non hodgkin's lymphoma stages | Reading corner Lymphoma Cancers that start in the lymph nodes

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Lymphoma
Cancers that start in the lymph nodes

Solid tumors with lymphocytes

Hodgkin's lymphoma and NHL (NON-Hodgkin's)
Hodgkin: 24th place, very good prognosis

NHL: 1/3 blood Cancers, 6th place, good prognosis

Presentation of lymphomas
Clinical

Appearance of palpable or not lymph nodes (intra abdominal, or thoracic, seen in imaging)
Splenomegaly
General signs: fever, weight loss, sweats, pruritus
Locations: Any tissue that contains cells

Diagnosis
Orientation: lymph node puncture

Diagnosis: Biopsy

Phenotyping, IMMUNO-histochemistry
To refine the diagnosis, we use markers that will specifically recognize proteins that are on the surface of the cells.

These markers are antibodies + fluorite that are detected with fluorescence microscopes.

Before any processing: EXTENSION balance
Chest X-Ray

Scanner (essential): thorax, abdomen, pelvis, sometimes neck

Ostéomédullaire biopsy

General: NFS, VS, HIV (it may be related to some NH lymphomas)

Pet-Scanner: Positron emission tomography

Classification
Ann Arbor

Stage I: a ganglionic area
Stage II: > 1 ganglionic area
Stage III: Adenopathies on both sides of the diaphragm
Stage IV: Locations extra ganglion
A: No general sign

B: At least one general sign (fever, weight loss > 10% in 6 months, sweats)

Hodgkin
Relatively rare

Incidence in young people and second peak around 60/70 years

Treatment

Chemotherapy always, repeated cures
Radiotherapy: Localized stages (I and II), not digestive, after chemotherapy, irradiation of the initial tumor
Results: 60 to 90% healing

Complications: Growth, cancers, heart/thyroid, fertility

NON-Hodgkin Lymphomas
Frequent

Etiologies

Virus (e.g. EBV)
Hiv
Immune deficiency (grafts, immunosuppressive)
Idiopathic
Follicular NHL, high-cell NHL

Prognosis

Indolent: Slow Evolution, no healing (unless Allograft)
Aggressive: Rapid evolution, good response to treatment (50% cure)
Treatment

indolent: Abstention, "mild" or "heavy" chemotherapy, monoclonal antibodies
Aggressive: always treat, "heavy" chemotherapy +/-allograft, monoclonal antibodies


Antibodies
Y-Structure with a constant zone and a variable zone (detects what is being attacked)

Polyclonal: Highly variable, risk of being toxic

Monoclonals: Manufactured in an artificial, very specific way

Cellular DESTRUCTION: MODES of Action
Direct: Specific antibody attaches to the cell and induces apoptosis

With the immune system: antibodies attaches to a cell, is recognized by the immune system that will destroy the target cell

Thanks to the add-on: cascade of protein activation, direct link between the complement and cell → cell explosion

Antibody associated with a radioactive product: destruction within a radius of 100 cells

POINTS to Remember
Lymphomas are tumors made of lymphocytes

Any organ can be reached

Hodgkin's lymphomas concern young patients and are good prognosis, radiation therapy supplements chemotherapy in localized forms

The NHL are numerous and are either indolent or aggressive, only the latter should always be treated with chemotherapy