Lymphoma of the skin non-Hodgkin's t-cell tumor. Survival prognosis for non-Hodgkin's lymphoma. Classification of the disease and clinical signs

Diffuse non-Hodgkin's lymphoma is considered the most common type of lymphoma. It occurs as a result of the production of abnormal lymphocytes by the body, which later pass into lymphoma cells.

The tumor may develop slowly. In this case, they talk about the indolent form of the disease and predict a favorable outcome for the patient. With the aggressive type, the rate of progression increases. The highly aggressive species is characterized by very rapid development.

People at risk for diffuse lymphoma include:

• after transplantation of an organ or bone marrow (in this case, the neoplasm sometimes appears years after surgery);
• with autoimmune diseases (usually immunosuppressants are prescribed that suppress the body's defenses, which provokes the occurrence of lymphoma);
• working in industries with harmful working conditions, exposed to carcinogens, chemicals, as well as woodworking, metal, flour-grinding waste;
• constantly in contact with solvents, chlorophenols, pesticides and other aggressive substances;
• who had a close relative with diffuse non-Hodgkin's lymphoma;
• suffering from hepatitis C, AIDS, insufficient immunity, exposed to harmful radiation.

The chances of developing pathology increase with regular use of alcoholic beverages, as well as smoking, drug addiction, after suffering a serious infectious disease.

Symptoms of diffuse non-Hodgkin's lymphoma

In the early stages, the disease proceeds without a pronounced clinical picture. Its main manifestation is the growth of lymphoid tissue, which begins with the upper half of the body, gradually descending. Lymph nodes remain painless, so a person may not see a doctor.

As the pathology develops, there are:

• fever;
• weakness in the whole body;
• drowsiness;
• sweating at night;
• problems with the gastrointestinal tract;
• visual impairment;
• pain in the joints and throughout the body;
• weight loss for no apparent reason;
• headache;
• sometimes - cough, shortness of breath, difficulty swallowing, rash, itching.

Stages of pathology

The development of the disease is presented in the table:

Diffuse large B-cell lymphoma

One type of non-Hodgkin's lymphoma is diffuse large cell lymphoma. It most often develops in people aged 25 to 40 years (mainly in women) and is accompanied by the following symptoms:

• cough
• shortness of breath;
• difficulty swallowing;
• swelling of the face and neck;
• dizziness;
• enlargement of the lymph nodes.

B-large cell diffuse lymphoma provokes swelling of the liver or spleen, limbs, bloating.

Diffuse large B-cell intravascular lymphoma is accompanied by the following symptoms:

• numbness of hands and feet;
• weakness in the whole body;
• severe headaches;
• vision problems;
• imbalance;
• strong weight loss;
• inflammation and soreness of the skin.

Diffuse large cell lymphoma, like other types of lymphomas, is treated comprehensively.

Diagnosis of the disease

histopicture

First, the patient is examined and complaints are collected. Changes in the skin, limbs, and the whole body are assessed. Next, a general blood test is performed. In the case of the development of pathology, anemia and thrombocytopenia are observed. The biochemical composition of blood is also studied. An increase in the concentration of ALT and AST sometimes indicates the development of liver failure.

To detect tumor cells, a biopsy is performed (tissue sampling from the neoplasm and neighboring areas).

CT, X-ray and ART allow to identify the exact localization of pathological foci, their diameter, and determine the stage of pathology.

To identify the stage of the disease, PET is used to study the metabolism in the tumor.

Therapy Methods

Diffuse non-Hodgkin's lymphoma requires an integrated approach to treatment. Doctors usually prescribe a course of polychemotherapy and chemotherapy. The first is often combined with the use of hormonal agents or radiation therapy. Many patients manage to achieve long-term remission.

Drugs for the treatment of diffuse cellular lymphoma are:

Monoclonal antibodies are used in the treatment of diffuse non-Hodgkin's lymphoma. They recognize special proteins that are localized on the outside of abnormal cells, and then penetrate into them and make the immune system work in the right direction. As a result, the body attacks the tumor cells, causing their destruction.

As a rule, together with antitumor drugs, immunomodulators are prescribed:

1. Interferon with antiviral effect. Changes the properties of cell membranes, increasing their resistance to viral agents. Contraindications for use are: hepatitis, childbearing, heart attacks in the past, disorders in the liver and kidneys, hypersensitivity to the components of the drug.
2. Amiksin. Has a wide range of applications. A fairly strong drug that is not used by pregnant women, as well as lactating women.

Biological treatment of diffuse lymphoma

This type of therapy includes the use of vaccines and sera, as a result of which the immune system begins to respond to foreign proteins. Preparations of protein origin are used after undergoing chemotherapy. This reduces the likelihood of infectious diseases and restore blood formation.

Radioimmunotherapy is considered an additional way to combat large B-cell tumors. During the procedure, monoclonal antibodies are combined with a radioisotope, as a result of which atypical cells die.

Symptomatic treatment

The following are other therapies for diffuse lymphoma:

1. A surgical intervention that is not performed on a tumor, but when problems arise due to it with other parts (organs) of the body.
2. The use of painkillers, anti-inflammatory and antiemetic drugs, as well as hormonal and psychotropic drugs.
3. Radiation therapy aimed at areas of bone metastasis and aimed at pain relief and inflammation.

It is possible to use a sanitizing operation, during which a non-radical excision of the neoplasm is carried out, as well as chemotherapy (to smooth out the symptoms).

Surgery, bone marrow and stem cell transplantation

Surgery is rarely used for diffuse non-Hodgkin's lymphoma. The priority is radiation and chemotherapy. It is impossible to get rid of the problem only by eliminating the affected lymph node. To eliminate the consequences of the disease and prevent the development of complications, bone marrow and stem cell transplantation is required.

Patients treated with surgery generally have a lower quality of life than patients treated with radiation and chemotherapy alone. However, surgery is sometimes mandatory, for example, with intestinal lymphoma.

