What is lymphoma: symptoms, treatment,diagnosis, prognosis

Update: December 2018

Currently, among children and adults, the group is gaining weight.
malignant neoplasms such as lymphomas. This
the category is characterized by lesions of the lymphoid tissue and the appearance
neoplastic cells. It includes two types of tumors:

  • lymphatic granulomatosis (Hodgkin’s lymphoma) – survival rate of about 80%
    the sick
  • non-Hodgkin lymphoma – survival rate of 20-25%

These two diseases are quite different in the causes of
the onset and course of the disease, and most importantly, survival
the sick.

General concepts about the lymphatic system

The lymphatic system is an integral part
cardiovascular system and consists of lymphatic vessels and
lymph nodes. The lymph node contains a specific
lymphoid tissue through which lymph passes and occurs
disinfection. It performs a number of vital functions:

  • cleanses the body of toxins and foreign bacteria
  • participates in metabolism (especially in fat metabolism)
  • fills the blood with immune cells (lymphocytes)

Lymphogranulomatosis

Lymphogranulomatosis или болезнь Ходжкина – это неопластический
a process that develops in the lymphoid tissue and is characterized by
the emergence of new cells Berezovsky-Sternberg. This патология
known since 1832, when the English Dr. Thomas Hodgkin described
seven cases of Hodgkin’s disease. Disease afflicts
mostly young people aged 20-25 years. Has been identified
pattern between the occurrence of Hodgkin’s disease and carriage
Epstein-Barr virus. There are 4 histomorphological variants.
diseases:

  • Lymphohistiocytic – 5% of cases
  • Nodular sclerosis – 30-45%
  • Mixed cell – 35-50%
  • Lymphoid depletion – 10%

The clinical picture of Hodgkin’s disease depends on the location
primary tumor source. Often the disease begins with
hypertrophy of the lymph nodes of the cervical, supraclavicular, inguinal and
axillary areas, which eventually merge into large
groups and germinate in the underlying tissue. Then develop the syndrome
superior vena cava, pleurisy and pericarditis, respiratory failure,
enlarged liver and spleen, weight loss down to
cachexia.

The main method of diagnosis of the disease is puncture
biopsy of the affected lymph node. In the drug are detected
Hodgkin cells, multi-core Berezovsky-Reed-Sternberg cells,
lymphocytes, neutrophils, eosinophils, and others.

The treatment of Hodgkin’s disease is combined and includes in
radiation and chemotherapy. Прогноз для the sick является
favorable, since Hodgkin’s disease is well treatable.
Пятилетняя выживаемость the sick после применения комплексной
treatment is 87–90% (more details in the article on symptoms and
treatment of lymphatic granuloma).

Malignant lymphomas – lymphosarcomas

This is a large group of lymphoproliferative disorders (more than 30
diseases) affecting lymphoid germ blood,
characterized by different histological features
blast cells, disease symptoms and prognosis
survival rate.

Tumor cells begin to accumulate in organs (in which there are
lymphoid tissue – spleen, tonsils, intestines, thymus
gland) and lymph nodes, coalescing among themselves in the tumor
masses. Опухолевые клетки могут быть или только в  определенном
place (rarely), or (most often) they spread with blood flow
in all the tissues of the body, but at the same time, some tumors grow quickly,
others are slower and affect different organs.

NHL incidence statistics

Currently, the incidence of this pathology is approximately 45%.
exceeds the occurrence of Hodgkin’s disease. Especially
lymphosarcomas occur in the United States, Canada and European countries. Seldom
the disease occurs in Asian countries (Japan, Singapore, India). AT
Russia, the incidence of lymphosarcoma is approximately 3%,
In recent years there has been a significant upward trend in NHL.
They occur at any age, in men 2 times more often, very
rarely in children under 3 years old, mostly diagnosed in the elderly
people.

