non hodgkin's lymphoma prognosis | Who is this brochure Intended?

Who is this brochure
Intended?



This brochure is intended primarily for people
Confronted with non-Hodgkin's lymphoma.
When you are diagnosed with cancer,
Very many questions and emotions are jostling.
We want to understand how and why the disease
Developed, what are the examinations and
Necessary treatments, how long they
May last... One wonders if a cure is
Possible, if the treatments allow to continue
A normal life or if it will be necessary to be helped...
There is a question about the cost of the disease,
is better to say or not to say to his entourage...
To all these questions and to many others, answers
will have to be made as they become more
On a case-by-case basis, based on the evolution of
Individual patient.
Your doctor will play an essential role in this regard. Him
Alone is able to accurately inform you about
The evolution of your case, as far as you him
Ask.
This brochure is not intended to teach you everything
On your treatment. It gives you however
Very important general information for the
Understand your situation. It can also
Help you ask the right questions to your doctor or
To the medical team, if you would like to know more about
Your particular situation.
Don't forget your loved ones either. They too
Ask a lot of questions. This document May
Therefore also be useful to them.

What is cancer?
A cancer is the result of a profound disturbance and
Complex functioning of certain cells, which
Multiply in an uncontrolled and anarchic way,
To such an extent that they eventually invade the organ in
Which they are and by sending other cells
Patients at a distance, to other organs.
Because
Initially, the damage accumulated by a
Cell that lead to the process of invasive spread
(carcinogenesis). These damage can be
Due to exposure to toxic products (first
From which tobacco smoke is found), to
Physical agents (natural or artificial ultraviolet,
Radiation, pollution), or some viruses. The link
With the food is established but still poorly known.
On the other hand it is established that alcohol, excess weight and
Lack of physical exercise increases risk
Some cancers, as well as exposures
to different chemical products.
Heredity rarely intervenes. Cancers do
Are never contagious.
Evolution
After a more or less long period, some
Cancer cells can escape from their
Original tumor and go to other
Parts of the body, via the blood vessels or
Nodes. These "secondary" colonies bear the
Name of metastasis.
The invasive spread process is usually very
Slow. It can span several years or even
Dozens, after the first cellular damage.
4 5
Lymphocytes are produced in the marrow
Bone, lymph nodes and spleen. They
Circulating in the lymph and in the blood. They play
An important role in the fight against microbes
And in the production of defense substances.