Nutrition and diet in case of illness

During the fight against pathology, the body experiences a strong load. It is important to choose the right nutrition for the patient. Food must be taken in small portions. It should contain all useful substances. Due to a decrease in appetite, it may be necessary to introduce tasty dishes into the diet.

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

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

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

Forecast

The prognosis at the first stage of diffuse non-Hodgkin's lymphoma is relatively favorable, at the last - poor. There are 5 factors that worsen the prognosis:

• age over 60;
• increased amount of LDH in the blood (at least 2 times);
• overall status over 1 on the ECOG scale;
• 3 and 4 stages of pathology;
• the number of extranodal lesions is more than 1.

Thus, the survival prognosis is determined by the stage of the lymphoma, the age of the patient, and other factors.

Non-Hodgkin's lymphomas include tumor processes of a malignant nature of a lymphoproliferative nature, which have various development scenarios and an unforeseen reaction to drug intervention.

This form of tumor-like formations is characterized by a special malignancy, because only a quarter of patients are cured of it. A distinctive feature of these is the lack of proper response to therapeutic measures traditionally used in the treatment process.

What is non-Hodgkin's lymphoma?

A malignant variety of lymphatic tumors begins to form in tissues of lymphoid origin, but in comparison with Hodgkin's pathology, the further behavior of such tumors cannot be predicted.

In addition, they have a characteristic tendency to germinate in organs that are not part of the structure of the lymphatic system.

The photo shows non-Hodgkin's lymphoma of the orbit of the eye.

In general, prognosis depends on the specific histological type of non-Hodgkin's mass, the adequacy of therapy, and the stage of the lymphoma.

Disease history

Non-Hodgkin's lymphoma has biological and morphological properties, clinic and prognosis that are different from other malignant tumors. Since the 70s of the last century, the tumor in medical circles has been officially called non-Hodgkin's or malignant.

Epidemiology

About 25,000 cases of lymphoma are detected and officially diagnosed among Russians every year, which is only 4% of the total number of pathologies of cancerous origin.

Most patients have non-Hodgkin's lymphoma, and only 12% suffer from Hodgkin's lymphoma.

Causes

The predominant number of such cancerous tumors is formed from B cells, the source of the remaining non-Hodgkin's lymphomas are T cells, which are also called natural killer cells.

It is impossible to name a specific reason for the formation of lymphosarcoma, it is only possible to single out a number of specific factors that contribute to the formation and development of the pathological process. These include:

1. Viral infections like hepatitis or Epstein-Barr, immunodeficiency virus etc.;
2. Helicobacter pylori, which is often blamed for the development of gastric ulcers, can also provoke non-Hodgkin's lymphoma, which is localized in the tissues of the stomach;
3. Old age and obesity, immunodeficiencies of various etiologies also contribute to the formation of lymphosarcomas;
4. Any organ transplant, chemotherapy or radiation exposure e in the treatment of oncological pathologies;
5. Influence of carcinogens like herbicides, insecticides, benzenes;
6. Autoimmune thyroiditis often leads to the formation of thyroid lymphoma.

Symptoms

The main symptom of non-Hodgkin's lymphoma is a typical increase in the size of the lymph nodes, which brings pain. Similar manifestations are observed mainly in the inguinal, axillary or cervical lymph nodes.

There are other signs of lymphosarcoma:

• Weight loss, up to exhaustion;
• Chronic fatigue;
• Night hyper sweating;
• Feeling of itching on the surface of the whole body;
• Feverish state;
• Anemia symptoms.

Types

The lymphatic system resists infectious agents with three different types of lymphocytic cell structures: B cells, T cells, and NK cells (also called natural killer cells).

B-cell tumors

B-cell lymphoma is characterized by high malignancy and rapid extranodal spread. Treatment is effective if it is started at the initial stages of pathology.

In general, B-cell lymphosarcomas are divided into:

• Large cell- when there is a characteristic increase in the cervical or axillary lymph nodes;
• Follicular- when persistent hyperthermia is observed and swelling of the inguinal, axillary and cervical lymph nodes occurs, which causes intense pain;
• Diffuse large B-cell lymphomas- characterized by the formation of specific ulcers and plaque-like rashes on the surface of the skin;
• Lymphosarcomas of the marginal zone- tumors, accompanied by particular soreness at the site of localization, can proceed hidden, prefers the abdominal cavity.

T- and NK

T / NK-cell lymphomas are considered by specialists as aggressive lymphosarcomas, they account for about 12% of clinical cases, among the total number of diagnosed non-Hodgkin's lymphomas.

For mature T/NK-cell lymphosarcomas, the five-year survival prognosis is about one third of the total number of patients.

T-cell

T-cell forms of lymphosarcoma are most common in men, often affecting the lymph nodes and skin cell structures. There are such types of T-cell non-Hodgkin's lymphomas:

• T-lymphoblastic lymphoma;
• peripheral lymphoma;
• T-cell angioimmunoblastic lymphoma;

Classification

Non-Hodgkin's lymphomas are classified according to several parameters:

• According to the rate of progression, non-Hodgkin's lymphomas are:

1. Indolent (lymphoplasmacytic lymphoma, etc.)- characterized by slow and favorable development;
2. Aggressive;
3. Highly aggressive- have the most unfavorable prognosis and usually end in death;

• In accordance with the localization of lymphosarcoma, they are divided into:

1. Nodal- when a tumor forms in the lymph nodes;
2. Extranodal- when lymphosarcoma develops in some other organ;

• Depending on the cytological structure of lymphoma, there are:

1. Small cell;
2. Large cell;

• According to the type of histology, there are:

1. Lymphosarcomas;
2. Immunoblastomas;
3. T-cell lymphoblastomas;
4. Fungal mycosis;
5. Reticulosarcomas;
6. Nodular lymphosarcomas;
7. Follicular lymphomas;
8. Primary nervous system lymphomas;
9. Large cell diffuse lymphosarcomas;
10. Skin cell lymphomas;
11. Burkitt's lymphoma, etc.

