Non-Hodgkin's aggressive lymphoma. Treatment of non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma- a whole group of more than 30 related diseases that do not have the characteristics of Hodgkin's disease. Lymphoma is a type of cancer that affects the lymphatic system, which consists of lymph nodes (small closed collections of lymphocytes) united by a system of small vessels.

The standardized incidence rates of lympho- and reticulosarcomas range from 2-6.9 in men and 0.9-5 in women.

Non-Hodgkin's lymphoma men get sick much more often than women, their age at the time of diagnosis varies widely.

The occurrence of non-Hodgkin's lymphoma

Etiology The origin of non-Hodgkin's lymphoma is unknown. It is believed that the reason lies in the penetration viral infection in the human body or due to suppression immune system especially after organ transplants. Epstein-Barr virus likely causes Burkett's lymphoma, a type of non-Hodgkin's lymphoma.

The course of non-Hodgkin's lymphoma

Variants of non-Hodgkin's lymphomas (lymphosarcomas) are established in accordance with the WHO morphological classification, which are correlated with the degree of malignancy presented in the International Working Formulation of Non-Hodgkin's Lymphomas for Clinical Use.

Low-grade non-Hodgkin's lymphomas:

lymphocytic, diffuse type;
prolymphocytic, nodular type;
lymphoplasmacytic.

Non-Hodgkin's lymphomas of intermediate grade:

prolymphocytic-lymphoblastic, nodular type;
prolymphocytic, diffuse type;
prolymphocytic-lymphoblastic, diffuse type.

High-grade non-Hodgkin's lymphomas:

immunoblastic, diffuse type;
lymphoblastic (macro-, micro-, with twisted and non-twisted nucleus), diffuse type;
Burkitt's tumor.

Mycosis fungoides, reticulosarcomas (according to modern concepts, most of the latter are represented by lymphoid tumors and a minor part by the histiocytic variant), plasmacytoma, and unclassified lymphomas are allocated to separate sections of the WHO classification.

For nodular lymphosarcoma the formation of pseudofollicular structures is characteristic, which, unlike true follicles, are determined both in the cortical and medulla lymph node, have large sizes, fuzzy contours and a relatively monomorphic cellular composition.

diffuse type growth is characteristic of all variants of non-Hodgkin's lymphomas. Diffuse lymphocytic lymphosarcoma characterized by a total proliferation of cells such as small lymphocytes that infiltrate the walls of blood vessels, which leads to the complete erasure of the normal pattern of the lymph node. Such changes are similar to those detected in CLL, and therefore a complex of clinical and hematological signs (time parameters, localization of the tumor process, picture of peripheral blood, bone marrow, etc.) is of decisive importance in differential diagnosis.

Diffuse lymphoplasmacytic lymphosarcoma the combined proliferation of lymphoid and plasma cells is characteristic; plasmatized lymphocytes are also found. Changes in this variant of lymphosarcoma are similar to the picture that occurs with Waldenstrom's macroglobulinemia; disease is often associated with various types monoclonal gammopathy.

Diffuse prolymphocytic lymphosarcoma is characterized by the proliferation of cells larger than small lymphocytes, which have rounded or irregular shape("dissected" nuclei), in which 1-2 nucleoli are visible. The chromatin of the nucleus is less dense than that of a small lymphocyte. When the process is generalized, peripheral lymph nodes, liver, spleen, and bone marrow are most often affected (in 25-45% of cases). The five-year survival rate is 63-70%. Modern treatment provides practical recovery of most of the patients in the first stage of the process.

With diffuse lymphoblastic lymphosarcoma, proliferation of lymphoblast-type cells is found, among which macro- and microgenerations occur. Cells with nuclei of a brain-shaped (twisted, convolute) shape can be detected. They are more often observed in children with localization of the process in the lymph nodes of the mediastinum and, as a rule, have a T-cell nature. Lymphoblastic lymphosarcoma is characterized by the presence of a large number of cells in a state of mitosis, decaying cells.

Diffuse immunoblastic lymphosarcoma differs in massive growth of large mononuclear or multinuclear cells with a large centrally located nucleolus and an abundant zone of basophilic cytoplasm. A large number of mitoses, dying cells are revealed. Along with immunoblasts, a significant number of plasma cells are found. The prognosis is unfavorable, the five-year survival rate of patients ranges from 21 to 32%.

Burkitt's lymphoma differs by monomorphic proliferation of blast cells of the lymphoid type with hyperbasophilic often vacuolated narrow cytoplasm. Against this background, a typical, albeit non-specific, feature is the presence of large macrophages, which create a picture of a “driving sky”. There is an opinion about the proximity of Burkitt's lymphoma cells to partially blast-transformed B-lymphocytes. Unlike other forms of non-Hodgkin's lymphomas, the tumor is primarily localized mainly

extranodally.

At reticulosarcoma(histiocytic lymphoma), a relatively rare tumor, cell proliferation with morphological and functional features of macrophages, large cells of a round or elongated shape, containing a light, medium-sized bean-shaped nucleus with 1-2 nucleoli, surrounded by a rather wide rim of weakly basophilic cytoplasm, are found. Some cells show the ability to phagocytosis. Cells are characterized by high activity of nonspecific esterase, the ability to secrete lysozyme, and the absence of specific markers.

undifferentiated the type is characterized by the proliferation of sharply anaplastic cells with a large, irregularly shaped nucleus surrounded by a narrow zone of weakly basophilic cytoplasm. It is believed that some of these tumors are of lymphoid origin.

Along with the above classification, others are used. So, some authors suggest subdividing lymphosarcomas depending on the primary localization of the process; the term "lymphocytoma" emphasizes the benign course of extramedullary tumors, consisting mainly of mature forms of small lymphocytes (or lymphocytes and prolymphocytes), forming a structure of nodular growth. Therefore, they are isolated from low-grade non-Hodgkin's lymphomas into a separate group of lymphoid tumors.

The progression of non-Hodgkin's lymphomas may be accompanied by a change in the morphological variant of the disease, the transformation of nodular lymphosarcoma into diffuse.

Symptoms of Non-Hodgkin's Lymphoma

For all morphological variants of non-Hodgkin's lymphomas, there is an equally frequent lesion of both the lymph nodes in general and their individual groups, the Waldeyer lymphoid ring and the gastrointestinal tract. More frequent primary involvement of retroperitoneal lymph nodes and abdominal cavity, bones and soft tissues is observed with lymphoblastic, spleen - with prolymphocytic variants. The pathological process, regardless of the morphological variant of the disease, in most cases first spreads not to the zones adjacent to the lymph nodes. The defeat of adjacent groups of lymph nodes often occurs in the lymphoblastic variant.

Early extranodal metastasis, bone marrow metastasis, involvement of the liver and spleen in the pathological process are somewhat more common in the prolymphocytic variant, and bone marrow damage and leukemization are more common in the presence of cells with a rounded and split nucleus. At the same time, in blast variants, the involvement of the bone marrow and the increase in the size of the lymph nodes occur earlier.

The greatest differences between morphological variants are noted when assessing survival. The five-year survival rate for the prolymphocytic variant of small cells with split and round nuclei is 70 and 53%, respectively. In the prolymphocytic-lymphoblastic variant of large cells with a split nucleus, the survival rates approach those in blast variants and are 14-21 months.

