Non-Hodgkin lymphoma (NHL) is a group of immune system cancers. According to the World Health Organization (WHO), there are thus more than 80 kinds (diffuse large B cells, follicular, marginal zone, mantle, peripheral T, etc.). NHL represents more than 90% of lymphomas diagnosed each year in France. What makes them differentiates from Hodgkin’s disease is the absence of tumor elements, called Reed-Sternberg cells.
What are non-Hodgkin lymphomas caused by?
LNKs occur when a manufacturing error of specific white blood cells, lymphocytes – B lymphocytes in 85% of cases, T lymphocytes in the remaining 15% – occurs. Abnormal cells spread through the body through lymph (fluid that irrigates all organs) and form lumps (tumors). And this, particularly in lymphoid organs, therefore, like lymph nodes, spleen, bone marrow. But also, in all the other tissues of the body.
Two types of shapes are distinguished, those called “aggressive” and those say “indolent”. The former evolve quickly and must be taken care of quickly. Despite heavy treatments, they heal themselves quite well. The second develop slowly. They cause frequent relapses, but can be controlled for several years. The prognosis will depend on severity and malignancy non-Hodgkin lymphoma. The median five-year survival time ranges from 50% to 80%.
What are the symptoms ?
Since defective lymphocytes proliferate in different parts of the body, the symptoms of non-Hodgkin lymphoma are not very specific to the disease, making the diagnosis difficult to make. Most often, the pathology is manifested by a lymphadenopathy, that is to say a painless and gradual increase in lymph node size, due to the multiplication of the diseased white blood cells that compose them.
Thus, depending on the region of the body concerned, the manifestations differ:
- When the thoracic lymph nodes are affected: swelling of the face and neck, a dry and persistent cough, difficulty in breathing …;
- When the groin glands are affected: heavy and swollen legs (edema)… ;
- When the’stomach (MALT lymphoma) orsmall intestine is affected: abdominal pain similar to that of a gastric ulcer, loss of appetite, diarrhea, constipation, bloating…;
- When the skin is affected: thickening and darker coloring of the epidermis, itching …
Other clinical signs are also frequently encountered:
- Important night sweats ;
- A weightloss unexplained;
- A fever persistent;
- Of itching of the skin (pruritus);
- From fatigue.
What are the causes and factors?
As with many cancers, the reasons for the occurrence of non-Hodgkin lymphomas are still poorly understood. However, research has highlighted several risk factors :
- Of family history ;
- A autoimmune disease (systemic lupus erythematosus, for example);
- A immunosuppressive therapy, linked to an organ transplant, congenital immune deficiencies…;
- A celiac disease not treated ;
- Some viral infections (VIH, virus d’Epstein-Barr, hepatitis C virus) ;
- Some prolonged infections with bacteria (Helicobacter pylori) ;
- Of environmental factors (exposure to dioxins, solvents, printing inks, pesticides, fertilizers, etc.).
How are they diagnosed?
Non-Hodgkin lymphomas are diseases that present with very varied clinical signs. Their diagnosis is thus complex and requires the intervention of specialists. While large nodes are usually indicative of a viral or bacterial infection, the persistence of certain symptoms may lead the doctor to the trail of cancer of the lymphatic system. He will then direct the patient to a onco-hematologist.
Various examinations will then be necessary to confirm the diagnosis: blood tests, surgical biopsy of the affected lymph nodes or tissues, medical imaging exams, anatomopathologique… They will also make it possible to define the type (B or T depending on the lymphocytes involved) the grade (rate of change), the stade lymphoma (from stage I to stage IV, localized or extensive) and the various sites affected in the body.
How are they treated?
The treatment of non-Hodgkin’s lymphomas is essentially based on a combination of drugs, in order to stem the proliferation of cancer cells and to suppress them. So the chemotherapy – often associated with immunotherapy – is privileged. Sometimes from the radiotherapy is recommended in addition. It is then a question of closely monitor the course of the disease via clinical and biological examinations.
However, when the pathology does not respond sufficiently and in certain cases of relapse, the doses of chemotherapeutic agents may be increased, destroying at the same time bone marrow stem cells, mothers of different blood cells. A transplant can then be considered: of the patient’s bone marrow (autologous transplant) – or from a donor – is taken before chemotherapy, then reinjected.