World Lymphoma Awareness Day: Symptoms, causes, diagnosis and treatment

Lymphocytes are types of white blood cells that defend the body.  

Lymphoma is characterised by a high multiplication of lymphocytes in the lymph nodes, spleen, liver and, more rarely, in other organs. There are two types of lymphoma: Hodgkin lymphoma or Hodgkin's disease, and non-Hodgkin lymphoma, which is more common.  

Both types of lymphoma affect different types of lymphocytes. 

What are the different types of lymphoma?

Patients living with lymphoma, which is also referred to as a haematological malignancy, account for almost half of all blood cancer patients. 

Hodgkin's disease, named after Thomas Hodgkin, a British physician who described it in 1832, primarily affects young adults aged 20 to 40. It accounts for 15% of lymphoma cases. 

Non-Hodgkin lymphoma (NHL), accounting for 85% of lymphoma cases, affects all ages but the risk is higher for people over 60, with two main cell types affected: B-cells (85%) and T-cells (15%). 

There are many other types of non-Hodgkin lymphoma: follicular lymphoma, mantle cell lymphoma (MCL), lymphoblastic lymphoma, diffuse large B-cell lymphoma and many others. Their diagnosis can only be made by analysing a lymph node sample under a microscope. 

What are the symptoms of lymphoma? How is the diagnosis made?

In most cases, lymphoma is manifested by an increase in the size of one or more lymph nodes. This increase in volume is due to the uncontrolled accumulation of abnormal lymphocytes. Only a biopsy can establish a definitive diagnosis and thus its exact nature. Other examinations, such as blood tests and medical imaging, will be used to assess the extent of the lymphoma in the body. 

For non-Hodgkin lymphoma, symptoms related to the abnormal size of a lymph node do not always make it possible to detect the cancer; doctors will need to detect other manifestations on the patient's body: swelling, fevers and/or unexplained weight loss. This can unfortunately lead to misdiagnosis. 

Depending on the type of lymphoma, an appropriate treatment will be proposed. 

What are the different risk factors of lymphoma?

For Hodgkin lymphoma, there are several risk factors that do not necessarily result in the development of blood cancer.  

These factors may be related to family health history, but there is still research to be done to identify the specific genetic mutations for this disease.  

Other factors are related to the state of the patient's immune system. Decreased immune defences due to autoimmune disease, infections of certain viruses or immunosuppressive treatments can sometimes conrtibute to the development of lymphoma.  

For non-Hodgkin lymphoma, exposure to toxic substances is also contributing factor. For example, overexposure to solvents, printing ink or pesticides in agriculture. 

What treatments are available for lymphoma?

A number of effective treatment options are available for patients diagnosed with lymphoma; the therapeutic strategies will differ according to the nature of the lymphoma: 

• Chemotherapy: Often a combination of several drugs (polychemotherapy), chemotherapy is typically administered by IV over a period of several sessions (from 6 to 12) with an interval of about 2 weeks. The most common side effects are nausea, vomiting, diarrhoea, constipation and hair loss.
• Radiotherapy: This treatment uses high doses of radiation to destroy cancer cells only in the affected lymph node areas. The usual side effects depend on the area treated, but may include nausea, vomiting, fatigue, skin rashes, etc. 
• Immunotherapy: Immunotherapy is treatment that uses the patient's own immune system to fight the lymphoma. It is administered intravenously, with several injections (between 4 and 8) given at intervals of several weeks. This method improves the results of the chemotherapy. During immunotherapy, the patient may experience headaches, nausea and vomiting. 
• Stem cell transplantation (SCT): If the lymphoma recurs, the patient will receive high doses of chemotherapy and/or radiation as "conditioning treatment" to prepare the body for transplantation. In SCT, stem cells are infused into the patient's bloodstream and travel to the bone marrow to start the process of creating new healthy blood cells. There are two main types: autologous transplantation (using the patient's own stem cells) and allogeneic transplantation (using stem cells from a donor). Possible side effects may be related to chemotherapy or radiation (nausea, vomiting, mouth sores) or to the transplant (viral or bacterial infections, bleeding, lung issues, graft-versus-host disease, etc.)
• Complementary care: Additional treatments or therapies may be prescribed to allows patients to manage their pain. Advice and recommendations on lifestyle (diet and exercise) are essential. Alternative treatments also exist to help patients feel better, such as relaxation, meditation, etc.

What happens after treatment? What kind of follow-up is there? How to live better after lymphoma?

After treatment, many patients are able to resume a normal life, especially for patients with Hodgkin lymphoma. The rate of recovery for lymphoma is high. 

Beyond the physical side effects, it is important to recognize the potential psychological impact of treatment. The patient's morale can be affected and there may therefor be a need for psychological support. The fear of recurrence is real, and patients need to be listened to, especially during their medical follow-up after treatment. 

Treatments for Hodgkin and non-Hodgkin lymphoma are constantly improving. Of course, the prospects for recovery depend on several criteria, including the type of lymphoma, the extent of the cancer, age, the proposed treatment and other diseases. 

To be supported as a patient or as a carer, is it important to lean on your friends and family, but there are also a number of charities and other organisations that exist to provide help, information, and support. 
 

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