The lymphatic system
A, B, C, D, E, F, G: main ganglion areas
1: Rate
The lymphatic system
The lymphatic system consists of vessels
Lymph and lymphoid tissue (lymph nodes, spleen
and other organs). On page 7 you will find a
Schematic representation showing the location
of the main vessels and lymph nodes.
The lymph vessels are filled channels
of a colorless liquid (lymph) from the
Tissues. Lymph transports waste products
By the body. There are also blood cells
White.
Through more diameter channels
More importantly, this tissue fluid joins
Finally the blood circulation. Before the
Lymph does come into the blood, it crosses
Minus a lymph node.
The lymph nodes are the "stations
Of the lymphatic system: they make the
Harmless pathogens, including
Bacteria and viruses. They also filter waste
Present in the lymph. lymph nodes
are found in various parts of the body, for example
In the neck (A), at the armpit level (B), along the
of the trachea (C), close to the lungs (D), near
of the intestine and the back of the abdominal cavity (E),
In the basin area (F) and at the groin level (G).
In addition to the lymph nodes, the tissue
Lymphoid is also present in other
Organs, especially at the level of the back-
(pharynx), respiratory tract, spleen (1),
The intestinal wall and bone marrow. In
lymphoid tissue, we find a certain type of
White blood cells, called lymphocytes.
6 7
Figures and factors
of risk
In our country, we record every year
About 1900 new cases (en 2012:908 Women
and 1178 men) of non-Hodgkin lymphomas and
Their number has risen sharply over the past ten
Years. This disease appears mainly in
People over the age of forty-five and is a
More common among men than in
Women.
Little is known about the causes of lymphomas
Not Hodgkin.
Heredity apparently does not play any major role in it.
In some forms of non-Hodgkin's lymphoma,
such as Burkitt's lymphoma, a virus appears to be
Involved.
Immune defence deficits in
People who are taking immunosuppressive treatments
After an organ transplant or
AIDS patients increase the risk of lymphoma
Non-Hodgkin's, as well as an important exposure
to certain pesticides.
Non-Hodgkin lymphomas, like all
Other types of cancer, are not contagious.
Lymphoma
Not Hodgkin
Lymphomas are tumors of the system
Lymphatic. Depending on the type of lymphocytes
Cells normally present in the lymph nodes)
At the origin of the disease, lymphomas are classified in
Two broad categories: Hodgkin's lymphoma
(described in another brochure) and lymphomas
Not Hodgkin.
There are a large number of non-
Different Hodgkin. They are particularly distinguished
Depending on their greater or lesser speed of
Development (see page 13).In most cases, the lymph nodes
Increase in volume as a result of a proliferation
Excessive cellular. Abnormal lymphocytes
That invade the lymph nodes no longer work
In an optimum way. The organization loses a
Part of its virus defense system
and bacteria. As a result, infections
occur more easily.
In almost two thirds of the patients, lymphoma
Its starting point in one or more lymph nodes.
In others, it starts elsewhere in the system
Lymph, for example at the level of lymphoid tissue
stomach, lungs, intestines. Lymphoma
Non-Hodgkin's can also develop in the
Skin level: It is then a lymphoma
Skin (see page 28).
Normal lymphocytes circulate in the blood
and the lymph. They move to other
lymph nodes. Cancer cells
Non-Hodgkin lymphomas spread
Also in this way, which can invade
Several ganglion relays close by.
8 9
Symptoms such as fever, high fatigue
and heavy sweating can also
occur during a flu for example. If a ganglion
Remains inflated for more than two
Weeks and/or if other symptoms persist, it is
is necessary to be examined by his doctor.
Symptoms
The first sign of non-Hodgkin's lymphoma
is often an easily palpable swelling of a
or more lymph nodes at the level
of the neck, armpit or, more rarely, the groin.
Usually these swellings are painless. A
Non-Hodgkin's lymphoma that appears in tissue
Lymphoid produces symptoms related to damage
or the volume increase of the body concerned
(for example, lymphoma starting in the
Digestive system). This may result in symptoms
Similar to those of a stomach ulcer or a
Intestine tumor.
There is also a rare form of lymphoma
That develops at the level of the skin. It causes
As the first local symptoms, the onset of a
Red plaque, swelling or ulceration.
Diagnosis and treatment of cutaneous lymphoma
will be dealt with in a chapter apart (see page 28).
General symptoms that are likely to
To appear are:
• Fever surges, sometimes in alternation with
periods during which the temperature is
Normal• Loss of weight or appetite;
• High fatigue for no apparent reason;
• Abundant perspiration, especially at night.
The symptoms mentioned above do not mean
Necessarily that one is in the presence of a
Non-Hodgkin's lymphoma. A passenger swelling
Lymph nodes may also be due to the
To other causes, for example an infection. Of
10 11
Biopsy
For a specific diagnosis, the pathologist has
Need a greater amount of fabric than the
A few free cells taken by a simple
Puncture. Therefore, it is necessary to carry out
A biopsy (= surgical tissue removal) from the
Lymph node reached or lymphoid tissue
Suspect. This is done under local anesthesia and consists of
Usually take a whole ganglion. The analysis
of the ganglion (or other tissue if there is no
Accessible ganglion) is carried out by different
techniques, including genetic techniques (examination
Chromosomes and certain genes).
The purpose of these analyses is to determine the type of