Lymphoblastic

For lymphoblastic lymphoma, the formation of large cancers in the abdominal cavity is typical.

Usually, pathology develops secretly with erased or absent symptoms, therefore it is more often detected at relatively late stages of development.

Therefore, patients with a similar diagnosis in 9 out of 10 cases go to the doctor when medicine can no longer help them.

This form of non-Hodgkin's lymphoma is characterized by active and extensive metastasis, which leads to intraorganic lesions of the tissues of the liver, kidneys, spleen, spinal cord, ovaries, etc. The thermal stage of lymphoblastic lymphoma is often accompanied by nervous system paralysis, which invariably entails fatal consequences.

It is almost impossible to cope with lymphoblastic lymphoma in an operative way, because it quickly metastasizes, growing into other systems. Therefore, the main task of treatment is the maximum possible inhibition of cell division of cancer and a decrease in the size of the tumor.

Lymphocytic

For lymphocytic lymphomas, painless symptoms are characteristic, accompanied by generalized or local swelling of the lymph nodes. Such lymphomas consist of finally matured B-lymphocyte cells. Pathology is typical for elderly patients and representatives of the middle age group.

Usually, when such a lymphoma is diagnosed, almost all patients already have a bone marrow lesion, and the tumor itself is at stage 4 of development.

Characteristic features of the tumor are an increase in the spleen and liver, the presence of gastrointestinal lesions. Already at the initial stages of the tumor process, pulmonary, bone tissue lesions and other parenchymal foci may occur.

Intestinal lymphoma

Among extranodal lymphomas, non-Hodgkin tumors of the gastrointestinal tract are the most common. Usually, such localization of the tumor process is secondary, being the result of lymphoma metastasis from the spleen and other intraorganic structures. Symptoms of intestinal lymphoma include:

1. The presence of dyspeptic symptoms;
2. Pain in the abdomen;
3. Enlargement of the spleen;
4. Flatulence;
5. Signs of intestinal obstruction;
6. Nausea;
7. Blood impurities may be found in the feces;
8. Loss of appetite.

A feature of this type of lymphoma is its cytological origin. As a rule, such tumors are formed from B-cell structures. Such tumors develop mainly against the background of Crohn's disease, HIV, protein deficiency in the blood.

NHL spleen

Lymphoma of the spleen of the non-Hodgkin variety occurs predominantly in the elderly. The tumor process usually begins in the marginal area of ​​the spleen.

At first, the pathology develops asymptomatically, but with the progression of the tumor process, the following symptoms of splenic lymphoma appear:

• weight loss;
• Feeling of heaviness in the area of ​​the right hypochondrium;
• Hyper sweating at night;
• Anemia;
• Rapid satiety even after the absorption of a small portion of food, which is associated with the compression effect of the tumor on the stomach;
• Frequent hyperthermia, especially in the evening and at night.

When the tumor begins to grow into neighboring tissues, pain symptoms will appear. In the later stages of the disease, the spleen acquires an alarmingly large size, which is the most characteristic sign of pathology.

Gradually, the cancer process covers the bone marrow and blood cell structures, which is determined during diagnostic studies.

Disease stages and prognosis

If there are three degrees of malignancy in non-Hodgkin's lymphomas - high, low and intermediate - then they have four stages of development:

1. For the initial stage a single lymph node or intraorganic parenchymal lesion is characteristic, which does not have characteristic external symptoms;
2. At 2 stages in patients, several lymph node structures are affected simultaneously or extranodal damage to several organs develops, but only localized on one side relative to the diaphragm. Symptoms may be partially absent;
3. Third the stage suggests the presence of non-Hodgkin's lymphoma, located on both sides of the diaphragm, localized in the chest region and spread to the peritoneum;
4. Terminal(4) the stage of non-Hodgkin's lymphoma is characterized by a severe condition and prognosis, in which the initial location of the tumor process does not matter at all, because the cancer cells have already penetrated the nervous system structures and the bone marrow, and involved the bone skeleton in the oncological process.

Diagnostics

The diagnosis of non-Hodgkin's lymphoma is managed by oncohematologists, who prescribe the necessary procedures:

• Biopsy of lymph node tissues;
• Thoracoscopic examination;
• bone marrow puncture;
• Laparoscopy;
• Radiography; A
• MRI or;
• Lymphoscintigraphy, etc.

Treatment

Therapeutic methods for the treatment of non-Hodgkin's lymphoma are based on the use of radiation therapy, chemotherapy, or surgery.

Surgery is used if the cancerous lesion has an isolated localized character. Radiation treatment is effective when non-Hodgkin's lymphoma has a low grade and is localized.

Sometimes radiation therapy is used when the use of chemotherapy is not possible or contraindicated.

Although most often the main method of treatment of lymphomas is polychemotherapy. Often, this technique is used in combination with radiation, although it is quite effective as an independent treatment. Such a combination of various techniques helps to achieve a more stable and prolonged remission period. Sometimes hormonal treatment is included in the treatment process.

As an alternative, immunotherapeutic effects with interferon preparations, bone marrow transplantation, monoclonal antibody therapy, and the use of stem cells are often used.

Today, effective treatment regimens have been developed based on the complex use of medications, targeted drugs, radiation, etc. And as a result of a polychemotherapeutic approach based on the use of several medications, it is possible to successfully cope with abnormally developed lymphocytes.

How many live in the NHL

In general, the prognosis of lymphatic formations of non-Hodgkin's lymphoma is determined by a kind of tumor scale, where one point is awarded for each unfavorable sign, and then all points are summed up.

• When assessed at 0-2 points - the prognosis is favorable;
• 2-3 points - indefinite;
• 3-5 points - negative prognosis.

Usually, a favorable prognosis is more typical for B-cell lymphotumours, which cannot be asserted with a T-cell origin of the formation. Late stages, high rates of malignancy, advanced age, and some types of tumor formations significantly aggravate the prediction.

