Non-Hodgkin's lymphoma - what is it and how is it treated? Life prognosis for people with non-Hodgkin's lymphoma Malignant non-Hodgkin's lymphoma no

One of the serious oncological diseases is non-Hodgkin's lymphoma, the prognosis for life in which is made taking into account many factors. During the course of the disease, lymph nodes throughout the body are affected. In medical practice, there are many varieties of this disease. In other words, this is a group of related diseases that combines ailments with identical symptoms and a similar course.

Features of non-Hodgkin's lymphoma

In whatever form the lymphoma proceeds, the disease poses a serious danger to life, since its feature is the rapid progression and the presence of a large number of metastases. People of all ages are susceptible to this disease, but most often the pathology is diagnosed in people who have crossed the forty-year milestone. It is worth noting that at a young age, cancer progresses faster, causing the development of severe complications in the form of new diseases, which often end in death.

The onset of the disease is characterized by the development of a destructive process of the lymphatic system. She is responsible for:

lymph cleansing;
the formation of lymphocytes (white blood cells);
the work of the spleen;
functioning of the vascular system, including glands and lymph nodes.

Depending on the type, non-Hodgkin's lymphoma may present with either B cells or T cells.

Cancer cells form in the lymph nodes and multiply rapidly, resulting in the formation of tumors.

This cancer belongs to the group of neoplastic pathologies, the survival prognosis of which varies from 1 to 10 years. This period is directly dependent on the subtype of lymphoma.

Causes of Non-Hodgkin's Lymphoma

The causes of non-Hojin's lymphoma are still the subject of research. It is only known that this type of oncology begins with a mutation of blood lymphocytes, which degenerate into malignant cells. At the same time, they change at the genetic level.

Risk factors that contribute to the development of a tumor can be:

hereditary predisposition;
unfavorable ecological situation;
professional activities related to chemical production;
severe diseases of viral etiology (AIDS, hepatitis C, etc.);
infectious diseases (Helicobacter pylori, etc.);
organ transplant operations;
chemotherapy and radiation performed in the treatment of another cancer;
obesity.

A special risk group includes people with congenital immunodeficiency and autoimmune diseases, such as various types of arthritis, inflammation of the thyroid gland, Sjögren's syndrome.

Non-Hodgkin's lymphoma initially affects the lymphatic system, gradually capturing other organs: the spleen, thyroid gland, tonsils and small intestine. Characteristic of this disease is both the localization of the affected lymphocytes in one place, and the spread throughout the body.

The occurrence of non-Hodgkin's lymphoma in children is due to the influence of several factors at once:

congenital pathology of the immune system (Wiskott-Aldrich syndrome);
exposure to ionizing radiation;
the presence of HIV infection;
viral diseases (Epstein-Barr infection);
frequent contact with chemical reagents, medications and carcinogens.

Forms of development of lymphoma and their classification according to the place of localization

In oncology, there are two forms of lymphoma:

aggressive;
indolent.

The aggressive acute form of the disease is transient and progresses rapidly. In the event of such a pathology, the patient usually dies very quickly.

Indolent (lymphoplasmocytic) lymphoma is characterized by a sluggish course, the chances of recovery are quite high, but with frequent relapses, death is possible. Lymphoma in this form can flow into diffuse, which significantly aggravates the situation. The prognosis for the health and life of a cancer patient in this case is unfavorable.

According to localization, the following types of non-Hodgkin's lymphomas are distinguished:

nodal tumors, which are characterized by damage to the lymph nodes;
extranodal, in which cancerous tumors can occur anywhere in the body.

When making a prognosis, the results of a cytological analysis are taken into account, which allows you to determine which tumors have formed - large or small cell.

What factors affect survival in lymphoma?

In accordance with the international index, developed with the aim of compiling preliminary forecasts of survival in fast-growing lymphoma, there are 5 main factors on which this indicator depends:

age category;
stage of the disease;
the presence of concomitant pathologies of the lymphatic system;
the general state of health of the patient and the individual characteristics of his body;
blood test results for LHD levels.

Patients with a favorable prognosis:

under the age of 60;
at the first and second stages of the development of lymphoma;
in the absence of metastasis outside the lymph nodes or the presence of metastases in only one area;
normal indicators of LDH analysis;
while maintaining all the functions of the body.

If the indicators do not correspond to those indicated and tend to worsen, then the prognosis for the life of patients is unfavorable.

According to research conducted in this direction, 75% of people in the low risk group can live for at least 5 years. The survival rate for high-risk patients is approximately 30%.

Over the past 10 years, new methods of treatment have been developed and implemented in the field of oncology, methods of treating malignant tumors and preventing the spread of metastases have been improved. This trend had a positive impact on the possibility of prolonging the life of cancer patients in both risk groups. It was noted that as a result of the application of innovative methods of treatment, the majority of high-risk patients were able to live for about 4 years.

Forecast of survival at different stages of development of non-Hodgkin's lymphoma

The basis for making a prognosis of the patient's survival and developing a treatment regimen is to determine the stage of the disease. In oncology, there are 4 stages of non-Hodgkin's lymphoma:

The first stage is characterized by the development of neoplasms in a group of lymph nodes. The process is accompanied by local inflammation. In this case, superficial damage to vital organs may occur. Diagnosis is complicated by the absence of severe symptoms, in which the clinical picture of the disease remains unclear.
The second stage is characterized by an increase in tumors and unilateral lesions of the lymph nodes. The patient's condition worsens and general weakness is noted. When the disease occurs in the B-cell form, the question of surgical intervention is raised.
The third stage is characterized by the spread of lymphoma to the diaphragmatic region, chest and abdominal organs. Several groups of unilateral lymph nodes and soft tissues are affected.
The fourth stage is characterized by the development of irreversible processes. Lymph nodes are affected throughout the body. The process involves the brain and spinal cord, internal organs, nervous and skeletal systems. The situation has the most unfavorable prognosis.

It is difficult to say exactly how long people live when diagnosed with non-Hodgkin's lymphoma. In the first two stages, with high-quality treatment, the survival rate is quite high. The value in this case is the general clinical picture of the disease and the patient's well-being. In the case of the course of the disease according to type A, signs of lymphoma may not manifest themselves in any way. If the disease proceeds according to type B, then in most cases there is intoxication of the body, accompanied by an increase in body temperature and a rapid decrease in weight.