of lymphoma (including the type of cell-
B or T-and aggression of the disease) and contribute
To evaluate his prognosis. This is essential because the
Treatment may differ very significantly
Depending on the type of lymphoma the patient suffers.
Degree of aggression
When the tissue examination indicates that
Found in the presence of non-Hodgkin's lymphoma,
At the same time it is determined how
of aggression. Non-Hodgkin lymphomas are
Classify into two groups:
• Lymphomas with low levels of aggression (or
indolent lymphomas): Cell compounds
Slow-growing cancers; These lymphomas
appear to be less serious in the diagnosis but
Harder to heal. They often become a
Chronic disease.
Diagnostic exams
When a patient has one or more
Symptoms, the doctor starts with a review
Clinical. Often, he also advises his
Patient to carry out a blood sample for
Lab exams. These exams can be
Provide guidance on the possible causes of
Observed symptoms.
Second, it is possible that additional examinations
are necessary. The patient is then
Referred to a specialist. This will generally be a
Hematologist. The specialist will also
A clinical examination and will carry out analysis
Blood. To be able to determine with certainty
Whether or not you are in the presence of cancer,
Microscopic examination of cells and tissues
Suspects is still needed (biopsy).
If the patient has a swollen lymph node
Should be carried out with a puncture or a
Biopsy of this ganglion for microscopic examination
of the cells. In the absence of swelling
of a lymph node, various tests are
necessary to locate the responsible anomaly
Symptoms. Then we take a sample
of suspicious tissue for analysis.The period of diagnosis and further examinations
is often difficult to live. You have to wait
Some time before all exams are
Made and the results are available.
In the meantime, there are many questions about
The nature of the disease, its severity and its evolution
Possible. Hospital teams are doing their
Possible for this period to be the shortest
Possible.
12 13
Additional Exams
Additional reviews are required
To be able to determine the extent of the disease.
CT-Scan
The CT-scan (scanner) is an imaging technique
That uses X-rays. It allows you to obtain
Extremely detailed images of the organs
Examined. Its principle is to take a
Series of successive X-rays of
The area to be explored (tomography). The data
Obtained are then processed by computer
To be transformed into images. The Devices
The most modern (spiral) can even
Rebuild 3d images.
In practice: The scanner looks like a large
Ring in which you are lying on a table
Mobile. The camera takes a series of shots during the
The table is progressively advancing.
In patients with non-
A CT scan of the rib cage and
The abdomen is necessary. A neck scanner can
sometimes be useful. Sometimes the patient is injected with a
Contrast product during examination, via a vein
of the arm. The product can cause a sensation
Disgust and hot flashes.
This review helps to see if there is an increase in
of lymph nodes and, if it is the
Case, where. This review also provides
Information on the condition of the spleen, liver and
Other organs.
• Lymphomas with high levels of aggression (or
Aggressive lymphomas): cell-to-rate compounds
of high growth; These cells are however
The most sensitive to treatment and the rates of
Healing are better.
Low level of aggressive non-Hodgkin's lymphoma
Can be transformed over the years into lymphoma
More aggressive degree of aggression. This
Evolution does not happen however frequently.
The doctor must know the degree of aggression
In order to be able to implement the most
Appropriate. The degree of aggression also provides
Information about the probable evolution of the disease.
Cell TypeIn addition to its level of aggression, it is also
Important to determine what type of cells are
Composes non-Hodgkin's lymphoma: lymphocytes
B or T (this is done by immunophenotyping, using
Monoclonal antibodies). This distinction is particularly
Deciding whether or not to use the
To immunotherapy. Non-Hodgkin's lymphoma
B cells is the most common form (70%). A
Non-Hodgkin's lymphoma, whether it is B or T cells,
Can be indolent or aggressive.
14 15
Ultrasound
Ultrasound is an imaging technique using
Ultrasound. It does not imply any irradiation. The
Ultrasound emitted by a probe through the tissues of the
Body and then returned as an echo.
This echo is analyzed by a computer system and
Turned into a real-time image on the screen.
In practice, you are usually lying on a
Classic Exam table. The Doctor walks
A gel-coated probe on the body part to be
Examine and visualize the result on the screen. It may
Often you comment in real time what it
Observe (but these images are not always easy
To understand when you are not accustomed!).
The examination is not painful and does not involve
Contraindications.
Ultrasound is not often necessary. She
Can help determine the size of the lymph node
abnormal lymph. It may also be necessary to
To perform an ultrasound of the liver and spleen.
On the other hand, it is generally useful to make a
Initial cardiac ultrasound when the doctor
Considering chemotherapy therapy.
PET-Scan
(Positron emission tomography)
Unlike CT-scan and MRI, the PET-scan
Gives little detailed images of the anatomy. His
Interest is that it allows to visualize areas where
The cells are the most active. For this review,
A small amount of radioactive sugar is injected into the
Patient (fluorodeoxyglucose or FDG). This "tracer"
