Lymphoma is common. Lymphomas: causes, signs, classification and diagnosis, treatment. Lymphomas are simple, high-quality and malignant

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To date, medicine has managed to take a step forward, and effective, yielding results in the treatment of lymphoma is no longer something incredible, unrealizable. A series of laboratory experiments and studies made it possible to learn more about this disease, to develop high-quality and effective methods for its neutralization. If earlier patients with this diagnosis lived no more than three years, now the chances of survival have increased significantly. AT medical practice there have even been cases where remission lasted more than ten years.

What are the main symptoms of lymphoma? What is this disease? Why does it occur? What are the key factors in its origin? The answers to these and many other questions are below.

What is lymphoma and how does it manifest?

Lymphoma, what is this disease? Lymphoma is considered to be a group of hematological cancers that affect the lymphatic tissues. They usually act as a kind of catalyst that causes an increase lymph nodes, various internal injuries and organ disorders. Diseases are accompanied by processes of uncontrolled accumulation of malignant lymphocyte cells.

It is the sudden growth of lymph nodes located in different areas that is the initial and most significant symptom of lymphoma. Therefore, in order to better understand what kind of lymphoma disease, to present its nature in more detail, it is necessary to study the features of the structure and functioning of the lymph nodes.

The structure of the lymph nodes

The lymph node is recognized as a peripheral link of the lymphatic system, which plays the role of a kind of filter element. It passes through itself a liquid - lymph from the internal organs, body structures. When it comes to anatomical and physiological features lymph nodes, it is necessary to highlight:

their shape - it can be oval, round, oblong or ribbon-like;
volumes - from 0.5 millimeters to 5 centimeters;
shades - various colors in gray-pink tones;
arrangement - in clusters (up to 10-12 pieces) hang over blood vessels or large veins;
shell - the lymph nodes are enclosed in a connecting capsule, which has branches going deep into the nodes (they are called trabeculae), which perform supporting functions.

Stromas act as the main structural foundation of the lymph nodes. These are sprout cells-bodies that were formed by the reticular connective tissue, they form a 3-dimensional network.

All lymph nodes can be conditionally divided into areas: the cortical substance (located near the capsular membrane) and the medulla (it is the inner part). The first contains lymph nodules (follicles), and the second contains accumulations of lymphoid tissues.

Many lymph nodes are called a system. It consists of vessels, penetrating all vital internal organs, creates an integral network through which a transparent liquid flows - lymph. Its main components are produced immune system lymphocytes. They are formed in the area of the medulla of the lymph nodes, they are necessary to maintain the normal functioning of the human body.

The functioning of the lymphatic system

Lymph nodes, vessels, lymph are all components of the lymphatic system. Together they solve a number of vital tasks, maintain the health of the body.

What exactly are the functions of the lymphatic system?

Creation of a protective barrier. Lymph (in addition to lymphocytes) may contain a variety of infectious or viral bacteria and microorganisms, dead cells and others. foreign bodies. Lymph nodes perform a filtration option, cleansing the lymph, ridding it of all particles of a pathogenic nature.
Providing transportation. Lymph nourishes and saturates the organs. So, it is she who delivers useful components and trace elements from the intestines to the tissues. Lymph, on the other hand, is engaged in the transportation of waste intercellular fluid, thereby providing the drainage necessary for the body.
Strengthening the immune system, the formation of the body's ability to resist external factors. Lymphocytes produced by the lymph nodes are the main assistants in the fight against pathogenic bacteria, viruses and infections. They eliminate any harmful particles that can be detected. It is for this reason that in many diseases the lymph nodes increase in size.

Exactly lymphatic system provides cellular nutrition, saturates internal tissues and organs, and thanks to it, beneficial substances are distributed throughout the body.

What happens to a person with lymphoma

Tumor lesions of the lymphatic system can be triggered by both lymphoproliferative diseases and metastatic factors. The first include lymphogranulomatosis and lymphosarcoma. These ailments contribute to an increase in lymph nodes up to 3-4 centimeters, their compaction.

Any touch and feel in the affected lymph nodes respond with pain, cause discomfort. In addition, uncontrolled cell division begins, which gradually develops into the formation of tumors and neoplasms.

Is lymphoma a cancer

Can lymphoma be classified as a cancer? A few years ago, this issue caused fierce and heated debate in medical circles, but by now it has been possible to establish the nature of this disease for certain.

Lymphoma is a tumor neoplasm of a malignant nature, that is, cancer. Meanwhile, a wide variety of its forms and types are distinguished, which differ from each other in the degree of malignancy.

Reasons for the development of lymphoma

To date, it has not been possible to establish for certain what exactly causes the symptoms of lymphoma, is the cause of the development of the disease. However, in the case histories of patients who have been diagnosed with this pathology, there are some similar details. This circumstance allows us to identify a number of factors that create favorable conditions for the onset of lymphoma in adults. Among them: gender and age, the presence of chronic diseases and much more. More on each of the reasons below.

Gender and age

It is no secret that with age, the general state of health deteriorates somewhat, the functionality and performance of organs decreases. It is this factor that creates a favorable environment for the occurrence of lymphoma. As a rule, the risk group is represented by people in the age range from 55 to 60 years.

Of course, this pathology can develop at an earlier age, but this happens much less frequently. As far as gender is concerned, it is an important factor with Hodgkin's lymphoma. Thus, the occurrence of this species among the male population is an order of magnitude higher.

Viral infections

Bacteria and other pathogens are one of the factors associated with lymphoma. So, the vast majority of people suffering from lesions of the lymphatic system are diagnosed with the Epstein Barr virus. It enters the body by airborne droplets (much less often by contact-household) by starting to provoke the development of various diseases. In addition to lymphoma, it can cause:

mononucleosis;
herpes of different types;
hepatitis;
brain diseases, especially multiple sclerosis.

How does Epstein Barr manifest itself in the body? The first symptoms of infection resemble an ordinary seasonal cold:

there is a general malaise, drowsiness;
the temperature increases;
the body becomes less efficient, quickly gets tired.

On the 5-7th day after infection, the patient's lymph nodes increase in size, give painful sensations. A rash that looks like an allergic reaction may also occur.

In addition to Epstein Barr, viruses such as HIV, AIDS, hepatitis C, herpes of the first and second type can also provoke the development of lymphoma.

Bacterial diseases

In addition to the viral impact, such a factor as harmful pathogenic bacteria stands out. They cause a variety of infectious diseases, negatively affect the functioning of the immune system.

According to statistics from the World Health Organization, in 47% of patients with lymphoma in orgasm, the microorganism Helicobacter pylori was registered. It is he who is the cause of intestinal disorders, stomach infections, digestive dysfunctions. The bacterium lives on the mucous membranes or attaches to the duodenum.

Symptoms of infection resemble poisoning. The patient is constantly sick, his stool is disturbed, his appetite disappears. There is also a characteristic eructation, accompanied by the smell of rotten eggs.

Other reasons

Modern research in the field of oncology has revealed that lymphoma was more often diagnosed in people who were somehow associated with harmful production. This circumstance allowed us to conclude that the chemical factor also affects the development of the disease. The risk zone includes:

people employed in agriculture who come into contact with chemicals;
people working in chemical shops and laboratories;
people working in industrial production.

Another reason for the emergence of oncological pathology is the long-term systemic use of immunosuppressants (drugs that inhibit the immune system). As a rule, these drugs are prescribed by attending physicians in order to combat autoimmune diseases. Since a failure occurs in the body, and instead of a protective function, immunity begins to perform a destructive one, its blocking is fully justified. The most common examples of autoimmune diseases are lupus, multiple sclerosis, and rheumatoid arthritis.

Lymphoma Symptoms

The leading symptom of lymphoma is the sudden and causeless growth of lymph nodes. It manifests itself in the early stages of the development of the disease, is caused by uncontrolled cell division, leading to the formation of tumor neoplasms. According to official statistics, hypertrophied lymph nodes are found in 90 percent of cases of diagnosing lymphoma.