The most positive prognosis with a survival rate of 5 years is possible with lymphatic formations of salivary glandular tissues, organs of the gastrointestinal tract, but negative prognosis is typical for tumors of the breast and ovaries, bone tissues and nervous system structures.

Video about the causes of lymphoma, types and stages:

Over the past decades, non-Hodgkin's lymphoma has been increasingly diagnosed by oncologists around the world. The number of deaths from this disease has almost doubled. Compared to 1990, the growth is approximately 4% - 8% per year, depending on the region. Most often, men get sick, and with age, the likelihood of this disease is steadily increasing, both for men and women. In the Russian Federation, about 25 thousand people are registered with such a diagnosis every year, so the question of what constitutes this disease arises more and more often.

Non-Hodgkin's lymphoma (NHL) is a group of diseases that combines about 80 different nosological forms in terms of clinical course, cellular composition and prognosis. The main characteristic of these diseases is the malignant degeneration of lymphocytes with damage to the lymphatic system and internal organs, including, except for.

Disease classification

Non-Hodgkin's lymphoma ICD 10 classifies the disease as follows:

• nodular or follicular
• Peripheral and cutaneous T-cell
• Diffuse non-Hodgkin's lymphoma (common)
• Unrefined and other forms

Classification by cellular composition

Most often in oncological practice, the classification adopted by the World Health Organization is used, which is based on the cellular composition. According to this classification, lymphoma is divided into two types:

1. . As the name implies, B-lymphocytes are affected, which are responsible for the production of antibodies that are responsible for the humoral immune response.

• , men aged about 30 years are more often ill. Curability reaches 50%.
• MALT - marginal zone lymphoma. It affects the stomach, grows very slowly, but is poorly cured.
• Small cell lymphocytic, slowly growing, but not very sensitive to treatment.
• or thymic large cell B - cell lymphoma, most often affects women 30-40 years old. It is curable in 50% of cases.
• Splenic and nodal lymphomas grow slowly.
• Large-cell diffuse B-cell lymphoma, characterized by rapid aggressive development of the disease, typical for men over 60 years of age.
• Follicular lymphoma. Often develops slowly, but can progress to a diffuse form with rapid growth.
• Primary CNS lymphoma is an AIDS-associated disease.

1. Non-Hodgkin's T - cellular lymphoma. It is characterized by a malignant change and uncontrolled growth of T-lymphocytes, which are formed in the thymus and are responsible for the barrier (cellular) immunity of the mucous membranes and skin.

• T - cell lymphoblastic, develops from progenitor cells, young people aged 30-40 years are more likely to get sick, in 75% of cases men. The course is favorable only if the bone marrow is not damaged.
• Extranodal NHL, formed from T-killers, can develop at any age, can be of varying degrees of aggressiveness.
• Anaplastic large cell. More often get sick at a young age, but responds well to treatment.
• Cutaneous T-cell lymphoma (Cesari syndrome), another name is mycosis fungoides. It occurs in patients 50-60 years of age, the growth rate and prognosis often depend on concomitant and background pathology.
• Angioimmunoblastic. It is characterized by a very aggressive course and a poor prognosis.
• T - cell lymphoma with enteropathy. It is highly aggressive and has a poor prognosis. Occurs in patients with gluten intolerance.
• T-cell non-Hodgkin's lymphoma, which affects the subcutaneous fat, another name is panniculitis-like. Poor prognosis due to poor response to chemotherapy.

Classification according to the aggressiveness of the disease

Just as convenient and clinically significant, both for oncologists and patients, is the classification according to the aggressiveness of the process, as this determines the prognosis, treatment tactics and observation. Allocate:

1. 1. Indolent lymphoma- has low aggressiveness, develops slowly, sometimes without showing itself for years, the prognosis for life is usually favorable.
   2. Aggressive NHL uniform- characterized by a high rate of growth and spread, the prognosis depends on the stage at which it was detected and the sensitivity to chemotherapy.
   3. intermediate form- grows gradually, constantly increasing the negative impact.

Possible causes of the disease

Despite the development of medicine, the exact cause of the development of lymphomas has not yet been established. Only for some of them are established risk factors and contributing factors that can cause the development of the disease, but not always it is. Contributing factors can be divided into groups:

1. Infection . For example, the Epstein-Barr virus can trigger the development of Burkitt's lymphoma, a follicular B-cell lymphoma. The T-cell leukemia virus provokes the development of T-cell lymphoma in adults. The bacterium Helicobacter pylori, which causes peptic ulcer disease, can also cause gastric MALT lymphoma. Hepatitis C viruses, human herpes type 8 and HIV infection can also cause lymphomas.
2. Chemical carcinogens and mutagens – insecticides, herbicides, benzenes.
3. Ionizing radiation.
4. Genetic diseases: Chediak-Higashi syndrome, Klinefelter syndrome and ataxia-telangiectasia syndrome.
5. Taking immunosuppressants, with associated pathology.
6. Autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, etc.
7. Old age and obesity.

However, it happens that non-Hodgkin's lymphoma develops in the absence of any of these factors.

Symptoms of the disease

Due to the fact that non-Hodgkin's lymphomas vary in cellular composition, and can affect a variety of organs, they are characterized by a wide variety of symptoms. One common is the defeat of the lymph nodes, both local and widespread.

The most important symptom for lymphomas is lymphadenopathy. Non-Hodgkin's lymphoma, the symptoms of which are very diverse, but not always specific, is suspected with a painless enlargement of the nodes, the presence of general intoxication signs, or symptoms of damage to a specific organ.

