Lymphomas are malignant neoplasms derived from white blood cells. Symptoms of lymphomas can be non-specific: they can be, for example, fatigue, night sweats or unexplained weight loss. If there is an enlargement of the lymph nodes, it is necessary to see a doctor - it may be caused by the lymphoma. What other symptoms of lymphoma may be and how are these conditions treated - why do doctors sometimes delay starting treatment in a patient with lymphoma?

Lymphoma(lymphoma) is a neoplastic disease whose starting point is the cells of the lymphatic system, i.e. white blood cells. Diseases belonging to this group most often originate from B lymphocytes, less often from T lymphocytes and cytotoxic (NK) cells. Each lymphoma is a malignant neoplasm, but some of them are characterized by a relatively benign course, while others are definitely more aggressive diseases.

Lymphomas are not - at least in Poland - an extremely common neoplasm.

According to the data of the National Cancer Registry for 2010, of all cancer cases, lymphomas accounted for approximately 2.5% in both women and men. When it comes to specific numbers, in total in 2010 over 3.5 thousand lymphomas were diagnosed in Poland.

In the case of statistics concerning the whole world, in 2012, the disease belonging to this group was diagnosed in over 560,000 patients, and over 300,000 deaths were recorded at the same time.

Anyone can develop lymphoma - both a young person and an elderly person. However, not everyone with lymphoma suffers from the same disease - there are many varieties of it.

Lymphomas - types

There are two types of lymphoma:

  • Hodgkin's lymphoma
  • non-Hodgkin's lymphoma (non-Hodgkin's lymphoma)

Hodgkin's lymphoma occurs primarily in young people - incidence peaks are observed between the ages of 20 and 40 and after the age of 50. In turn, non-Hodgkin's lymphoma occurs mainly in elderly patients over 60 years of age (however, there are some exceptions here - some of their types are more common in definitely younger patients).

The group of non-Hodgkin's lymphomas includes many different individualsthe exact cells they originate from, but also the course of these diseases.

Examples of diseases included in this group (according to the World He alth Organization) are:

  • Follicular Non-Hodgkin Lymphoma
  • hairy cell leukemia
  • B-cell lymphoblastic leukemia
  • marginal zone lymphoma
  • Burkitt's lymphoma
  • anaplastic large cell lymphoma
  • chronic lymphocytic leukemia
  • multiple myeloma (multiple myeloma, Kahler's disease)
  • mycosis fungoides
  • Waldenström's macroglobulinemia
  • peripheral T-cell lymphoma
  • mantle cell lymphoma
  • diffuse large B-cell lymphoma

Lymphomas - causes

Lymphomas - like other cancers - develop when abnormal cells multiply uncontrollably. The incidence of lymphomas is influenced by factors such as :

  • exposure to pesticides and ionizing radiation
  • immunodeficiencies (whether due to the use of immunosuppressants or HIV infection)
  • autoimmune diseases (e.g. rheumatoid arthritis or celiac disease)
  • family burdens (if someone in the family has suffered from lymphoma, the risk of this disease in their relatives is increased)
  • geographic location (it has been observed that, for example, most cases of Hodgkin's lymphoma occur in the United States, Canada and northern Europe, while in Asia the incidence of this unit is much lower)
  • socioeconomic status (people with a higher status have a higher risk of, for example, Hodgkin's lymphoma)
  • having received chemotherapy for some reason (the risk of lymphoma is increased, especially when chemotherapy was combined with radiotherapy)
  • infections (both bacterial and viral infections - there is a special relationship between EBV infection and the occurrence of Hodgkin's lymphoma).

Lymphomas - the first symptoms are nonspecific

Lymphomas can lead to symptoms from two different categories. The first of these are non-specific ailments that can be considered a symptom of completely different diseases.

We are talking about problems such as fever with an undetermined cause, weight loss or night sweats.

Lymphoma and colds and flu

Lymphoma is most often confused with a prolonged cold or the flu. No wonder in thesecases, symptoms such as:

  • low-grade fever or fever
  • sweating at night
  • fatigue, general body weakness
  • weight loss
  • cough and even shortness of breath (when the lymphoma is located in the chest)
  • nasal obstruction, nasal discharge (when the lymphoma is located in the nasopharynx)
  • itchy skin of the whole body

If these symptoms persist despite treatment, see a doctor as soon as possible.

