REFERENCES
- ail.it
- airc.it
- Veronesi Foundation
- Lymphoma Guidelines - 2018 Edition
- AIOM (Italian Association of Medical Oncology)
- Follicular Lymphoma - Patient Guidelines
- ESMO (European Society for Medical Oncology)
Non-Hodgkin's Lymphoma (LNH) is a malignant tumor that originates from B and T lymphocytes present in the blood, lymphatic tissue, lymph nodes, spleen, thymus and bone marrow.
It affects the adult and older population over 65 and, in Italy, represents about 3% of all cancers.
Eziologia e fattori di rischio
The causes of LNH are still not entirely clear, however some factors have been identified that seem to increase the risk of the onset of the disease:
- non-modifiable factors: age and sex. The disease is more common among adults, particularly after the age of 65, and affects men the most.
- modifiable factors: exposure to radiation and chemotherapeutic agents (used for previous medical treatments) and chemical substances such as insecticides, benzene, ionizing radiation.
- clinical factors: immunodepression (HIV infection, autoimmune diseases, anti-rejection drugs after a transplant, etc.), chronic viral infections (hepatitis C, Epstein-Barr virus infection, responsible for mononucleosis, etc.), bacterial infections such as Helicobacter Pylori, the first cause of primary lymphoma of the stomach.
Symptoms
The symptom commonly associated with lymphoma is the substantial swelling of the lymph nodes in different parts of the body (neck, groin), not accompanied by pain, which does not diminish as the days go by and lasts more than a month.
Other symptoms attributable to NHL may vary depending on the site affected by the disease:
- swelling and enlargement of the organs involved, such as the spleen or stomach, with possible nausea or sense of pressure and fullness even after eating little;
- cough, chest pain and difficulty in breathing, when the disease affects the chest;
- headache and speech difficulties, when it spreads to the nervous system;
- fever, night sweats, weight loss and itching all over the body.
Although less specific, symptoms such as fatigue and lack of appetite should not be overlooked either.
The stages of the disease
Knowing the staging of the disease is always a fundamental step in choosing the most appropriate treatments.
For the LNH four stages have been identified, indicated with the Roman numbers I, II, III and IV, in which we evaluate:
- number of lymph nodes involved;
- locations of the disease;
- presence or absence of general signs such as fever, weight loss and night sweats.
To make the staging more precise, in addition to the Roman numerals, the following letters are also used:
- A (no symptoms)
- B (presence of specific symptoms)
- E (a disease that involves an organ outside the lymphatic system)
- S (disease involving the spleen)
- X (very large tumour mass)
The International Prognostic Index (IPI) is a method of classification of non-Hodgkin's lymphomas based on the stage classification and five criteria: age, disease stage, extension of the disease outside the lymphatic system, performance status (capacity to perform daily activities) and lactate dehydrogenase level (high levels of this enzyme in the blood are associated with the presence of tissue and cellular damage).
Diagnostic methods
In the presence of symptoms that may lead to suspicion of NHL, it is essential to consult a doctor who, after a thorough analysis of the medical history, will check the patient and prescribe the most appropriate diagnostic tests to confirm or not the presence of the disease.
However, to confirm the diagnosis it is necessary to perform a biopsy, i.e. the removal of a lymph node and a part of the suspected mass for microscopic analysis.
If the diagnosis is positive, the patient will have to undergo further tests, positron emission tomography (PET) and computerized axial tomography (CAT), in order to establish the exact extent of the disease and the parts of the body involved.
Unlike other cancers, non-Hodgkin's lymphoma is not preventable. However, in general it is advisable to avoid exposure to known risk factors (Epstein-Barr virus, HIV, chemicals, radiation) and change one's lifestyle by limiting body weight, excessive intake of alcoholic beverages and smoking.
Treatment
The choice of treatment is based on the evaluation of the stage of development of the disease, the type of lymphoma, the age of the patient and his general health conditions.
Treatment options for non-Hodgkin's lymphoma include surgery, chemotherapy, with different combinations of drugs, and radiation therapy. The latter can be used alone or in combination, depending on each case.
In recent years, scientific research has allowed the development of increasingly targeted drugs capable of acting selectively on cancer cells. An example is the monoclonal antibodies, molecules that bind a protein found on tumour cells in a specific way. Monoclonal antibodies can also be linked to a radioactive molecule that releases radiation precisely at the level of the tumour cell, limiting damage to surrounding healthy cells (radioimmunotherapy).
In case of failure to respond to treatment or relapse after initial therapy, it is possible to have recourse to autologous stem cell transplantation (with cells taken from the same patient) or allogeneic (with cells from a compatible donor).