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Health Matters

What do we know about Lymphoma?

About half of all blood neoplasms registered every year are lymphomas, or cancers of the lymphatic system.

This system is composed by lymph nodes from the different regions of our body (including lymphoid tissues related to mucous) and other lymphoid tissues, such as the bone marrow and the spleen. Altogether, the main purpose of this system is to remove the excess of fluids in our body and to produce immune cells.  Lymphocytes are a kind of white cells that fight against infections. When these cells become malignant they develop an uncontrollable growth, build up in lymphoid organs and block the immune system’s regular functioning.


Many viral infections have been identified as responsible for the development of lymphoproliferative diseases, including Epstein Barr Virus (EBV), Herpesvirus 8 (HHV-8), HTLV-1 or HIV infection, along with other factors, namely some bacterial infections (Helicobacter pylori), old age, male gender, impaired or decreased immunity syndromes, previous history of transplant or some autoimmune diseases. All these conditions have been associated, in different degrees, to an increased risk for this disease. Some studies suggest that exposure to chemical agents such as benzene, certain herbicides and insecticides, may also be associated to a further development of the disease. Some chemotherapy drugs used to treat other neoplasms may as well increase the risk of lymphoma, years later.


B cells lymphomas are divided in two types: Hodgkin's Lymphoma (HL) and Non-Hodgkin's Lymphoma (NHL). 12% of all registered cases fit the first group, a disease which is currently curable. Most NHL are B cell lymphomas, either of rapid growth (high level of malignancy) or slow growth (low level of malignancy). The rest are lymphomas originating from T cells or, much more rarely, in NK cells (Natural Killer).


Within the B cells NHL, Follicular Lymphoma and Diffuse Large Cell Lymphoma account for about 60% of all cases. The remaining groups are (by decreasing order of frequency) Chronic Lymphatic Leukaemia / Diffuse Small Cell Lymphoma, MALT Lymphoma, Mantle Cell Lymphoma, Marginal Zone Lymphomas and Burkitt Lymphoma.


A routine test for screening of this disease is not recommended, at least in persons showing no symptoms. The best way to assure early detection is being aware of all signs and symptoms which may be associated to the disease and which may vary and even be unspecific, including: enlarged lymph nodes, increased abdominal volume, feeling of surfeit, pain or feeling of chest pressure, fever, night sweats, unexplained weight loss or sharp fatigue. In some cases, there might be no symptoms at all until there is a greater tumour volume.


It is mandatory to start this kind of screening by excluding multiple benign causes such as infections, which may also lead to enlarged lymph nodes or similar symptoms. Despite the differences, the first step is objective examination (size, texture and location). If necessary, this is followed by the definitive diagnosis, preferably including a biopsy of an affected lymph node. Nevertheless, there are other complementary diagnostic techniques, such as a lymph node, blood or bone marrow flow cytometry, cytogenetics and molecular genetics, which confirm and help diagnosis, identifying anomalous populations and associated genetic lesions, respectively.


For staging (evaluation of the extension of the disease) and treatment response assessment, further biopsies may be required (bone marrow, organs or masses with suspected tumour infiltration) as well as other analysis and imaging exams such as a chest X-ray, an abdominal ultrasound, chest, abdomen and pelvis computed tomography, amongst others.


Many progresses have been made over the last few years, concerning NHL treatment and understanding on how DNA changes turn normal lymphocytes into lymphoma cells. New drugs have been tested in clinical studies, considering innovative molecules and target-directed therapies (specific parts of cells or molecules). Also, improvement of monoclonal antibodies, along with chemotherapy, are a proven effective therapeutic strategy in many lymphoma conditions.


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