A favorable prognosis is also possible in the later stages of lymphoma, especially with a relapse no earlier than 2 years later. If the recurrent process resumes within 10-11 months, then the risk of death increases.

The role of histology in predicting survival

Histological analysis (pathomorphological examination) allows you to determine the degree of the disease and the chances of recovery. Due to the asymptomatic course of non-Hodgkin's lymphoma, patients, as a rule, seek help too late, when the last stage of the disease is ascertained.

In the terminal stage of cancer, when the process of growth of tumor cells becomes uncontrollable, the prognosis for survival is very low.

Formations of a lymphocytic nature, accompanied by damage to the bone marrow, most often occur in the elderly. In the fourth stage, there is practically no chance of survival in patients.

Conclusion

The life expectancy of the patient largely depends on how correctly the treatment of non-Hodgkin's lymphoma will be carried out. Unfortunately, no doctor is able to give a 100% guarantee of cure and make an accurate prognosis. Doctors will not answer the question of how long a person can live after a surgical operation, since the tumor can behave differently, especially if metastases remain in the body. However, the chances of achieving a stable remission with early diagnosis and treatment are much higher.

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For many, the diagnosis of non-Hodgkin's lymphoma becomes fatal. Prognosis for the life of the patient? What treatment increases the chances of living longer? Can recovery come?

Each of these questions is relevant. Non-Hodgkin's lymphoma is a cancer of the lymphatic system that is manifested by B and T cells. A feature of this type is that the destructive process of the system begins in the body, which is responsible for cleaning the lymph, lymphocytes, the work of the spleen and blood vessels, nodes and glands, and protects against various viruses and infections. Cells in the lymphatic system begin to multiply rapidly, disrupting the natural process, which leads to the appearance of tumors.

Types of lymphomas and stages of development of oncology

When diagnosing a patient, doctors diagnose a neoplasm and determine its type according to the existing classification.

In medicine, non-Hodgkin's lymphomas are divided according to the following criteria:

Cancer cell division rate:
- lymphoplasmacytic (indolent). This form has a slow development, the prognosis for recovery or long-term remission is very high;
- aggressive. With this option, the patient has a slight chance of recovery, but there is always a risk of a rapid course and death;
- high aggressiveness. In this case, doctors do not undertake to make any predictions, since the patient dies in the shortest possible time.
Depending on the location:
- extranodal. The tumor appears in any of the human organs;
- nodal. The lymph nodes are affected.
Cytological analysis is also important in the prognosis, which makes it possible to establish the structure of the formed cells. They can be large-celled and small-celled.

When forming a treatment regimen and making a prognosis for the patient's survival, doctors also take into account the stage of the disease at which the patient turned to them.

In oncology, it is customary to talk about 4 stages of development:

First stage. The formation is diagnosed in one of the groups of lymph nodes; in the vital organs, the formation affected only superficial tissues.

Second stage. At this stage, the formation is enlarged and affects several lymph nodes on one side of the diaphragm.
Third stage. Here, the lesion already involves several groups of nodes on one side of the diaphragm.
Fourth stage. In the last stage, the lesion involves both sides of the diaphragm, involving the vital organs of the abdominal cavity.

The first two stages have a high survival rate in case of timely diagnosis and proper medical treatment. Important in the prognosis will be the clinical picture that the patient feels. With variety A, a person may have no symptoms at all, no signs of intoxication of the body. If the patient's clinical picture of the disease manifests itself according to type B, then his weight begins to rapidly decrease, his body temperature rises and falls for no apparent reason.

Giving forecasts to patients, doctors pay attention to relapses. A favorable picture and a high chance of a long life in late lymphoma, when relapses occur no more than two years later. In the case when the disease resumes in less than a year, doctors talk about a high risk of mortality.

Histology indicators - the basis of the prognosis for life

Histological examination is a mandatory diagnosis that allows you to assess the degree of development of oncological education and give chances for recovery. In the lymphoblastic form, the organs of the abdominal cavity are affected, while the cancer cells have a large shape.

Most often, patients turn to a specialist for help already at the last stage, when there is no chance of recovery. This feature is associated with the asymptomatic course of the disease.

Lymphoblastoma always gives extensive metastases, cancer cells divide rapidly, so patients are diagnosed with damage to vital organs:

spleen;
kidneys;
liver;
ovaries;
spinal cord.

If the patient develops the terminal stage, then this is a sure sign of an imminent death with neuro-systemic paralysis. The prognosis for the recovery of a patient with this type is zero. Doctors try to prescribe maintenance therapy that will stop the rapid division of tumor cells.

Lymphocytic formations are more diagnosed in people of middle or advanced age. Asymptomatic course and local involvement are the main characteristics for lymphocytic lymphoma. As medical statistics show, the survival rate in such patients is very low, since asymptomatic course and bone marrow damage at stage 4 do not give a chance for recovery.

Intestinal lymphoma leads in the frequency of manifestations of non-Hodgkin's lymphoma. These are mainly secondary lesions, the result of metastases from other organs. This disease can be diagnosed at an early stage, as the symptoms are pronounced.

Most patients report the following symptoms:

pain in the lower abdomen;
flatulence;
urge to vomit;
there are blood impurities in the feces;
weight loss, loss of appetite.

The formation of tumor cells occurs according to the type of B-cell structures. The chances of recovery with treatment at the initial stage are very high.

Lymphoma of the spleen is more common in older people. At the initial stages, the tumor is asymptomatic. A person begins to lose weight quickly, pain appears in the right hypochondrium and fast saturation with food even after a small amount. In the last stages of the course of the disease, the tumor has a huge size, while surgical intervention does not bring the desired recovery.

What are the prognosis for survival in stage 4 lymphoma?

Unfortunately, many people do not pay attention to the symptoms that the body gives them, do not undergo regular medical examinations, and do not donate blood for research. All these reasons are the result of late diagnosis of oncological formations.

When lymphoma is diagnosed at stage 4, the patient or his relatives ask the only and most important question: what are the prognosis of survival?

No doctor will give an exact answer, everything will depend on the body's defenses, the will and psychosomatic state of the patient, the drug therapy that will be prescribed.