Survival rates in stages I-II of non-Hodgkin's lymphomas with a high degree of malignancy in the primary lesion of the gastrointestinal tract significantly exceed those observed in the general group of patients with these variants.

Primary non-Hodgkin's lymphoma of the spleen- rare localization (less than 1 % ), while its involvement in the pathological process is often (40-50%) found in lymphosarcomas. Somewhat more often, the primary lesion of the spleen is found in the prolymphocytic variant. More often, with spleen lymphoma, bone marrow is involved in the pathological process. However, in the lymphoblastic variant, metastases from the spleen are more often localized in the abdominal lymph nodes.

The most common lung involvement is found in low-grade non-Hodgkin's lymphomas. The prognosis for this primary localization is also determined by the morphological variant. The defeat of the nervous system ascertain, as a rule, with blast variants of non-Hodgkin's lymphomas.

The nodular type of non-Hodgkin's lymphomas within any histological type is characterized by a more favorable course of the disease. In the lymphocytic variant, despite the rapid generalization of the process, a relatively benign course is also noted.

The clinical and hematological picture in certain morphological variants of diffuse lymphosarcomas has its own characteristics. Yes, for lymphocytic variant a rather early generalization of the process is characteristic. Unlike chronic lymphocytic leukemia, it is often possible to trace the sequence of involvement and the pathological process of various groups of lymph nodes; histological examination of the bone marrow reveals a nodular or nodular-diffuse type of lesion (and unlike the diffuse nature of infiltration in chronic lymphocytic leukemia).

Generalization of the process, on average, occurs after 3-24 months. Bone marrow damage can also be detected with a normal hemogram (in 47% of patients it is not changed at the time of diagnosis), in some patients lymphocytopenia is detected. Despite the early generalization and involvement of the bone marrow in the process, the prognosis of the disease in this variant is relatively favorable (up to 75% of patients live for more than 5 years).

Clinical and hematological peculiarity differs T-cell variant of lymphosarcoma: splenomegaly, generalized enlargement of lymph nodes, infiltrates in the lungs, skin lesions. The primary focus is a T-dependent paracortical region of the lymph nodes. There is a high lymphocytosis in the blood, the nuclei of most of the lymphocytes are twisted. Average duration life with this rare variant is short - 10 months.

With a rare lymphoplasmacytic cytological variant clinical syndromes the course of the disease is determined by the localization of the tumor, the degree of prevalence of the process, often - the amount of IgM in the blood serum.

Prolymphocytic variant found in 45-51% of all cases of lymphosarcoma. With it, an increase in the occipital, parotid, popliteal, and lymph nodes is often detected. Despite the uneven generalization and frequent leukemization (in 25-45%) of the process, with this option, the five-year survival rate of patients is 63-70%. In the prolymphocyte-lymphoblastic subvariant, the prognosis is less favorable.

lymphoblastic variant, rather heterogeneous in its morphological (twisted, non-twisted nucleus, macro-, microforms) and immunological (T- and B-phenotype) characteristics, most often occurs in children. Lymph nodes of various localization are affected. The disease is distinguished by the rapid growth of tumors and the involvement of new anatomical zones in the process. More often than in other lymphosarcomas, the initial cytopenia, T-cell phenotype of lymphocytes, is found in the hemogram.

Burkitt's lymphoma of B-cell origin is attributed to the lymphoblastic type of lymphosarcoma. Its classic variant is manifested mainly by bone lesions (especially mandible), kidneys, ovaries, lymph nodes of the retroperitoneal regions, lungs, parotid salivary glands. The bone marrow is rarely involved in the process. With localized forms, the prognosis is favorable with long-term remissions up to a complete cure. The most common type of T-lymphoblastic lymphoma is "prothymocyte". In the vast majority of cases, the mediastinum is affected, metastases are detected in the central nervous system, lungs; in 50% of cases - leukemization. The disease is more often detected in boys of the first 5 years of life and adolescents 13-16 years old.

Immunoblastic lymphosarcoma(B-cell phenotype predominates) can develop as a primary tumor of the gastrointestinal tract, lymph nodes, Waldeyer rings, etc. Cytopenia is often detected, leukemization - in rare cases. The disease progresses rapidly, the five-year survival rate of patients is 21-32%, however, removal of a solitary tumor can contribute to many years of remission and even cure. Immunoblastic lymphosarcoma as a secondary process is described in multiple myeloma, Waldenström's macroglobulinemia, and other lymphoproliferative diseases.

Fungal mycosis is a malignant lymphoid tumor that always occurs primarily in the upper layers of the dermis, consisting of polymorphic T-helpers. The first manifestation of the disease may be nonspecific inflammation. The diagnosis is verified according to histological, cytochemical studies (lymphoid cells give positive reaction for acid phosphatase, beta-glucuronidase and acid nonspecific esterase). There is a point of view that the early, chronic phase of the disease may be reactive, and the "lymphoblastic" represents a true malignant transformation. Cesari's syndrome, characterized by the appearance in the hemogram of lymphoid cells with a brain-shaped nucleus, is considered as the leukemic phase of mycosis fungoides.

The histiocytic variant of malignant non-Hodgkin's lymphomas is rare. Its clinical picture is varied. Metastases can be found in many organs. Leukemization and bone marrow involvement are rare, with cytopenia often present.

The nosological affiliation of the identified new forms remains debatable. So, Lennert's lymphoma, originally described as an unusual variant of lymphogranulomatosis with a high content of epithelioid cells, is proposed to be considered an independent form. The absence of typical Berezovsky-Sternberg cells, fibrosis, a high content of immunoblasts, plasma cells, transitions to lymphosarcoma served as the basis for distinguishing this disease from lymphogranulomatosis and isolating it under the name "Lennert's lymphoma" (malignant lymphoma with a high content of epithelioid histiocytes, lymphoepithelial lymphoma, epithelioid cell lymphoma ). A feature of the clinical manifestations of Lennert's lymphoma is the frequent involvement of the palatine tonsils, lymph nodes, elderly age patients, the presence of polyclonal gammopathy and allergic skin rashes in history.

It is proposed to refer to non-Hodgkin's lymphomas also described in last years angioimmunoblastic lymphadenopathy with dysproteinemia(lymphogranulomatosis X). Clinically, the disease is manifested by fever, weight loss, skin rashes, generalized lymphadenopathy, often in combination with hepato- and splenomegaly, persistent hyperglobulinemia, sometimes signs of hemolysis. Histologically, a triad is characteristic: proliferation of small vessels, proliferation of immunoblasts, deposits of PAS-positive amorphous masses in the walls of blood vessels. The number of eosinophils and histiocytes fluctuates, but sometimes the number of the latter is markedly increased. Perhaps the presence of giant cells, small foci of necrosis. A number of researchers regard the changes described above not as malignant lymphoma, but as reactive, associated with disorders in the B-lymphocyte system.

