Features of the clinical picture in Non-Hodgkin lymphoma

03.04.2017

What is non-Hodgkin's lymphoma? An oncological disease that occurs in the lymphoid cells of hematopoietic germs.

If we compare it with lymphogranulomatosis, the survival rate of patients is only 25% of all diagnosed cases.

This disease differs from other forms of cancer in that it has a completely different biological nature, completely different symptoms, structure and prognosis.

In 1971, the eminent German surgeon Theodor Billroth proposed calling this tumor neoplasm non-Hodgkin's lymphoma or cancer.

About the disease

What is non-Hodgkin's lymphoma? It is one of the types of lymphatic tumors. The cells of the neoplasm differ in structure from Hodgkin lymphoma, and therefore the methods of treating the latter pathology are not suitable for the treatment of the disease in question. In addition, the further development of NLZ is difficult to predict.

In many cases, non-Hodgkin lymphomas grow into organs that have nothing to do with the lymphatic system. The pathology also affects lymphatic tissues, which are found in:

• thymus, or thymus gland;
• spleen;
• tonsils;
• small intestine.

The disease mainly affects older people due to the characteristics and causes of its development. In children, NHL develops very rapidly, provoking the appearance of other severe pathologies, which ultimately leads to death.

According to official medical statistics, non-Hodgkin's lymphoma is diagnosed in approximately 4% of people diagnosed with cancer.

Existing types of lymphomas

It is possible to predict the course of the disease only after establishing the type of lymphoma, since each of them has its own characteristics, pathology and specific treatment. In total, there are 35 main types of the disease, incl. 5 types belong to the varieties of Hodgkin lymphoma, and 30 types are considered non-Hodgkin lymphoma.

The most common type of lymphoma is Hodgkin's lymphoma, which affects the lymphatic system. There are 5 main subtypes of this type of disease: the type enriched with lymphocytes; sclerosis of nodes (nodular sclerosis); mixed-cell type (accounts for up to half of all cases of disease); lymphoid depletion; sclerosis with lymphoid predominance. Until recently, the prognosis for this type of disease was disappointing, but treatment methods have now been developed that provide an optimistic outlook for recovery.

Non-Hodgkin's lymphomas constitute a long line of neoplastic diseases arising from lymphatic cells. They belong to the group of so-called lymphosarcoma. Very often this type of disease is explained by infection with the Epstein-Barr virus. In general, many subspecies are distinguished, which are grouped into slowly developing indolent variants; into progressive aggressive types and into a subgroup with moderate activity, but affecting internal organs (primarily the spleen) without damaging the nodes, called extranodal. Survival in this group has a different prognosis: for the indolent course of the disease it is quite optimistic.

The characteristic morphological types of non-Hodgkin lymphoma include: B-cell type in the marginal area; MALT lymphoma; follicular varieties, which have a very good prognosis for survival with timely treatment. At the same time, this large group includes subtypes with a rather negative prognosis: T-regional type and T-cell variants of a peripheral nature.

Typical extranodal forms of the disease include skin lymphoma, lymphoma of the stomach and gastrointestinal tract, and Burkitt's lymphoma. The latter type is characterized by the most active growth of a malignant tumor, affecting a number of organs, incl. spleen

Causes

The reasons that provoke the development of the pathology in question have not yet been fully studied. Most non-Hodgkin's lymphomas are formed from so-called B cells, but a number of tumors are formed due to mutation of T cells. It is known that even after the occurrence of the latter process, not all children subsequently develop a malignant tumor in the lymphatic system.

What is known about the reasons for the development of this pathology is that it appears due to the influence of a number of factors:

1. Infection of the body with viruses of various etiologies (HIV and others).
2. Congenital pathologies of immunity.
3. Stomach ulcer, the long course of which provoked the appearance of Helicobacter pylori. In this case, lymphoma occurs in the gastric tissues.
4. Age-related changes in the body.
5. Organ transplantation in which the human immune system is suppressed.
6. Obesity.
7. Chemotherapy and radiation used in the treatment of other cancer diseases.

The environment has a significant influence on the state of the body. Negative environmental conditions and regular contact with chemicals contribute to malignant cell mutation. In some cases, non-Hodgkin's lymphoma develops due to long-term use of medications.

