mantle cell lymphoma symtom | NON-Hodgkin lymphomas-Treatments

NON-Hodgkin lymphomas-Treatments



Lymphomas are cancers of the lymphatic system. There are many variations, depending on the type of cells that cause the disease. Currently more than 30 kinds of non-Hodgkin lymphomas are known. They are all different and each require a suitable treatment. As a convenience, we will discuss non-Hodgkin's lymphoma in the singular.

Anatomy of the lymphatic system the lymphatic system in women
The lymphatic system consists of vessels and lymphoid tissue (lymph nodes and other organs).

Lymphatic vessels are channels that convey a colorless liquid (lymph) from tissues. The white blood cells are also found in the lymph. Through increasingly important diameter channels, this tissue fluid joins the bloodstream. Before the lymph reaches the blood, it crosses at least one lymph node.

Lymph nodes are the "sewage treatment plants" of the lymphatic system: they make pathogens harmless, especially bacteria and viruses. In addition, they filter the cellular wastes present in the lymph. The lymph nodes are located in various parts of the body, for example in the neck, at the armpits, along the trachea, near the lungs, near the intestine and at the back of the abdominal cavity, in the basin area or even at the level of The groin.

Besides that in the lymph nodes, lymphoid tissue is also present in other organs, especially at the level of the back-throat (pharynx), the airways, the spleen, the intestinal wall and the bone marrow. A certain type of white blood cells is found in lymphoid tissue, called lymphocytes. The lymphatic system in humans

Lymphocytes are produced in the bone marrow, lymph nodes and spleen. They circulate in the lymph and in the blood. They play an important role in our immune defenses by fighting against abnormal cells and microbes, or by producing antibodies.

Some figures
In our country, about 2,000 new cases of non-Hodgkin's lymphoma are recorded each year. Their number has risen sharply over the last ten years.

According to the Cancer Registry figures, in 2011, 1,027 new cases were counted in men and 888 in women. The disease occurs mainly in people over 45 years of age and is slightly more common in men than in women

Classification
Depending on the type of lymphocytes (cells normally present in the lymph nodes) causing the disease, lymphomas are divided into two broad categories: Hodgkin's disease and non-Hodgkin lymphomas.

There are a large number of different non-Hodgkin lymphomas. They are particularly distinguished by their greater or lesser speed of development. In almost two thirds of the patients, lymphoma has its starting point in one or more lymph nodes. In others, it begins elsewhere in the lymphatic system, for example at the level of the lymphoid tissue of the stomach, lungs, intestine... Non-Hodgkin's lymphoma can also develop at the skin level: it is a cutaneous lymphoma.

Degree of aggression

When tissue examination indicates non-Hodgkin's lymphoma, its degree of aggression is determined at the same time. Non-Hodgkin lymphomas are classified into three groups:

Lymphomas with low levels of aggression (or indolent lymphomas): Slow-growing cancer cell compounds

Lymphomas with medium aggression: cell compounds with intermediate growth rates

Lymphomas with high levels of aggression (or aggressive lymphomas): cell compounds with high growth rates. These cells are however the most sensitive to the treatments.

Low-level, non-Hodgkin's lymphoma can be transformed over the years into more aggressive lymphoma. But this is not always happening.

Cell Type

In addition to its degree of aggression, it is also important to determine what type of cell (lymphocytes) consists of non-Hodgkin's lymphoma: B or T lymphocytes. Each kind can be indolent or aggressive. The most common form (70%) is B-cell non-Hodgkin's lymphoma.

Staging of non-Hodgkin's lymphoma

Based on the results of the various exams, doctors can determine the stage of the disease. Traditionally, four stages are distinguished:

Stage I: The disease is limited to a single ganglionic territory, for example the lymph nodes 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, or to a single organ and to one or more ganglion territories located on the same side of the diaphragm.

Stage III: The disease reaches the ganglion territories located on either side of the diaphragm, and sometimes also the spleen and/or another organ.

Stage IV: At the start of the lymphatic tissue, the disease has spread to other organs such as the lungs, liver, bone marrow or skin.

If the patient does not have general symptoms, the letter A is added to the stage. The letter B means that one or more general symptoms are present, namely:

Alternating periods of fever and normal temperature

Weight loss and lack of appetite

Strong fatigue for no apparent reason

Abundant sweating, especially at night

Immunity disorders

The causes of non-Hodgkin's lymphoma are not yet accurately known. Heredity apparently does not play any major role. However, scientific research has shown that the risk increases with age or in cases of immunity disorders:

Disrupted immune defenses

Auto-immune diseases

Aids

Immunosuppressive treatments after organ transplant

Other causes of non-Hodgkin's lymphoma

Two viruses (HTLV-1 and Epstein Barr) could also play a favourable role. In addition, exposure of farmers to high doses of certain pesticides, solvents, or chemical fertilizers appears to be associated with increased incidence of non-Hodgkin's lymphoma.

The first symptom of non-Hodgkin's lymphoma is often an easily palpable swelling of one or more lymph nodes at the neck, armpit or groin level. Usually these swellings are painless.

Non-Hodgkin's lymphoma that develops from another site of lymphoid tissue is accompanied by symptoms related to damage or volume increase of the organ concerned. These anomalies can then be very similar to those of a stomach ulcer or a bowel tumor, for example.

There is also a rare form of lymphoma that develops at the level of the skin. It causes as the first local symptoms the appearance of a red plaque, swelling or ulceration. 

