September 15th – World Lymphoma Awareness Day

Widely spread, yet little known: lymphoma, the tumour that affects the lymphatic system, deserves more attention as an early diagnosis is essential for treatment. With a focus on the emotional well-being of patients.

As in previous years since 2004, the 15th September marks World Lymphoma Awareness Day (WLAD). This annual event started from an initiative by the Lymphoma Coalition, a global network formed in 2002, comprising over 80 lymphoma patient groups from more than 50 different countries.

The Report from Aiom (Italian Association of Medical Oncology) called “Cancer Numbers in Italy 2022” estimates around 14,400 new diagnoses of Non-Hodgkin Lymphomas (NHL) in 2022, while in 2020, 2,150 people were diagnosed with Hodgkin’s Lymphoma (HL). Despite the prevalence of this malignant tumour, few are truly aware of its characteristics, symptoms, and treatment options. According to a survey by Elma Research, while two out of three Italians claim to know what lymphoma is, 20% are unaware that it is a cancer of the lymphatic system, and 28% don’t know that seeking specialists like hematologists and oncologists is necessary. Furthermore, only 20% can correctly identify at least three warning signs of lymphoma, including swelling of neck lymph nodes, chronic fatigue, fever, abdominal pain, cough, and shortness of breath.

However, awareness of lymphoma is crucial, primarily for recognizing the symptoms early and starting treatment immediately. Early intervention can save lives, given the excellent prospects for recovery in malignant lymphomas.

What is a lymphoma?

Lymphoma is a malignant tumour of the lymphatic system. To explain it better, one must first understand how the affected system functions.

The lymphatic system is part of the immune system, made of bone marrow, tonsils, thymus, spleen, and lymph nodes, all connected by lymphatic vessels through which lymph, a fluid containing lymphocytes, circulates throughout the body. Lymphocytes are a type of white blood cell responsible for defending the body against infections and diseases. They originate in the bone marrow and differentiate into B and T lymphocytes. B lymphocytes develop in the bone marrow and lymphatic organs, while T lymphocytes develop in the thymus.

The peculiarity of lymphoma lies in the close relationship between organs and cells within the body’s circulatory system. Lymphoma can spread throughout the body during its journey through the lymph and blood. In lymphoma, cancerous cells develop from lymph nodes and tend to invade nearby lymph node regions before gradually spreading to more distant ones.

The symptoms typically include:
– Swelling of lymph nodes in the neck, armpits, or groin
– Night sweats
– Fever
– Cough
– Breathing difficulties
– Abdominal swelling and pain
– Fatigue
– Increased bleeding tendencies due to reduced platelet counts.

Since these symptoms can also be associated with other medical conditions, thorough investigation is necessary before jumping to conclusions.

The diagnostic process typically begins with a visit to a General Practitioner, who may recommend further examinations and refer the patient to a haematologist or oncologist. This eventually leads to lymph node biopsies, the definitive test for diagnosing lymphoma. Additional tests, such as blood tests, CT scans, magnetic resonance imaging, chest X-rays, and bone marrow biopsies, may be performed to determine the type, extent, and staging of lymphoma.

Hodgkin or Non-Hodgkin Lymphoma?

Lymphomas are divided into two types: Hodgkin’s Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL).

Hodgkin’s Lymphoma is named after the physician who described its characteristics in 1832. It is a rare tumour, with a ratio of 1:9 compared to NHL, and is more common among young people aged 15-35.

From a histopathological point of view, it differs from NHL because it features a specific giant cell with two nuclei called the Reed-Sternberg cell. It primarily affects B lymphocytes.

Non-Hodgkin Lymphomas are more common, primarily affecting individuals over 65. They can involve T or B lymphocytes and are categorised as indolent (low malignancy and slow growth) or aggressive (high malignancy and rapid growth).

Hodgkin’s Lymphoma has a better prognosis compared to Non-Hodgkin Lymphoma, with a higher likelihood of recovery. However, survival estimates are indicative and depend on individual cases and how early the disease is recognised.

Hodgkin’s Lymphoma, typically treated with chemotherapy, leads to complete recovery in 70% of cases,” says Luigi Maria Larocca, a professor of Pathological Anatomy at UniCamillus’ MSc in Medicine and Surgery and BSc in Biomedical Laboratory Techniques. However, for Non-Hodgkin Lymphoma, medical science has made significant progress as well. “In the case of Non-Hodgkin B-cell lymphoma, monoclonal antibody therapy can be used. Rituximab is a molecule that binds to the CD20 protein expressed by B lymphocytes and destroys tumour cells,” explains Larocca.

Rituximab is used alongside chemotherapy to reduce the dosage of chemotherapy drugs and, consequently, its toxicity. “The anti-CD20 therapy has represented a groundbreaking development for those lymphomas that were difficult to eradicate in the past, even though they were indolent. Now, they can go into complete remission,” Larocca adds.

In cases of relapse “Other forms of therapy are required, such as specific drugs, autologous bone marrow transplants, and gene therapy. Nevertheless, lymphoma patients today have numerous possibilities to lead normal lives and overcome the disease.

Non-Hodgkin T-cell lymphomas are rarer and typically more aggressive. “One of these is cutaneous T-cell lymphoma, known as mycosis fungoides,” explains Larocca. “Initial symptoms include patches, which over time become papules and then nodules, eventually transforming into systemic tumours.” However, its progression takes about a decade, providing ample time for monitoring and treatment before it becomes insidious.

Hence, it is crucial to recognize the disease promptly because, in the majority of cases, there are high chances of survival.

The Psychological Impact of Lymphoma

In addition to early diagnosis, there is another reason to increase public awareness of lymphoma: focusing on the emotional well-being of those affected by this disease, to provide care, respect, and not underestimate its psychological impact.

It’s not a coincidence that the message for WLAD 2023 is “We Can’t Wait to Focus on our Feelings,” emphasizing the urgency of addressing this aspect of the disease. Cancer patients may experience fear of disease progression or relapse, anxiety, distress, and feelings of isolation due to the social stigma associated with cancer. Therefore, it’s crucial to consider this aspect, to better communicate with lymphoma patients, make them feel supported and understood, and provide them with the strength that comes from their deepest bonds, including family, partners, and friends.

In such situations, talking to a psychotherapist can be important for recognizing and managing one’s emotions effectively, communicating better with family, and discussing the diagnosis with children, especially if they are young.

Self-help support groups with individuals going through the same battle can also be essential. Not feeling alone is crucial for taking control of one’s days and finding the determination needed to face daily life.

Most importantly, it’s necessary to focus on one’s emotions as human beings and not feel confined to the definition of “cancer patients.” Cancer is an aspect of a person’s life but should not define them. Patients are first and foremost human beings, parents, children, partners, friends, workers, individuals with passions, desires, dreams, and aspirations.

Awareness of lymphoma helps fight the disease without losing sight of the most important part of the disease itself: being alive.