Considering all the existing methods of treating non-Hodgkin's lymphomas, we can say that about 60% of patients survive in the first 5 years. If the form of the disease is aggressive, then the survival rate does not exceed 30%. In the case when the lymphoma becomes chronic, the chances of survival vary between 90-92%.

Unfortunately, some types of tumors become resistant to therapy, turn into a diffuse aggressive form and lead to rapid death. Treatment will be an important factor in survival.

The duration and quality of life of the patient will depend on how correctly the doctor draws up a scheme for influencing the tumor:

Most clinics prescribe a course of chemotherapy for stage I-II lymphoma. If it is possible to conduct a parallel course of chemotherapy and stem cell transplantation, then the chances of recovery increase significantly.
If stage III–IV disease is diagnosed, chemotherapy may be offered to increase remissions. Until today, doctors agree that non-Hodgkin's lymphoma is incurable, it can be stopped, the rate of cell division can be reduced.
Irradiation can be used for lymphomas in the case of a local lesion with a T-cell type. After such exposure, a relapse can occur both for several months and for several years.
Alternative methods may also be used in treatment. These are mainly immunotherapy, bone marrow or peripheral stem cell transplants. Stimulation of the body's own forces in the fight against neoplasms very often gives positive results, allowing you to significantly increase remissions.

No doctor can give an accurate prediction of the life expectancy of a patient with non-Hodgkin's lymphoma. But with early detection of the disease and proper treatment, the chances of remission increase.

It is important for people diagnosed with non-Hodgkin's lymphoma to understand what the disease is. Possession of information will help to quickly begin treatment, then the prognosis for life will be favorable.

This lymphoma is malignant tumor that affects the lymphatic system. Primary foci are formed directly in the lymph nodes, or in other organs, and after that they metastasize further with blood or lymph.

What is non-Hodgkin's lymphoma?

Non-Hodgkin's lymphoma is not one thing, but group of oncological diseases, at which cells have a different structure from cells at . Most often, this disease affects the elderly, however, it occurs at any age. In children, non-Hodgkin's lymphoma can occur after 5 years of age.

The insidiousness of these lymphomas is that, forming in the lymph nodes or in the lymphatic tissues (in, in, and so on), can leave the places of their original focus and hit, the central nervous system and so on.

In childhood non-Hodgkin's lymphoma is most often of high malignancy, it causes diseases in other systems and organs, leading to death.
In adults as a rule, there are lymphomas with a low degree of malignancy - they develop more slowly and less often affect other organs and systems.

Learn more about non-Hodgkin's lymphoma from the video:

Kinds

The non-Hodgkin form of the disease is more common than the Hodgkin form; specialists divide it according to the ICD-10 code into C82 follicular and C83 diffuse lymphoma, each of them is further divided into several subclasses.

Subtypes of non-Hodgkin's lymphoma:

diffuse B-cell;
follicular;
mantle tissue cells;
Burkitt;
peripheral T-cell;
dermal T cells.

Lymphoma arises from T or B cells, and depending on whether it is B-cell or T-cell, the choice and strategy of treatment depends, as well as how long people live with such a disease.

Depending on the rate at which the tumor develops, it is divided into:

indolent- the tumor grows slowly and in most cases the prognosis for the patient is favorable;
aggressive;
highly aggressive- the rapid growth of education leads to death.

Classification depending on localization:

nodal- when the tumor does not spread beyond the lymph nodes;
extranodal- the focus of the tumor is located in organs that do not belong to the lymphatic system.

According to their structure, lymphomas are divided into large and small cells. In medicine, about 30 species, types and subspecies of this pathology are distinguished.

At-risk groups

Recently, non-Hodgkin's lymphomas are becoming more common:

Patients at risk who underwent organ or bone marrow transplant, as a rule, the disease manifests itself within a few years after transplantation.
Lymphoma can also develop in people with autoimmune diseases, because in most cases they are prescribed immunosuppressive therapy, in addition, BCG vaccination can provoke the development of a tumor.
At risk are people who regularly exposed to carcinogens, agricultural workers, workers in the chemical industry, as they, by the nature of their activities, are constantly in close contact with pesticides, herbicides, chlorophenols and solvents.

From the foregoing, it can be understood that people are more susceptible to the occurrence of non-Hodgkin's lymphoma, whose body is exposed to exposure to antigenic stimulation, as a result of which the body loses its immune control over a latent infection.

The hallmark of non-Hodgkin's lymphomas is that they do not stay in place, but grow into other organs that have lymphatic tissue.

The severity of the pathology

Non-Hodgkin's lymphomas are divided into 4 stages, of which the first 2 are local, and the last are common:

1 stage characterized by the fact that only one area is involved in the process. For example, only one lymph node becomes inflamed and enlarged, and there are no symptoms or any other sensations at this stage.
2 stage. The tumor enlarges and other tumors arise, thus the lymphoma becomes multiple. The patient may complain of symptoms.
3 stage. Malignant tumors grow and affect the area of the chest and abdominal cavity. Almost all internal organs begin to be involved in the process.
4 stage- the latest. A cancerous tumor grows into the bone marrow and central nervous system, this stage ends with a fatal outcome.

Every stage is always followed by the letter A or B. This complements the overall picture of the disease.

“A” is placed if the patient has no external signs of the disease, “B” - when there are external signs, for example, weight loss, fever, increased sweating.

Forecasts

Oncologists to predict lymphoma currently use the following scale:

0 to 2- the outcome of the disease is favorable, most often this refers to formations that arose from B-cells.
2 to 3- it is difficult to determine the forecast.
3 to 5- an unfavorable prognosis, treatment is aimed only at prolonging the life of the patient, there can be no talk of healing.

The number of points is made up of each adverse symptom that is detected in the patient during the diagnosis.

In the photo above - lymphoma of the cervical region of the last stage.

For forecast relapses of the disease are taken into account if they happen no more than 2 times a year, then doctors give a high chance for a long life, but if relapses occur more often, then we can talk about an unfavorable course of the disease.

Symptomatic manifestations

High malignancy and aggressive course of the disease are manifested in the formation noticeable swelling on the head, neck, groin and armpits. Education does not hurt.