Along with an increase in lymph nodes, symptoms such as:

Temperature increase. As a rule, it does not cross the mark of 38 degrees, but in rare cases it can reach 40. In addition to the heat, the patient feels a slight malaise, weakness, and drowsiness. The condition resembles the prodromal period of the development of a viral cold.
Increased sweating. This symptom is especially characteristic of those who have been diagnosed with Hodgkin's lymphoma. Sweating is most active at night. Sometimes it is so intense that the bedding becomes damp. It is noteworthy that the sweat itself does not differ in any pungent odor or color.
Sudden weight loss. People with lymphoma often lose a lot of weight without any effort. This is due to disorders and failures occurring in the body: metabolic disorders, hormonal changes, etc. In certain cases, the disease is accompanied by a lack of appetite, vomiting, nausea. As a result, a person loses kilograms.
Pain. Often, patients who have been diagnosed with non-Hodgkin's lymphomas complain of causeless pain. They can be localized in a variety of areas: in the hypochondrium, abdomen, lower back, etc. Headaches are especially difficult to tolerate, which are problematic to relieve even with the help of special pills.

In addition to the above symptoms, patients often complain of itching, feeling of weakness and drowsiness, chronic fatigue. In cases where the lymphoma is located in the chest area, a person may experience a cough. It refers to the specific symptoms of the disease, which manifests itself only under certain circumstances.

Types of lymphomas

To date, more than thirty forms of lymphoma have been registered. They differ according to such criteria as:

structure;
the size;
location.

Conventionally, all varieties of this disease are usually divided into two types: Hodgkin's lymphoma and non-Hodgkin's lymphoma.

Patients who have been diagnosed with Hodgkin's lymphoma suffer from various disorders skeletal system, vital important organs. They have common diseases of the bone marrow, mutilation of the spine. Another integral feature of this type of cancer is intoxication syndromes. Complaints about excessive sweating, fever, sudden weight loss - that's what worries patients with similar diagnoses. In some cases, Hodgkin's lymphoma provokes compression of the lungs, pulmonary trachea, which leads to the development of paralysis.

Non-Hodgkin's lymphomas are malignant tumors. They usually occur in elderly patients (over 60 years of age). Of particular concern to oncologists are the following types:

Burkitt's lymphoma;
lymphoblastic;
diffuse;
large cell;
marginal.

The treatment of lymphoma is a complex and time-consuming process, it is selected in accordance with the individual characteristics of the patient, as well as the stage of the disease.

Stages of lymphoma

Each stage of this cancer has a number of specific features and characteristics, including: the age of the tumor, the level of its prevalence in the body, as well as the degree of damage. In total, specialists in the field of oncology distinguish four stages. Below are more details about each of them:

On the initial stage one or more lymph nodes located in a certain area (for example, axillary) are affected. Lymphoma is localized in one place, one organ. Among the symptoms characteristic of this stage of the development of the disease, one can note: hypertrophied lymph nodes, pain, weight loss.
The second stage occurs at the moment when the disease manages to affect more than two lymph nodes located on one side of the diaphragm.
The third stage involves serious injuries inflicted on the lymph nodes, their involvement in the pathological process. At this stage, the lymph nodes located on opposite sides of the diaphragm can be hypertrophied.
The last stage is considered disseminated. By its onset, a person has already been affected by several vital organs, metabolic processes have been disrupted.

Survival of patients is largely determined by the stage of development of the disease, as well as the correctness of the therapy. Under favorable conditions and timely diagnosis, treatment of lymphoma can give positive results in the form of a long-term remission.

Treatment and prevention

Chemotherapy and radiation therapy are the main measures of influence on the tumor of lymphoma. As a rule, they are assigned separately, but in certain cases their combination is allowed.

Achieving a long-term remission is possible only with timely started and correctly selected treatment. It is carried out through:

radiation therapy. It is prescribed to patients with the first stage of the disease, when there is no massive damage to the lymph nodes.
Chemotherapy. This method involves the active use of potent medicines designed to fight tumors and neoplasms.

The disease is treated in any medical institution, which has oncologists on its staff. It is they who keep records of patients, carry out laboratory and hardware studies, and make up health programs.

When treating lymphoma, it is very important to find a doctor whom you can completely trust, whose recommendations you will unquestioningly follow. This is one of the factors for successful achievement of long-term remission. It is noteworthy that during periods of lymphoma subsidence, patients are recommended to visit specialized sanatorium-resort institutions, this has a beneficial effect on the dynamics of the disease.

- Tumor diseases of the lymphatic system, represented by malignant B- and T-cell lymphomas. The primary focus can occur in the lymph nodes or other organs and further metastasize by the lymphogenous or hematogenous route. The clinic of lymphomas is characterized by lymphadenopathy, symptoms of damage to one or another organ, fever-intoxication syndrome. Diagnosis is based on clinical and radiological data, the results of a hemogram study, biopsy of lymph nodes and bone marrow. Anticancer treatment includes courses of polychemotherapy and radiotherapy.

ICD-10

C82 C85

General information

Non-Hodgkin's lymphomas (NHL, lymphosarcomas) are malignant lymphoproliferative tumors that differ in morphology, clinical signs and course, differing in their characteristics from Hodgkin's lymphoma (lymphogranulomatosis). Depending on the place of occurrence of the primary focus, hemoblastoses are divided into leukemias (tumor lesions of the bone marrow) and lymphomas (tumors of lymphoid tissue with primary extra-medullary localization). Based on the distinctive morphological features of lymphoma, in turn, are divided into Hodgkin's and non-Hodgkin's; among the latter in hematology include B- and T-cell lymphomas. Non-Hodgkin's lymphomas occur in all age groups, but more than half of cases of lymphosarcoma are diagnosed in people over 60 years of age. The average incidence among men is 2-7 cases, among women - 1-5 cases per 100,000 population. During recent years there is a trend towards a progressive increase in the incidence.

Causes

The etiology of lymphosarcoma is not known for certain. Moreover, the causes of lymphomas of different histological types and locations vary significantly. Currently, it is more correct to talk about risk factors that increase the likelihood of developing lymphoma, which are currently well studied. The influence of some etiofactors is pronounced, the contribution of others to the etiology of lymphomas is very insignificant. These unfavorable conditions include:

infections. Human immunodeficiency virus (HIV), hepatitis C, T-lymphotropic virus type 1 has the greatest cytopathogenic effect on lymphoid cells. Epstein-Barr virus infection has been shown to be associated with the development of Burkitt's lymphoma. It is known that the infection Helicobacter pylori associated with gastric ulcer, can cause the development of lymphoma of the same localization.
Immunity defects. The risk of lymphomas increases with congenital and acquired immunodeficiencies (AIDS, Wiskott-Aldrich syndrome, Louis Bar, X-linked lymphoproliferative syndrome, etc.). Patients receiving immunosuppressive therapy for bone marrow or organ transplantation are 30 to 50 times more likely to develop NHL.
Accompanying illnesses. An increased risk of NHL incidence has been noted among patients with rheumatoid arthritis, lupus erythematosus, which can be explained both by immune disorders and the use of immunosuppressive drugs to treat these conditions. Thyroid lymphoma usually develops against the background of autoimmune thyroiditis.
Toxic effect. There is a causal relationship between lymphosarcomas and previous exposure to chemical carcinogens (benzene, insecticides, herbicides), UV radiation, and radiation therapy for cancer. Direct cytopathic action is exerted by cytostatic drugs used for chemotherapy.

Pathogenesis

Pathological lymphogenesis is initiated by one or another oncogenic event that causes a violation of the normal cell cycle. Two mechanisms can be involved in this - activation of oncogenes or suppression of tumor suppressors (antioncogenes). A tumor clone in NHL in 90% of cases is formed from B-lymphocytes, extremely rarely from T-lymphocytes, NK-cells or undifferentiated cells. Different types of lymphomas are characterized by certain chromosomal translocations, which lead to suppression of apoptosis, loss of control over the proliferation and differentiation of lymphocytes at any stage. This is accompanied by the appearance of a clone of blast cells in the lymphatic organs. Lymph nodes (peripheral, mediastinal, mesenteric, etc.) increase in size and can disrupt the function of nearby organs. With infiltration of the bone marrow, cytopenia develops. Growth and metastasis of the tumor mass is accompanied by cachexia.