Causes of disease

Why lymphomas arise is still a mystery to
doctors and scientists. There is no particular trait found in
всех the sick одновременно. But the following is known:

  • ATирус Эпштейна-Барр вызывает лимфому Беркитта у
    ATИЧ-инфицированных пациентов и the sick, получающий
    immunosuppressive therapy.
  • У многих the sick с NHL обнаруживались генетические дефекты в 8
    chromosome.
  • AT США у большинства пациентов был выделен человеческий
    T-cell lymphotropic virus type 1 (HTLV-1), which is proven
    transmitted through human biological fluids (semen, blood,
    saliva, milk).

Environmental factors also play a big role in causing
diseases. There is a high risk of morbidity:

  • prolonged contact with pesticides, herbicides
  • while taking some medications
  • when exposed to radiation, ionizing radiation
    (X-rays, ultraviolet irradiation).

Lymphosarcoma classification

Division NHL REAL (The Revised European-American Classification
of Lymphoid Neoplasms) is complex and based on
molecular structure and biological characteristics of tumors.
ATиды лимфом:

AT-клеточная лимфома T-cell lymphoma
  • Burkitt’s lymphoma;
  • Диффузная крупноклеточная AT-клеточная лимфома;
  • Plasmocytoma;
  • ATолосатоклеточный лейкоз;
  • Follicular lymphoma;
  • Immunocytoma
  • Mushroom mycosis (Sesari syndrome);
  • Angiocentric lymphoma;
  • Кишечная T-cell lymphoma;
  • Anaplastic large cell lymphoma;
  • Large granular lymphocytic leukemia.

Lymphosarcomas are malignantly divided into three categories:

  • low – small malignancy have
    плазмацитома ATальденстрёма и фолликулярная смешанно-клеточная
    NHL
  • intermediate degree is observed with follicular development
    large and diffuse large lymphomas.
  • high degree – the most dangerous with a high degree
    malignancies are considered lymphoma Burkitt and immunoblastic
    NHL.

Клиническая картина NHL

Symptoms of lymphoma are quite diverse, each type has its own
features Общим признаком для всех NHL является первичное
lymph nodes (node) or liver
and spleen (extranodal). AT патологический процесс вовлекаются
lymph nodes of the cervical, axillary region, mediastinal,
peritoneal and retroperitoneal (that is, on the lateral surfaces of the neck,
armpits, in the elbow folds, under the clavicle, in the groin).

AT начале заболевания лимфатические узлы увеличиваются в
become dense and painless, then coalesce into
large groups (conglomerates) may ulcerate and form
fistulous passages. Symptoms of lymphoma due to hypertrophy
nodes:

  • cough, inspiratory dyspnea
  • feeling of coma in the throat, swallowing
  • blood stasis in the upper half of the body due to compression
    veins (cyanosis and puffiness of face)
  • swelling of limbs
  • intestinal obstruction
  • obstructive jaundice

Over time, lymphoblastic cells spread throughout the body.
(disseminate), affecting the bones, liver, spleen, nervous system,
mammary glands, testicles and so on. To extranodular (that is, not
lymph node related disease symptoms
relate:

  • Decreased appetite, weight loss (over 6 months more than
    10%), general malaise, fever, increased
    night sweats, poor sleep, apathy, increased
    irritability
  • Breast augmentation and induration, symptom of umbilication
    (nipple retraction)
  • The appearance on the skin of dense, painful nodules prone to
    merge
  • Meningism (defeat of the meninges with blast cells),
    characterized by headaches, repeated vomiting, not
    relieved by positive meningeal signs
  • With bone marrow damage – anemia, a tendency to severe
    leaking infections, bleeding tendency, frequent nasal
    bleeding, prolonged heavy menstruation, hematomas, etc.
  • The defeat of the musculoskeletal system is manifested strong
    pains in the spine, pelvic bones, muscle atrophy, pain in the joints
    and bones even at rest
  • Enlarged lymph nodes are not painful on palpation, skin
    normal color, lymph nodes soldered to each other
  • If the tonsils are affected, swallowing is difficult,
    voice timbre changes, tonsils increase in size
  • Separately, I would like to consider the symptoms of Burkitt’s lymphoma,
    the most common tumor from this group. Lymphoma
    Burkitt mainly affects the gastrointestinal tract, causing
    гипертрофию lymph nodes. The tumor process is accompanied by
    severe abdominal pain, bloating, constipation, intestinal
    obstruction. ATозможно развитие перфорации кишечника и
    peritonitis.
  • If thoracic lymph nodes are involved in the tumor process
    cavity, respiratory tract, thymus – difficult to swallow,
    dry cough appears, chest tightness
    cavities, progressive shortness of breath
  • With the defeat of the central nervous system – seizures, vomiting, severe headaches,
    cranial nerve palsy