When the disease begins in the chest or in the abdominal region, it is not possible to see or feel the nodes, in this case metastasis occurs to the bone marrow, liver, spleen, or other organs.

When a tumor begins to develop in the organs, the following symptoms occur:

temperature;
weight loss;
heavy sweating at night;
fast fatiguability;
general weakness;
lack of appetite.

If the lymph nodes or the organs of the peritoneum themselves are affected, then the patient may complain of abdominal pain, constipation, diarrhea, vomiting. If the lymph nodes in the sternum or in the lungs and respiratory tract are affected, then there is a chronic cough and shortness of breath.

With damage to bones and joints, the patient experiences pain in the joints. If the patient complains of headaches, vomiting, and blurred vision, then most likely the lymphoma affected the central nervous system.

Important: lymphoma symptoms get worse once a month, but since the symptoms are extremely similar to other diseases that have nothing to do with lymphoma, consultation with a specialist is necessary.

Causes of the disease

Until the end, the etiology of the onset of the disease has not been studied, it is only known that The following factors can become provocateurs:

prolonged contact with aggressive chemicals;
unfavorable ecological situation;
severe infectious diseases;
ionizing radiation.

More often the disease diagnosed in men, the risk of developing a tumor increases with age.

Diagnostics

Diagnosis of lymphoma begins with a visual examination of the patient. The doctor examines the lymph nodes, finds out whether the spleen and liver are enlarged.

Also done taking a sample of lymph node tissue for testing - this helps determine the type of lymphoma. If necessary, a bone marrow biopsy is performed to check for the presence or absence of cancer cells in it.

Without an appropriate diagnosis, it is impossible to establish the type of lymphoma, and, therefore, it is impossible to prescribe adequate treatment. It must be said that treatment is not required in all cases, sometimes the specialist chooses expectant tactics.

There are cases when such tactics bear fruit - the lymphoma decreases or disappears altogether, this phenomenon is called spontaneous remission however, this is extremely rare.

Treatment

The doctor, based on the morphological type of lymphoma, its prevalence, localization, and the age of the patient chooses either surgery, or radiation therapy, or chemotherapy.

If the tumor is isolated, that is, only one organ is affected (most often this is observed with damage to the gastrointestinal tract), then surgical intervention.
If the tumor has a low malignancy and a certain localization, then radiation therapy is usually prescribed.

Polychemotherapy course is the most common choice of doctors in the treatment of non-Hodgkin's lymphomas. It can be carried out independently, or combined with rays.

With this combined method of treatment, longer periods of remission can be achieved, sometimes hormone therapy will be added to the course.

In some cases, carry out interferon treatment, bone marrow transplantation and stem cells, as well as alternative treatment using monoclonal antibody immunotherapy.

Prevention

There is no cure for non-Hodgkin's lymphoma. Of the general recommendations, one can only say about reducing exposure to hazardous industrial chemicals, about increasing immunity, about healthy nutrition and sufficient, but moderate physical activity.

As for secondary prevention, it consists in identifying pathology at the initial stages of development and immediate and adequate treatment.

Folk remedies and nutrition

In the treatment of lymphoma it is very important to eat right. The diet should help to increase the immune forces of the body, especially if the treatment is carried out with rays or chemotherapy.

Necessary completely eliminate fatty, smoked, pickled.

More seafood, dairy products, fresh vegetables and fruits should be introduced into the diet. Nutrition must be balanced, since the patient will lose his appetite, it is important to ensure that he does not lose weight.

Only a doctor can choose a diet. Experts recommend eating fractionally and in small portions, it is better not to drink water while eating.

If the patient has aversion to food, it is acceptable to use spices, mayonnaise, etc. (only in small quantities) to make the food smell more appetizing. Food should be at room temperature, it is easier to perceive and the patient will eat more willingly.

Folk remedies with this disease, you can only use it after consulting a doctor, as a rule, doctors do not mind such an additional method of therapy, however, they should know what exactly you will use:

Celandine Since ancient times, it has been used as an antitumor agent. In order to prepare a healing decoction, you will need a fresh root of the plant and its leaves. The raw materials must be crushed and rammed into a three-liter bottle, it is not recommended to close the lid, it is better to use a gauze napkin. Every day, the raw materials must be pierced with a stick, and on the 4th day, squeeze everything well through cheesecloth and let the juice stand for two days. The remaining cake is poured with vodka and insisted for another 10 days, after which it is squeezed and the juice is allowed to settle for two days. Fresh juice is used to treat tumors, and vodka tincture can be used to treat wounds and so on. Juice is drunk on a nightingal spoon in the morning and at night, washed down with a small amount of milk.
Can cook wormwood-based products. Take 3 tablespoons of the crushed plant and fill them with a thick gelatin solution. From the resulting product, you need to roll balls the size of a tablet with a needle, dry the balls on oiled paper, and drink two or three pieces a day.

Medicine advances every year, and the prognosis for patients with lymphoma improves At the moment, after a course of medical and surgical treatment, more than half of adult patients recover.

As for children, in this case the percentage is even higher, so do not give up, hope, believe and live long.

Lymphoma is the general name for the process of uncontrolled growth of lymph cells.. As in many medical terms, the essence of the concept is revealed in the word denoting it. The term "lymphoma" is formed by combining the words "lymph" and "oma", which means a tumor, growth.

To a very common question “is lymphoma a malignant tumor?” The answer can be short and unequivocal: “Yes”. The term "cancer" is a Russian-language tracing paper (that is, a literal translation) of the Latin word "cancer" (crab). In the original language of science - Latin, this was the name from ancient times for all internal tumors, asymmetrical and having an irregular angular shape when palpated and accompanied by unbearable gnawing pains. Therefore, the term "cancer" (or in the literal Russian translation - "cancer") was assigned to all malignant tumors. And in a broad sense, it is often transferred to any tumor process, although the combinations “blood cancer” or “lymph cancer” used in colloquial speech warp the hearing of a specialist, since cancer is a malignant tumor from epithelial cells. Based on this, It would be more correct to call lymphomas malignant tumors rather than the term "cancer".