Lymphocytes can be localized in various organs and tissues (spleen, lymph nodes, stomach, lungs, skin, etc.). The disease progresses slowly. For a long time, the spleen is slightly enlarged, the lymph nodes are of normal size or slightly enlarged. In the blood, the number of leukocytes is normal or close to normal, with a predominance or normal content of mature lymphocytes. The level of platelets is within the normal range, their number may decrease to 1*10 9 /l-1.4*10 9 /l in some patients after 7-10 years. More often, only a slight tendency to a decrease in the level of hemoglobin and the number of erythrocytes is revealed, reticulocytes fluctuate within 1.5-2%. Bone marrow biopsy reveals individual proliferates consisting of mature lymphocytes; histological studies of an enlarged lymph node and other affected organs help to verify the diagnosis. Malignancy of a lymphocytoma with transformation into lymphosarcoma or chronic lymphocytic leukemia is not mandatory, and if it does occur, it is often after many months or years.

Diagnosis of Non-Hodgkin's Lymphoma

The first symptoms of lymphosarcoma are an increase in one (49.5%) or two (15%) groups of lymph nodes, generalized adenopathy (12%), signs of intoxication, leukocytosis (7.5%) or leukocytopenia (12%) in the hemogram, lymphocytosis ( eighteen%), increase in ESR (13,5%). Differential diagnosis should be carried out with chronic lymphocytic leukemia, infectious mononucleosis, nonspecific lymphadenopathy. From the period of the appearance of the first signs of the disease to the establishment of a true diagnosis, months often pass.

Primary extranodal lesions can occur in any organ where there is lymphoid tissue. Only 15 cases of isolated liver damage have been described, but its metastatic lesion is found in more than 50% of patients. The primary localization of the process in the spleen (less than 1%), mammary gland, lungs and pleura is rare.

The diagnosis of lymphosarcoma is established on the basis of data from a histological examination of the lymph nodes or other tumor formations, their cytological (imprint, punctate), cytochemical and immunological studies are mandatory. For diagnostic purposes and to assess the prevalence of the pathological process, punctate and biopsy of the bone marrow are examined.

Lymphocytomas long time proceed favorably. Peripheral lymph nodes are often slightly enlarged, the spleen in the splenic variant is large, a low content of lymphocytes in the blood and their focal proliferation in the bone marrow are found. The tumor substrate is predominantly composed of mature lymphocytes (or lymphocytes and prolymphocytes), which form a structure of nodular growth. After a long time, the transformation of lymphocytes into lymphosarcomas or chronic lymphocytic leukemia is possible.

Treatment for non-Hodgkin's lymphoma

Therapy for lymphosarcoma is determined primarily by the morphological variant (degree of malignancy), the nature of the prevalence of the pathological process (stage), the size and location of the tumor, the age of the patient, the presence of other diseases.

The fundamental method of treatment of non-Hodgkin's lymphomas is polychemotherapy, which can ensure the development of clinical and hematological remission, its consolidation and anti-relapse treatment. Local radiation therapy in most cases is justified in combination with chemotherapy or as a palliative irradiation of tumor formations. As an independent method, radiation therapy for non-Hodgkin's lymphomas can be used only in clearly proven stage I of the disease in low-grade non-Hodgkin's lymphomas, with bone involvement in the process.

After local radiation therapy or surgical removal of the tumor, complete remission persists in many patients for more than 5-10 years. The disease progresses slowly with the generalization of the process.

Elderly patients with low-grade non-Hodgkin's lymphomas, as well as in the presence of severe concomitant diseases, can be treated with monochemotherapy (chlorbutin, pafencil, cyclophosphamide, etc.). With a primary lesion of the spleen, regardless of the morphological variant of the disease, a splenectomy is performed followed by a course of chemotherapy. With an isolated lesion of the stomach in the program combined treatment include its resection. For skin lesions, chemotherapy is used, including prospidin and spirobromine.

In stages III-IV of the disease in aggressive non-Hodgkin's lymphomas, induction of remission is carried out by courses of polychemotherapy followed by consolidating treatment. On the area of the most aggressive tumor growth, local radiation therapy can be used, it is also effective in primary lymphosarcomas of the pharyngeal ring. However, since the possibility of generalization of the process cannot be ruled out, it is advisable to combine radiation treatment with chemotherapy.

In generalized stages of non-Hodgkin's lymphomas of low grade malignancy, the programs COP, COPPP, BACOP, etc. are used.

With blast variants, it is advisable for young people to prescribe programs for the treatment of acute lymphoblastic leukemia and the prevention of neuroleukemia.

The results of cytostatic therapy for non-Hodgkin's lymphomas also depend on the timely use of hematological resuscitation, immunocorrection and antibiotic therapy.

Since hematopoiesis in some patients remains intact for some time, it is possible to conduct polychemotherapy on an outpatient basis, which, with a clear organization dispensary observation facilitates the treatment process, allows patients to avoid the severe psychological effects of oncological and hematological hospitals.

After achieving clinical and hematological remission for 2 years at intervals of 3 months. anti-relapse therapy. Upon reaching a stable remission, treatment is stopped.

In the last 10 years, survival in aggressive non-Hodgkin's lymphomas has increased markedly due to the use of programs that include 5-6 cytotoxic drugs. Modern therapy contributes to the achievement of complete remissions in 70-80% and 5-year relapse-free survival in 65-70% of patients.

In recent years, clinical experience has been accumulating in the use of allogeneic and autologous bone marrow transplants for non-Hodgkin's lymphomas.

Lymphocytomas may not require special treatment for a long time. In their therapy, surgical removal of the tumor, monochemotherapy (cyclophosphamide, chlorbutine), glucocorticosteroids, antihistamines and other means. In cases of transformation into lymphosarcoma or chronic lymphocytic leukemia, combined cytostatic therapy programs are prescribed for these diseases.

Forecast disease depends on the type of lymphoma, the stage of the disease, its spread, response to treatment, etc. Properly selected treatment increases the prognosis for recovery.

Prevention of non-Hodgkin's lymphoma

To date, the method by which it would be possible to prevent the occurrence of non-Hodgkin's lymphoma is unknown. Most people with non-Hodgkin's lymphoma have not been exposed to known risk factors.

A malignant tumor that develops from cells of the lymphoid tissue is characterized by local growth and is not accompanied by diffuse damage to the bone marrow in the initial stages. Non-Hodgkin's malignant lymphomas are extremely heterogeneous in origin, level of differentiation, and functional characteristics of the cells that make up the tumor substrate. In adults, primary tumors of various groups of lymph nodes are mainly diagnosed. Extranodal lesions are less common.

The primary localization of the pathological process correlates with the cytological variant of the tumor and largely determines clinical manifestations disease and prognosis. Men get sick more often than women, in adults the disease prevails at the age of 16-30 years, and also after 90 years.

An increased risk of morbidity is observed in children with congenital and acquired immunodeficiency. Of particular importance is antigenic stimulation in many chronic infectious diseases that cause dysfunction of immunoregulatory mechanisms. There is evidence of an association between the persistence of the Epstein-Barr virus and Burkitt's lymphoma (which is endemic among children on the African continent) and other types of lymphomas. The factors that cause the development of these tumors include:

ionization radiation,
exposure to radiation and chemotherapy (dioxin, cytostatics),
autoimmune diseases (systemic lupus erythematosus, Sjögren's syndrome).