Lymphoma у детей имеет свои features Most often in the tumor
the process involves the bone marrow, blast cells inhibit leaflets
hematopoiesis, causing anemia, increased bleeding, frequent
воспалительные diseases.

Diagnosis of lymphoma

К основным методам диагностики заболевания relate:

  • Puncture biopsy of the lymph node followed by
    cytological examination punctate, which is usually detected
    незрелые формы Т- и AT-лимфоцитов. By the degree of maturity
    опухолевых клеток определяется злокачественность NHL. AT зависимости
    a liver biopsy may be performed against a lesion of internal organs,
    bone marrow lumbar puncture.
  • X-ray examination (computed tomography,
    review tomography), magnetic resonance imaging,
    ультразвуковое дуплексное сканирование пораженных organs.
  • General clinical studies (complete blood count, urine,
    biochemical analysis, coagulogram).
  • Laparoscopy and trial laparotomy with examination
    ascitic exudate.
  • Immunological study of blood to detect antibodies to
    Epstein-Barr virus specific tumor process markers
    (BCL-2, CD 19, 20, 22, HLA / DR).

Lymphoma treatment

The choice of tactics for treating NHL depends on the prevalence
tumor process and morphological type of cells. In any
case, treatment should be comprehensive and objective. Main
treatment methods:

  • Surgical treatment – for single internal tumors
    organs. Complete excision of the affected tissue and
    nearby lymph node groups. In severe splenism (i.e.
    excess function of the spleen when it destroys not only
    tumor cells, but normal blood cells) remove
    sezenku.
  • Radiation therapy – used in combination with chemotherapy,
    is an effective method at all stages of treatment
    used in the pre- and postoperative period.
  • Chemotherapy – involves the use of cytostatics
    (cyclophosphamide, fluorouracil), monoclonal antibodies (rituximab),
    glucocorticosteroids (methylprednisolone, budesonide). In lymphomas
    often use monochemotherapy.
  • Bone marrow transplantation (transplant) – contributes to
    recovery of blood cell structure, reduces symptoms
    diseases.

The main criterion for the onset of lymphoma remission is
the disappearance of punctate blast cells. In recent decades
A non-invasive method such as PCR, which identifies
Lymphoid clone altered DNA.

Prognosis for lymphomas

The 5-year survival rate for NHL varies according to
morphological options:

  • Хороший прогноз, превышающий 70%  — при фолликулярных
    lymphomas, MALT lymphomas, marginal B-cell lymphomas
    zones
  • When T-lymphoblastic, peripheral T-cell NHL –
    survival rate below 30%.
  • In primary orbital lymphomas, lymphomas of the lungs, gastrointestinal tract, salivary
    glands, Pirogov-Valdeyera rings – more favorable projections –
    5-year survival rate over 60%
  • Lymphomas of the mammary glands, bones, central nervous system,
    Ovarian and testicular lymphomas are highly malignant and low
    percent survival rate.

Also in high grade lymphomas
life expectancy of patients is directly dependent on
timely started treatment and its results:

  • If complete remission is achieved, then 5 years survival rate
    about 50%
  • With partial remission – 15%, so it is very important to
    active intensive therapy immediately after diagnosis
    high-grade lymphoma to achieve complete remission
  • Five-year survival in low-grade lymphomas
    is 80% regardless of the result of treatment – full or
    partial remission.

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