MRI (Magnetic resonance imaging)
The MRI looks like a CT-scan, which would have
Replaced X-rays with magnetic fields
Very powerful. Here too, the doctor can get a
Kind of Virtual cross section of the body.
The different organs are displayed on a screen
Computer. A contrast product (gadolinium)
is usually injected before the exam. The MRI
Usually gives better images than the as high as
At the soft tissue level, but the scanner is
Generally enough.
In practice: This exam looks like CT-scan but
It lasts longer (up to one hour). You
will have to remain lying and motionless in a sort of
"Tube". The device makes a lot of noise, which can
Be unpleasant.
Bone Marrow Review
A bone marrow sample is taken from the
Means of a puncture. We start with anesthesia
The skin and the surface of the bone where it will take place
The puncture. Then using a hollow needle
Special, the doctor stings through the bone into
Bone marrow to suck a small amount
of it. This causes, despite the anesthesia,
A curious sensation of tightness that can
Be painful. Bone marrow has an aspect
Bloody. That's perfectly normal.
Rarely, with another needle but at the same site
Anesthesia, the Doctor also collects a piece of
Bone (biopsy). It is sometimes necessary to achieve this
Examination at both sides of the basin (left
And right).
16 17
• Stage III: The disease reaches the territories
Ganglion located on either side of the
diaphragm, and sometimes also the spleen.
• Stage IV: At the start of the lymphatic tissue, the
Disease has spread to other organs
Like lungs, liver, bone marrow or
The skin.
If the patient has no symptoms
Generals, the letter A is added to the stadium. The letter B
means that one or more general symptoms are
Present, namely:
• Fever over 38 °c (but can alternate with
periods during which the temperature
is normal);
• Weight loss of more than 10%;
• Very abundant perspiration, especially at night.
Will accumulate where the cells use the most
Energy, and therefore especially in tumors
Made up of cancerous cells.
PET-Scan is especially useful for detecting
Metastases. There are devices that combine
A PET and a CT-scan. The PET-Scan is the test
More sensitive to detect all lesions
Lymphoma but it is not necessary to
All lymphomas.In practice: The exam consists of two times. The
First is the injection of radioactive tracer into a
Vein of the arm. You then have to wait about a
Time to calm, so that the product will allocate
Throughout the organization.
Then the actual exam takes place. You
Will be lying on the machine's mobile table, you
Stay calm and in the Twilight for
About 30 minutes. In total, this review therefore takes
Two to three hours.
Stage
Based on the results of the reviews described above,
Doctors can determine at what stage
Find the disease.
Traditionally, there are four different stages.
• Stage I: The disease is limited to a single territory
Lymph nodes, for example
of the neck, or to a single organ.
• Stage II: The disease is limited to several
ganglion territories located on the same side of the
Diaphragm.
18 19
Some people develop a very
Specific non-Hodgkin's lymphoma
Level of the stomach wall. The disease is
Then usually related to a gastric infection
By Helicobacter Pylori which can be treated by
Antibiotics and antacids, with healing of
Lymphoma.
More aggressive lymphomas are mostly treated
Chemotherapy, possibly associated with
Monoclonal antibodies (immunotherapy). In the event
Relapse or a form of lymphoma that is proving to be
From the outset of a severe prognosis, more
Intensive, consisting of "heavy" chemotherapy,
followed by a stem cell transplant can be
Necessary.
Chemotherapy
Chemotherapy is the treatment of cancer
By medications called cytostatic.
These drugs are capable of destroying
Cancer cells. They can be administered
By infusion, injection or in the form of
Tablets. By blood, they spread
In the body and can therefore reach the
Cancer cells in virtually any
Place of the body.
Chemotherapy is applied by cycles or
"Cures": each treatment period (spread over
One or more days) is followed by a period of
Rest (usually 2-3 weeks) allowing
The body to recover. Chemotherapy is not
Always possible in people in very bad
General health.
Treatments
Lymphoma usually responds very well
Chemotherapy (drugs that attack
Cancer cells) and radiation therapy
(High-energy radiation treatments).
Since the end of the years 1990, a new
Drug generation from research
has come to strengthen the range of treatment
Possible. These are monoclonal antibodies (a
form of immunotherapy) capable of recognising
and destroy the lymphoma cells.
These three families of treatments (chemotherapy,
Radiotherapy and monoclonal antibodies) can
be used alone or associated with each other,
Depending on the needs.
In general, however, the treatment of
Is mostly based on chemotherapy, often
Associated with immunotherapy in the case of lymphoma
To B-cells. Radiation therapy is only useful in
particular cases.
The evolution of the disease, its prognosis and the choice
Treatments depend on the particular type of
Lymphoma, the extent of the disease and the age of
Patient. Given the large number of situations
Potential, it is not possible to describe in
The different therapeutic approaches, which
Should be selected on a case by case basis.
In the Face of some indolent lymphomas (very little
Without altering the quality of life of the
Of the patient, one can sometimes settle for a
Careful medical surveillance. A treatment
Would be initiated later than if symptoms
appeared or aggravated.
20 21