Over the past 10 years, ideas about the origin of lymphoid tumors have significantly expanded. Thanks to modern methods diagnostics, new types of non-Hodgkin's malignant lymphomas, which were not previously included in the classification, are described. The International Lymphoma Research Group has developed recommendations for combining the rational aspects of the European and American classifications, which have been called the "Revised Euro-American Classification of Lymphomas" - a classification that brings together lymphomas with similar morphological features.

According to the nature of growth, non-Hodgkin's malignant lymphomas are divided into nodular (follicular) and diffuse. Nodular lymphomas are characterized by the formation of pseudofollicular structures, which, unlike real follicles, are contained not only in the cortical, but also in the medulla of lymphocytes, are large, have fuzzy contours. Follicular growth is inherent mainly in B-lymphomas from the centers of follicles (they can develop from three zones: mainly from small cells, from small and large cells, mainly from large cells). Diffuse type of growth with total proliferation of cells, complete erasure of the structure of the lymph node, inherent in all types of non-Hodgkin's malignant lymphomas. They are divided according to the degree of malignancy (high, low, intermediate), as well as along the course.

Clinical picture various forms Non-Hodgkin's malignant lymphomas share many common features. The first symptom of the disease is often an enlargement of the lymph nodes, spleen, testicles, lobes thyroid gland etc. In some cases, the development of a tumor is preceded by a clinic of general intoxication. Often, the disease can develop under the guise of an autoimmune hemolytic anemia, hemorrhagic vasculitis, polyarthritis, eczema.

Lymph nodes have a dense texture, are mobile, painless, form conglomerates, reaching large sizes (16-20 cm in diameter), can compress the large vessels of the mediastinum, cause stagnation in the system of the superior vena cava. In case of compression of the trachea, respiratory function may be impaired. Due to enlargement of the lymph nodes in the gates of the liver and compression of the common bile duct, jaundice occurs. An increase in mesenteric and retroperitoneal lymph nodes leads to dysfunction of the intestines, urinary organs.

Among lymphoblastic lymphomas, the type of B-cell origin is about 20%. Children are more often ill than adults. The main lesions are localized in the lymph nodes, skin, bones. The bone marrow is involved early in the pathological process.

Lymphoplasmacytic lymphoma (immunocytoma) is more often observed in elderly patients. Lymph nodes, spleen, bone marrow are affected, extranodal lesions occur less frequently, and tumor cells appear in the peripheral blood.

Lymphoma of the mantle zone is characterized by lymphadenopathy, splenomegaly, extranodal lesions, especially of the digestive tract. The course of the disease is moderately aggressive. In the case of progression of the pathological process, infiltration by tumor cells of the bone marrow is observed.

Follicular lymphoma from the cells of the centers of the follicles (centrocytes) is observed among lymphomas much more often, usually in adults. Almost 40% of patients with tumors of lymphoid tissue suffer from follicular lymphoma. Lesions are found in the lymph nodes, spleen, bone marrow, as well as extranodal. In the case of progression, the disease can transform into large-cell B-non-Hodgkin's malignant lymphoma.

The classic variant of Burkitt's lymphoma has been described in children from East Africa and New Guinea. It is characterized by damage to the bones, lymph nodes, kidneys, ovaries, lungs. The bone marrow is rarely involved in the process.

T-lymphoblastic non-Hodgkin's lymphomas are more common in adolescents and young men. The disease is accompanied by an increase in lymph nodes and / or a tumor of the mediastinum ( thymus), often leukemic.

In patients with mycosis fungoides (Cesari's syndrome), numerous skin lesions (nodules, plaques) are found. In addition, there is damage to the lymph nodes. T-cell lymphoma of the intestine is observed in adults, accompanied by enteropathy, ulcers and perforation of the mucous membrane of the small intestine.

How is non-Hodgkin's lymphoma treated?

Basis for planning treatmentnon-Hodgkin's lymphomas is the degree of malignancy and the stage of the tumor lesion. AT complex therapy non-Hodgkin's malignant lymphomas use polychemotherapy in combination with radiation therapy and surgical methods.

Surgical treatment is indicated only for single tumors. digestive system, thyroid and mammary glands. If there are doubts about the effectiveness of the radical intervention, as well as in high-grade lymphomas, surgical intervention must be supplemented with polychemotherapy.

Indications for removal of the spleen in non-Hodgkin's malignant lymphomas are primary lymphoma of the spleen without signs of generalization, the threat of rupture of the spleen, progressive cytopenia, due to hypersplenism (with splenomegaly). Radiation therapy as an independent method of treatment for non-Hodgkin's malignant lymphomas is rarely used.

The degree of intensity of treatment and the choice of chemotherapy regimen depend on the morphological variant of the lymphoma, the immunophenotype, and the stage of the disease. For non-Hodgkin's malignant lymphomas of a low degree of malignancy, monochemotherapy with cyclophosphamide or chlorbutine (leukeran) can be carried out for a long time. Prednisolone in combination with them enhances the action anticancer drugs. Such courses of treatment are repeated every 5-6 months. With lymphomas of a high degree of malignancy, courses of polychemotherapy are prescribed.

In recent years, α-interferons (Laferon, intron A) have been used to treat certain forms of low-grade non-Hodgkin's malignant lymphomas. Usually such treatment is carried out in parallel with chemotherapy, before or after it. Appointment of alpha-interferon can increase the number of complete remissions by 1.5-2 times.

A new direction of therapy is the appointment (, specific to the CD20 antigen).

What diseases can be associated

In the case of progression of the pathological process, normochromic anemia and thrombocytopenia develop.

Bone marrow damage can be observed in any morphological form of non-Hodgkin's malignant lymphomas.

Treatment of non-Hodgkin's lymphoma at home

Duration treatment for non-Hodgkin's lymphoma can be 12-18 months, every 5-6 months the patient must undergo hospitalization and repeated courses of chemotherapy. Hospitalization cannot be avoided even in the operating room, postoperative period. the rest of the time, treatment can take place at home, medicines in low dosages are taken in remission. All prescriptions of the attending physician must be observed. Self-medication is unacceptable.

The average life expectancy of patients with non-Hodgkin's malignant malignant lymphoma of low grade is 7 years, high - up to 1 year.

What drugs are used to treat non-Hodgkin's lymphoma?

- 200 mg per day or 400 mg every other day; the course of treatment is repeated every 5-6 months;
- 10 mg 5 times a week; the course of treatment is repeated every 5-6 months;
- at a dose of 30-40 mg per day; enhances the effect of anticancer drugs;
a-interferons (laferon,) - used in parallel with chemotherapy, before or after it; prescribed in a dose of 6,000,000 - 9,000,000 IU per day.

Treatment of non-Hodgkin's lymphoma with alternative methods

Treatment of non-Hodgkin's lymphoma folk remedies does not cause the opposite effect, and therefore hopes should not be placed on it. You can discuss with your doctor immune-strengthening decoctions to be taken during remission, but these will not play a decisive role in treatment.

Treatment of non-Hodgkin's lymphoma during pregnancy

The diagnosis of non-Hodgkin's lymphoma against the background of pregnancy is extremely unfavorable, the disease develops aggressively due to the youth of the body itself. Pregnancy-associated lymphomas tend to be histologically aggressive, and without adequate treatment, which should begin as early as possible, adversely affect the mother's health.