What can cause the disease

The causes of non-Hodgkin lymphoma are not yet fully understood. The following factors can indirectly influence the development of the disease and further prognosis:

• working with aggressive chemicals;
• living in areas with unfavorable environmental conditions;
• severe viral infections, in particular the Epstein-Barr virus;
• exposure to ionizing radiation.

It can also be noted that men suffer from non-Hodgkin lymphoma somewhat more often than women. Also, the likelihood of detecting the disease increases with age: according to statistics, the majority of those affected are people over 40 years of age. The form of the disease often depends on age: children and young people often experience symptoms of the small cell form of the disease or Burkitt's lymphoma, while older people usually have follicular lymphomas.

Symptoms of the disease

The manifestation of symptoms of non-Hodgkin lymphoma depends on the nature of the disease itself. If the pathology develops aggressively and is characterized by increased malignancy (more often observed in children over 5 years of age than in older people), then the presence of a neoplasm is indicated by swelling of a small area of ​​skin resulting from an increase in the size of the lymph nodes.

They are mainly localized:

• on the head and back of the head;
• in the groin area;
• in the armpits.

The development of such neoplasms in most cases is not accompanied by the appearance of pain. Although the tumor appears in these areas, it can develop in other parts of the body: the chest or abdominal area.

Gradually, pathogenic cells spread throughout the body, affecting the central nervous system, liver and spleen. This leads to the formation of symptoms characteristic of damage to these organs.

The presence of non-Hodgkin's lymphoma is indicated by an increase in body temperature. Later, the patient experiences a sharp decrease in weight, which can occur against the background of an increase in appetite. Malignant lymphoma also manifests itself in the form of:

• profuse sweating at night;
• general weakness;
• increased fatigue;
• itching felt over the entire surface of the body;
• fever.

Among the obvious signs that may indicate the formation of a malignant tumor in the lymphatic system are symptoms of anemia. They are characterized by increasing cases of infection of the body against the background of a decrease in the number of white blood cells. The location of the neoplasm is indicated by the following manifestations:

1. Pain in the abdominal area. Intestinal disorders, expressed in the form of vomiting, diarrhea and constipation. These signs indicate that the lymphoma has formed in the abdominal cavity.
2. Chronic cough and shortness of breath. They report damage to the lymphatic tissue in the chest.
3. Joint pain.
4. Headache, blurred vision and vomiting. These symptoms indicate damage to the brain and other central nervous system organs.

What treatment methods are used in the fight against non-Hodgkin's lymphoma?

Chemotherapy

In many ways, the methods by which treatment will be carried out depend on the nature of the disease, the size of the tumors, stage and malignancy. But in general, the following ways to combat the disease can be distinguished:

• Chemotherapy. It is this that is the basis of treatment. In the early (first and second) stages of low-grade lymphomas, monochemotherapy is used. If the stages are severe or the lymphoma behaves extremely aggressively, then polychemotherapy is used. Sometimes chemotherapy is combined with radiation therapy, but radiation in its pure form can only help at stage I. Radiation therapy is also sometimes used locally in those areas where the tumor behaves most aggressively.
• Surgical removal of the tumor. Of course, this method is used only if the stage and type of tumor allows. With successful use of radiation therapy and surgical intervention, the prognosis is quite positive: remission may occur for a period of 5 to 10 years.
• Application of programs BATSOP, TsOP, etc. I must say, these programs show quite good indicators.
• Palliative treatment designed to relieve pain and improve the patient's quality of life to the extent possible. It is used in the terminal stages, when the prognosis is poor and the chances of defeating the disease are very low. In addition to medications, the patient may need the help of a psychologist, as well as the support of relatives.

Stages of development of the disease

Like other forms of cancer, non-Hodgkin's lymphomas develop through several stages:

1. First stage. The first stage of the pathology is characterized by local damage to the lymphatic system, excluding the sternum and abdominal region.
2. Second stage. The affected area spreads to other parts of the lymphatic system. Cancer cells penetrate the gastrointestinal tract.
3. Third stage. In the third stage, lymphoma is found on both sides of the diaphragm. Subsequently, the tumor penetrates into the abdominal cavity.
4. Fourth, or terminal stage. It is characterized by a severe course and a negative development prognosis. At this stage, cancer cells have spread throughout the body and affected the central nervous system organs, including the bone marrow. In addition, metastases are observed in the bones.