Some chemotherapy may also
Cause damage to the nerves (neuropathy). The
Consequences are hearing loss or
Symptoms located in the hands and feet
such as pain, loss of sensitivity,
A burning sensation, stinging, hypersensitivity
Cold/hot, feeling weak.
Usually these disorders disappear
Progressively at the end of the treatment, but can
Endure in some people.
Some chemotherapy may be toxic
For the heart, the liver or the kidneys. In some cases, it
is necessary to reduce the dose of chemotherapy
Or even to postpone and even stop the treatment.
To learn more about chemotherapy, you
Can see the brochure that is fully
Devoted.
Radiotherapy
During radiotherapy, high X-rays
Energy produced by a machine called
Particle accelerator are used to
Destroying cancer cells.
A radiotherapy treatment usually lasts
Several weeks at the rate of one session per day.
Studies are being carried out to see
If other schemes are more efficient, for example
Using the same dose of rays on less than
Days, or using lower doses two
Times a day.
Most non-Hodgkin lymphomas can
Be sensitive to these rays, but this technique
A combination of different medications
(cytostatic) is often used. In the case of
Non-Hodgkin lymphomas, this is usually
of an association of cyclophosphamide, Vincristine,
Adriamycin and Methylprednisolone, called CHOP.
These medications can be used in combination with
With treatment targeted by Rituximab, an antibody
Specifically addressing the
B lymphocytes (therefore useless for T lymphomas).
Side effects of chemotherapy
Chemotherapy attacks cells with division
Fast, which is the case of cancer cells.
But it can also have an effect on the cells
Fast-dividing, such as those of the marrow
of the oral and intestinal mucous membranes and
Of the roots of the hair.
These effects depend on the drugs used,
The dose and duration of therapy. They can
Translate to:
• Hair loss;
• Inflammation of the oral mucosa;
• Loss of appetite;
• Nausea and vomiting;
• Diarrhea;
• Increased risk of infection (due to reduced
Number of white blood cells);
• Bleeding and bleeding (following the
Reduction in the number of blood platelets);
• Fatigue (due to the reduction in the number of
red blood cells).
These disorders usually disappear after
Stop the treatment. Many of them, as
Vomiting, can be prevented or treated
Very efficiently thanks to medications.
22 23
This sequelae can be corrected by a sample
of semen or ovarian tissue before the onset of
Treatment. Feel free to talk about it with your
Doctor.
Immunotherapy
The immune system is made up of a
Set of specialized cells produced by the
Bone marrow and lymph nodes. These cells are
Mainly present in the blood, the lymph nodes
Lymph and spleen, but can also be
Circulate directly inside the tissues. They
Ensure the protection of the body against
External attacks (microbes, viruses and other
Intruders) by eliminating these "invaders".
Immunotherapy is based on the system
Immune to recognize cells
Cancers, attacking them and destroying them. Several
Strategies are possible. In the case of treatment
Non-Hodgkin's lymphoma, the use of
Laboratory-synthesized antibodies: antibodies
Monoclonal. They attach themselves to a protein
On the surface of the cells
Including on the abnormal cells of the
Lymphoma, and release to their contact substances
Chemicals that destroy them. The Cells on
which the antibody has set are eliminated, which
Allows healthy cells to take their place.
Immunotherapy is a standard treatment of
B-Cell non-Hodgkin's lymphoma, antibodies
Used being "programmed" to target B cells.

