The untimely death of Luo Jing, the host of CCTV’s “News Broadcast”, made many viewers who knew and loved him very sad. From diagnosis to death in less than 10 months, the result was too fast to accept. While grieving, people cannot help but ask, how “evil” can lymphoma be? Why, despite aggressive and reasonable treatment, did Rogin fail to survive even one year? Since the British pathologist Hodgkin reported seven cases of lymphoma in 1832, it has been studied for nearly two hundred years, but the cause of the disease has not been completely clarified and may be related to ionizing radiation, genetic factors and certain viruses. Therefore, we should not believe the so-called “prevention strategies” that are so pretentious and elaborate. In the face of lymphoma, human beings nowadays can only fight an encounter war and cannot make a targeted defense like preventing certain infectious diseases. However, even in an encounter war, maximum understanding of the adversary is still a necessary prerequisite for us to win. It is better to have a good understanding of the disease than to be ignorant of it. Lymphoma is relatively rare in China, but in recent years, the annual number of new cases is increasing year by year, and the annual number of deaths exceeds 20,000. In the incidence ranking of malignant tumors, it ranks 9th in men and 10th in women. The high incidence age is 40 to 50 years old, and the average age of death is less than 50 years old. Pathologically malignant lymphoma can be divided into two major categories, Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL), which can be further divided into different types based on cell size, morphology and distribution patterns. It is important to understand that the clinical manifestations, treatment and prognosis of different pathological types of lymphoma vary, while lymphomas of the same pathological type have relatively similar biological behaviors, so it is difficult to generalize how “evil” lymphoma is. Luo Jing’s lymphoma is a diffuse large B-cell lymphoma (DLBCL), which is the most common pathological subtype (subtype, i.e., the next level of classification) in China, accounting for about 40% of all NHL, and belongs to a group of lymphomas with a moderate risk level. DLBCL has been recognized as a separate disease type in the latest new WHO 2008 pathology classification of lymphoma – including more than a dozen subtypes, each with a different biological behavior. We can consider DLBCL as one of the more intensively studied pathological types. Doctors and scholars in various countries have been making strenuous efforts to subdue this persistent disease. However, initially, due to the different evaluation criteria of lymphoma adopted by various clinical trials and oncology centers, there are different definitions of many relevant factors, no consistent efficacy evaluation criteria, and lack of uniform clinical trial endpoints, making it difficult to compare the results of various clinical trials. To exaggerate, a hundred schools of thought have turned into a chicken-and-egg self-evaluation, which seriously affects the assessment of their efficiency. In 1999, an international working group of clinicians, radiologists and pathologists specializing in NHL research developed guidelines for the evaluation of efficacy and prognosis of lymphoma. The guidelines were soon widely accepted by clinicians and new drug certifying bodies and were used in the approval of a large number of new drugs. Subsequently, the German Lymphoma Collaboration initiated an international harmonization project for lymphoma to produce a consensus on a revised new standard for the evaluation of lymphoma efficacy, which was published in the February 10, 2007 issue of the Journal of Clinical Oncology. The new guidelines have further advanced NHL research. In terms of treatment, the use of more rational combination chemotherapy regimens has transformed DLBCL from an incurable disease to a potentially curable one. For cases detected early, the 5-year survival rate can reach over 70%. We can see in the news that some of Luo Jing’s colleagues believe that he got lymphoma because he was under pressure at work, but in fact, no scholar has ever made such an interpretation on the etiology. People always tend to believe in simple and straightforward explanations, but the actual situation is much more complicated. Of course, Rogin’s untimely death was indeed related to his neglect of his health condition. Even though it is true that we cannot make etiologically effective prevention, if the disease had been detected in its early stages, perhaps the outcome of treatment would not have been what it is today. Although Luo Jing discovered the disease during a physical examination, the discovery was not early, and data show that the 5-year survival rate for cases with clinical stage III-IV is less than 30%. Chen Hu, director of the transplantation department of the PLA 307 Hospital, deeply regretted that Luo Jing eventually died of a tumor even after receiving a hematopoietic stem cell transplant. In fact, the chemotherapy based on stem cell transplantation is only significantly higher than the conventional chemotherapy group in terms of 5-year survival probability (55% vs. 37%), but the prognosis is still difficult to estimate for each patient. The prognosis of HL, another large family of lymphoma, is much better, with a 5-year survival rate of 98% for stage I and II HL, which has been classified as one of the curable malignancies in classical textbooks, but the necessary prerequisite is still early detection and rational treatment; the 5-year survival rate for stage IV HL cases is only 31.9%. In traditional Chinese medical literature, there is a reference to “Shang Gong treating the untreated”, which is actually the concept of disease prevention today. The ideal situation is, of course, prevention at the causative level to prevent cancer-causing factors from invading the body, which is called primary prevention. However, from the point of view of known cancer-causing factors, they are almost everywhere in people’s life, and it is impossible to completely prevent cancer-causing factors from invading human body, not to mention such tumors as lymphoma, where the cancer-causing factors are far from clear. The second best thing we can do is to try to detect and cure lymphoma as early as possible, so as to minimize the damage caused by tumors. So, how can we achieve early detection? Since all lymphomas are clinically characterized by painless, progressive lymph node enlargement. A simple self-test is “palpation”, which is recommended. Because most patients with lymphoma develop first in superficial lymph nodes, such as the neck, groin and axillary lymph nodes, these areas are easily palpable. Usually, when a pathogen invades the body and infection occurs, the lymph nodes will swell and become painful, and the lymph lumps will naturally shrink after the inflammation disappears. Therefore, if you find that your lymph nodes are painlessly and progressively enlarged and you can exclude obvious causes of lymph node enlargement (such as inflammation), you should go to the hospital for relevant tests to exclude the possibility of lymphoma. Another unique clinical manifestation of HL is the painful lymph nodes caused by alcohol consumption. When a patient with lymphoma develops systemic symptoms such as fever, emaciation and night sweats, it often indicates that the lymphoma has entered an advanced stage or the lesion has become diffuse. Finally, I have to remind readers that only early detection and standardized treatment of lymphoma have a chance of long-term survival, and for China, where medical resources are seriously unbalanced, “standardized treatment” is not available in any hospital. Only the oncology department of large general hospitals or regular cancer hospitals may have this technical strength. Note 1. In 1832, British pathologist Hodgkin reported 7 cases of tumors originating from lymph nodes and spleen, but it was Wilks, a British physician in 1865, who proposed it as a unique tumor and officially named it as Hodgkin’s lymphoma. 2. About the naming of tumors: what we usually call cancer is actually the collective name of various malignant tumors. Malignant tumors originating from epithelial tissues are collectively called carcinomas, and those occurring from mesenchymal tissues are collectively called sarcomas. Benign tumors usually add the word “tumor” after the name of the tissue from which they originate, but those called so-and-so tumors are not always benign, such as lymphoma, which often omits the word malignant in clinical practice, which does not mean it is benign. 3. About 5-year survival rate: In order to count the survival rate of cancer patients and compare the advantages and disadvantages of various treatment methods, the medical profession adopts the prognosis of most patients as a statistical indicator, which is often referred to as 5-year survival rate by doctors. Five-year survival rate refers to the proportion of patients who survive for more than five years after various comprehensive treatments for a certain tumor. The five-year survival rate is often used to indicate the efficacy of various cancer treatments.