Non-Hodgkin's lymphoma
Description
Non-Hodgkin's lymphoma is a cancer of the lymphatic system that usually originates in lymphocytes (white blood cells) of one or more lymph nodes. White blood cells are part of the lymphatic system that helps fight diseases and infections. There are several types of non-Hodgkin lymphomas, which are determined according to the appearance of cancerous cells under a microscope.
Non-Hodgkin's lymphoma occurs in all age groups, but the frequency increases with age, especially after 60 years. Non-Hodgkin's lymphoma accounts for approximately 4% of new cancer cases each year; The probability of being reached over the course of life is 1 in 43 for Canadian men and 1 in 50 for Canadian women.
Causes
The exact cause of non-Hodgkin's lymphoma is not known, but doctors believe that a virus or the activation of abnormal genes may be responsible for some cases of this condition. The following risk factors would be responsible for certain cases:
Age (60 years or older);
Auto-immune disorders (e.g. rheumatoid arthritis);
Exposure to pesticides, chemical solvents and dyes;
Exposure to certain viral infections such as those caused by Epstein-Barr virus;
Immunodeficiency states such as AIDS, congenital immunodeficiency, or immunosuppression with drugs;
Pre-exposure to chemotherapy or radiation therapy.
It is possible to develop non-Hodgkin's lymphoma, even in the absence of these risk factors.
Symptoms and Complications
swollen lymph nodes in the neck, armpits or groins is the first symptom of non-Hodgkin's lymphoma. Other possible symptoms include unexplained fever, night sweats, weight loss and pain in the stomach and intestines. As the disease progresses, all infected people develop anemia because of the loss of red blood cells, hence the symptoms of fatigue and weakness.
The nature of the symptoms tested depends on the location of the lymphoma. Lymphoma in the thorax may result in swelling of the face, breathing difficulties or accumulation of fluid in the lungs (pleural effusion). If lymphoma sits in the abdomen or in the small intestine, it can lead to loss of appetite, diarrhea, constipation, weight loss or pain and a bloating sensation. A lymphoma located in the groin can cause swelling of the legs. At the skin level, lymphomas can cause thickening, darker coloration and itching in some areas.
Diagnosis
Your doctor will ask you questions about your symptoms and he will give you a physical exam. If he suspects non-Hodgkin's lymphoma, he will perform further tests to confirm the diagnosis.
Blood tests will check for abnormalities in the blood cells and organ function (e.g., liver, kidney). X-rays, ultrasounds, providing CT scans or positron emission tomography will analyze the lymph nodes that your doctor cannot examine because they are located deep inside your body.
A lymph node biopsy (the resection of a small lymph gland sample for microscopic examination) will confirm the diagnosis. A doctor may take a bone marrow biopsy to determine if the cancer has spread. This test requires the insertion of a needle in the lower back to remove tissue from it and the microscopic examination of this tissue to determine if cancer cells are present.
The information obtained from these tests will give a stage and a grade to non-Hodgkin's lymphoma. By using these features, you and your doctor will be able to decide on the best treatment for you.
The clinical stages used in the evaluation of non-Hodgkin's lymphoma are as follows:
Stage 1: Cancer is present in a single ganglion group;
Stage 2: Cancer is present in more than one ganglion group, these groups are located on the same side of the diaphragm (thin muscle located under the lungs that promotes respiration and separates the thorax from the abdomen);
Stage 3: Cancer is present in ganglion groups on both sides of the diaphragm;
Stage 4: Cancer has reached one or more organs (e.g., liver, lungs, brain, bone marrow);
Recurrent: Term used for cancer that reappeared after treatment.
The two grades of non-Hodgkin's lymphoma are indolent lymphomas and aggressive lymphomas. indolent lymphomas grow more slowly and cause fewer symptoms than aggressive lymphomas.
Treatment and prevention
The treatment depends on the grade and stage of the cancer. If you are suffering from indolent non-Hodgkin's lymphoma, your doctor may offer you the option of observing the disease carefully without treating it. During this time, your doctor will follow you closely and will only begin treatment when your condition begins to worsen.
Treatments usually used against non-Hodgkin's lymphoma are:
Biotherapy (a method that helps the patient's immune system to kill cancer cells);
Chemotherapy (use of drugs to kill cancer cells);
Radiotherapy (use of high doses of X-rays to kill cancer cells);
Transplantation of stem cells (healthy blood cells can be replaced more quickly).
The treatment can use a single method or a combination of methods. The treatment depends in fact on the type of lymphoma, the stage of cancer and other factors. Since many of the treatments for non-Hodgkin's lymphoma may be detrimental to fertility, your doctor may discuss some options such as sperm storage or egg collection for future pregnancies.
There are two types of white blood cells in the body: T lymphocytes and B lymphocytes. People with B-lymphocyte lymphoma are more easily cured than those with T-cell lymphoma.
In the early stages of the disease, radiotherapy is used to destroy the cancerous tumor. Radiation therapy usually helps prolong the patient's life even though it may not always cure it.
To treat more advanced or aggressive non-Hodgkin's lymphoma, chemotherapy is usually used, i.e. the administration of anti-cancer drugs. These medications can be administered separately or in combination with others. If treatment is initiated early enough in the cancer process, radiation therapy associated with chemotherapy can cure more than half of the cases of lymphoma. If cancer does not respond to treatment or reappears, chemotherapy can be intensified or restarted.
The combination of chemotherapy and radiotherapy can be effective in treating large lymphomas or controlling pain or hemorrhage caused by tumors.
In some cases, physicians may perform bone marrow or stem cell transplantation after administering very high doses of chemotherapy. Chemotherapy destroys cancerous white blood cells as well as platelets, white blood cells, normal and healthy red blood cells. During this procedure, a doctor removes the bone marrow from a compatible donor and grafts it to the recipient after high doses of chemotherapy have been given. Occasionally, bone marrow replacement comes from the patient itself (rather than from a donor) if the bone marrow had been retained earlier during treatment.
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