Structure and function of the lymphatic system

The lymphatic system is less known to most people than the circulatory system. Weakly visible colorless lymph, unlike bright scarlet blood, did not become the subject of attention of poets and did not turn into a symbol of sacrifice and struggle. Although, with any damage to the blood vessels, the lymphatic vessels are also damaged, passing directly next to and accompanying the vessels that carry blood. Through the system of lymphatic vessels, fluid returns from the tissues of the body to the circulatory system. The tissue fluid, which is formed due to diffusion from the smallest blood capillaries of the liquid part of the blood - plasma, nourishes all the cells of the tissues of the body and ensures their vital activity. At the same time, nutrients and oxygen enter the cells, and metabolic products arising from biochemical processes from the cells.

Part of the tissue fluid returns through the venous system, and part - through the lymphatic capillaries enters the lymphatic. The lymphatic system consists of an extensive network of lymphatic vessels and special formations located along these vessels - the lymph nodes.

Lymph nodes are small round or oblong structures through which the lymphatic vessels pass. In these formations, the reproduction of blood cells, bearing the name. Actually lymph is a tissue fluid containing cellular metabolic products, protein particles, fats and a large number of lymphocytes.

largest nodes of the human lymphatic system. They are also often the most noticeable and common manifestations of lymphoma.

The role of the lymphatic system is by no means less important in the body than the role of the blood-conducting system. If blood is a source and transport of energy necessary for human life, then lymph is not only a transport for the return of proteins and fats from tissues to the blood, but also an all-encompassing protection and protection. Through the lymphatic vessels, lymphocytes reach all corners of the human body. The main job of lymphocytes is the sorting of protein particles. Recognizing and separating the proteins necessary for the body from foreign ones, lymphocytes isolate or destroy alien protein structures. In this case, the extermination of all microorganisms and viruses that enter the body from the outside, consisting of protein particles, occurs. In this way, the lymphatic system is the anatomical basis of the body's immune defense system.

The concept of lymphoma

Lymphomas are classified as malignant tumors. The benignity or malignancy of the tumor process is determined, contrary to the idea of many, not by the harmful effect of the tumor on the body, but by the degree of quality (usefulness) of the cells involved in the growth of the tumor. Mature, functionally complete cells with uncontrolled reproduction form a benign tumor growth. A benign tumor under certain conditions can also lead to the death of the patient. For example, in case of damage or compression and disruption of the activity of vital organs.

In a malignant tumor process, uncontrollable reproduction of functionally defective, immature, low-quality cells occurs. At the same time, the number of healthy mature cells proportionally decreases. Accordingly, the function of the system that is affected by malignant tumor growth is sharply disrupted. And the vital activity of a huge number of continuously multiplying immature cells increases the load on all body systems, depletes it and destroys organs and tissues consisting of normal cells.

The laws of nature are one. The appearance of an excessively large number of actively consuming and non-producing dependents inevitably leads to the death of any organized system, whether it be a family, a state or a living organism.

Tumor processes of lymphatic tissue affect not only humans, but also our companions - domestic animals. These are the most common types of tumors in cats and dogs.

The historical division of lymphomas is rather unusual. All malignant diseases of the lymphatic system are divided into two parts. At the same time, in one part there is only one disease - lymphogranulomatosis (or Hodgkin's disease). And the other part includes all other existing lymphomas. Accordingly, there was a stable division into "Hodgkin's lymphoma" (that is, Hodgkin's lymphoma) and "non-Hodgkin's lymphomas" (that is, all the rest).

Video: Non-Hodgkin's Lymphoma Medical Animation

Hodgkin's disease (lymphogranulomatosis)

Lymphogranulomatosis was first described in 1832 by Dr. Thomas Hodgkin, who combined observations of seven patients who died from an unknown disease affecting the lymph nodes. It would be fair to call this disease Hodgkin-Wilks disease. It was Samuel Wilks who in 1855 described the disease in detail, adding eleven of his patients to the seven cases described by Hodgkin. Wilkes named the disease Hodgkin.

Symptoms

The main symptom of Hodgkin's lymphoma is swollen lymph nodes. The growth of lymph nodes occurs gradually and painlessly. When the increase becomes noticeable to the eye, the patient suddenly discovers dense, round, painless formations, most often in the neck or above the collarbone. Lymph nodes located in other areas - axillary, inguinal - can also increase. The defeat of the lymph nodes located in the abdominal and chest cavity is not determined by the eye, but gives symptoms caused by compression of the internal organs - cough, difficulty breathing, pain. The disease is also manifested by symptoms common to all lymphomas - weakness, night sweats, periodic fever.

Diagnostics

The exact diagnosis is confirmed by microscopic examination of the punctate of the lymph node.. At the same time, specific Berezovsky-Reed-Sternberg cells are detected. These are gigantic (in comparison with lymphocytes) cells with several nuclei. It is they who are those poor-quality immature functionally cells that have a detrimental effect on the functioning of the lymphatic system and the whole organism.

Specific changes in laboratory parameters in lymphogranulomatosis are not observed. It is noted:

Increase (which is typical for all inflammatory and immune processes);
Lymphocytopenia (decrease in the number of lymphocytes) caused by the main cause of lymphoma - a violation of the process of growth and reproduction of lymphocytes;
Various manifestations (decrease in the number of red blood cells) caused by the influence of the disease on the formation of blood cells.

All these manifestations are not exclusive signs of only one disease, but are inherent in very many. That's why a blood test in the diagnosis of Hodgkin's lymphoma is not decisive.

Instrumental diagnostic methods, such as ultrasound and x-ray diagnostics (including the application) are used as auxiliary methods to clarify the location and size of the affected lymph nodes or internal organs.

The process of disease development

The picture of the development of the disease reflects the history of the body's struggle with the emerging harmful effects. Each step of the further spread of the disease in the body is designated as a stage.

1 stage

At the first stage, lymph nodes are affected only in one area or in one isolated organ.

2 stage

When the lesion spreads to two or more groups of lymph nodes located only in the chest or only in the abdominal cavity, the disease enters the second stage of development. The second stage also includes the defeat of both a local group of lymph nodes and a separate organ, if the affected areas are located in one (thoracic or abdominal) cavity.

3 stage

The detection of damage to regional lymph nodes located in both the thoracic and abdominal regions indicates the entry of the disease into the third stage of development. The third stage of the disease includes the identification of lymphoma in the spleen.

