non hodgkin's lymphoma stages |Non-Hodgkin lymphomas

Non-Hodgkin lymphomas

Non-Hodgkin lymphomas represent a heterogeneous group of cancers that develop in B or T lymphocytes.

Often, the lymph nodes of the neck, armpits or groin increase in volume in a quick and painless way.

Those affected may experience pain, breathless, or other symptoms when the hypertrophied lymph nodes compress the organs.

A lymph node biopsy is necessary to make the diagnosis.

Treatment may include radiation therapy, chemotherapy, monoclonal antibodies, or an association thereof.

The majority of people affected are cured or survive for many years.

This group of cancers actually includes more than 50 different diseases that affect B or T cells (lymphocytes), which are white blood cell types (Polynucléose). Each of these lymphomas has a different look to the microscope, a different cell type, and will cause different symptoms and progression mode. Most non-Hodgkin lymphomas (85%) affect B lymphocytes. Less than 15% develop from T lymphocytes. Non-Hodgkin's lymphoma is more common than Hodgkin's lymphoma. In the United States, nearly 70 000 new cases are diagnosed annually, and this number is steadily increasing, especially among the elderly and those suffering from immune deficiency. People who have received an organ transplant and some people who have been infected with hepatitis C or the human immunodeficiency virus (HIV) are at increased risk of developing non-Hodgkin's lymphoma.

Although the cause of non-Hodgkin lymphomas is unknown, several factors strongly suggest that some infrequent types are of viral origin. A rare type of rapid-changing non-Hodgkin's lymphoma, which is observed in southern Japan and the Caribbean, may result from infection with the human T-lymphotropic virus type 1 (HTLV-1), a retrovirus close to HIV. Many cases of Burkitt lymphoma (Burkitt's lymphoma), another type of non-Hodgkin's lymphoma, would be related to Epstein-Barr virus.

Leukemias (leukemias) are also white blood cell cancers. In leukemia, the majority of the cancerous white blood cells are found in the bloodstream. In lymphoma, the majority of the cancerous white blood cells are found in the lymph nodes and in organs such as spleen and liver. However, leukemia and non-Hodgkin's lymphoma can sometimes be joined, as people with lymphoma may have cancerous white blood cells in the bloodstream, and leukemic people may have cells Leukemic in lymph nodes and other organs.

Symptoms
Often the first symptom is a rapid and often painless hypertrophy of the lymph nodes at the cervical, axillary or inguinal level. The hypertrophied lymph nodes located in the chest can compress the airways, causing cough and difficulty breathing, or compress the thoracic blood vessels, resulting in edema of the face, neck and arms (compression syndrome of the upper vena cava). The lymph nodes in the abdomen can compress various organs and cause a loss of appetite, constipation, abdominal pain or progressive leg edema.

Some lymphomas that can develop in the bloodstream and bone marrow; People with diabetes may have symptoms related to the decrease in red blood cells, white blood cells or platelets. The decrease in red blood cell levels may cause anemia, resulting in fatigue, shortness of breath and paleness. The decrease in white blood cells can complicate infections. Reducing platelet levels can lead to bruising or bleeding. Non-Hodgkin lymphomas often invade the bone marrow, the digestive tract, the skin and sometimes the nervous system, causing different symptoms. Some people have a persistent fever with no apparent cause, the famous fever of unknown origin, which usually stands for advanced stage disease.

Did you know?
Non-Hodgkin lymphomas actually group more than 50 different diseases.

In children, the first symptoms (anemia, rash and neurological disorders such as muscle weakness and abnormal sensations) are probably due to the infiltration of lymphoma cells in the bone marrow, blood, skin, The gut, the brain, and the spinal cord. Lymph nodes that increase in volume usually concern deep ganglia, resulting in the following symptoms:

Accumulation of fluid around the lungs, causing breathing difficulties

Pressure on the intestine, causing loss of appetite or vomiting

Obstructions of the lymphatic vessels, causing fluid retention, especially at the level of the lower and upper limbs

Symptoms of non-Hodgkin's lymphoma

Symptoms

Because

Respiratory discomfort

Facial edema

Hypertrophy of the lymph nodes of the thorax

Loss of appetite

Severe constipation

Abdominal pain or distension

Enlarged abdomen

Progressive edema of the lower limbs

Obstruction of the lymph vessels of the groin or abdomen

Weight loss

Diarrhea

Flatulence

Bloating and stomach cramps (suggesting malabsorption: nutrients are not normally absorbed in the blood)

Lymphoma cells invade the small intestine.

Shortness

Chest Pain

Cough (indicating a fluid accumulation around the lungs, called pleural effusion)

Obstruction of the lymph vessels in the thorax.

Edema of the face and neck

Obstruction of the chest blood vessels.

Thickened, dark skin areas with itching

Lymphoma cells infiltrate the skin.

Weight loss

Fever

Sweats

The disease spreads throughout the organism.

Fatigue

Shortness

Paleness (indicating anemia, i.e. a deficiency in red blood cells)

One or more of the following symptoms manifest:

Digestive tract Bleeding

Destruction of red blood cells by a enlarged spleen or by pathological antibodies

Invasion and destruction of bone marrow by lymphoma cells

Inability of the bone marrow to produce enough red blood cells because it is harmed by treatment (medications or radiotherapy)

Predisposition to severe bacterial infections

Lymphoma cells invade the bone marrow and lymph nodes, which reduces antibody production.