Treatment

To treat diffuse large B-cell lipoma, several standard methods are used:

1. Radiation therapy . It involves irradiating the affected area with x-rays. It is used in the early stages of the disease with a radiation dose of at least 40 Gray, and the rays are directed pointwise, directly to the tumor.
2. Polychemotherapy. Just like radiation therapy, it is used for the first and second stages of the disease. At the first stage, at least 3 courses of therapy are carried out using Bleomycin, Doxorubicin, Dacarbazine, Vinblastine. For the second stage, 6 courses using Oncovin, Doxorubicin, Cyclophosphamide are indicated.
3. Chemotherapy . It is a high-dose treatment using the patient's own stem cells.
4. Bone marrow transplant. Used when other methods are ineffective. For transplantation, bone marrow is taken from donors, obtained through aspiration of the ilium or sternum. Also, hematopoietic stem cells obtained from fetal liver can be used.

   Bone marrow is administered intravenously. This ensures complete survival of the introduced cells. Bone grafting is accompanied by immunosuppressive therapy, which includes drugs: prednisolone, cyclophosphamide and azathioprine.

Photo of the advanced stage

Lymphoma classification

The type of lymphoma in question is classified according to several criteria. Depending on the rate of tumor development, such neoplasms are divided into:

• Indolent. The pathology proceeds slowly and has a favorable prognosis.
• Aggressive.
• Highly aggressive. In most cases they lead to death.

Depending on the location, cancerous tumors are divided into:

1. Nodal. The tumor affects only the lymph nodes.
2. Extranodal. Non-Hodgkin's lymphoma occurs in organs that do not belong to the lymphatic system.

Above were the main classifications accepted in medical practice. According to their structure, lymphomas can be either small-cell or large-cell. There are also other types of tumors, characterized by their own characteristics.

Examples include chronic lymphocytic and B-cell prolymphocytic leukemia, plasma cell myeloma, and extraosseous plasmacytoma. It was stated above that in medicine it is customary to distinguish about 30 types of non-Hodgkin lymphoma.

Some of them will be discussed in more detail below.

Forecasts

Survival from lymphoma depends on 5 main factors:

• patient's age;
• presence/absence of additional diseases of the lymphatic system;
• stages of damage;
• general condition of the patient;
• blood test for LDH coming from the lymph.

Any deviations entail poor prognosis for life expectancy. Depending on the fulfillment or non-fulfillment of these conditions, several risk groups are distinguished:

1. In the complete absence or single unfavorable circumstance, the hazard factor is considered minimal.
2. The presence of 2 negative conditions indicates an intermediate stage between low and medium risk.
3. If there are 3 unfavorable circumstances, it reports a high level.
4. With 4 or more negative factors, the risk factor is the highest, the prognosis is unfavorable.

Survival rates for Hodgkin's lymphoma

Malignant granuloma responds well to therapy. It is possible to achieve complete remission. The sooner the fight against pathology is started, the more favorable the prognosis for the patient. According to statistics, more than 85% of patients are completely cured.

The following factors influence survival:

• stage of pathology. Thus, patients with stage 2 go into remission in 90% of cases, and with stages 3-4 - in 80%;
• metastasis of other organs;
• relapse (re-development) of lymphogranulomatosis after treatment. In 15-25% of people who have overcome the disease, it recurs again. In this case, the prognosis is relatively unfavorable.

There are no clear recommendations aimed at preventing malignant granuloma. It is recommended to strengthen the immune system, protect the body from the influence of harmful substances, and lead a healthy lifestyle.

The prognosis for lymphogranulomatosis at stage 4 is the most disappointing. Therapy in this case is aimed exclusively at alleviating the patient’s condition, relieving severe pain syndromes and maximizing support for the cardiac system.

Lymphoma is a type of cancer involving immune system cells called lymphocytes. Lymphoma is found in many different types of cancer (about 35). But all diseases of this type are divided into two categories:

The first type affects only about 12% of people and is currently a treatable disease.