Classification

Lymphosarcomas that primarily develop in the lymph nodes are called nodal, in other organs (palatine and pharyngeal tonsils, salivary glands, stomach, spleen, intestines, brain, lungs, skin, thyroid gland, etc.) - extranodal. According to the structure of the tumor tissue, NHL are divided into follicular (nodular) and diffuse. According to the rate of progression, lymphomas are classified into indolent (with a slow, relatively favorable course), aggressive and highly aggressive (with rapid development and generalization). If untreated, patients with indolent lymphomas live an average of 7-10 years, with aggressive ones - from several months to 1.5-2 years.

The modern classification has over 30 various kinds lymphosarcoma. Most tumors (85%) originate from B-lymphocytes (B-cell lymphomas), the rest from T-lymphocytes (T-cell lymphomas). Within these groups, there are different subtypes of non-Hodgkin's lymphomas. The group of B-cell tumors includes:

diffuse large B-cell lymphoma- the most common histological type of lymphosarcoma (31%). It is characterized by aggressive growth, despite this, in almost half of the cases it can be completely cured.
follicular lymphoma- its frequency is 22% of the number of NHL. The course is indolent, but transformation into aggressive diffuse lymphoma is possible. The prognosis of 5-year survival is 60-70%.
small cell lymphocytic lymphoma and chronic lymphocytic leukemia- close types of NHL, which account for 7% of their number. The course is slow, but poorly amenable to therapy. The prognosis is variable: in some cases, lymphosarcoma develops within 10 years, in others, at a certain stage it turns into a rapidly growing lymphoma.
mantle cell lymphoma- in the structure of the NHL is 6%. Only 20% of patients overcome the five-year survival limit.
Marginal zone B-cell lymphomas- are divided into extranodal (can develop in the stomach, thyroid, salivary, mammary glands), nodal (develop in the lymph nodes), splenic (with localization in the spleen). Differ in slow local growth; at early stages well give in to treatment.
B-cell mediastinal lymphoma- is rare (in 2% of cases), but unlike other types, it affects mainly young women 30-40 years old. In connection with the rapid growth causes compression of the mediastinal organs; cured in 50% of cases.
Waldenström's macroglobulinemia(lymphoplasmacytic lymphoma) - is diagnosed in 1% of patients with NHL. It is characterized by hyperproduction of IgM by tumor cells, which leads to an increase in blood viscosity, vascular thrombosis, and capillary rupture. It can have both relatively benign (with a survival rate of up to 20 years) and transient development (with the death of the patient within 1-2 years).
hairy cell leukemia is a very rare type of lymphoma that occurs in older people. The course of the tumor is slow, not always requiring treatment.
Burkitt's lymphoma- it accounts for about 2% of the NHL. In 90% of cases, the tumor affects young men under 30 years of age. The growth of Burkitt's lymphoma is aggressive; intensive chemotherapy allows to achieve a cure of half of the patients.
lymphoma of the central nervous system The primary CNS lesion may involve the brain or spinal cord. More commonly associated with HIV infection. The five-year survival rate is 30%.

Non-Hodgkin's lymphomas of T-cell origin are represented by:

T-lymphoblastic lymphoma or progenitor leukemia- occurs with a frequency of 2%. They differ in the number of blast cells in the bone marrow:<25% опухолевых клеток патология расценивается как лимфома, при >25% - like leukemia. It is diagnosed mainly in young people, the average age of the diseased is 25 years. The worst prognosis is T-lymphoblastic leukemia, the cure rate for which does not exceed 20%.
peripheral T-cell lymphomas including cutaneous lymphoma (Sesari syndrome, mycosis fungoides), angioimmunoblastic lymphoma, extranodal natural killer lymphoma, lymphoma with enteropathy, panniculitis-like lymphoma subcutaneous tissue large cell anaplastic lymphoma. The course of most T-cell lymphomas is rapid, and the outcome is poor.

Symptoms

Options clinical manifestations NHL varies greatly depending on the localization of the primary focus, the prevalence of the tumor process, the histological type of the tumor, etc. All manifestations of lymphosarcoma fit into three syndromes: lymphadenopathy, fever and intoxication, extranodal lesions. In most cases, the first sign of NHL is an increase in peripheral lymph nodes. At first they remain elastic and mobile, later they merge into vast conglomerates. At the same time, the lymph nodes of one or many areas can be affected. With the formation of fistulous passages, it is necessary to exclude actinomycosis and tuberculosis.

Such non-specific symptoms of lymphosarcomas, such as fever without obvious causes, night sweats, weight loss, asthenia, in most cases indicate a generalized nature of the disease. Among the extranodal lesions, non-Hodgkin's lymphomas of the Pirogov-Waldeyer ring, gastrointestinal tract, brain dominate, less often the mammary gland, bones, lung parenchyma, and other organs are affected. Nasopharyngeal lymphoma on endoscopic examination has the appearance of a pale pink tumor with tuberous contours. Often, the maxillary and ethmoid sinuses, orbit sprout, causing difficulty in nasal breathing, rhinophony, hearing loss, exophthalmos.

Primary testicular lymphosarcoma may have a smooth or bumpy surface, elastic or stony density. In some cases, swelling of the scrotum develops, ulceration of the skin over the tumor, an increase in the inguinal-iliac lymph nodes. Testicular lymphomas are predisposed to early dissemination with damage to the second testicle, central nervous system, etc. Breast lymphoma on palpation is defined as a clear tumor node or diffuse breast compaction; nipple retraction is uncharacteristic. When the stomach is affected, the clinical picture resembles gastric cancer, accompanied by pain, nausea, loss of appetite, and weight loss. Abdominal lymphosarcomas can manifest themselves as partial or complete intestinal obstruction, peritonitis, malabsorption syndrome, abdominal pain, ascites. Skin lymphoma is manifested by itching, nodules and reddish-purple induration. The primary lesion of the central nervous system is more typical for patients with AIDS - the course of lymphoma of this localization is accompanied by focal or meningeal symptoms.

Complications

The presence of a significant tumor mass can cause compression of organs with the development of life-threatening conditions. With damage to the mediastinal lymph nodes, compression of the esophagus and trachea develops, SVC compression syndrome. Enlarged intra-abdominal and retroperitoneal lymph nodes can cause intestinal obstruction, lymphostasis in the lower half of the body, obstructive jaundice, and compression of the ureter. Germination of the walls of the stomach or intestines is dangerous by the occurrence of bleeding (in case of vascular erosion) or peritonitis (when the contents enter the abdominal cavity). Immunosuppression makes patients susceptible to infectious diseases posing a threat to life. High-grade lymphomas are characterized by early lymphogenous and hematogenous metastasis to the brain and spinal cord, liver, and bones.

Diagnostics

The issues of diagnosis of non-Hodgkin's lymphomas are within the competence of oncohematologists. Clinical criteria for lymphosarcoma are an increase in one or more groups of lymph nodes, intoxication, extranodal lesions. To confirm the proposed diagnosis, it is necessary to conduct a morphological verification of the tumor and instrumental diagnostics:

Study of the tumor cell substrate. Performed diagnostic operations: puncture or excisional biopsy of lymph nodes, laparoscopy, thoracoscopy, aspiration puncture of the bone marrow with subsequent immunohistochemical, cytological, cytogenetic and other studies of diagnostic material. In addition to diagnosis, establishing the structure of NHL is important for choosing treatment tactics and determining prognosis.
Imaging methods. Enlargement of the mediastinal and intra-abdominal lymph nodes is detected using mediastinal ultrasonography, radiography, and chest CT, abdominal cavity. The examination algorithm according to indications includes ultrasound of the lymph nodes, liver, spleen, mammary glands, thyroid gland, organs of the scrotum , gastroscopy. For the purpose of tumor staging, an MRI of the internal organs is performed; lymphoscintigraphy and bone scintigraphy are informative in detecting metastases.
Laboratory diagnostics . It is aimed at assessing risk factors and the function of internal organs in lymphomas of various localizations. In the risk group, HIV antigen, anti-HCV is determined. Changes in peripheral blood (lymphocytosis) are characteristic of leukemia. In all cases, a biochemical complex is examined, including liver enzymes, LDH, uric acid, creatinine, and other indicators. B2-microglobulin can serve as a peculiar oncomarker of NHL.