The treatment strategy, as well as the prognosis for recovery and successful delivery, depends on the stage of the disease at the stage of its detection. In the second and third trimester, polychemotherapy containing Mabthera, among other things, will be an adequate prescription. In the first trimester, the patient will be recommended medical abortion.

In treatment, the doctor will certainly start from the "risk-benefit" ratio for both the mother and the fetus. It is noted that most anticancer drugs tend to penetrate the placental barrier.

Which doctors to contact if you have non-Hodgkin's lymphoma

The course of non-Hodgkin's lymphoma is also likely when the analysis of peripheral blood remains unchanged. The number of leukocytes is normal or elevated, especially in some forms of low-grade non-Hodgkin's malignant lymphomas, for example, in lymphocytic ones, the course of which is accompanied by leukocytosis. Significant changes in leukocyte formula are not watching. Red blood counts and platelet counts usually do not change at the onset of the disease.

The diagnosis of non-Hodgkin's malignant lymphomas can be established after a biopsy and examination of the removed tumor or part of it using histological, cytological, in particular cytochemical and immunophenotypic methods for examining the bone marrow and trephine biopsy. To clarify the clinical stage, that is, the prevalence of the pathological process, the patient's examination is supplemented with ultrasound data, computed tomography, nuclear magnetic tomography, scintigraphy of the liver, spleen, and skeletal bones.
The absence of CO34 and CO24 receptor cells on the membranes is considered to be an unfavorable prognostic factor in malignant lymphoblastic lymphomas. The phenotypic hallmark of low-grade lymphomas is the expression of pan-B cell antigens.

Criteria for an unfavorable course of lymphomas:

age over 60;
progression of B-symptoms: fever, weight loss of more than 10% within 6 months, night sweats;
extranodal spread of the pathological process.

Differential diagnosis is carried out with diseases accompanied by lymphadenopathy, in particular lymphogranulomatosis, leukemia, cancer metastases, infectious diseases(typhoid, paratyphoid, brucellosis, Infectious mononucleosis, tuberculosis of the lymph nodes, cat-scratch disease, trichinosis, syphilis), Crohn's disease, sarcoidosis, diffuse diseases connective tissue, systemic lupus erythematosus, systemic vasculitis, primary and secondary immunodeficiency, including HIV infection.

With lymphogranulomatosis (Hodgkin's disease), the diagnosis is verified on the basis of cytological and histological studies biopsies of lymph nodes (Berezovsky-Sternberg cells).

The information is for educational purposes only. Do not self-medicate; For all questions regarding the definition of the disease and how to treat it, contact your doctor. EUROLAB is not responsible for the consequences caused by the use of the information posted on the portal.

Non-Hodgkin's lymphoma is one of the most common types of cancer that affects hundreds of people around the world. To understand how to recognize a disease and treat it, you must first understand what it is.

Non-Hodgkin's lymphoma is a collective concept, it refers to a whole group of oncological diseases in which malignant cells affect lymphoid tissues. In other words, this category includes all types of existing lymphomas with the exception of Hodgkin's lymphoma. A distinctive characteristic of the latter is the presence of altered and multinucleated cells in the affected tissues.

Features of the disease

Non-Hodgcon's lymphomas include about 80 different diseases that differ in aggressiveness and localization.

Among patients, there is approximately the same number of men and women, although in some varieties of the disease there is still a dependence on gender. As for the age categories, older people have a slightly higher risk of developing oncology. Meanwhile, the disease is often diagnosed in children.

Since non-Hodgkin's lymphomas are not one, but many diseases united by one characteristic, several forms and varieties should be considered at once. Such features as the duration and intensity of the course of therapy, the prognosis of treatment and possible complications will directly depend on the characteristics of the disease.

B-cell form

The most common type of classification can be considered the one adopted by the World Health Organization. It is based precisely on cellular composition oncology. There are 2 broad categories: B-cell and T-cell lymphomas. Each of them should be mentioned in more detail.

What is B-cell non-Hodgkin's lymphoma? This is a malignant disease of the lymphoid tissue, in which B-lymphocytes are affected. Their main task is to produce antibodies, therefore, they are also involved in the immune humoral response. There are several types of lymphomas:

Nodal and splenic. These species are characterized by slow growth.
Burkitt's lymphoma. According to medical statistics, it is men who are about 30 years old who are more likely to suffer from this form of the disease. Doctors are in no hurry to give favorable prognosis: with Burkitt's non-Hodgkin's lymphoma, the survival rate of patients for 5 years is only 50%.
Follicular. In most cases, this oncological disease develops rather slowly, but it can turn into diffuse form which is characterized by rapid development.
MALT lymphoma of the marginal zone. This form spreads to the stomach and increases slowly. With all this treatment, it is extremely difficult to treat.
Primary mediastinal (or mediastinal). This disease most often affects women, the 5-year survival rate after treatment is 50%.
Lymphocentric small cell. Development is slow, but the cure rate is quite low.
Primary CNS lymphoma.
Diffuse non-Hodgkin's lymphoma large cell. This variety refers to rapidly progressive oncological diseases.

Varieties of non-Hodgkin's T-cell lymphoma

T-cell lymphoma is a malignant disease in which there is an uncontrolled growth of T-lymphocytes. They are produced in the thymus and support cellular (or barrier) immunity. skin and mucous membrane.

lymphoblastic form. Most patients with this diagnosis are young men under 40 years of age. A favorable outcome of treatment is predicted only if the bone marrow is not involved in the process.
Large cell non-Hodgkin's lymphoma anaplastic. Most often this disease occurs in young people, but with timely diagnosis it responds well to treatment.
Extranodal NHL. This form of the disease affects T-killers, its aggressiveness can vary.
Cesari's syndrome (or cutaneous). This form is often called fungal mycosis and is formed mainly in older people (50-60 years).
Lymphoma with enteropathy. It is noticed that this type of cancer is typical for people with gluten intolerance. It is characterized as extremely aggressive and difficult to treat.
Angioimmunoblastic. This type difficult to treat, and therefore doctors do not make favorable prognosis for life.
Non-Hodgkin's lymphoma is panniculitis-like. Such oncology develops in the subcutaneous fat. A characteristic feature of this form is low sensitivity to chemotherapy, which makes the treatment ineffective.

Species by aggressiveness

Another option for classifying neodgkin's lymphomas is the division according to the aggressiveness of the process. This is very convenient for doctors, as it allows you to optimally choose the course of treatment and tactics of observation.

Aggressive NHL. This type includes oncological diseases with rapid development, active spread, and in some cases with resistance to chemotherapy. The prognosis of treatment here can be made based mainly on the stage of oncology at which non-Hodgkin's lymphoma was detected. Relapses of these forms of the disease occur quite often.
Indolent. Unlike the previous form, indolent lymphoma grows slowly and metastasizes. Sometimes cancers of this form may not manifest themselves for years (that is, they do not cause pain and other symptoms of pathology in a person). In general, with timely treatment of non-Hodgkin's lymphoma, the prognosis here is quite good.
Intermediate. These types of diseases start out slowly, but over time they increase the pace, tending more towards aggressive forms.

Reasons for development

Until now, doctors have not been able to accurately identify the factors that provoke the development of non-Hodgkin's lymphoma of any type. However, the following point should be taken into account here. According to its origin, the disease is divided into:

primary - oncology primarily affects lymphoid tissues (an independent focus), and then gives metastases to other organs;
secondary - in this case this disease acts in the form of metastases, therefore, the presence of malignant cells in the body can be called the cause.