For T-cell lymphosarcomas, the following symptoms are characteristic:

• Generalized enlargement of the lymph nodes
• Spleen enlargement or splenomegaly
• Lung and skin damage

Compression syndromes are characteristic of non-Hodgkin's lymphomas and do not occur in Hodgkin's lymphoma:

• Syndrome of the superior vena cava, with damage to the lymph nodes of the mediastinum, is manifested for the first time by hyperemia and swelling of the face.
• When the thymus is affected, compression of the trachea occurs, which is manifested by coughing and shortness of breath.
• Compression of the ureter by pelvic or retroperitoneal lymph nodes, which can lead to hydronephrosis and secondary renal failure.

Lymphoma is a malignant tumor and upon reaching stage 2-3, symptoms appear that are characteristic of any oncological process.

• Rapid fatigue, weakness, decreased performance
• Irritability, emotional lability, apathy.
• Decreased appetite and weight
• Increased sweating at night
• Constant subfebrile or febrile temperature
• When the abdominal and thoracic cavities are affected, pleural effusion and chylous ascites may develop.
• Anemia, initially found in a third of patients with NHL, later develops in almost all forms.

If any of the above symptoms or their complex appears, you should consult a doctor as soon as possible. When determining the prognosis and treatment tactics, it is very important to establish the stage of the disease. For this, a modified classification is used, based on the level of prevalence of the process in the body.

Stages of the disease

There are four stages of non-Hodgkin's lymphoma:

1. I (first) stage. Characterized by the defeat of a single lymph node or the appearance of a single tumor without local manifestations.
2. II (second) stage. It is manifested by the defeat of several lymph nodes or manifestations of extension of the nodes only on one side of the diaphragm (either the abdominal cavity or the chest) with or without local symptoms. In B- and large-cell non-Hodgkin's lymphomas, this stage is divided into operable and inoperable forms.
3. III (third) stage. The process is common on both sides of the diaphragm and epidural types of lymphomas.
4. IV (fourth). Stage 4 non-Hodgkin's lymphoma is the most severe, the last stage, which is characterized by a generalized spread of the process with damage to the bone marrow, central nervous system and skeleton.

Unfortunately, at the first stage, the detection rate of lymphomas is extremely low, more often the diagnosis is made already at the 2nd or 3rd stage of the disease.

Establishing the staging of the process, the degree of aggressiveness and the cellular form is important in order for the prescribed treatment of non-Hodgkin's lymphoma to be as effective as possible.

Diagnosis of non-Hodgkin's lymphomas

Any diagnosis begins with a questioning of the patient, taking an anamnesis, including family and professional, to identify a genetic predisposition or contact with chemical carcinogens. General symptoms of intoxication are revealed, which the patient should inform the doctor about. An examination is carried out, which can reveal enlarged lymph nodes. In addition to enlarged peripheral lymph nodes, one of the first warning signs is often the expansion of the mediastinum, revealed by radiography.

In addition to routine examination methods, such as blood biochemistry, chest radiography, the following set of diagnostic procedures must be performed:

• Ultrasound examination (ultrasound) of the abdominal organs, which allows you to examine the liver, spleen, intra-abdominal lymph nodes, kidneys
• Computed tomography in the localization of the tumor in the head, neck, chest, abdomen, pelvis
• MRI (magnetic resonance imaging) is used in the localization of the tumor in the brain and spinal cord.
• Biopsy, that is, the removal of a fragment of the tumor for histological examination. This method is definitive for establishing an accurate diagnosis.
• Immunohistochemical, molecular genetic, cytogenetic studies to determine the type of lymphoma, in order to clarify the prognosis and prescribe adequate treatment.
• Examination of the bone marrow by puncture or biopsy, in order to find out if it is affected by the tumor process.
• Spinal tap to detect tumor cells in the cerebrospinal fluid
• Radionuclide scanning, to determine the damage to internal organs and bones.

After a complete examination, which includes all of the above methods, the stage of the disease is established. If a diagnosis of non-Hodgkin's lymphoma is established, the prognosis for life, the probability of cure and the rate of development of the disease is determined by the international prognostic index (IPI), which includes the following five factors: the general condition of the patient, the patient's age, the stage of the disease, the presence of damage to internal organs, the level of LDH in blood.

Favorable signs include:

1. The first and second stages of the process at the time of initiation of treatment.
2. The patient's age is up to 60 years.
3. Intactness of internal organs.
4. Good general health.
5. Normal LDH levels.

And the unfavorable are the following:

1. Stages three and four.
2. Age over 60 years.
3. Widespread lesions of the lymph nodes and internal organs.
4. Poor health of the patient.
5. High level of LDH.

This group includes the entire spectrum; from low-grade B-cell neoplasms, which are incurable, but can last for years, to high-grade lymphomas, which quickly lead to death without treatment, but, when treated with modern methods, end in the recovery of a fairly significant number of patients.

What is non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma is the second most common malignant tumor affecting AIDS patients.

Non-Hodgkin's lymphoma of the bone is a rare tumor, accounting for 1% of all non-Hodgkin's lymphomas, often generalizing within a few months after discovery. In half of the cases, primary bone lymphosarcomas develop in people older than 50 years.

Causes of Non-Hodgkin's Lymphoma

The risk of developing lymphoma in HIV-infected people is 60-160 times greater than in people who do not suffer from this infection. The incidence of NHL increases as immunosuppression worsens. Almost half of the patients have a history of AIDS-defining diseases. Non-Hodgkin's lymphomas are also more common in people with immunodeficiency of a different nature.

There is a close relationship between the development of NHL in HIV-infected people with EBV. EBV proteins can be detected in more than 50% of patients with lymphoma, especially immunoblastic and large cell. It is assumed that infection (EBV cells in an HIV-infected patient contributes to their uncontrolled proliferation. Oncogenic mutations have also been identified, for example, in the p53 and C-tuye genes.

The incidence of NHL is on the rise. In the United States, it has increased by 3-4% annually since the 1970s and currently stands at approximately 15 cases per 100,000 population. The pathogenesis of most NHL remains unclear, but some etiological factors have been identified.