They are usually administered by infusion,
Which takes a few hours. This treatment is
is not necessary in all cases. The Rays
Are selectively directed to the lymph nodes
Lymphatics to treat.
The radiotherapy methods currently used
Specifically target the area to be treated. This
Increases the chances of successful treatment,
While limiting side effects. For lymphomas,
The rays are selectively directed to
Lymph nodes to be treated.
Side effects of radiation therapy
Radiotherapy has short side effects and
In the long term.
The former are often passengers and disappear
Progressively shortly after the end of the treatment. A
Radiation therapy can also cause burns to the
Skin similar to sunburn in the area
Irradiated, and a marked fatigue. These disorders disappear
After the treatment.
The latter are often definitive. Has longer
term, radiation therapy can lead to a risk of
Increased secondary cancer in the irradiated area and
Sometimes cause certain lesions in the organs
Healthy irradiated.
To learn more about radiation therapy, you
Can see the brochure that is fully
Devoted.
Risk of infertility
In adolescents or young adults, some chimioou
Radiotherapy can cause sterility.
24 25
Usually combined with chemotherapy. For
Treat non-Hodgkin's T-cell lymphoma,
Immunotherapy is still being tested by the
Through clinical trials.
Radio-Immunotherapy
In Radioimmunotherapy, radioactive isotopes
can be associated with monoclonal antibodies.
Antibodies will bind to cancer cells
and radiate them in a very localized way. The advantage
Of this method is that cancer cells
Are attacked by both the immune system
Stimulated by monoclonal antibodies and by
Radiation targeted at the tumor. This treatment is
Currently administered in some forms
Specific non-Hodgkin's lymphoma to
Cells B.
Side effects of immunotherapy
The side effects of immunotherapy are
Report during the administration. Generally, they
are limited to a sensation of general ill-being,
Fever and nausea.
Some people may be allergic to
Medication. This allergy appears mainly
In the first or second administration,
And usually induces low blood pressure
and breathing difficulties.
Monoclonal antibodies also attack
Normal B lymphocytes, the defense against
Infections can be reduced, leading to a
Increased susceptibility to infections.
Stem cell transplant
When non-Hodgkin's lymphoma reacts
Not sufficiently treated or reappears
After some time (re-offending), some patients
Undergo heavy treatment based on a
Intensive chemotherapy and possibly a
Total body irradiation followed by a transplant of
Stem cells. This stem cell transplant
Essential because intensive treatment has destroyed
All the bone marrow and killed all the cells
Strains, preventing the production of cells
Blood. Hence the need, after the treatment
Intensive, to administer intact stem cells,To allow blood regeneration in cells
Red, white blood cells and platelets. The treatment
and care as part of a cell transplant
Strains (formerly, we were talking about marrow transplant)
require very specific knowledge.
The intervention therefore takes place exclusively in
Specialized hospitals.
In most cases, stem cells used to
To the transplant will be collected in the first
Patient himself and frozen (autograft). In
Some cases, they will come from a healthy donor
Compatible (allograft).
Not all patients can be subjected to this
Type of treatment. It is currently being proposed to
Patients with non-Hodgkin's lymphoma
Particularly aggressive, or to some patients with
indolent non-Hodgkin's lymphoma. Age (less
65 years for autografts and less than 75 years
For allografts) and the general condition of the patient
Also play a role in this decision.
Learn more about cell transplants
You can see the brochure
is entirely consecrated.
26 27
Skin lymphoma
Non-Hodgkin's lymphoma can also develop
At the skin level. This form of cancer is
Called Primitive non-Hodgkin's skin lymphoma
("primitive" meaning that lymphoma has developed
In the first place in the skin) or even "mycosis
Fungoides ". Cutaneous lymphoma is mainly
Diagnosed in people over 40 years of age.
The first symptoms mainly take
The shape of a red plate, swelling or
Ulceration. These may appear at a
or several places, and cause pain and
Itching. These symptoms are sometimes
Accompanied by the usual signs of lymphoma
Non-Hodgkin's: fever surges, weight loss,
Abundant sweating and heavy fatigue. As
Other non-Hodgkin lymphomas, lymphoma
may be disseminated by blood and/or
Lymph to other organs.
Diagnostic exams
The diagnostic examination consists mainly of
A thorough examination of the skin. A dermatologist
Performs one or more skin biopsies
(Removal of a fragment of skin tissue).