If we talk about the causes of primary lymphoma, then in medicine there are several factors:

Infections in the body. The hepatitis C virus, HIV infection, or human herpes virus (type 8) can provoke the appearance of pathological cells. Epstein-Barr virus often causes Burkitt's lymphoma, or the follicular form of the disease. People exposed to the bacterium Helicobacter pylori (which causes stomach ulcers) have a markedly increased risk of developing MALT lymphoma.
Some genetic diseases. Among them are: ataxia-telangiectasia syndrome, Chediak-Higashi syndrome, as well as Klinefelter's syndrome.
Ionized radiation in any dose.
Effects of benzenes, insecticides, herbicides, and many other mutagens or chemical carcinogens.
Diseases of an autoimmune nature. A typical example would be rheumatoid arthritis or systemic lupus erythematosus.
Long-term use of various immunosuppressants.
Age changes in body tissues. With age, the risk of developing non-Hodgkin's lymphoma increases markedly. The doctor's recommendation to reduce this risk is regular medical examination. This will make it possible to identify the disease at an early stage and start treatment in a timely manner.
Overweight.

It is worth noting: the presence of one or several factors from the above list does not mean the indispensable development of oncological diseases. They only increase the risk of its occurrence.

Stages of lymphomas

The entire period of the course of oncological disease is usually divided into 4 stages (stages), and lymphoma in this case is no exception.

1 stage. Non-Hodgkin's lymphoma at this stage is represented by the defeat of one lymph node or the appearance of one independent focus. Local manifestations have not yet been observed.

2 stage. This stage includes a malignant neoplasm that has spread to two or more lymph nodes and also went beyond the lymph nodes, but is localized only on one side of the diaphragm. So, the tumor can spread either only in the abdominal cavity or only in the chest.

3 stage. The next stage of development is the presence of foci on both sides of the diaphragm.

4 stage. This stage of development of lymphoma is considered the last. At this time, the lesion extends to the bone marrow, skeleton and central nervous system. This stage is not in vain considered the last and most difficult for the patient. One of the manifestations is constant severe pain which can no longer be stopped with the help of conventional analgesics.

Clinical picture

Symptoms of non-Hodgkin's lymphoma are very diverse and depend on the form of the disease and localization. A common symptom of a malignant lesion of lymphoid tissues is an increase in lymph nodes (common or local) and pain in this region. This condition is accompanied by symptoms of damage to a particular organ or signs of general intoxication of the body.

T-cell forms often manifest themselves as follows:

increase;
there is an increase in the spleen and a violation of its work;
lungs and skin are damaged.

There are several symptoms that are characteristic of non-Hodgkin's lymphomas, but are absent in Hodgkin's lymphoma. Among them:

damage to the lymph nodes of the mediastinum (the space of the chest cavity), there is swelling of the face and hyperemia (excessive blood flow to a certain part of the body);
if malignant cells develop in the thymus, there is frequent shortness of breath and cough;
an increase in pelvic or retroperitoneal lymph nodes provokes kidney failure or hydronephrosis (gradual atrophy of the kidneys).

However, it is impossible not to note the symptoms that accompany any oncological disease. With non-Hodgkin's lymphoma, they begin to appear at stage 2 of the disease and gradually become brighter:

a sharp decrease in efficiency, the appearance of weakness and fatigue;
lack of appetite;
weight loss;
the appearance of irritability, apathy;
constant heavy sweating, mainly at night;
signs of anemia.

Diagnosis of lymphomas

An increase in lymph nodes indicates not only an oncological disease, but also the presence of an infection in the human body. If an infectious component is suspected, the patient is prescribed medicinal product designed to eliminate the source. After some time, the inspection is repeated. If no improvement is observed, a series of laboratory tests and instrumental diagnostic procedures. The principles and methods of treatment of non-Hodgkin's lymphoma will be chosen by the doctor based on the examination data.

Blood tests to determine the state of the body and search for pathology.
x-ray chest. According to the results of this procedure, the condition of the lymph nodes of the chest is revealed.
CT - conducting computed tomography gives information about the status of all lymph nodes and the possible presence of metastases in other organs.
MRI. Using magnetic resonance imaging, doctors determine the current state of the spinal cord and brain and the possible presence of malignant cells in them.
PAT. Under this term lies the diagnostic procedure positron emission tomography. During it, a special substance is injected into the patient's vein, which helps to identify all cancerous foci in soft tissues.
Gallium scan. This method effectively complements PET, as it detects malignant cells in bone tissue.
Ultrasound provides information about the condition internal organs.
Biopsy. This diagnosis is the extraction of tumor cells and their further study in the laboratory. A biopsy can be performed in different ways, therefore, incisional, excisional, puncture, spinal puncture and bone marrow aspiration are distinguished.

Treatment

In each case, the course of treatment is prescribed taking into account the results of the diagnosis. Some forms of lymphomas do not need treatment at first (this includes types of tumors with slow development and the absence of pronounced symptoms).

Chemotherapy. With non-Hodgkin's lymphoma, several courses of chemotherapy are prescribed. Therapeutic effect is achieved with the use of strong anticancer drugs, which are designed to block the growth and reproduction of pathological cells. The interval between courses is about 2 or 4 weeks. Dosage form: intravenous solutions or tablets.

Radiation therapy. The essence of the treatment comes down to the impact on the human body of ionized rays, which are detrimental to a cancerous tumor. Such treatment of non-Hodgkin's lymphoma in some cases is the main one, but most often it is combined with chemotherapy.

Surgery. In the case of lymphomas, surgery is used very rarely, due to its low efficiency. Its appointment makes sense only in the case of a limited spread of the tumor.

Immunotherapy. Treatment of non-Hodgkin's lymphoma is often carried out with drugs that contain interferon, monoclonal antibodies and chemotherapy drugs. The essence of this effect is to supply the body with those substances that human body under normal conditions produces independently. Such medicines significantly reduce the size of the tumor, slow down its growth and dramatically increase the human immunity to fight the disease.

Bone marrow transplant. This method of therapy is turned to when other types of treatment do not work. Before transplantation, the patient undergoes high-dose radiation or chemotherapy. Subsequent transplantation is required because high doses of radiation or drugs kill not only cancer cells, but also healthy tissue. It is for the restoration of the bone marrow that transplantation is prescribed.

Important! Self-medication with such a diagnosis is strictly prohibited! Lymphomas of any type and nature are not treated with folk remedies; this requires a professional approach and a set of measures to eliminate the tumor.

Forecast

As shows medical statistics and medical reviews, non-Hodgkin's lymphoma is effectively treated at stages 1 and 2 of development. In this case, the survival of patients over the next 5 years is about 80%. This is a fairly high figure given the severity of the disease. In the case of treatment of patients with stage 3 oncology, the survival rate is lower, since the tumor has time to spread far beyond the focus, and it is much more difficult to cope with it. At stage 4, the survival rate is low - only 20%.