• Longevity.
• Long-term immunosuppression, such as congenital immunodeficiencies, HIV infection (AIDS-associated HXL), post-transplant lymphoproliferative disease.
• EBV infection in Burkitt's lymphoma, lymphomach in HIV-infected and organ transplant patients.
• Helicobacter pylori infection in intestinal lymphomas.
• Chlamydia infection in lymphomas from the cells of the marginal zone of the appendages of the eye.
• HCV in marginal zone cell lymphomas.
• Systematic hair coloring.

Approximately 80% of NHL cases in HIV-infected people are characterized by a high degree of malignancy.

In 90% of cases or more, the tumor is represented by immunoblastic or berlitt-like lymphoma.

In immunocompromised patients, lymphoma is not always monoclonal. Polyclonal lymphomas are sometimes encountered, which indicates their high propensity to metastasize.

Non-Hodgkin's lymphoma (lymphosarcoma of the bone) was formerly considered to be a reticulosarcoma of the bone. Later, on the basis of clinical, histological, immunophenotypic and genetic data, it was found that the tumor cells of bone reticulosarcoma and extraskeletal malignant lymphomas have a single lymphoid origin. In fact, bone reticulosarcoma is an analogue of lymphoma that occurs extraskeletal, more often in the lymph nodes. In contrast to lymphogranulomatosis, this tumor began to be referred to as non-Hodgkin's lymphoma or primary lymphosarcoma of the bone.

Typical localizations are vertebrae, flat bones (pelvis, ribs, sternum) and metaphyses of long tubular bones. Often the disease begins with a pathological fracture.

Morphologically, all lymphomas of the bone are divided into low-, moderately and highly differentiated forms. Most bone lymphosarcomas are large cell or mixed small-large cell diffuse forms (often B-cell, rarely T-cell and KT-cell). Cells of lymphosarcoma are characterized by more pronounced polymorphism compared with tumors of the Ewing's sarcoma family and other small round cell sarcomas and are surrounded by a distinct network of reticulin argyrophilic fibers. The presence of reactive lymphocytes sometimes makes diagnosis difficult.

Classification of non-Hodgkin's lymphomas

Immunological identification of lymphocytes and molecular analysis of immunoglobulin and the gene rearrangement of its receptor in T-lymphocytes have made it possible to develop a more advanced classification of NHL based on biological rather than morphological features of cells. Most non-Hodgkin's lymphomas are B-cell.

Currently, the WHO classification is used. It is based on the pathology of NHL, its origin (T- or B-lymphocytes) and the collective opinion of experienced specialists about the belonging of this tumor to one or another type of lymphoma.

In everyday practice, the clinical features of lymphoma, in particular its malignant potential, are the most important parameter in choosing treatment tactics. They are taken into account in the classification that divides these tumors into two large groups: low ("flaccid", low-grade) lymphomas and high ("aggressive", nigh-gracle) lymphomas of malignancy.

Symptoms, signs and stages of non-Hodgkin's lymphoma

The tumor manifests itself clinically in the advanced stage of HIV infection.

Often, an extranodal lesion is found. In 80% of patients, the tumor process at the time of diagnosis corresponds to stage IV and proceeds with the involvement of the gastrointestinal tract, bone marrow, central nervous system, liver, as well as recurrent cancerous effusion in the body cavities.

Differential diagnosis includes tuberculosis and cytomegalovirus infection.

The majority of adult patients (60-70%) of NHL present to the doctor with complaints of swollen lymph nodes, while in children, extranodal lesions are usually the reason for the visit. Usually, a painless enlargement of the lymph nodes of one or more anatomical regions is noted. In low-grade NHL, lymph node enlargement may persist for a long time or progress slowly, while in high-grade lymphomas, the lymph nodes continue to rapidly crown. Hepatosplenomegaly is often noted. Extranodal lesions are characterized by a variety of clinical manifestations. These lesions affect the intestines, testicles, thyroid gland, bones, muscles, and lungs. CNS, paranasal sinuses, skin. Common symptoms include night sweats, weight loss, and fever if blood cultures are negative.

To clarify the diagnosis, a biopsy of the lymph nodes is performed, if there is no lymphadenopathy, then a biopsy of the extranodal lesion. The resulting material is subjected to immunohistochemical, cytogenetic, molecular and morphological studies.

The stage of the tumor process is determined not on the basis of pathomorphological (including surgical intervention) assessment, but on the basis of the results of a clinical and laboratory examination:

• chest x-ray;
• a clinical blood test and a blood smear examination to detect leukemia of the tumor;
• aspiration biopsy and trepanobiopsy of the bone marrow for morphological and cytogenetic studies, as well as immunophenotyping;
• determination of biochemical parameters of liver and kidney functions, calcium and uric acid content in blood serum;
• determination of markers of the tumor process - LDH activity and the amount of p-2-microglobulin;
• other studies - depending on the clinical features of the disease (CT of the head, MRI of the spine, lumbar puncture, bone scintigraphy).

The clinical staging of NHL is a modification of the Ann Arbor classification of stages of Hodgkin's disease.

When X-ray and CT is determined by the destruction of the bone in the form of "corroded", "nostrilous" type of "melting sugar". Sometimes confluent osteolytic foci have fuzzy contours and create a picture of local rarefaction of the bone structure, which, in the absence of changes in the cortical layer, periostosis, and extraosseous component, can be missed on x-ray examination. MRI is generally recognized as the most sensitive method for determining bone marrow infiltration. With an increase in reactive changes, the bone acquires a “variegated” appearance due to a mixed picture of small lytic foci with sclerosed contours and areas of reactive bone (Fig. 4.47).

With the prevalence of reactive changes, the bone affected by lymphosarcoma becomes dense. Less commonly, lymphosarcoma is detected, which causes a cellular restructuring of the bone structure with defibration and fragmentation of the cortical layer. With the progression of the process, the cortical layer is destroyed in a limited area, a mild periostosis and a small extraosseous component appear. With the defeat of the paraarticular parts of the bones, reactive synovitis may join.