Non-Hodgkin's cancer attacks the body's lymphatic system, which is made up of vessels that carry fluid called lymph to the body. When subtypes of B or T cells begin to multiply uncontrollably, malignant transformation occurs. Abnormal cells may collect in one or more lymph nodes or other tissues such as the spleen. Through the lymphatic system, the tumor quickly spreads to distant parts of the body.

Lymphoblastic tumor

This type of tumor is characterized by damage to the abdominal region. In most cases, the disease develops asymptomatically. The presence of a tumor becomes known in the last stages of development or during examination of the specified area. Due to the described cause, approximately 90% of patients with lymphoblastic tumor die.

One of the main signs of this form of cancer is active metastasis. Pathogenic cells affect the liver, spleen, spinal cord and other organs. The fourth stage of tumor development is accompanied by paralysis of the nervous system, which subsequently leads to irreversible and fatal consequences.

Treatment of lymphoblastic tumor involves the use of methods that inhibit the development of the tumor. Surgical intervention in these cases is ineffective due to the fact that metastases spread very quickly throughout the body.

Symptoms

Like any other cancer, Non-Hodgkin lymphoma progresses differently in each case, but specific manifestations of the disease are still present. These include:

• lymphadenopathy – single, and as it progresses, multiple lesions of nodal lymphatic formations;
• extradonal tumor compactions - determine the location of the anomaly - the organ in which the oncology has formed. This could be the stomach, epithelial tissue, central nervous system;
• general weakness of the body - cancer cells, affecting the lymph fluid, interfere with the normal cleansing of the body, not having time to fully remove toxins and tumor decay products, which causes general physical malaise;
• fever is a symptom characteristic of most cancer diagnoses, indicating the presence of pathological changes occurring in the human body and its attempts to independently cope with the tumor;
• enlargement of the spleen - occurs starting from the second stage and as the disease progresses, the symptom worsens;
• pulmonary and bronchial lesions - the respiratory system is the most vulnerable organ to this form of cancer, and oncologists consider this sign to be one of the basic ones in the process of diagnosing the disease.

This type of lymphoma is fundamentally different from Hodgkin’s in the following criteria, which are absent in the second type of neoplasm:

• sign of the superior vena cava , with complete damage to the mediastinum, finds its manifestation in facial swelling and hyperemia;
• with a damaging effect on the thymus, significant compression of the trachea is observed, which provokes coughing attacks and frequent shortness of breath;
• pressure exerted on the ureter by nearby lymph nodes causes renal dysfunction and, as a result, hydronephrosis.

What is the treatment for benign lymphoma? Can she disappear on her own? This article describes the features of mantle zone lymphoma.

Information about Hodgkin's lymphoma, localized in https://stoprak.info/vidy/onkologicheskie-zabolevaniya-krovi/limfaticheskaya-sistema/sredosteniya-prichiny-raspolozhenie-metody-borby.html mediastinum.

Lymphocytic tumor

Like the previous type of tumor, lymphocytic tumor develops asymptomatically for a long time. Its presence may be indicated by tumors on the surface of the skin that appear as a result of the proliferation of lymph nodes. This neoplasm develops from mutated B cells. The pathology is mainly encountered by middle-aged and elderly people.

Due to its asymptomatic course, a lymphocytic tumor is usually detected at the moment when it has reached the fourth stage of development, and metastases have affected the bone structure.

One of the main signs indicating the presence of a malignant formation in the body is enlarged internal organs. In the initial stages, cases of damage to the respiratory system and spleen are common.

Nutrition and diet during illness

During the fight against pathology, the body experiences severe stress. It is important to choose the right diet for the patient. Food must be taken in small portions. It must contain all useful substances. Due to decreased appetite, it may be necessary to introduce tasty foods into the diet.

To prevent swelling and other problems, it is important to exclude:

• fermented, pickled products;
• fatty, fried and heavy foods.

If, due to the lack of salt in the diet, the patient’s appetite decreases, then you can diversify the menu with caviar and olives, but only in limited quantities and together with the use of drugs that remove sodium. Salt restriction does not apply to cases where the patient suffers from vomiting and diarrhea.