Chemotherapy. Most often, treatment of lymphomas begins with a course of polychemotherapy. This method can be independent or combined with radiation therapy. Combined chemoradiotherapy allows to achieve longer remissions. Treatment continues until complete remission is achieved, after which another 2-3 consolidating courses are necessary. It is possible to include hormone therapy in cycles of treatment.
Surgical interventions. It is usually used for isolated lesions of any organ, more often - the gastrointestinal tract. If possible, operations are radical in nature - extended and combined resections are performed. In advanced cases, with the threat of perforation of hollow organs, bleeding, intestinal obstruction, cytoreductive interventions can be performed. Surgery must be supplemented with chemotherapy.
Radiation therapy. As a monotherapy for lymphomas, it is used only for localized forms and a low degree of malignancy of the tumor. In addition, radiation can also be used as a palliative method when other treatment options are not possible.
additional treatment regimens. From alternative methods immunochemotherapy with the use of interferon, monoclonal antibodies has proven itself well. In order to consolidate remission, transplantation of autologous or allogeneic bone marrow and the introduction of peripheral stem cells are used.

Forecast and prevention

The prognosis for non-Hodgkin's lymphomas is different, depending mainly on the histological type of the tumor and the stage of detection. With locally advanced forms, long-term survival averages 50-60%, with generalized forms - only 10-15%. Unfavorable prognostic factors are age over 60 years, stages III-IV of the oncological process, involvement of the bone marrow, and the presence of several extranodal foci. At the same time, modern PCT protocols in many cases allow achieving long-term remission. Prevention of lymphomas correlates with known causes: it is recommended to avoid infection with cytopathogenic viruses, toxic effects, excessive insolation. In the presence of risk factors, it is necessary to undergo regular examination.

The group of hematological diseases of the lymphatic tissue includes such a disease, lymphoma; symptoms: swelling of the lymph nodes, and in some cases damage to organs (abdominal cavity, liver lymphoma, stomach lymphoma). The main symptom is enlarged lymph nodes, other signs may vary depending on the subtype of the disease. Lymphoma is less common in children than in adults. In addition, in childhood, the disease responds well to treatment.

Lymphoma is a type of cancer that includes 35 subtypes. Lymphoma is a cancer that affects cells that play a critical role in the immune system. Primarily, this disease affects the cells of the lymphatic system.

The disease is characterized by the presence of a primary tumor, as in solid tumors. Lymphomas not only metastasize, but also disseminate throughout the body in parallel with the formation of a condition similar to lymphoid leukemia.

Medicine highlights non-Hodgkin's lymphomas and lymphogranulomatosis.

main symptom this disease is swelling of the lymph nodes in the armpits, in the groin or in the neck. Unlike infectious diseases, the affected lymph nodes do not hurt, in addition, they do not become smaller when taking antibiotics or over time. Sometimes an enlarged liver, spleen, and lymph nodes can cause a feeling of fullness, back pain, difficulty breathing, and a feeling of tightness in the neck or face. Signs of lymphoma:

weight reduction;
exhaustion, fatigue;
indigestion;
excessive sweating;
increase in body t.

Lymphomas are benign and malignant.

Malignant:

diffuse large cell;
immunoblastic diffuse;
follicular large cell;
mixed cell diffuse.

Benign:

from small lymphocytes diffuse;
from small lymphocytes;
mixed cell follicular;
follicular from split small lymphocytes.

Benign lymphoma has simple symptoms. A tumor of the lymph nodes or another organ consists of mature, differentiated lymphocytes, they most often have a nodular growth pattern. At the initial stage of the disease, there is no toxicosis. There are practically no changes in the patient's blood.

Malignant lymphoma at the beginning of the disease is manifested by weakness and fever, which can last for several hours. Itching at night and sweating profusely. In some cases, swollen lymph nodes are clearly visible in the patient. Malignant lymphomas slowly progress, worsening the patient's condition and spreading the disease to various organs (brain, liver, skeleton, lungs, and so on).

According to some experts, cancer of the lymph nodes occurs when the body is exposed to various carcinogenic substances (herbicides, pesticides) and viral infections. In addition, cancer of the lymph nodes in more affects people with weak immune systems, women with late pregnancy, and HIV-infected people.

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Varieties of lymphomas

Non-Hodgkin's have absorbed a fairly large group of tumors, but they do not represent lymphogranulomatosis (Hodgkin's disease). Oncology is examined by taking a sample of biopsied tissue, and only then can a diagnosis of Hodgkin's or non-Hodgkin's lymphoma be made. If Berezovsky-Sternberg-Reed cells are found, then the patient is diagnosed with Hodgkin's disease. If these cells are absent, then the tumor is classified as non-Hodgkin's disease.

Non-Hodgkins are divided into many subspecies that differ in symptoms and histological pattern. Some species do not need healing long time. They are classified as indolent. Other varieties, on the contrary, are distinguished by many signs, active progression and require prompt therapy. The growth of lymphocytes originates in the lymph nodes, while the patient develops a classic lymphoma. But there are also such formations in which the lymph nodes do not swell. This is due to the fact that the disease does not develop in the lymph node, but in the internal organs: the spleen, brain, lungs, stomach. This variety is called extranodal.

For example, lymphocytic lymphoma is characterized by local or generalized swelling of the lymph node. This subtype is painless.

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Skin lymphoma symptoms

The disease is a tumor, manifested in a pathological increase in lymphocytes. The disease is manifested by the formation of nodules, plaques and areas of erythema, as well as an increase in lymph nodes. Lymphoma of the skin is divided into two forms:

I - the disease captures the dermis.

II - malignant lymphocytes migrate from the lymph nodes and lymphoid organs.

This oncology is formed against the background of eczema. The affected area of the skin is inflamed, flaky and becomes red. In addition, hair loss, generalized inflammation of the lymph nodes and nail dystrophy are observed.

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Causes and types of breast lymphomas

The causes of the development of the disease are not exactly established, but the facts that cause its development are known:

autoimmune diseases;
viral infections;
venereal diseases;
intoxication;
impact narcotic substances, alcohol;
immunosuppression, AIDS.

Breast lymphoma is very rarely primary. Most often, it manifests itself as a result of oncological diseases of the blood.

Lymphoma is considered to be a malignant tumor of lymphoid tissue that develops outside the bone marrow. For most ordinary people, the term is associated with a severe oncological disease, the essence of which is difficult to understand, as well as to understand the types of this tumor. Enlargement of lymph nodes is considered an invariable sign of lymphoma., while the general symptoms of a malignant lesion may be absent for a long time with a relatively favorable course or progress rapidly with aggressive low-grade tumors.

Lymphoma occurs in people of all ages, but specific varieties are more often diagnosed at certain intervals of life. There are more men among the patients, but there is no explanation for this gender difference yet. The disease is more often affected by the white population, and for certain forms of the tumor, a clear relationship has been established with the geographical area, for most forms - with genetic abnormalities and viral infection.

Lymphomas are extremely diverse in their characteristics, ranging from the morphological features of tumor cells to clinical manifestations.

Thus, the same type of tumor in patients of different sex and age may manifest itself differently, determining different prognosis and overall life expectancy. In addition, such individual characteristics as the nature of genetic abnormalities, the presence or absence of viral infection, localization of the lesion.

To date, scientists have not been able to develop a clear and comprehensive classification of lymphomas, questions still remain, and modern diagnostic methods help to identify new types of neoplasms. In this article, we will try to understand the terminology and main types of lymphomas, the features of their course, without delving into complex mechanisms tumor development and numerous forms encountered by oncologists.

Causes and types of tumors of lymphoid tissue

large nodes of the human body affected by lymphoma

Our body in the process of life constantly encounters many harmful factors and influences, foreign agents and microorganisms, which are protected from by lymphoid tissue. A giant network of lymph nodes is scattered throughout the body, connected thin vessels and acting as a kind of filters, catching everything alien and dangerous from the lymph. Also lymph nodes also retain tumor cells in cancer of various localizations, then they talk about.