Diagnosis and stages of the disease

Clinical and biochemical blood tests, including determination of LDH activity.

Chest X-ray. CT scan of the head, abdomen and pelvis.

Biopsy of lymph nodes (preferably with a thin needle) and bone marrow.

Lumbar puncture and CSF examination, even if there are no symptoms.

At the stage of radiation diagnosis, primary lymphosarcoma of the bone must be differentiated from osteomyelitis, osteosarcoma, chondrosarcoma, Ewing's sarcoma, a rare cellular form of this tumor - with cysts, FD and GCT. When the process is generalized in the skeletal system, lymphosarcoma has to be differentiated from metastases of breast cancer, small cell lung cancer, and multiple myeloma. Each of the listed nosological forms has its own clinical and visualization differential diagnostic criteria, allowing in most cases to clarify the nature of the lesion of the skeletal system. However, sometimes the correct interpretation of the pathological process is possible only after a biopsy of the affected bones.

At the stage of histological examination, differential diagnosis is carried out with other hemoblastoses: myeloid leukemia, anaplastic plasmacytoma, LCH, metastases of small cell carcinoma and round cell sarcomas: Ewing's sarcoma, rhabdomyosarcoma.

Unfavorable prognostic factors

• A history of AIDS-defining diseases or a CD4 count of less than 100 cells per 1 liter.
• Karnofsky score less than 70%.
• Age over 35 years.
• Extranodal involvement, including bone marrow infiltration.
• Increased activity of LDH.
• Immunoblastic subtype of lymphoma.

Treatment of non-Hodgkin's lymphoma

Ideally, the care coordinator at the hospital where the patient is admitted should be a specialist with experience in the treatment of AIDS-associated lymphomas. Administering HAART concomitantly with anticancer therapy reduces the incidence of opportunistic infections and may improve survival. Topical treatment may be effective in stage I or II lymphoma, but in the vast majority of patients with AIDS-associated lymphoma, the disease corresponds to stage IV, when systemic treatment is needed.

Lymphoma is treated with combination chemotherapy. The most commonly used CHOP scheme is in the form of 3-week cycles, although other schemes can be used. Excessive intensification of chemotherapy is difficult for patients to tolerate, partly due to immunodeficiency and a decrease in the functional reserve of the bone marrow. With the defeat of the meninges, chemotherapy drugs (methotrexate and cytarabine) are administered subarachnoidally. Prophylactic subarachnoid chemotherapy is indicated if there is a high risk of meningeal involvement (eg, in patients with paraspinal and paranasal Burkitt's lymphoma or bone marrow lymphoma infiltration) or if CSF testing for EBV is positive.

The effectiveness of treatment (response rate and duration of remission) in HIV-infected patients is lower than in patients with lymphoma of a similar histological structure who do not suffer from this infection. The median survival does not exceed 12 months. Death occurs from recurrence of lymphoma or from opportunistic infections. The survival rate of patients who have a longer remission after chemotherapy is 6-20 months, while a small proportion of patients live longer.

Rituximab, a monoclonal antibody, is used to treat NHL in non-HIV patients. However, opinions about the role in the treatment of NHL in HIV-infected people are controversial. There are no data on its effectiveness, a possible decrease in the number of CD4 lymphocytes and an increase in viral load, confirmed in stage III clinical trials.

Low-grade non-Hodgkin's lymphomas

Low-grade NHL accounts for 20-45% of all NHL. They are prone to dissemination, and by the time they see a doctor, patients usually have widespread lymphadenopathy, hepatosplenomegaly, and often changes in the picture of the blood and bone marrow.

Follicular lymphoma

Follicular lymphoma usually develops in older people, although it also occurs in younger people. Occasionally, by the time of diagnosis, the tumor process corresponds to stage I, when radiation therapy is possible. But more often, follicular lymphoma is diagnosed at stage III or IV, when it is incurable. The disease has an undulating course, and the median survival of patients is 6-10 years. Follicular lymphoma can transform into high-grade NHL.

Lymphoma cells are characterized by reciprocal chromosomal translocation, as a result of which the Bcl-2 oncogene from chromosome 18 moves to chromosome 14 and enters the zone of action of genes that regulate the synthesis of immunoglobulin heavy chains (IgH). Overexpression of the protein product Bcl-2 prevents the onset of apoptosis (programmed death) of the lymphoma cell, so that the basis of lymphoma from the cells of the center of the follicle, in essence, is the uncontrolled accumulation of tumor cells.

Principles of treatment

In a small part of patients whose disease corresponds to stage I, they resort to irradiation of the affected group of lymphatic corners. Sometimes this leads to recovery, but in many patients there are latent tumor foci, which further lead to generalization of the tumor process or relapse.

With an advanced stage of the disease (II and more common stages), chemotherapy is prescribed only with a pronounced clinical picture.

Patients with advanced but asymptomatic disease may be enrolled in a UK clinical trial to compare active-watchful waiting with rituximab in the hope of delaying chemotherapy.

Symptomatic patients are traditionally given first-line chemotherapy with chlorambucil or CVP or CHOP. Randomized trials conducted in recent years have shown that, in terms of response rate and duration of remission, first-line chemotherapy according to the R-CVP regimen is superior to therapy according to the CVP regimen, R-CHOP is superior to CHOP, and R-MCP (response rate 92.4%, disease-free survival 82 .2%) outperforms MCPs (mitoxantrone, chlorambucil, prednisolone) (response rate 75%, recurrence-free survival 50.7%). The long natural course of follicular lymphoma and the wide choice of chemotherapy regimens in the further treatment of patients make it difficult to assess the impact of these regimens on overall survival. However, the 30-month survival after R-MCP chemotherapy was significantly higher than after MCP chemotherapy (89.3% and 75.5%, respectively). It is possible that a longer duration of maintenance therapy with rituximab will further improve treatment outcomes. Rituximab is currently included in all of the above first-line chemotherapy regimens.