After examination of the tissue taken from the microscope,
The pathologist determines what type of
Cells consists of possible cutaneous lymphoma:
B or T lymphocytes. Skin lymphoma Not
T-Cell Hodgkin is the most
Frequent.
If it turns out to be a cutaneous lymphoma,
Additional reviews are needed to
Determine the extent of the disease's spread. It may
BE:
• Biopsy of a lymph node;
• Scanning of the thoracic cavity and abdomen;
• Positron emission tomography (PET-scan);
• Bone marrow examination.
These exams are described above.
Stage
Based on the results of the exams, the doctors
Can determine the stage of evolution of the
Disease. For T-cell cutaneous lymphoma, it is
Distinguishes four stages:
• Stage I: The disease is confined to the skin (stains or
Plaques) and lymph nodes have not
increased in volume.
• Stage II: The disease is confined to the skin (tumors)
and lymph nodes have increased
Volume (but without cancerous infiltration at the
ganglion biopsy).
• Stage III: The disease reaches the skin in its
Together (generalized redness).
• Stage IV: disease spread to lymph nodes
or other organs.
Stages I and II are sometimes described as "early",
While stages III and IV are called "advanced".
Degree of aggression
As with other non-Hodgkin lymphomas,
It is important to know the degree of aggression
(see page 13) to be able to implement the plan of
most appropriate treatment.
28 29Treatments
The treatment of B-cell skin lymphomas or
T may consist of:
• Cortisone-based creams;
• Ultraviolet light therapy (PUVA or UVB);
• localized radiotherapy;
• Total body irradiation;
Chemotherapy
Immunotherapy
Retinoids.
These different treatments can also be
Combined.
Cortisone based Creams
Patients with cutaneous lymphoma
Indolent in an early stage are generally
Treated solely by means of creams based on
Corticosteroids. Corticosteroids can
Stop the development of skin cells
Cancer. Prolonged use of corticosteroids
can result in a variety of side effects, including
Thinning of the skin, the faster appearance of
and an increased risk of skin infections.
Ultraviolet light Therapy
(PUVA or UVB)
UVA treatment can be administered to
Patients with indolent skin lymphoma
T cells in an early stage.
This treatment combines a drug,
Psoralen (P), and Ultraviolet A (UVA) rays. The
Medication (one tablet to take two hours
Before UV exposure) makes the skin cells
Very sensitive to rays. Cancer cells
are thus not destroyed UV. The treatment is
Renewed two to three times a week until
That we see a good improvement.
The UV exposure time increases as the
As the cure: a few seconds for the
First exposure to about ten minutes for the
Last. This treatment can cause nausea.
After the treatment, you may also
suffer from "sunburn" when you get out.
So it's important to protect yourself well. Couvrezvous
With adapted clothing (trousers,
Long sleeves...), and use glasses of
Sun, lip balm and the
Sunscreen. This disadvantage disappears when the
Drug is eliminated by the body, about eight
Ten hours after the treatment.
Ultraviolet B (UVB) alone is sometimes used,
That is, without a drug combination.
Localized radiation therapy
For localized B or T cell cutaneous lymphoma,
You can radiate two to ten times this exact place.
Radiation can cause irritation and ulceration
But, with appropriate care, these
Usually disappear within two months of the
Follow the treatment. An irradiation of the scalp
Causes hair loss, temporary or permanent
Depending on the dose of radiation therapy received.
Total body radiation
When UV therapy and radiation
are not effective, it is possible to resort to
To an irradiation of the whole body. This treatment
is carried out in a specialized centre with
The necessary equipment.
30 31
Chemotherapy
Patients with cutaneous lymphoma in
An advanced stage are mainly treated by
Chemotherapy, administered by injection or
Tablets, or sometimes by means of a cream or
of a lotion. Chemotherapy can usually
take place in ambulatory, without a hospitalization
is necessary.
Immunotherapy
Immunotherapy is sometimes used to treat
Patients with T-cell cutaneous lymphoma
In an advanced stage.
Retinoids
Retinoids are medications that can
be administered in tablet form for
Treat T-cell skin lymphoma (whatever
The stadium). These are synthetic substances in the
Operation close to that of vitamin A,
that have an inhibitory effect on T cells in the
Skin. Retinoids are sometimes combined with the
Therapy with UV rays or immunotherapy. The
Treatment with retinoids may have different effects
including depression, thinning
Of the skin, a drying of the mucous membranes
or liver dysfunction,
The assimilation of lipids or thyroid.
A few more tips
Fatigue