Doctors especially emphasize that even constant developments and research in this area do not allow treating oncological diseases with 100% efficiency. That is why a lot depends on the patient himself. Early detection of symptoms of the disease and contacting the clinic significantly increase the chance of a full recovery.

is a type of cancer that affects the lymphatic system. The lymphatic system consists of lymph nodes, which are united by small vessels. Specialists divide this type of cancer into Hodgkin's lymphoma and non-Hodgkin's lymphoma (another name is Non-Hodgkin's). They differ in cell structure. Non-Hodgkin's lymphoma responds to treatment worse than Hodgkin's lymphoma, the response to medical intervention is unpredictable.

This name of a group of diseases has come into use since 1971 by the scientist Billroth.

Non-Hodgkin's lymphoma: what is it?

Non-Hodgkin's lymphoma (NHL) is common name cancer diseases, which make up more than 30 varieties, where the structure of cells is fundamentally different from the structure of Hodgkin's lymphoma cells. With this type of disease, malignant cells are formed in organs with lymphatic tissue (spleen, thymus, tonsils, etc.) and in the lymph nodes themselves.

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According to statistics, the prognosis of life is such that only 25% of patients are cured of this disease.

But there are several factors that influence the outcome of the disease. These factors are timely appeal to medical institution, correct diagnosis, qualified treatment, age and even gender of the patient. So, according to studies, non-Hodgkin's lymphoma women get sick much less often than men. It is also more common in the elderly and adults than in children. But if the disease is found in children (usually older than 5 years) or adolescents, then NHL can provoke new diseases in the organ system and often this leads to death.

Causes of the NHL

In recent years, this type of cancer has been on the rise. Especially often this disease occurs in people over 40 years of age and ranks sixth in terms of mortality among malignant diseases. In this situation, naturally, scientists are trying to study true reason illness. But to date, the exact cause has not been fully established. Based on observations, studies of patient histories, doctors have identified some causes of non-Hodgkin's lymphoma. Consider them:

Heredity. As often seen in many cancer If someone in the family has had cancer, then the risk of disease in the next generation is high. This is also the case with non-Hodgkin's lymphoma. Accurate laboratory research there are no proofs for this. But there are statistical observations confirming this factor.
Old age and obesity. Often the disease occurs after 60 years. Perhaps this is due to a different etiology acquired due to the age of the patient.
Ecology. It has been established that in areas where a man-made disaster occurred, people are often exposed to oncological diseases, including lymphomas.
Viral infections. HIV, the Epstein-Barr virus, has been shown to severe forms hepatitis can provoke the occurrence of lymphoma, due to the fact that they suppress human immunity
Radiation. If a patient has had cancer while receiving radiation therapy, the risk of developing lymphoma increases. This is due to the fact that during radiation therapy, healthy blood cells are deformed. This can provoke the appearance of one type of lymphoma.

This list is not exhaustive. Scientists are also studying the effect bad habits such as smoking, alcohol, certain medications, different kind carcinogens on hematopoiesis in humans.

Signs of illness

The clinical picture of neodgkin's lymphoma is very bright. First of all, lymphoid tissue suffers. This group of lymphomas manifests itself in three stages:

These symptoms are not reliable and require additional diagnosis.

Disease classification

NHL has 4 degrees of development and 3 types of the course of the disease. The choice of treatment method and prognosis depend on the degree and type of the disease. Consider them:

The first stage is the easiest, since the disease does not manifest itself in any way. Only some changes in the blood test are possible. Single enlargement of lymph nodes is possible.
The second stage is characterized by primary changes in the internal organs, tumors in the peripheral lymph nodes are possible.
The third stage shows clear signs of the disease. It spreads to both sides of the diaphragm and the abdominal cavity.
The fourth stage is characterized by damage to the central nervous system, bone marrow, and skeleton. This stage of non-Hodgkin's lymphoma is the most difficult for both the patient and specialists when choosing treatment methods.

Non-Hodgkin's lymphoma is divided into three types of leakage. They are called aggressive, indolent and highly aggressive. Just when clinical picture bright, with the simultaneous manifestation of all four, this indicates an aggressive type of non-Hodgkin's lymphoma. The indolent form proceeds sluggishly and does not manifest itself for a long time. But with an aggressive form, the survival prognosis is much better than with a sluggish course. It is extremely rare that the indolent type of non-Hodgkin's lymphoma can be cured. A highly aggressive species is characterized by a fast, uncontrolled course of the oncological process.

Non-Hodgkin's lymphomas are divided into B-cell and T-cell. Depending on what type of patient the patient is ill with, predictions can be made.

B-cells include:

T-cell lymphomas include:

Progenitor cell lymphoma or leukemia- is rare (2%). Leukemia or lymphoma differ in the number of blast cells in the bone marrow.
Peripheral lymphomas These include cutaneous lymphomas, panniculitis-like, extranodal, angioimmunoblastic, and lymphomas with enteropathy.

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The prognosis for life with T-cell lymphoma is poor, since this type of lymphoma is super-aggressive and more often patients are in the terminal stage of the disease.

Diagnostics

Non-Hodgkin's lymphoma is an extremely severe type of cancer, therefore, the choice of diagnostic method followed by the choice of therapy is up to oncohematologists. The main stage of diagnosis is a biopsy of the tissues of the lymph nodes and a puncture of the bone marrow. But to clarify the prognosis of life, the state of internal organs, a series of medical procedures, diagnostic methods are also carried out, such as blood tests, x-rays, MRI, ultrasound, lymphoscintigraphy, bone scintigraphy. After a thorough diagnosis and determination of the type and stage of non-Hodgkin's lymphoma, if any, the type of therapy is selected by specialists.

NHL: Treatment

When confirming the diagnosis of NHL, doctors choose a treatment regimen based on what specific form of non-Hodgkin's lymphoma the patient suffers from, how widespread the disease is inside the body, and at what stage the lymphoma is.

The main methods of treatment are:

Chemotherapy
Radiation therapy
Surgery
Transplantation

The success of treatment depends on how much the disease has progressed, at what stage it is. If the disease is localized and does not tend to develop, it is possible to achieve complete destruction of the lymphoma, cure, or at least prolong the life of a person. With widespread distribution malignant formations treatment is quite complex and is aimed at increasing life expectancy and improving the quality of life of the patient. With super-aggressive and some indalescent types of NHL, when the disease is not amenable to therapy, the patient is not left to fend for himself. It appears to be spiritual psychological help.

If the prognosis for aggressive NHL is favorable, there is standard therapy according to the ACOP (CHOP) scheme, which involves the administration of drugs: Doxorubicin, Onkovin, Cyclophosphamide, as well as taking Prednisolone. Treatment is carried out in courses.

With partial regression of non-Hodgkin's lymphoma drug therapy carried out in combination with radiation therapy in the affected areas.

If large tumor sizes are observed after treatment, the so-called diffuse large cell NHL, then the risk of recurrence is high. The dose of medication is increased. Experts call this therapy “despair therapy”. Remission can be achieved in 25% of cases. But this achievement is short-lived. Then the patient is prescribed high-dose chemotherapy. This method of treatment is appropriate for the first relapses observed in aggressive lymphoma.

For indolet type lymphoma malignant neoplasms poorly treatable. Doctors use, which gives a short remission. But after some time, relapses often occur.

Surgery is warranted if the tumor has not spread and is isolated, which is extremely rare.