4 stage

In the fourth stage, the lymphoma goes beyond the lymphatic system itself and spreads to the internal organs, affecting the liver, kidneys, intestines, and bone marrow.

what affects stage 4 lymphoma?

Clarifying letter designation of the stages of the disease

To more accurately determine the degree of development of the disease process, letter designations are used that complement the picture of the progression of the disease.

A - the patient has no external manifestations of the disease;

B - the patient has one of the following symptoms:

pronounced (more than 10%) weight loss over the past six months;
temperature rise;
nocturnal torrential sweat.

E - the spread of lymphoma outside the lymphatic system, to organs or tissues near the affected lymph nodes;

S - damage to the spleen;

X - detection of a tumor formation of large lymphatic tissue.

Disease stages and prognosis

Lymphogranulomatosis, which is the most common of lymphomas, is one of the most favorable in terms of prognosis. If Hodgkin's lymphoma is detected at the first or second stage, clinical recovery after treatment occurs in 70% of patients. The development of the disease reduces the level of a favorable outcome. Stage 4 of the disease makes the prognosis unfavorable. However, as always when forecasting in medicine, we must not forget that we are talking about an organism that is unique in its individuality. A simple transfer of statistical indicators cannot be truly decisive in the outcome of the disease. Factors that cannot be measured, such as faith, hope, perseverance, influence the body's resistance and give their favorable results, increasing the effectiveness of treatment.

Treatment of Hodgkin's lymphoma

Treatment of lymphomas is aimed at the destruction of uncontrollably multiplying pathological cells. Radiation therapy is used in the early stages of the disease, as a method that allows for a targeted localized effect on a limited area and reduces the degree of general damaging effects on the body. The destructive effect of radiation can be focused on one affected lymph node or a group of them. At the same time, damage to other areas is minimized.

The method of general effect on the body is chemotherapy, that is, the use of drugs that inhibit the growth and reproduction of cells. In this case, the effect is on all cells, but due to the disproportionately increased rate of growth and reproduction processes in the cells of the tumor tissue, the effect of chemotherapy drugs is primarily manifested in them.

In most cases, the method of combined application of both radiation and chemotherapy is used.

Non-Hodgkin's lymphomas

In the 180 years that have passed since the time of Dr. Thomas Hodgkin, medicine has not been able to achieve significant results in studying the nature and mechanism of development of other lymphomas.

This is probably the reason for such an asymmetric classification of lymphomas, where in one part there is one lymphogranulomatosis, which is more studied and quite successfully treatable, and in the other there are more than three dozen different manifestations of tumor processes of the lymphatic system.

Classification of non-Hodgkin's lymphomas

Any classification is intended for precise definition and recognition of any object, phenomenon or process. The diversity and variability of the tumor processes of the lymphatic system so far does not give medicine the opportunity to build a full-fledged comprehensive classification of non-Hodgkin's lymphomas. The current attempts to create classifications on any one basis do not allow to accurately and unambiguously accurately determine the specific form of the disease.

The most simple classification according to the degree of malignancy of non-Hodgkin's lymphomas. More precisely, according to the rate of progression of the development of the disease, since all lymphomas are malignant.

Classification according to the rate of development of the disease

Lymphomas with a very slow development of the process, which do not affect the state of the body for a long time - indolent lymphomas.
Lymphomas with a very rapid, sometimes lightning-fast development of the process, which has an extremely pronounced detrimental effect on the body - aggressive lymphomas.
Lymphomas with an intermediate rate of development of the process, which have a noticeable and increasing effect on the body, are an intermediate form of lymphomas.

Another type of classification quite often used in practice is the division according to the place of occurrence of the tumor process.

Classification according to the place of occurrence of the disease

Lymphomas that occur in the lymph nodes (nodus) are nodal.
Lymphomas that occur outside the lymph nodes (in the stomach, bone marrow, lungs, spleen, etc.) are extranodal.

The World Health Organization has adopted for general use a single classification for the standardization of statistical and scientific data by physicians around the world.

WHO classification of non-Hodgkin's lymphomas

B-cell tumors that develop from precursors of B-lymphocytes.
T-cell and NK-cell tumors that develop from precursors of T-lymphocytes.
T-cell lymphomas that develop from peripheral (mature) T-lymphocytes.

The division used in the WHO classification is based primarily on the structural features of pathologically altered cells. These features are revealed by careful microscopic examination using a microscope. Structural differences are very important for scientific research, but for application directly in the clinic to address issues of treating patients, the picture of the development of the disease seems to be more important.

For clinical use, the classification adopted by the congress of oncologists in the American city of Ann Arbor is used. As a defining feature in the Ann Arbor classification, the stage of development of the disease is used. Focusing on the stage of development of lymphoma, it is possible to more accurately develop tactics and methods of treatment to combat the disease.

Ann Arbor classification of non-Hodgkin's lymphomas

1 stage

Lymph nodes of one local group are affected or manifestations of lymphoma are found in one internal organ.

2 stage

Affected groups of lymph nodes, more than one, located on one side of the diaphragm. In this case, the transition of the process to one nearby organ is possible.

3 stage

The defeat of groups of lymph nodes on both sides of the diaphragm. It is possible to attach a lesion to one nearby organ and the spleen.

4 stage

The disease has spread beyond the lymphatic system. The defeat of remotely located internal organs (liver, lungs, bone marrow, pleura, stomach, intestines).

Lymphoma stages and affected area. At stages 3 and 4, inflamed nodes appear below the line of the diaphragm

To clarify the clinical picture of the disease, a letter designation (A or B) is added to the serial number of the stage, characterizing the presence or absence of pronounced external signs in the patient - weight loss, severe weakness, temperature, heavy night sweats.

Some types of non-Hodgkin's lymphomas

Among non-Hodgkin's lymphomas, there are a number of more common, or simply better known because of their unusualness or high malignancy of the disease.

Lymphosarcoma

Perhaps, lymphosarcoma is considered the most famous type among non-Hodgkin's lymphomas. It can occur at any age, initially affecting the lymph nodes on one side of the neck, but other localization of the tumor (tonsils, pharynx, inguinal lymph nodes, gastrointestinal tract) is not excluded. Lymphosarcoma is an aggressive tumor characterized by rapid growth and early metastasis to other lymph nodes (mediastinum, liver, spleen, abdominal cavity). At the same time, the patient's condition worsens sharply, which notes a significant weight loss, fever, accompanied by nocturnal torrential sweat.