To perform barrier functions and participate in immune defense lymph nodes are supplied with a whole complex of mature and maturing cells of the lymphoid series, which themselves can become a source malignant tumor. Under unfavorable conditions or the presence of mutations, the process of differentiation (maturation) of lymphocytes, the immature forms of which constitute the neoplasm, is disrupted.

Lymphoma always grows outside the bone marrow, affecting the lymph nodes or internal organs- spleen, stomach and intestines, lungs, liver. As a tumor develops, its cells can move out of the primary localization, metastasizing like cancer and getting into other organs and the bone marrow (lymphoma leukemia).

figure: stage 4 lymphoma, target organs are affected by metastases, leukemization of lymphoma is shown

The causes of lymphomas and lymphosarcomas are:

Viral infection (infection with the Epstein-Barr virus, T-lymphotropic virus, HIV, hepatitis C virus, etc.).
Immunodeficiencies - congenital or acquired on the background of HIV infection, after radiation therapy or the use of cytostatics.
Autoimmune diseases - systemic lupus erythematosus, rheumatoid arthritis.
Genetic anomalies - translocations, when genes move from one chromosome to another, breaks in DNA sequences, etc., as a result of which cell division and maturation of lymphocytes are disrupted.
External carcinogenic factors - polyvinyl chlorides, dioxin, some herbicides.

Some terminology

To understand the variety of tumors of lymphoid tissue, you need to know what terms it is customary to call their varieties.

The term " lymphoma» usually used for all tumors of the lymph nodes and lymphoid tissue, but means it is mostly neoplasia of mature lymphocytes or prolymphocytes, that is, such a tumor is mature, and downstream can be quite benign, for many years without making itself felt, except for an increase in the lymph node. Transition of lymphoma to a malignant analogue ( lymphosarcoma or ) occurs quite rarely and after many years and even decades from the moment of its occurrence.

For absolutely benign neoplasms from mature lymphocytes, the term " lymphocytoma”, but often it is replaced by the familiar “lymphoma”.

All malignant neoplasias from lymphoblasts that develop in the lymph nodes or lymphatic tissue of the internal organs are called lymphosarcomas. This term very well reflects the malignancy of such tumors, because it is known that they always consist of immature cells and are accompanied by all the signs of an oncological process. Lymphosarcomas are manifested not only by an increase in lymph nodes, but also by general symptoms, such as fever, weight loss, metastasis, and bone marrow damage.

The use of the word "cancer" is not correct in relation to tumors of the lymphatic system, but is often used by people far from medicine, for whom this definition indicates the undoubted malignancy of the process. "Cancer of the lymph nodes" is nothing more than high-grade lymphoma or lymphosarcoma. Such terminological subtleties are available only to doctors, so it is excusable for the layman not to know them.

should be distinguished from true lymphomas cancer metastases in the lymph nodes when tumor cells get there with the lymph flow from the focus of neoplasia growth. As a rule, such lesions are found first of all near the organ in which the cancerous tumor grows. For example, with possible enlargement of the lymph nodes around the trachea and bronchi, and histological examination will clearly show the presence of tumor complexes of the epithelial structure in them, and not the pathological proliferation of lymphocytes, as in the case of lymphoma.

Video: medical animation of lymphoma using the example of non-Hodgkin's

Features of the classification

There are many types of lymphomas, and it is not so easy to understand them. Until recently, the division into non-Hodgkin's lymphomas (NHL) and Hodgkin's disease was considered generally accepted., but such a contraposition of one disease to all other tumors is not entirely successful and does not reflect the characteristics of different types of lymphomas, and even more so does not help in determining the prognosis or treatment tactics.

In 1982, it was proposed to divide non-Hodgkin's lymphomas into low-grade and high-grade neoplasms., and within each of this group to distinguish types depending on the morphological features of tumor cells. This classification was convenient for clinical use by oncologists and hematologists, but today it is outdated, since it includes only 16 subtypes of non-Hodgkin's lymphomas.

The most modern is the WHO classification, developed in 2008 on the basis of the European-American classification, proposed and refined at the end of the last century. More than 80 varieties of non-Hodgkin's lymphomas are grouped according to the degree of maturity of tumor cells and their origin (T-cell, B-cell, large cell, etc.).

Hodgkin's lymphoma (lymphogranulomatosis), although it is called lymphoma, but, in fact, it is not, since the neoplasm is made up of cells of macrophage and monocytic origin, and not lymphocytes and their predecessors, therefore, the disease is usually considered separately from other lymphomas, formerly referred to as non-Hodgkin's, but within the framework of malignant neoplasms lymphoid tissue in which it develops. Lymphogranulomatosis is accompanied by the formation of peculiar nodules (granulomas) from specific tumor cells, so this name more accurately defines the essence of the disease, but still the well-established "Hodgkin's lymphoma" is more familiar and widely used to this day.

According to the prevalence of the tumor, there are:

Nodular lymphoma (a similarity of lymphoid follicles is found in the cortical and medulla of the lymph node).
Diffuse tumor (diffuse tumor lesion of many lymph nodes and internal organs).

By origin and source of growth of lymphoma are:

Primary.
Secondary.
T-cell.
B-cell.

The degree of differentiation of tumor cells implies the isolation of neoplasms:

Low degree of malignancy.
High degree of malignancy.

Learn more about the types of non-Hodgkin's lymphomas

Non-Hodgkin's lymphoma is a rather broad concept, so the suspicion of such a tumor always requires clarification of the degree of its malignancy and the source of education.

There are two groups of lymphocytes in lymphoid tissue: T-lymphocytes and B-lymphocytes.. The former are necessary for the implementation of cellular immunity, that is, they themselves are directly involved in the capture and inactivation of foreign particles, B-lymphocytes are able to form antibodies - specific proteins that bind to a foreign agent (virus, bacterium, fungus) and neutralize it. In lymphoid tissue, these cells are grouped into follicles (nodules), where the center is predominantly B-lymphocytic, and the periphery is T-cell. Under appropriate conditions, inadequate reproduction of cells of a particular zone occurs, which is reflected in the definition of the type of neoplasm.

Depending on the maturity of the tumor cells, lymphomas can be low or high degree of malignancy. The first group includes neoplasms that develop from small or large lymphocytes, cells with split nuclei, and the second group includes immunoblastic, lymphoblastic sarcomas, Burkitt's lymphoma, etc., the source of which is immature cells of the lymphoid series.

If a lymphosarcoma grows from an already existing benign lymphoma, then it will be called secondary. In cases where the root cause of the tumor cannot be established, that is, a previous mature lymphoid tumor is not detected, they speak of primary lymphoma.

Mature cell lymphomas (lymphocytomas)

Relatively benign lymphomas originate from mature lymphocytes, so many years can be almost asymptomatic, and the only sign of the disease will be an increase in lymph nodes. Since this is not accompanied by any painful sensations, and lymphadenopathy or lymphadenitis with various infections is a fairly frequent phenomenon, it does not cause due attention from the patient. With the further development of the disease, signs of tumor intoxication, weakness appear, the patient begins to lose weight, which makes him go to the doctor.

Approximately a quarter of all mature cell lymphomas eventually transform into lymphosarcoma, which will respond well to treatment. A local change in the lymphoid tissue or damage to any one organ, an increase in the number of lymphocytes in the blood test, as well as the presence of rapidly multiplying mature lymphocytes in the affected lymph node should be the reason for the timely treatment of a still benign tumor.

B-cell non-Hodgkin's lymphomas

The most common variant of non-Hodgkin B-cell lymphoma is neoplasia from the cells of the center of the lymphoid follicle, which makes up about half of all the NHL.

Such a tumor of the lymph nodes is diagnosed more often in older people and does not always have the same manifestations. The maturity of tumor cells predetermines either a non-progressive course for a long time, when patients 4-6 years old feel relatively well and practically do not complain, or the tumor behaves aggressively from the very beginning and quickly spreads to various groups of lymph nodes.

Lymphocytoma of the spleen It also predominantly affects the elderly. Being relatively benign, for a long time it is manifested only by an increase in some groups of lymph nodes (cervical, axillary) and the spleen. A feature of this type of lymphoma is the stabilization of the condition of patients and long-term remission after removal of the spleen.

