hospital. It must be treated with chemotherapy sessions and autologous bone marrow transplants. And to add: “In case of relapse, targeted oral therapy inhibiting B cells is effective.”

follicular lymphoma

Follicular lymphoma is most often located in peripheral lymph nodes. It is a frequent lymphoma generally appearing around the age of 55. This type of lymphoma is usually very symptomatic with often large masses The evolution is slow, with a well-preserved general condition, treatment is only done if there are clinical symptoms or risks of compression of a vital organ sometimes years after diagnosis. The risk is the transformation of this lymphoma into a more aggressive variant, with a rapid worsening of symptoms. A lymph node biopsy is required. Follicular lymphoma can be treated with immunotherapy (antiCD20) alone or with chemotherapy.

Burkitt’s lymphoma

Two forms can be distinguished. The endemic form affects a large number of people (particularly in sub-Saharan Africa) and is often associated with infectious mononucleosis virus (epstein barr). “The sporadic form is rarer, it is the most common non-Hodgkin’s lymphoma in children but it can occur at any age. It has a good prognosis after treatment with intensive and specific chemotherapy”, explains Dr. Brice. Type T lymphomas are rarer and have a poor prognosis. There are many entities depending on the lymphoid cell of origin.

Cutaneous lymphoma

Cutaneous lymphoma is a rare but chronicdisabling and affecting people whose median age is over 60 years. This cancer develops as skin tumors. It is the proliferation of lymphocyte cells whose starting point is the skin. It can, like lymphomas, arise from B lymphocytes or T lymphocytes (the latter being the most frequent) and the clinical presentation remains variable. In general, it may initially appear as red patches, diffuse redness, or chronic skin nodules. A biopsy of the area should be taken for cell analysis. Many sub-categories are distinguished, the most common of which is mycosis fungoides, with generally favorable indolent evolution with topical treatments.

What are the symptoms of lymphoma?

Symptoms are mainly lymphadenopathy (inflammation of the lymph nodes), A painless swollen glands in the neckarmpits or groin, respiratory or abdominal signs by compression of deep adenopathies from night sweats, fever as well as weight loss more rarely.

The occurrence of various symptoms such as those mentioned above should prompt you to consult a specialist. Moreover, the appearance and theenlargement of one or more lymph nodes is also a reason for consultation.

What causes lymphoma?

Tumors appear as a result of uncontrolled growth of B cells in the body, white blood cells that produce antibodies. Non-Hodgkin’s lymphoma occurs mainly after 60 years, people with a weak immune system (HIV carriers) or immunosuppressive treatments (organ transplants) are particularly at risk. Other infectious agents are associated such as lhepatitis C, helicobacter pylori for stomach lymphoma.

The diagnosis of lymphoma is quite difficult: the appearance of a lump in a lymph node (in the neck, armpits or groins) or an organ, weight loss, fever, sweating or great fatigue are signs that may accompany the presence of lymphoma. The scanner can find deep adenopathies which are significant if greater than 15 mm. Lymph node biopsy with histology makes it possible to make the diagnosis but also to specify the category of the lymphoma. The biopsy performed beforehand makes it possible to preserve a frozen fragment of the ganglion and will be used for later studies.

What are the treatments for lymphoma?

The treatment must be carried out under the supervision of the specialized doctor, who will make the decision as to the drug protocol, depending on the lymphoma, the age of the patient and the prognostic factors. This decision is taken collectively, at the meeting of several doctors whose specialty is lymphoma. It is at the end of this multidisciplinary committee, the RCP, (multidisciplinary consultation meeting) that it is decided to offer the patient a treatment. The treatment of lymphomas is mainly based on the chemotherapyI’immunotherapy for B-cell lymphomas and in some cases, therapeutic intensification, radiotherapy, will be offered. During treatment, the patient is regularly monitored by the medical team. The examinations carried out at the start of the disease (blood test, scanner and PET scanner) are redone at regular intervals, in order to monitor the effectiveness of the treatments. The objective is toget the total disappearance cancer cells. We can then speak of complete remission and after a few years of recovery.

Discover : the patient association France Lymphoma Hope. Created in 2006, France Lymphoma Espoir is an association of patients and relatives affected by lymphoma. She has been approved by the Ministry of Health to represent patients with health authorities since 2018. The main objectives are: Inform / Support / Encourage research and represent patients.

Thanks to Dr. Pauline Brice from the hematology department at Saint-Louis Hospital (Paris).