Diagnosis of lymphosarcoma is based mainly on the data of microscopic examination of node prints (cytological analysis) and biopsy material (histological examination). In this case, the primary right to establish the initial diagnosis is cytology, since it does not require a lot of labor. Taken, dried and fixed material can be ready for viewing in a couple of hours. Imprints of lymph nodes make it possible to establish the presence of lymphoblasts in the material and the absence of mature lymphocytes, which confirms the presence of lymphosarcoma.

Burkitt's lymphoma

A disease that is (which is an exception among lymphomas) endemic - that is, associated with a particular area of \u200b\u200bresidence. Most of the identified cases of Burkitt's lymphoma are in Central Africa. It is believed that the Epstein-Barr virus plays a triggering role in the occurrence of this form of lymphoma. Being the causative agent of another dangerous disease - infectious mononucleosis, this virus affects the gene structure of lymphocytes, causing the occurrence of lymphoma.

Burkitt's lymphoma is characterized by a severe, rapidly progressive course with a tendency to rapidly extend beyond the lymphatic system and damage organs. The abdominal cavity is often affected with an increase in regional groups of lymph nodes, intestines.

Burkitt's lymphoma does not occur in our country.

Skin lymphoma

More often it is a manifestation of the spread of the tumor process outside the lymphatic system. That is, the primary source of damage is located inside the body, and the appearance of tumor formations in the form of various skin lesions is a symptom of the final stage of lymphoma development. In some cases, there is a primary lymphoma skin lesion. The course of these diseases is very variable. Depending on the specific structural form of altered lymphocytes that cause the formation of skin lymphoma, the disease can proceed practically without consequences for several decades, and with high aggressiveness, lead to the death of the patient in a few months.

Stomach lymphoma

A rare disease in which a tumor overgrowth of lymphoid cells occurs in the stomach. Damage to the stomach can be secondary. In this case, we are talking about the manifestation of the third or fourth stage of non-Hodgkin's lymphoma, which originates from a different source. True lymphoma of the stomach develops in isolation from the lymphatic tissue of the walls of the stomach. The disease tends to grow slowly and is accompanied by pronounced "gastric symptoms" - stomach pain, nausea, vomiting, loss of appetite, weakness. This allows in half of the cases to detect lymphoma in the early stages of development (stages 1-2). The applied surgical treatment in combination with chemotherapy allows in most cases to obtain a successful result.

Follicular lymphoma

It got its name from the place of its origin - the follicles of the lymph nodes. In most cases, it is distinguished by the presence of a characteristic indolent flow and nodal localization. That is, the development of the disease occurs extremely slowly, secretly, without the manifestation of external symptoms and the release of lymphoma beyond the lymph nodes. However, in the invisibility of this form of the disease, there is a danger of its detection only at a late stage, when the development of the process already leads to damage to organs, often the spleen and bone marrow, and skin.

mediastinal lymphoma

A rare form of lymphoma. It can be in the form of lymphoma originating from the thymus gland (thymus) or in the form of primary lymphoma of the regional lymph nodes of the mediastinum.

A feature of primary mediastinal lymphomas is their relatively frequent occurrence in the form of diffuse B-cell lymphoma, which has a tendency to expressive growth, germination into the affected organ and rapid spread.

At the same time, a very common lesion of the mediastinal nodes in Hodgkin's disease is secondary and has nothing to do with this form of non-Hodgkin's lymphomas. Although the symptoms of the disease are the same. These are manifestations of compression of the mediastinal organs, expressed as cough, chest pain, shortness of breath.

Lymphoma of the brain

More often it is a manifestation of a secondary lesion in various types of non-Hodgkin's lymphomas. Primary cerebral lymphoma is a very rare disease and is usually based on diffuse large B-cell lymphoma.

The symptomatology is associated with the occurrence of a volumetric tumor formation and manifests itself in the form of various neurological complaints - headaches, disorders in the sensitive, motor sphere, coordination and higher nervous activity (memory disorders, cognitive abilities).

A feature of the disease is the difficulty of confirmatory diagnosis associated with the difficulty of obtaining tumor material for research.

Treatment of non-Hodgkin's lymphomas

Chemotherapy and radiation therapy remain the only methods in the treatment of non-Hodgkin's lymphomas. However, the use of radiation therapy is limited to local damage to the lymph nodes, that is, it is possible only in the first stage of the disease (according to the Ann Arbor classification).

Chemotherapy remains the leading method. In non-Hodgkin's lymphomas, preference is given to intensive combination chemotherapy using several drugs simultaneously.

In some forms, it is possible to use surgical intervention (removal of a lymphoid tumor) as an element in complex treatment.

Video: Lymphoma Report

Lymphomas are a broad group of tumors of lymphatic tissues. These tumors have a different origin, symptoms, manifestations and processes. The whole group can be divided into two subgroups: one is made up, the other is non-Hodgkin's lymphomas.

General description, causes

Non-Hodgkin's lymphomas are neoplasms of altered lymphocytes, initially have a malignant form and an unpredictable response to drug treatment. These tumors, depending on the variety, have different periods of development, ranging from slowly developing (indolent) to very aggressive forms that quickly affect almost the entire body of the patient.

First of all, with the development of diseases of this type, the lymph nodes and lymphatic tissues contained in the structure of organs are affected. At risk are the organs of the gastrointestinal tract, the spleen, and various secretory glands. Less commonly, other organs are affected.

Lymphoma has no age restrictions; adults, children, and the elderly are susceptible to it. As you age, your risk of developing lymphoma increases. In Russia, up to 25,000 patients with such complaints are officially registered every year, which is about 4% of the total number of cancers.

The causes of this type of pathology are not fully understood. Possible risk factors include the following:

genetic mutations;
the impact of intensive chemotherapy and radiation therapy in the treatment of cancer;
the state of immunodeficiency due to various reasons;
reaction to toxins (carcinogens - benzenes, insecticides, herbicides);
viral diseases.

But exposure to these factors does not necessarily lead to the development of lymphoma.

Classification of the disease and clinical signs

Lymphomas are classified according to different criteria.