Tumor in the intestine

Intestinal lymphoma occurs quite often among patients faced with this pathology. However, such a tumor mainly develops as a result of metastasis of a neoplasm that has arisen in other organs. Among the characteristic signs indicating lymphoma in the intestine are the following:

• dyspepsia;
• pain in the abdominal area;
• spleen growth;
• flatulence;
• constipation;
• nausea;
• the appearance of blood clots in the stool;
• decreased appetite.

As a rule, this form of lymphoma develops due to a mutation of B cells that occurs against the background of immunodeficiency.

Symptoms of diffuse large B-cell lymphoma

The most common signs of the disease are:

• an increase in size of any lymph nodes;
• body temperature is higher than normal;
• weakness, fatigue;
• increased sweating;
• excessive weight loss;
• decreased immunity, which is expressed in constant acute respiratory infections;
• malfunctions of the digestive system.

When the pathological process is localized in the organs of the abdominal cavity or chest, the symptoms listed below may appear:

• feeling of fullness in the stomach;
• shortness of breath;
• breathing difficulties;
• painful sensations in the lower back.

Approximately 20% of patients suffer from general weakness, decreased performance, poor memory, itchy skin, fever that worsens at night, painful cough and discomfort in the chest area. Sometimes the early stage of pathology is not accompanied by any symptoms, and abnormalities are detected only by radiography.

Tumor in the spleen

Damage to the spleen is observed mainly in elderly people. During the initial stages of development, the tumor does not manifest itself in any way, but later the following symptoms indicate its presence:

• sudden weight loss;
• a feeling of heaviness arising in the right hypochondrium;
• increased sweating during sleep;
• anemia;
• tumor growth leads to rapid satiety, even if the person has eaten little food; hyperthermia.

Pain occurs after the tumor begins to grow into neighboring tissues. Subsequently, cancer cells are detected in the blood and bones.

Relapses of the disease

With follicular lymphoma, relapses occur quite often (especially if it is a disease of cytological type 3A), and each subsequent remission is usually shorter than the previous one. If the disease recurs, it is necessary to re-perform a biopsy to exclude transformation of the pathology into diffuse large B-cell lymphoma. As with the initial detection of pathology, during the period of relapse the patient may not need to urgently restart therapy if the tumor is not growing and there are no unpleasant symptoms (in any case, the decision is made by the doctor based on clinical indicators). The treatment tactics for renewed follicular lymphoma depend on many factors, among which the decisive ones are: the physical condition of the patient, the duration of previous remission and the method of achieving it. So, if after the first therapy remission persists for a long time, then a return to the same treatment regimen is possible.

Diagnostics

Diagnosis of lymphoma aims not only to establish the presence of a tumor, but also to identify its current form. For these purposes, many different examinations are carried out, including blood tests, ultrasound, and x-rays. A biopsy of the affected organ is required.

If a tumor is detected in a lymph node, the latter is removed.

Additionally, fluid is taken from the abdominal cavity if a tumor is detected in this area. To examine the bone marrow, a puncture is performed. After the form of the disease has been established (based on flow cytometry, immunological and other types of tests), an ultrasound is prescribed, which makes it possible to determine the extent of the prevalence of cancer cells in the body.

In addition to these procedures, MRI, CT and positron emission tomography (PET) are performed. At the same time, ECGs are performed to detect obvious signs of the influence of a malignant tumor on the heart and metabolic processes. The latter method also allows you to determine the presence of infections in the body.

Prognosis and prevention

If diffuse lymphoma is detected early and a full course of therapy is carried out, the prognosis for the patient is quite favorable. In the case when the disease was detected already at stage 4, the chances of survival are insignificant. Unfortunately, due to the long absence of clinical signs, detection of lymphoma often occurs at later stages of development.

Since the exact causes of the formation of large cell lymphomas have not been studied, there is no specific prevention of this pathology. To reduce the risk of illness, you should follow some rules:

• get rid of bad habits;
• lead a healthy lifestyle;
• avoid contact with harmful substances;
• undergo regular medical examination.

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The success of treatment largely depends on the timely detection of pathology, so if you regularly undergo routine examinations in the hospital, you can identify the disease in time, which will significantly increase the chances of recovery.