In some cases, the tumor lesion is found in the mucous membranes gastrointestinal tract, respiratory system, in the skin, thyroid gland. Such lymphomas are called MALT-omas and are considered low-grade neoplasms. Symptoms of this type of lymphoma, localized in the gastrointestinal tract, may resemble a stomach or duodenal ulcer, and they can even be detected by chance during endoscopic examination for gastritis or ulcers. Lymphoma of the stomach is associated with the carriage of a Helicobacter pylori infection, which causes a response from the mucous membrane in the form of an increase and the formation of new lymphoid follicles, when the likelihood of a tumor due to the multiplication of lymphocytes increases.

"Cancer of the lymph nodes in the neck" patients may name a tumor from the cells of the mantle zone of the lymphoid follicle, in which a typical symptom is an increase in lymph nodes in the neck and under the lower jaw. The tonsils may also be involved in the pathological process. The disease proceeds with symptoms of intoxication, fever, headaches, signs of damage to the liver, spleen and gastrointestinal tract.

T-cell lymphomas

T-cell lymphomas often affect the skin and are represented by mycosis fungoides and Cesari's syndrome. Like most of these tumors, they are more common in men over 55 years of age.

Fungal mycosis is a T-cell lymphoma of the skin, accompanied by its redness, bluishness, severe itching, peeling and blistering, which lead to induration, the appearance of mushroom-like growths that tend to ulcerate and cause pain. An increase in peripheral lymph nodes is characteristic, and with the progression of the tumor, its sections can also be found in the internal organs. In the advanced stage of the disease, symptoms of tumor intoxication are pronounced.

manifestations of various forms of lymphoma

Cesari disease manifested by a diffuse lesion of the skin, which becomes bright red, flaky, itchy, hair loss occurs and the structure of the nails is disturbed. For characteristic appearance these manifestations are sometimes referred to as the "red man" symptom. Today, many scientists tend to consider Cesari's disease as one of the stages of mycosis fungoides, when tumor cells reach the bone marrow due to tumor progression (lymphoma leukemization).

It is worth noting that skin forms have a more favorable prognosis in the absence of involvement of the lymph nodes, and the most dangerous option is the one that is accompanied by damage to the internal organs - the liver, lungs, spleen. Patients with this form of T-cell cutaneous lymphoma live on average for about a year. In addition to the tumor itself, the cause of death of patients is often infectious complications, the conditions for which are created on the skin affected by the tumor.

T- and B-cell lymphosarcomas

Lymphosarcomas, that is, malignant tumors from immature lymphocytes, are accompanied by damage to many lymph nodes, including the mediastinum and abdominal cavity, spleen, skin, and tumor intoxication. Such neoplasms metastasize rather quickly, grow into the surrounding tissue and disrupt the outflow of lymph, which leads to severe edema. Like mature lymphomas, they can be either B-cell or T-cell.

diffuseB-large cell lymphosarcoma lymph nodes account for about a third of all cases of non-Hodgkin's lymphoma, more often diagnosed in people over 60 years of age, growing rapidly and rapidly, but about half of the patients can be cured completely.

The disease begins with an increase in the supraclavicular and cervical lymph nodes, which thicken, form conglomerates and grow into the surrounding tissue, so it is no longer possible to determine their boundaries at this stage. Compression of the veins and lymphatic vessels leads to swelling, and nerve involvement causes severe pain.

Follicular lymphoma, unlike the previous form, grows slowly, develops from the cells of the central part of the lymphoid follicle, but over time it can go into a diffuse form with rapid progression of the disease.

In addition to the lymph nodes, B-cell lymphosarcomas can affect the mediastinum (more often in young women), the thymus, stomach, lungs, small intestine, myocardium and even the brain. Symptoms of the tumor will be due to its localization: cough, pain in chest with a pulmonary form, abdominal pain and impaired stool with damage to the intestines and stomach, impaired swallowing and breathing due to compression of the mediastinal organs, headaches with nausea and vomiting, focal neurological symptoms in brain lymphosarcoma, etc.

A peculiar type of undifferentiated malignant tumors of lymphoid tissue is Burkitt's lymphoma, which is most common among residents of Central Africa, especially children and young men. The disease is caused by the Epstein-Barr virus, which can be found in approximately 95% of patients. Interest in this lymphoma is due to the fact that new cases of it began to be recorded during the spread of HIV infection, and then, in addition to the inhabitants of the African continent, Europeans and Americans began to appear among patients.

atypical lymphocytes in Epstein-Barr virus infection

A characteristic feature of Burkitt's lymphoma is the defeat of the predominantly facial skeleton, which leads to tumor growths in the upper jaw, orbit, severe edema and deformation of facial tissues ( shown in the photo above.). Quite often tumor nodes are found in an abdominal cavity, ovaries, mammary glands and covers of a brain.

The progressive course of the tumor leads to rapid exhaustion, patients experience fever, weakness, severe sweating, and pain is also possible.

With HIV infection in the AIDS stage (final stage), pronounced immunodeficiency contributes not only to the introduction of tumor-causing viruses into the body, but also to a significant weakening of the natural antitumor defense, therefore, lymphomas are often a marker of the terminal phase of the disease.

T-lymphoblastic lymphoma is much less common, than B-cell tumors, their symptoms are very similar, but neoplasias originating from T-cells progress faster and are accompanied by a more severe course.

Summing up, we can identify the main features and symptoms of lymphoma:

Mature tumors are characterized by a long benign course, while malignant lymphosarcomas, originating from poorly or undifferentiated cells, are characterized by rapid progression, damage to many organs, involvement of surrounding tissues and metastasis.
Lymphomas often transform into lymphosarcomas, but at the same time they retain high sensitivity to therapy and the likelihood of long-term remission or complete cure.
Symptoms of lymphomas and lymphosarcomas include:
1. obligatory damage to the lymph nodes or lymphoid tissue of internal organs - one or many groups, both peripheral and located inside the body (in the abdominal cavity, mediastinum);
2. signs of intoxication and the oncological process - weight loss, weakness, fever, sweating, loss of appetite;
3. swelling of tissues due to impaired lymph flow through the lymph nodes affected by the tumor;
4. symptoms of organ damage and skin with appropriate localization of the tumor or its metastases (shortness of breath, cough, nausea, vomiting, gastric or intestinal bleeding, signs of damage to the nervous system, etc.);
5. anemia, thrombocytopenia with bleeding, impaired immune defense when colonized by tumor cells in the bone marrow and the transition of lymphoma to leukemia.

In the process of the spread of tumor cells throughout the body, they may be introduced into the bone marrow (lymphoma leukemization), then the manifestations and response to the treatment will correspond to leukemia. The likelihood of such a development of events is greater in aggressive immature types of lymphosarcomas, which are prone to metastasis and damage to many internal organs.

Hodgkin's disease (lymphogranulomatosis)

Hodgkin's lymphoma was first described at the beginning of the 19th century by Thomas Hodgkin, but the development of medical science of that time involved the observation of symptoms and clinical features disease, while laboratory "reinforcement" of the diagnosis has not yet been. Today it is possible not only to make a diagnosis on the basis of a microscopic examination of the lymph nodes, but also to conduct immunophenotyping in order to identify specific surface proteins of tumor cells, and the result of a detailed study of tumor tissues will be the determination of the stage and variant of the disease, which will affect both treatment tactics and prognosis.

As noted above, until recently, Hodgkin's disease was opposed to all other types of lymphomas, and this made a certain sense. The fact is that with lymphogranulomatosis in the lymphoid organs, a specific tumor process is observed with the appearance of peculiar cells that are not found in any other type of lymphoma. In addition, a feature that distinguishes lymphogranulomatosis from other lymphomas is the monocyte-macrophage origin of the parent tumor cell, and in lymphomas, the tumor always grows from lymphocytes, whether undifferentiated, young or already mature forms.

Causes and forms of Hodgkin's disease

Disputes about the causes of lymphogranulomatosis (LGM) do not subside to this day. Most scientists are inclined to the viral nature of the disease, but the influence of radiation, immune suppression, genetic predisposition is also discussed.

In more than half of patients, Epstein-Barr virus DNA can be detected in tumor tissues, which indirectly indicates the role of infection in the development of neoplasia. Among the sick, men are more common, especially Caucasians. The peak incidence occurs at a young age (20-30 years) and after 55 years.

