The World Health Organization (WHO) classifies them into two large groups: Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma, and these two groups currently include more than 60 different types of lymphoma.
Lymphocytes are mainly found in the blood and in the lymphatic organs: ganglia, spleen and bone marrow, but as they are cells that circulate in the blood, they can actually be found in any organ of the body, as their defence function is necessary throughout the body. For this reason, although it is more frequent in the lymphatic organs, a lymphoma can occur in any organ of the body: the skin, the digestive tract, the central nervous system, etc.
The symptoms depend on whether the type of lymphoma that the patient has is aggressive or indolent:
Aggressive lymphomas are diseases that progress rapidly and always bring about symptoms, because the tumour lymphocytes multiply at a high rate. The symptoms are rapid growth of ganglia, spleen and/or tumour masses, weight loss, excessive sweating, fever and/or unexplained burning pain. If one of the ganglia or tumour masses grows near an organ, it may compress it and symptoms may also appear that lead to suspicion. This type of aggressive lymphoma always needs preferential treatment when it is diagnosed.
In contrast, indolent lymphomas are those in which the enlargement of the ganglia, spleen or tumour masses is very slow. Most patients do not have any symptoms of the disease and can be monitored without treatment. Only in the event that, at any time, node growth and/or the onset of symptoms is observed, would it be necessary to treat the patient, which is why monitoring is essential in all patients with lymphoma, whether or not they have symptoms.
Who does it affect?
Lymphomas are not very common diseases compared to other types of tumour. Non-Hodgkin’s lymphomas are the 6th most common cause of cancer in Europe, comprising only 4% of all annual cases, whilst Hodgkin’s lymphoma is even rarer: 1% of all annual cancers. Lymphomas are most common in males and in older people, with the greatest incidence occurring between 70 and 80 years old. In younger patients, Hodgkin’s lymphoma is more common, as well as some subtypes of non-Hodgkin’s lymphoma.
The incidence of both types of lymphoma has increased over the last 20 years and is expected to continue to increase.
The factors associated with greater risk of developing a lymphoma are not as well known as other types of cancer, but some types of lymphoma appear to be associated with viral infections, certain professions, exposure to toxic substances, immune system alterations or ionising radiation. Although several cases of lymphoma may be diagnosed in the same family, the actual risk cannot be predicted in relatives of a patient with lymphoma, and therefore screening tests are not helpful.
To diagnose a lymphoma, a lymph node or suspected tumour mass biopsy is required. The biopsy confirms or rules out the suspicion and identifies the type of lymphoma according to WHO criteria.
The extent of the disease and possible individual risk factors are then studied and the type and intensity of treatment is decided. Laboratory tests on blood and bone marrow, a complete physical examination and imaging tests are performed to assess all possible locations of lymphoma, usually CT or PET-CT scans. If there is also a suspicion of lymphoma in other less common organs, additional tests may be necessary (for example, an endoscopic study if intestinal disease is suspected, or a skin biopsy if it is thought that the lymphoma may affect the skin, etc.).
The treatment of lymphomas is based on chemotherapy, which can be accompanied in specific cases by targeted radiation therapy aimed at a localised area to intensify the effect of treatment. In B lymphomas, chemotherapy is combined with a monoclonal antibody, rituximab, which makes it more effective. In some types of lymphoma, after treatment it may be necessary to add a strategy to prolong the response obtained, such as bone marrow transplantation or maintenance treatment.
The type of treatment is personalised according to the type and spread of the lymphoma, the characteristics of the patient, such as age and general health, and whether the expectations are that the disease may be cured or that only palliative care may be given.
Treatment of lymphoma may also be done in clinical trials, where new treatment options are investigated that may improve the outcomes of current treatments, or offer options to patients whose disease has not responded or has recurred after treatment was received. Your haematologist will advise you on which trials are available and which are best suited for you.
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