Other general symptoms that may appear are:

Fever flares, with no apparent cause (such as an infection)

Loss of weight or appetite

Strong fatigue for no apparent reason

Abundant sweating, especially at night

Lymphomas usually respond very well to chemotherapy and radiation therapy. Since the end of the years 1990, a new generation of drugs from research has come to strengthen the range of treatments possible. They are monoclonal antibodies (a form of immunotherapy) capable of recognizing and destroying lymphoma cells.

These three treatment families (chemotherapy, radiotherapy and monoclonal antibodies) can be used alone or in combination, depending on the needs. The evolution of the disease, its prognosis and the choice of treatments depend on the type of non-Hodgkin's lymphoma, the extent of the disease and the age of the patient.

The treatment of indolent and aggressive lymphomas

In low-aggressive forms, the treating physician usually offers single radiation therapy, "mild" chemotherapy or monoclonal antibody therapy. In the Face of certain indolent lymphomas (very little evolutionary), without altering the quality of life of the patient, careful medical supervision may suffice. Treatment will only be initiated if symptoms appear or aggravated. Some people develop a localized form of non-Hodgkin's lymphoma at the stomach wall. The disease is then usually accompanied by a gastric infection that can be treated with antibiotics and antacids.

For more aggressive forms, doctors mainly use chemotherapy, possibly associated with monoclonal antibodies or radiation therapy. In the case of relapse or a form of lymphoma which is immediately a severe prognosis, more intensive treatment, consisting of "heavy" chemotherapy, followed by a transplant of stem cells or bone marrow may be necessary.

1. 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 tablet form. By blood, they spread into the body and can thus reach the cancer cells in virtually every place in the body. Non-Hodgkin's lymphoma generally responds very well to chemotherapy treatments.

Read more about chemotherapy. 

Side effects of chemotherapy

Cytostatic do not only attack cancer cells, but also healthy cells that divide. As a result, unpleasant side effects, such as falling hair, tingling in your fingers or feet, and bowel disorders are likely to occur. Side effects such as nausea and vomiting can be largely conflated by medications.

A very common side effect is fatigue. This can persist long after the treatment. Anemia, increased susceptibility to infections and some propensity for bleeding can also occur.

In adolescents or young adults, some chemo-or radiotherapy may be a cause of sterility. This sequelae can be corrected by taking semen or ovarian tissue before the treatment begins. Don't hesitate to talk to your doctor before you start treatment for non-Hodgkin's lymphoma.

2. Radiation therapy

Radiation therapy can completely or partially destroy a malignant tumor. Irradiation is applied to the only part of the body where the cancer cells are located. This means that the irradiation zone varies from one patient to the next.

Lymphomas generally respond very well to radiation therapy, which is used in addition to chemotherapy in the face of certain types of non-Hodgkin's lymphoma. Click here to get more general information about radiation therapy.

Side effects of radiation therapy

Since radiotherapy also damages local healthy cells, some side effects may occur. They are usually passengers. A common side effect is fatigue. The other consequences vary depending on the irradiated areas.

As with chemotherapy treatment, radiation therapy can cause sterility in adolescents or young adults. Talk to your doctor before you start your treatment for non-Hodgkin's lymphoma. Thanks to a pre-removal of semen or ovarian tissue, this sequelae can be corrected. 

3. Immunotherapy

Immunotherapy relies on the immune system to recognize and attack cancer cells and destroy them.

Several strategies are possible. In the case of treatment of non-Hodgkin's lymphoma, laboratory-synthesized antibodies are used: monoclonal antibodies. They are attached to a particular protein present on the surface of lymphoid cells, as well as abnormal cells of most lymphomas. The cells on which the antibody has set die or are more susceptible to the action of chemotherapy.

Immunotherapy is a standard treatment of B-cell non-Hodgkin's lymphoma, the antibodies used being "programmed" to target B cells. They are usually administered by infusion, which takes a few hours. This treatment is usually combined with chemotherapy. To treat non-Hodgkin's T-cell lymphoma, immunotherapy is still being tested through clinical trials.

The Cancer Foundation informs you from a to Z about immunotherapy in a chapter apart.

Radio-Immunotherapy

In radioimmunotherapy, radioactive isotopes are associated with monoclonal antibodies. The antibodies will bind to the cancer cells and radiate them in a very localized way. The advantage of this method is that cancer cells are attacked both by the immune system stimulated by monoclonal antibodies and by radiation targeted to the tumor.

This treatment is currently administered as part of clinical trials against various forms of B-cell non-Hodgkin's lymphoma.

Side effects of immunotherapy

The side effects of immunotherapy are appearing during the administration. Generally, they are limited to a sensation of general discomfort, increased susceptibility to infections, fever and nausea. If a toxic substance is coupled to monoclonal antibodies, the side effects generally depend on the substance in question.

4. Stem cell transplant

When non-Hodgkin's lymphoma does not respond adequately to treatment or reappears after a period of time (recurrence), some patients receive heavy treatments based on cytostatic (intensive chemotherapy) and possibly Total body irradiation, followed by a stem cell transplant.

This stem cell transplant is indispensable because the intensive treatment destroyed all the bone marrow and killed all the stem cells, preventing the production of the blood cells. Hence the need, after intensive treatment, to administer intact stem cells, to allow the replenishment of blood in red blood cells, white blood cells and platelets.

Treatment and care in the context of a stem cell transplant (formerly called a marrow transplant) requires very specific knowledge. The intervention takes place exclusively in specialized hospitals.

Not all patients can receive this type of treatment. Doctors are currently proposing it to patients with particularly aggressive non-Hodgkin's lymphoma, or to some patients with indolent non-Hodgkin's lymphoma. The age (less than 65 years) and the general state of the person also play a role in this decision.