Diagnosis and classification

Ganglionic biopsy is indispensable for the diagnosis of non-Hodgkin's lymphoma, which must be differentiated from Hodgkin's lymphoma and other disorders resulting in lymph node hypertrophy.

Although more than 50 different diseases meet the definition of non-Hodgkin's lymphoma, physicians usually prefer to group them into two broad categories.

Indolent lymphomas are characterized by

A long life expectancy (several years)

A quick response to many treatments

Unsatisfactory cure rate when standard treatments are used

Aggressive lymphomas are characterized by

Rapid progression in the absence of treatment

High healing rates with standard chemotherapy

Although non-Hodgkin lymphomas usually affect middle-aged and elderly people, children and young adults may also develop lymphomas. In these latter cases, they are generally aggressive subtypes.

Staging

For many people with non-Hodgkin's lymphoma, the disease has already spread when the diagnosis is placed. In only 10 to 30% of people with dementia, the disease is limited to one region. Non-Hodgkin lymphomas have the same staging system as those used for Hodgkin's lymphomas (Hodgkin's lymphoma: staging). In addition, a ostéomédullaire biopsy is almost always performed.

Prognosis and treatment

For some people with indolent lymphoma, treatment is not necessarily necessary at the time of diagnosis. In the presence of indolent lymphoma, treatment, when necessary, prolongs life expectancy and dissolves the symptoms for many years. In case of aggressive lymphoma, healing is possible. Long-term healing or survival rates depend on the type of non-Hodgkin's lymphoma and the stage of the disease when initiating treatment. Paradoxically, indolent lymphomas react quickly to treatment and pass in the remission phase (disease control), often with an extension of long-term life expectancy, even if people are generally not cured. On the other hand, aggressive forms of non-Hodgkin lymphoma, which usually require very active treatment to hope for remission, have a good chance of healing.

Non-hodgkinal stage I and II lymphomas

Indolent lymphomas with limited impairment (stages I and II) are often treated with radiotherapy targeted at sites and adjacent areas affected by lymphoma. With this approach, the majority of people do not present a recurrence of the disease in the irradiated area. Non-Hodgkin lymphomas may reappear in another area of the body up to 10 years after treatment; That is why long-term follow-up is necessary. People with aggressive lymphoma should be treated at a very early stage by association chemotherapy and sometimes radiation therapy. With this approach, recovery is observed in 70 to 90% of cases.

Non-hodgkinal stage III and IV lymphomas

The overwhelming majority of people with indolent lymphoma have stage III or IV disease. They do not always need treatment at first, but they are followed to detect a possible progression of lymphoma, which would then require treatment, sometimes several years after the first diagnosis. There is no evidence that the early treatment of high-stage indolent lymphomas increases life expectancy. If the disease starts to progress, there are many therapeutic options.

It is not known what treatment is best at first; The choice depends on the extent of the disease and the symptoms of the patient. The treatment may include monoclonal antibodies (rituximab) alone or chemotherapy with or without rituximab. These antibodies are administered intravenously. Sometimes, monoclonal antibodies are modified so that they can transport radioactive particles or toxic chemicals directly into cancer cells, in different parts of the organism. The treatment usually makes it possible to obtain a remission. The average duration of the remission varies between 2 years and over 5 years. When rituximab is associated with chemotherapy, the rate of remission is better. Therapeutic strategy can sometimes also include maintenance treatment (administered after initial treatment to avoid relapse). The role of rituximab, association chemotherapy and a type of radiotherapy (called radioimmunotherapy) in the maintenance phase is being studied.

In the case of aggressive stage III or IV non-Hodgkin's lymphoma, chemotherapeutic associations should be administered rapidly, and often associated with rituximab. Many potentially effective chemotherapy associations are available. Chemotherapeutic associations are often named by the initials of each drug used in this association. For example, one of the earliest and most frequently used associations is known as CHOP (Cyclophosphamide, [Hydroxy] doxorubicin, vincristine [Oncovin], and prednisone). The addition of rituximab showed better results compared to the single CHOP; This is why it is now systematically added to this association (R-CHOP). More than 70% of advanced-stage aggressive non-Hodgkin lymphomas heal with R-CHOP chemotherapy. New drug associations are being studied. Chemotherapy, which often induces a decrease in the number of certain blood cells, is sometimes better tolerated when administered in conjunction with certain proteins (called growth factors) that stimulate growth and blood cell production.

Did you know?

Chemotherapeutic drug associations are often referred to as the initial of each drug used in this association.

Relapse

In case of relapse (recurrence of lymphoma cells), the choice of treatment depends on the extent of the disease and the symptoms. In the event of relapse of non-Hodgkin's lymphoma, a specific radiotherapy, called Immunoradiothérapie, is an option. After a first relapse, the duration of the remission tends to decrease.

Most people who experience a recurrence of aggressive lymphoma receive high-dose chemotherapy medications associated with autologous stem cell transplantation, i.e., their own stem cells (cell transplant Stumps). With this type of treatment, the healing rate can reach 50%. Sometimes stem cells from a family member or even from an unrelated donor (allogeneic transplant) may be used, but this type of transplant presents a greater risk of complications. It is unlikely that people with indolent lymphoma will heal with an autologous stem cell transplant, but it seems to be the best therapeutic option.