Fatigue is a very common side effect
Cancer and/or its treatments. This fatigue
Usually fades after the end of the treatments.
But it can be felt much longer.
Talk to your doctor and the medical team, they
can help you reduce the effects.
The causes of this fatigue are multiple and
Inactivity is one of them. The Foundation against
The Cancer therefore offers
Physical activities adapted to people in
Course of treatment, or within one year after the end
Treatments. It allows you to find a certain
which can facilitate small daily efforts.
More information on www.raviva.be.
32 33
So that eating is a pleasure
When it comes to cancer, an optimal diet
First is to take pleasure in eating
and a drink! So the best food advice is:
Do not immediately impose various restrictions,
But rather keep your past habits.
Do not follow on your own initiative an alleged
Cancer regime. Their effectiveness is far from being
Demonstrated, and this is likely to weaken more
Your body. Also be cautious before
Take food supplements. Some
Can disrupt the effectiveness of your
Treatment. An individualized accompaniment by a
Dietician specialized in the field of oncology
(Oncodiététicien) is the best approach.
The Cancer Foundation puts your
Disposition of many boards and a directory
Oncodiététiciens on its website www.cancer.be/
Food-Recipes.
Attention to Interactions
Medicinal!
Some medications may change
The effectiveness of cancer treatments,
This is in the sense of strengthening or
Decrease in effect. And that as well with
Conventional medicines than with those
So-called soft medicines. That is why it is
Very important to always report to the team
Medical care which is the other
Treatments you follow (medications, but
Also vitamins, plants, diets,...). Do
A list and discuss it with your doctor when
of your consultations. You can find more
Information in our brochure "Medicines
and cancers "as well as in the" Guide
Food supplements, available on the
Our website www.cancer.be, under the heading
"Living with cancer."
34 35
The importance of good morale
After the end of a cancer treatment, one feels
Often, paradoxically, a great emptiness: one loses the
Contacts, often warm, established with the team
Caregiver, and we no longer receive their encouragement
Benevolent. You have to get back on your feet in life
"Normal", sometimes return to work, and yet
You feel like a survivor of an adventure
Hard to share.

If you are struggling, do not keep them

For you. Talk to a loved one, a member

The health care team, a psychologist or the

Members of a patient association.

Be aware that, as part of the national Cancer Plan,

You have the possibility to receive free

Psychological support in a hospital setting. The

Cancer Foundation also offers a

Complementary psychological Coaching (see

Www.cancer.be, or via Cancerinfo 0800 15 801).

Importance of a relationship of trust

With those who treat you

This brochure did not, by far, respond to

Any questions you ask yourself or

That you will be asking yourself as the evolution of

Your illness. That is not his goal. During your

Course you will meet a lot

Of professionals: Doctors, nurses and others.

Never hesitate to question them and, if necessary,

To repeat your questions until you get an answer

Understandable. It is essential to build

A real dialogue with them. This will allow you to

To be mutually agreeable and confident

The decisions that are necessary.