Depending on the localization, there are:

nodal lymphomas;
extranodal lymphomas.

Nodal are called formations that develop in the lymph nodes. Extranodal tumors affect not only the lymph nodes, but also the tissues of other organs.

Non-Hodgkin's lymphomas are formed from modified lymphocytes. All lymphocytes are divided into three types:

According to this division, lymphomas of the corresponding types are distinguished.

B-cell lymphomas, in turn, are divided into the following subspecies:

large cell lymphoma;
small cell lymphoma;
plasma cell myeloma;
extraosseous plasmacytoma;
lymphoplasmacytic lymphoma;
follicular lymphoma;
mantle cell lymphoma;
from mature B cells;
from precursors of B cells;
unspecified (not included in the classification) and others.

T- and NK-type tumors also have their own varieties:

smallpox-like lymphoma;
hepatosplenic;
lymphoblastic;
from T cell precursors;
subcutaneous panniculitis-like;
mycosis fungoides, etc.

All types of non-Hodgkin's lymphomas have a diffuse type of distribution, that is, when they form in the lymph nodes, they disrupt their structure and grow into the tissues of other organs.

Features of diffuse type lymphoma

Diffuse B-cell type non-Hodgkin's lymphoma is one of the most common among lymphatic tumors, occurring in a third of all reported cases. It can form both in the cells of the lymph nodes and in the tissues of other organs - the spleen, thyroid gland, bone marrow, etc. Large-cell diffuse B-cell lymphoma most often develops in people aged 40 to 60 years.

Features of this type of lymphoma is that it develops in the mediastinal region. Mediastinal diffuse large cell lymphoma is one of the most aggressive B-cell tumors. First of all, it affects the lymph nodes in the area behind the sternum, rapidly spreading to other groups and organs.

All non-Hodgkin's lymphatic tumors are characterized by stages of development:

At the 1st stage, there is a destructive change in one lymph structure.
On the 2nd - a nodal change in more than two lymphostructures on one side of the diaphragm (above or below relative to it).
On the 3rd - a nodal change in lymph structures in combination with an extranodal lesion of other organs.
On the 4th - a multifocal change in one or more organs in combination with a change in distant lymph nodes.

The symptoms of non-Hodgkin's lymphomas are varied. More often they appear with the aggressive development of tumors. There is a group of clinical signs, the so-called B-symptoms, which are characteristic of most types of diffuse large B-cell lymphoma:

increase in body temperature;
rapid weight loss;
increased sweating at night (hyper sweating).

In addition, the patient may notice signs such as:

enlarged lymph nodes and other organs;
skin rash;
pain in the region of internal organs;
weakness and fatigue;
gum bleeding.

Indolent large cell lymphoma does not manifest itself for a long time, in connection with this, the patient notices changes in the body too late, often already irreversible.

Types of diagnosis of the disease

Patients with diffuse large B-cell lymphoma are treated by an oncologist or oncohematologist. Diagnostic studies include:

study of anamnesis;
palpation of all groups of peripheral lymph nodes, liver and spleen and their ultrasound examination;
computed tomography of the areas of location of groups of lymph nodes;
general and biochemical blood test, blood test for HIV infection, hepatitis B- and C-type;
bone marrow biopsy and myelogram.

In some cases, additional diagnostic procedures specific to each individual patient are required:

with the defeat of one testicle - ultrasound of the second testicle and lumbar puncture;
with a primary lesion of one of the sections of the gastrointestinal tract, all its sections are examined;
in case of damage to the membranes of the brain and spinal cord - computed or magnetic resonance imaging of the affected area, examination by a neurologist, lumbar puncture;
if the patient has complaints, an X-ray examination of the bones;
in the presence of indications - osteoscintigraphy;
in the presence of malignant lymphomas - scintigraphy.

If the patient has complaints of discomfort in the organ or organs that have not been examined, then they should also be examined.

The diagnosis is made on the basis of a study of the structure of the tumor tissue. The earliest affected lymph node is suitable for research. Moreover, during the operation, it must be completely removed without damaging it. Inguinal lymph nodes are not taken for histological examination if there are affected nodes of other groups.

Data from a single biopsy is not enough to establish an accurate diagnosis, but for patients who require urgent treatment, cytological data can be used at the first stage.

The main methods of treating the disease

Treatment of non-Hodgkin's lymphoma is carried out by methods:

radiation therapy (using x-rays);
chemotherapy;
surgical intervention (mostly carried out to take samples of material for histological examination).

The intensity of each type of therapy depends on the stage of development of the disease, the degree of its aggressiveness and the response to this type of treatment.

According to statistics, chemotherapy has the greatest therapeutic effect. X-ray irradiation is used in cases where chemotherapy is contraindicated. Surgical removal of the affected area is possible when it is local. Sometimes a combination of these methods is the most effective. Additional medication may be required.

At the end of treatment for diffuse large B-cell lymphoma, the first two years the patient must come for a follow-up examination, which is repeated every three months. Then the control inspection is carried out once every six months for three years and then once a year. After 6, 12 and 24 months, computed tomography of the primary lesions is performed.

To assess the prognosis of b-cell lymphoma, the International Prognostic Index scale is used. It includes 5 divisions (from 0 to 5). In order to determine the index on this scale, each of the following indicators, if any, is taken as 1 point:

3-4th stage of tumor development;
score on the ECOG scale - from 2 to 4 points (assessment of the patient's motor activity and his ability to self-service, where 4 points is a complete disability);
the age of the patient exceeds 60 years;
the level of lactate dehydrogenase (an enzyme involved in the formation of lactic acid, which is broken down and does not accumulate in a healthy body) is above normal;
extranodal involvement of several organs.

The points obtained are summed up, and the final indicator is analyzed:

0 - 1 point - low level;
2 - low intermediate;
3 - high intermediate;
4-5 - high.

The prognosis of the disease in a particular case depends on many factors:

age;
the state of the patient's immune system;
the degree of development of the disease;
type of lymphoma;
the extent of the lesion;
the nature of the response to therapy, etc.

On average, the number of patients with complete remission reaches 85%, 70% of patients pass the five-year survival threshold without recurrence.

Diffuse lymphoma is a serious disease, but modern medicine is doing everything possible to increase the effectiveness of treatment and the survival rate of patients.