The main change that reliably indicates Hodgkin's disease is the detection in the affected lymph nodes of large Reed-Berezovsky-Sternberg cells and small Hodgkin cells, which are the predecessors of the former.

Depending on the cellular composition of the lymph nodes, there are:

Lymphohistiocytic variant of LGM, when mature forms of lymphocytes predominate in the lymph nodes. This type of disease is considered the most favorable, most often found on early stage and allows the patient to live 10-15 years or more.
The nodular-sclerotic form of LGM, which accounts for about half of all cases of the disease, is more common in young women and is characterized by thickening of the lymph nodes due to sclerosis (proliferation of connective tissue). The prognosis is usually good.
The mixed cell variant is diagnosed in childhood or old age, the lymph nodes have a variety of cellular composition(lymphocytes, plasma cells, eosinophilic leukocytes, fibroblasts), and the tumor is prone to generalization. With this form of Hodgkin's lymphoma, the prognosis is very serious - the average life expectancy after diagnosis is about 3-4 years, the symptoms of a generalized lesion are rapidly growing and are accompanied by the involvement of many internal organs.
The LGM variant with suppression of lymphoid tissue is the rarest and, at the same time, the most severe, corresponding to stage IV of the disease. With this form of Hodgkin's disease, lymphocytes in the lymph nodes are not detected at all, fibrosis is characteristic, and the five-year survival rate is only about 35%.

stages of lymphoma, depending on the degree of organ damage

The stages of Hodgkin's lymphoma (I-IV) are determined by the number and localization of the affected lymph nodes or organs, as well as on the basis of the examination of the patient, clarification of complaints and symptoms with the involvement of laboratory and instrumental diagnostic methods. Be sure to indicate the presence or absence of symptoms of intoxication that affect the determination of the prognosis.

Manifestations of lymphogranulomatosis

LGM has quite diverse Clinical signs, and even the onset of the disease in different patients can proceed in different ways. In most cases, there is an increase in peripheral lymph nodes - cervical, supraclavicular, axillary and other groups. At first, such lymph nodes are mobile, do not cause pain and anxiety, but in the future they become denser, merge with each other, the skin over them may become red. In some cases, the lymph nodes can be painful, especially after drinking alcohol. An increase in body temperature and intoxication are not typical in the initial stages of the disease.

Approximately one-fifth of patients call the appearance of dry cough, shortness of breath, chest pain, swelling of the neck veins as the first signs of trouble. Such symptoms give an increase in the lymph nodes of the mediastinum.

Less commonly, the disease begins suddenly, among full health with fever, sweating, rapid weight loss. The acute onset of LGM indicates a very poor prognosis.

As the tumor process progresses, a phase of detailed clinical manifestations begins, in which there is:

Enlargement of lymph nodes of different groups.
Sharp weakness.
Decreased performance.
Sweating, especially strong at night and during periods of fluctuations in body temperature.
Pain in the bones.
Fever.
Skin itching, both in the area of the affected lymph nodes, and throughout the body.

In addition to such "general" symptoms, enlarged lymph nodes can cause other disorders, squeezing blood vessels, gland ducts, and internal organs. The advanced stage of LGM patients can call "cancer of the lymphatic system", since there is a lesion of the lymphoid organs, which can no longer be confused with banal lymphadenitis or lymphadenopathy, there is a tendency to progress and worsen the patient's condition.

Enlarged lymph nodes are found in different parts of the body, they are dense, form conglomerates, but are never associated with the skin. Almost always, such changes are observed on the neck, in the axillary region. If the lymph nodes of the abdominal cavity are affected, jaundice may occur due to compression of the gallbladder duct. Sometimes the lymph nodes increase to such a size that they can be easily felt through the anterior abdominal wall.

Signs of a tumor process in the pelvic, inguinal lymph nodes can be pronounced swelling of the legs, since the outflow of lymph from lower extremities. Retroperitoneal lymph nodes can compress the spinal cord and ureters.

The spread of the tumor from the lymph nodes to the internal organs leads to the addition of more and more new symptoms. So, with the defeat of the gastrointestinal tract, patients experience pain, diarrhea, bloating, which increases exhaustion and can lead to dehydration. Involvement of the liver is considered a bad sign and is manifested by jaundice, bitterness in the mouth, enlargement of the liver. Almost half of the patients suffer from lung damage, which is manifested by cough, shortness of breath, chest pain. The spleen in the period of a widespread tumor process increases almost always.

Tumor cells with lymph flow can move from the lymph nodes or internal organs to the bones, which is quite typical for all variants of the course of LGM. Usually, the spine, ribs, pelvic bones and sternum are exposed to tumor damage. Bone pain is the main sign of metastasis of a malignant tumor in them.

Diagnosis and treatment of tumors of the lymphatic system

Diagnosis of tumors of the lymphatic system requires a thorough examination of the patient and the involvement of all kinds of laboratory and instrumental methods. In some cases, complex and rather expensive cyto- and molecular-genetic, immunohistochemical studies may be required to establish the exact type of tumor.

Since all tumors of lymphoid tissue are accompanied by an increase in lymph nodes, the detection of such a sign should always be alarming. Of course, you should not immediately panic and think about the worst if, for example, the submandibular or inguinal lymph nodes have increased, because this often happens against the background of various infections and fairly common diseases (tonsillitis, infections of the genital tract). Pet lovers can find enlarged lymph nodes after a cat scratch, and those who do not follow oral hygiene almost constantly feel enlarged lymph nodes under the lower jaw.

In the case of the infectious nature of lymphadenopathy, the appointment of antibiotics always leads to a subsidence of the inflammatory process and a decrease in the size of the lymph nodes. If this does not happen, then there is a need for a detailed examination.

First of all, the doctor will find out in detail the nature of the complaints, the time of their occurrence and duration, the presence of signs of intoxication in the form of weight loss, unexplained fever or night sweats.

Laboratory confirmation of the diagnosis involves : general analysis blood, in which it is possible to detect an increase in the number of lymphocytes with some leukopenia, an acceleration of ESR.

The main and most reliable way to diagnose lymphomas is considered to be a biopsy of the lymph node. when its fragment is taken for microscopic examination for the presence of tumor cells. Sometimes it becomes necessary to re-take material for research or remove the entire lymph node.

lymph node biopsy

To further clarify the diagnosis, establish its stage, prevalence and nature of changes in the internal organs, use:

X-ray of the chest organs.
CT, MRI (for examining the liver, spleen, brain, lungs, neck, etc.)
Fibroesophagogastroscopy (with suspected primary lymphomas or the spread of the tumor process from other organs).
Radioisotope bone scan.
Puncture with bone marrow biopsy.

diagnostic image of a patient with lymphoma, pos. B - the result of 3 months of chemotherapy

The choice of the examination scheme depends on the type and localization of the tumor and is determined by the oncologist individually for each patient. Once a diagnosis has been made, it is necessary to further treatment lymphoma, which involves the appointment of chemotherapy drugs, radiation and even surgery.

Surgical treatment has very limited use in lymphomas and is used more often in isolated forms of tumors or to alleviate the patient's condition in advanced stages, reduce pain syndrome or pressure of enlarged lymph nodes on internal organs. In the case of a primary lesion of the spleen, they resort to its removal, which gives a very good therapeutic effect and even a complete cure for the tumor.

- main and most effective method fighting tumors of the lymphatic system. The administration of chemotherapy drugs makes it possible to achieve long-term remission in many patients, even with aggressive high-grade lymphomas. Elderly and debilitated patients may be prescribed a single antitumor drug, while blast forms in young people require the use of programs for the treatment of acute lymphocytic leukemia.

With aggressive low-grade tumors, the simultaneous administration of 5-6 drugs shows itself well. Of course, this treatment comes with risks. side effects, but the correction of emerging disorders, monitoring of blood counts, the appointment of antiemetics, antibiotics, vitamins and trace elements contribute to its better tolerability.

Radiation may be given in parallel with or before chemotherapy, especially in cases of local lesions, as well as the spread of the tumor in the bones, mediastinal organs.