Treatment for signs of tumor progression after the first remission includes such means as:

• purine analogs: fludarabine and 2-CDA;
• auto- or allogeneic stem cell transplantation;
• labeled anti-CO20 antibodies;
• IFN alpha;
• rituximab (as a palliative measure without other drugs);
• antisense oligonucleotides to interrupt Bcl-2 protein synthesis.

What should be the optimal combination of the listed methods of treatment is currently unknown. Since none of the existing methods heals zhurchatelno. patients with lymphoma usually have time to try all the available methods over the years of treatment. Of interest is the emergence of antibodies with auto- or allo-oan transplantation of stem cells after pre-transplantation chemotherapy in the giving regimen. Since the result of treatment (the presence of mild minimal residual disease or its absence) correlates with the duration of the zemission, then such intensive therapy may be effective, i.e. induce a long-term remission.

Forecast

The prognostic indicator of follicular lymphoma distinguishes three categories of risk based on clinical parameters - age, stage of conquest, hemoglobin content, LDH activity, and the number of affected groups of lymph nodes. The 10-year survival rate in these three prognostic groups was 76%, 52%, and 24%.

Determination of the gene expression profile also has prognostic value. It is noteworthy that the pattern of T-lymphocyte and monocyte gene expression in an infiltrating lymphoma node can predict survival.

High-grade non-Hodgkin's lymphomas

Tumors of this group include lymphomas with a pronounced ability to involve the CNS in the process - lymphoblastic, Burkitt's lymphoma, adult T-cell leukemia / lymphoma, primary CNS lymphomas and lymphomas with a less pronounced tendency to metastasize to the CNS. However, the frequency of metastasis in the CNS of lymphomas of the last group increases significantly with multiple extranodal lesions, damage to the testicles, colonic sinuses, or paraspinal tissues. Such patients should undergo clinical and instrumental neurological examination and preventive therapy.

Burkitt's lymphoma

endemic.

• Endemic Burkitt's lymphoma exists in the countries of Equatorial Africa.
• 90% of cases are associated with EBV infection.
• In children and young people, the disease is clinically manifested by an increase in cervical lymph nodes.

Non-endemic.

• The role of EBV infection is traced in approximately 20% of cases.
• Abdominal lesions are more common
• Associated with HIV infection

Treatment

Short intensive therapy with the introduction of methotrexate, cyclophosphamide and ifosfamide into the subarachnoid space. Long-term remission in 50-70% of patients can be achieved, for example, with CODOX-M chemotherapy for low-grade lymphoma or alternating between CODOX-M and IVAC for high-grade lymphoma.

Lymphoblastic lymphoma

Lymphoblastic lymphoma is manifested by leukemia, symptoms of compression of the mediastinal organs by enlarged lymphoid tissue, and pleural effusion, is more common in children and usually consists of T-lymphocytes. Treatment consists in the urgent elimination of tumor compression and the prevention of tumor decay syndrome. Intensive chemotherapy according to the schemes used in acute lymphocytic leukemia, in combination with the treatment of CNS metastases, has improved the prognosis in children, but results in adults are still unsatisfactory.

Unfavorable prognostic factors include involvement of the bone marrow in the process, an increase in LDH activity of more than 300 IU/l, age over 30 years, and a delayed response to therapy. Autogenous or allogeneic stem cell transplantation may improve the survival of patients with a poor prognosis.

Diffuse large B-cell lymphoma

This tumor, the most common of high-grade NHL, presents with lymph node involvement or extranodal lesions. Radiation therapy or more commonly used short-term CHOP chemotherapy followed by irradiation of the affected group of lymph nodes can achieve stable remission in 90% of patients in stage IA. In more advanced stages of the disease, chemotherapy according to the R-CHOP scheme has been adopted as standard. The feasibility of this therapy is shown in the GELA study, in which the 3-year relapse-free and overall survival of patients over 60 years of age who received 8 courses of R-CHOP was 53% and 62%, and for patients who received only CHOP, 35% and 51%. In the UK, the National Institute for Improvement in Care (NICE) has approved the R-CHOP regimen as first-line chemotherapy for diffuse large B-cell lymphoma. In Germany, treatment with CHOP supplemented with every 14 days of GCSF showed a higher rate of achieving complete remission (77% and 63.2%, respectively) and a longer time to recurrence of tumor progression with the introduction of GCSF every 21 days compared with pure CHOP scheme.

Recurrent diffuse large B-cell lymphoma

Further treatment of patients with relapses of diffuse large B-cell lymphoma includes high-dose chemotherapy followed by autologous stem cell transplantation. Such tactics are accepted as the standard, if there are no contraindications to it. However, the results of a meta-analysis did not reveal the benefits of high-dose chemotherapy with autologous stem cell transplantation in the first remission of lymphoma.

Prognosis for diffuse B-cell lymphoma

In accordance with the international prognostic indicator, prognostic groups are distinguished taking into account age, stage of the disease, the number of affected groups of lymph nodes, LDH activity and functional activity An indicator corresponding to 0 or 1 point corresponds to a low-risk group 2 points - moderate risk, 3 points - moderately high risk and 4-5 points lam - high risk. The 5-year survival rate for conventional therapy ranges from over 70% for the low-risk group to 20% for the high-risk group.

Recent studies of gene expression of lymphoma cells made it possible to identify variants of diffuse B-cell lymphoma with different biological activity, which significantly improved the prognosis assessment. The prognosis for lymphoma from B-lymphocytes of the germinal center of the follicle is more favorable than for lymphoma from activated B-lymphocytes

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 how fast the tumor develops, it is divided into:

1. indolent- the tumor grows slowly and in most cases the prognosis for the patient is favorable;
2. aggressive;
3. 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:

1. 0 to 2- the outcome of the disease is favorable, most often this refers to formations that arose from B-cells.
2. 2 to 3- it is difficult to determine the forecast.
3. 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:

1. 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.
2. 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.