NHL nutrition:

It should be frequent and fractional, not allowing you to gain excess weight; adequate in terms of energy expenditure to avoid weight accumulation;
Food should be healthy, containing both proteins, fats, carbohydrates in moderation, and containing vitamins and minerals necessary for recovery;
The amount of salt should be limited, therefore, it is necessary to limit the use of pickles and smoked meats.

Non-Hodgkin's lymphoma (NHL) is general definition a number of malignant diseases that are similar in biological characteristics and differ from Hodgkin's lymphomas in cellular structure. Are characterized pathological change B cells and T cells in the lymph nodes. In international practice, this type of disease is considered one of the most mysterious and has not yet been fully studied. Non-Hodgkin's lymphoma strikes at lymphatic system and quickly spreads in the body through the lymph flow.

What is a disease

First of all, groups of lymph nodes and organs with lymphatic tissue (spleen, small intestine, thymus). NHL has a biological character different from other forms of cancer, accompanied by uncontrolled reproduction of B- and T-cells of the lymph, which leads to the formation of tumors.

The disease can proceed in an aggressive and non-aggressive form, which significantly affects the rate of its development and symptoms. How long patients with such a diagnosis live depends on the cellular characteristics of the detected tumor.

What can cause the disease?

Among the main causes of NHL, experts distinguish:

Heredity. A direct link in the course of laboratory studies has not been established, but statistics suggest that in the case of the development of oncology in direct relatives, the likelihood of NHL increases.
Radiation. Beam and radiation exposure obtained in the course of work in hazardous production, or in the treatment of other oncological diseases.
Ecology. Development is facilitated by interaction with toxic substances, being in the zone of a man-made disaster.
Viruses. HIV, hepatitis C and other severe forms of viruses significantly reduce the level of immunity, and provoke the development of non-Hodgkin's lymphoma.

NHL is most commonly affected by people over 40 years of age. For childhood this oncology is rare, but if it occurs, the chances of recovery are very small.

Symptoms of the disease

Symptoms of the disease depend on the form in which it occurs. Most often, there is swelling of various parts of the body, which occurs due to an increase in the size of the lymph nodes. Symptoms are located on the head, in the groin, or in the armpits.

The development of non-Hodgkin's lymphoma is also characterized by the following symptoms:

Increase in body temperature;
Increased night sweats;
Constant itching all over the body;
Weakness and fatigue;
Loss of body weight due to lack of appetite;
Anemia.

In the case of NHL, the intensity of symptoms increases dramatically in a short time.

Specific symptoms include the manifestation of petechiae, or local microbleeding on the surface of the skin, which are formed due to a lack of platelets in the blood.

Disease classification

Non-Hodgkin's lymphomas in medical practice are usually classified according to several main parameters. According to the nature of the development of the disease:

Indolent. Cancer progresses slowly and is more treatable;
Aggressive. Cancer develops rapidly, treatment rarely gives a positive result.

By location:

Nodal lymphoma. The lesion is localized in the lymph nodes;
extranodal lymphoma. The disease affects organs outside the lymphatic system;
Diffuse lymphoma. Cancer cells are located on the walls of blood vessels, which greatly complicates the diagnosis.

According to the structural features, small cell and large cell lymphoma are distinguished.

Non-Hodgkin's includes a large list of subspecies:

Diffuse large B-cell lymphoma;
lymphocytic leukemia, small cell lymphoma;
CNS cancer;
Lymphoma from mantle cells.

All of these varieties are different in the nature of development and the complexity of diagnosis.

Varieties of non-Hodgkins respond to treatment much worse and most often lead to a fatal outcome.

Lymphoblastic tumor

Lymphoblastic tumor affects the abdominal cavity, refers to a diffuse type of lymphoma. The disease does not show obvious symptoms and is most often diagnosed during non-cancer examinations in the late stages.

Oncology of this type is characterized by an increased rate of metastasis, the liver, spleen, spinal cord. In the extreme stage, it penetrates the nervous system, leads to paralysis and, in 90% of cases, to fatal consequences.

This type of tumor is not operable and can only be drug treatment aimed at slowing down the progression of the disease.

Lymphocytic tumor

Lymphocytic tumor also develops without obvious symptoms, which significantly complicates its detection on early stages. This type of oncology is accompanied by an increase in lymph nodes with the formation of swelling on the surface of the skin.

The appearance of a tumor is associated with a mutation of B-cells in the human body. The main sign for the diagnosis of a lymphocytic tumor is a clear increase in the size of the internal organs. In the early stages of development, the lungs and spleen are affected.

This type of tumor is characterized by slow development, but it is practically not amenable to treatment.

Stages of development of the disease

In oncology, the stage at which the pathology is detected plays an important role in making a diagnosis and predicting recovery. Non-Hodgkin's lymphoma can go through four stages of development, each of which changes the degree of prediction of a cure.

I stage

The first stage is characterized by local damage and inflammation of the lymph node, proceeds without obvious clinical symptoms which makes diagnosis difficult.

At this stage, the disease develops only in the lymphatic system, other organs are not affected.

II stage

In the second stage, a tumor is formed, appear general symptoms diseases: fatigue, apathy, lack of appetite. Cancer cells at this stage can affect the organs of the gastrointestinal tract.

With B-cell lymphoma, surgical removal of the tumor is resorted to, if the course of the disease allows it.

III stage

In the third stage, NHL affects the area of the diaphragm and abdominal cavity. The disease affects almost all internal organs.

IV stage

In the fourth stage, cancer affects the spinal cord and brain, as well as the central nervous system, metastases affect the bones. The chances of a stage 4 patient recovering are slim.

How is the diagnosis carried out?

It is extremely difficult to diagnose non-Hodgkin's lymphoma in the early stages of the disease. If you suspect the development of this type of disease, in addition to a visual examination of the lymph nodes, a number of examinations are performed:

Histological examination;
Puncture of a diseased lymph node;
chest x-ray;
Blood and urine analysis;
Biopsy.

If the diagnosis of NHL is confirmed, a bone marrow puncture and procedures such as laparoscopy, thoracoscopy are prescribed. It is necessary to take immunological samples of the patient in order to choose the right course of treatment.

With timely diagnosis, the patient's chances of recovering or living longer are significantly increased.

Treatment options for non-Hodgkin's lymphoma

Treatment of non-Hodgkin's lymphoma depends on the biological characteristics of the cancerous tumor and the stage of its development.

Most often resort to measures aimed at slowing down and suppressing the development of the tumor:

Irradiation;
Chemotherapy.

Surgical intervention is possible in rare cases of local development of the disease without the formation of metastases in the body. After removal of the affected area, an additional course of treatment is necessary to minimize the risk of recurrence. It is important to adjust the diet, exclude fatty and smoked foods, alcohol and carbonated drinks from the diet.

In medical practice, bone marrow transplantation is also used to treat non-Hodgkin's lymphoma.

Radiation therapy

Radiation therapy is ionized radioactive radiation. It is used and leads to a positive effect in the first stage of NHL. Depending on the course of tumor development, it can be used in combination with chemotherapy.

Chemotherapy

Chemotherapy is a well-known method of fighting cancer, which involves the use of potent drugs. This method is considered the most effective at stages 1-2 of the development of non-Hodgkin's lymphoma, but can be prescribed at any stage.