Bone marrow transplantation may be a promising way to fight the tumor or individual blood cells of both the patient and the donor. If the lymphoma has spread to the bone marrow, only a donor organ can be used.

As regards self-employment and folk remedies, so loved by many, once again you just need to be reminded that cancer is not the case when you can refuse official medicine in favor of the unconventional. Such neglect of one's health can cost one's life.

In conclusion, I would like to note that most lymphomas still respond well to treatment provided timely diagnosis and initiation of therapy. Do not waste time, wait until it “passes by itself” or trust your health to traditional healers. In case of any trouble, you should immediately contact an oncologist who is able to provide qualified assistance aimed at prolonging life and healing.

Video: lymphoma in the program “Live Healthy!”

The author selectively answers adequate questions from readers within his competence and only within the limits of the OncoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not currently provided.

Modern methods of treating malignant oncological pathologies have a more qualitative and radical effect on education, kill cancer cells and prevent the development of new ones.

But, despite the achievements of scientists, the disease has not yet been defeated - millions of people on the planet die every year from cancer.

Very often, the ineffectiveness of treatment is determined by too late diagnosis of the disease. That is why it is so important, having noticed the first signs of the presence of a tumor, immediately contact the clinic.

Lymphoma is one of the manifestations of cancers in the blood cells. Pathology begins to develop in the lymphoid tissues, which determined its name.

This type of cancer is characterized by an aggressive course and an extremely unfavorable prognosis for survival, since its first stages are almost asymptomatic.

Through the lymphatic flows, cancer quickly spreads throughout the human body, affecting vital departments and systems.

Manifestations

Like any oncological disease, lymphoma in adults has certain symptomatic signs, by the presence of which, with a high degree of probability, this pathology can be diagnosed. Allocate general and local features.

Common symptoms include symptoms that are inherent in any cancerous manifestation, regardless of its location. To local - signs indicating the defeat of malignant tumors of a particular organ.

If we analyze the symptoms of the course of the disease as a whole, then we can identify a number of the most important manifestations, the presence of which should alert a person and encourage him to go to the clinic.

Enlarged lymph nodes

Several dozen diagnoses have been identified in which the lymphatic system reacts to their development with inflammation of the nodal joints. However, in this case, the picture of their condition is specific - the increase is not infectious.

Almost until the advanced stages of cancer, they do not cause pain, the exception is pronounced discomfort against the background of the use of alcoholic beverages.

In this case, the reason for the increase is their overload as a filtering substance with toxins, which are the product of the vital activity of cancer-affected cells. Settling on its walls, they are firmly fixed and begin to randomly divide, multiplying in volume.

In proportion to these processes, the lymph nodes also swell. With lymphoma in adults, the submandibular and axillary zones of the system are most susceptible to this phenomenon.

With ultrasound, it is possible to determine the presence of a tumor precisely by their condition - normally, the node, even in a state of inflammation, has pronounced gaps in its central part, and if the cause of the increase is oncology, the entire department will be darkened. Very often, it is on this symptom that the pathology is diagnosed.

Sweating at night

Many patients do not understand the connection between night sweats and cancer. In fact, everything is simple - the body, even at night, is in a state of constant struggle with a dangerous formation. At this point, nothing distracts him from trying to help himself, which is manifested in excessive sweating.

This is especially pronounced when the processes of metastasis are actively working, squeezing the brain sections of the back in combination with the therapy of analgesics of the opioid class.

In the body of the patient, endocrine functions fail, the temperature rises.- and as a result - sweating. The armpits, face, upper and lower extremities are most affected.

Periodic increase in temperature

The symptom belongs to the category of general and accompanies almost all oncological diagnoses. At the same time, its manifestation is somewhat specific. As a rule, the indicator of temperature increase against the background of the development of a cancerous anomaly is very insignificant - it rises by only a few divisions.

In the case of this disease, everything is different - a thermometer reaches a mark of 38.5 - 39 ° C and can be kept at this level for several weeks. At the same time, it is almost impossible to stop it - after the end of the drug, the temperature rises again.

Accompanied by sweating, alternating with chills. The symptom itself is favorable, since the fact of an increase in temperature is immune emissions with which the body tries to protect itself and suppress the tumor.

It is characteristic that at the final stages of the course of the disease in adult patients, when defensive forces the body is already running out, temperature fluctuations have not been detected.

Sudden weight loss

Occurs without any reason and manifests itself in a sharp decrease in body weight, more than 10% of the previously existing weight. As a rule, it takes 1.5 - 2 months for a person to lose such a number of kilograms against the background of the development of pathology.

A sharp decrease in body weight occurs in this case, for the following reasons:

decreased appetite- the human body intuitively reacts to any deviations in its functioning, and trying to save itself from the additional load (and self-fight against pathology, this is a load!), As a result daily dose nutrients and calories are reduced;
forced loss of nutrients- in our case, with sweating;
increased energy demand- the main forces are expended on the fight against cancer, the energy of which is hardly restored by a rather meager diet.

Constant fatigue

In this case, constant fatigue and lethargy manifests itself as a paralyzing sensation that occurs sporadically, for no apparent reason - a person feels tired even with minimal physical exertion, and this state persists already at the moment of morning awakening.

This phenomenon does not depend on the energy expended during the day. In this case, often, the inability to focus and concentrate on something specific causes spontaneous bouts of nausea.

Constant fatigue is a consequence of the ability of this type of oncological anomaly to release protein cytotoxins, which, being in normal concentration, effectively resist pests, and in excess - exude the body's strength.

Fever

Fever almost 100% accompanies lymphoma in an adult. It is the result of an attached infection that occurs against the background of a growing malignant tumor of the organ.

Education actively produces pyrogenic components, which, in turn, cause fever, negatively affecting the thermoregulation zones. In addition, pronounced necrosis of tissues affected by the cell mutation plays an important role in this process.

Skin rashes

Skin rashes are characteristic only of certain types of oncological pathologies. The specificity of this form of cancer is its rapid spread throughout the body due to the fact that pathological cells freely germinate into other organs, flowing through the human body with lymphatic and blood flows.

On the background sharp decline the immune forces of the sick organism, the pathology with blood enters any zones and departments, manifesting itself with epithelial rashes, redness and skin manifestations.

Nature given symptom hidden in the irresistible desire of the body to get rid of toxins by forcibly removing them to the outside through penetration through the epithelial tissues. This process, in fact, is a rash that removes toxic elements.

Types and distinctive manifestations

Under this term, a number of oncological pathologies affecting the lymphatic tissues are concentrated. Thanks to them precise classification it is possible to develop an optimal therapeutic scheme for eliminating the tumor:

Hodgkin's lymphoma- it is distinguished by specific cells localized in the affected tissue fragments. The disease spreads sequentially, by the gradual transition of cancerous components from one node to another. It has a more optimistic prognosis and is relatively easy to treat;
non-Hodgkin's lymphomas- consist of subspecies of anomaly, different in the area of education, and differing in specific manifestations for each type of tissue. All of them are characterized by individual clinical picture, atypical histology, which determines the optimal scheme of therapeutic effects on the tumor;

lymphedema- pathologies affecting the area of \u200b\u200bthe limbs due to severe hypoplasia of the lymph node connections. Moderate lymphedema develops in the process of outflow of lymphatic fluid into the inner subcutaneous layers. The more the disease progresses, the more pronounced the processes of swelling of soft tissues.

It can be either congenital, at the genetic level, or acquired against the background of developed oncology lymphoma in adult patients. Distinctive feature anomalies - symmetrical sequential damage to the limbs from the bottom, to their base;

lymphangiosarcoma- a malignant pathology occurring in the lymphatic endothelium. The disease is extremely rare, but deadly for a sick person. It is usually preceded by a long time period of lymphostasis, which has an extremely negative effect on the quality of the walls of the system and vascular tissues.

They develop after the patient has already been treated for lymphoma by surgical excision. A characteristic feature of the disease is that it most often affects the female half of the adult population diagnosed with lymphoma.

The nature of this phenomenon has not yet been substantiated. To save the patient's life, an urgent radical intervention is required, otherwise the lethal outcome from the defeat of this form of malignant formation of the system can occur very quickly.

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