How do you tell lymphoma from a cold or flu?

With the flu, the high temperature persists all the time, while with the cancer in question, it appears and disappears (even several times a day) for no apparent reason.

This symptom should arouse our suspicion.

In addition, lymphoma is characterized by a dry and persistent cough. This also occurs in the course of flu, but only at the beginning of the disease. As it develops, it turns into a wet cough.

Changes on the skin and lumps under the skin, which are not typical for flu or colds, but for lymphoma, should also pay attention.

In addition, the development of a tumor of the lymphatic system may be indicated by ascites and / or swelling of the lower limbs, as well as bruising or bleeding (if it is located in the bone marrow, which produces blood cells).

Important

Lymph nodes are enlarged in the course of lymphoma, influenza or other infectious diseases.

However, in the course of an infection, lymph nodes are painful, usually soft, elastic and can be moved in relation to the skin. Additionally, the skin above them is red and warm. Such lymph nodes are usually evidence of the body's fight against infection.

However, if the lymph nodes are painless ( although in some patients pain occurs after drinking alcohol), enlarged to at least 2 cm, and also hard, dense, often grouped in bundles, the skin above them is not changed (not is flushed or warm) and lasts more than 2-3 weeks, there is cause for concern. Then you should see a doctor.

Lymphoma and mononucleosis

The symptoms of mononucleosis are very similar to those of lymphoma. In the course of both diseases, the following appear:

  • swollen, hard lymph nodes (in the groin, armpits, on the neck or under the jaw), which most often enlarge in bundles. However, those in the course of mononucleosis are sensitive to touch
  • fever - in the case of the "kissing disease" it lasts continuously for up to 2 weeks. In the course of lymphoma, fever appears anddisappears (even several times a day)
  • abdominal pain - in lymphoma, abdominal pain occurs when the lymphoma is located in the stomach or intestine. In the case of mononucleosis, it is caused by enlargement of the spleen, so it is most often located in the upper abdominal cavity on the left side (this symptom occurs in 50% of patients)

In addition, lymphoma does not develop other symptoms of mononucleosis, such as gray coated tonsils (causing an unpleasant, nauseous smell from the mouth) and the characteristic swelling of the eyelids, bridge of the nose or browbones.

It is worth knowing that the EBV virus, which causes mononucleosis and which remains in the body for life after primary infection, may be responsible for the development of Burkitt's lymphoma. This risk increases in people with a weak immune system, such as those who are HIV positive.

Lymphoma and atopic dermatitis

Sézary's syndrome and the erythrodermic form of mycosis fungoides, a variant of cutaneous T-cell lymphoma, may be confused with severe cases of atopic dermatitis.

Both in the course of cutaneous lymphoma and severe atopic dermatitis, erythroderma may develop, i.e. generalized skin involvement by the disease, which is manifested by reddening and peeling of over 90%. the surface of the skin.

In addition, in both cases the skin is itchy and hair may fall out. You can also feel enlarged lymph nodes.

So how do you distinguish AD from cutaneous lymphoma?

First of all, AD is a disease usually diagnosed in children (most often it occurs in newborns or between 6 and 7 years of age). Cutaneous lymphoma, on the other hand, usually appears in the elderly, often in a severe form.

Therefore, a patient with late-onset and / or severe atopic dermatitis requires special attention with diagnosis that excludes / confirms the development of primary cutaneous lymphoma.

In addition, atopic dermatitis is often accompanied by food hypersensitivity or intolerance or allergy (almost 50% of children suffering from AD also suffer from bronchial asthma or hay fever), which is not observed in the course of lymphoma.

Moreover, in patients with atopy, bacterial, viral or fungal infections can be observed, which is not characteristic of cancer of the lymphatic system.

In addition, skin lymphomas can be confused with such skin diseases as:

  • psoriasis
  • allergic contact eczema
  • fish scale
  • other manifestations of erythroderma

Lymphomas - more specific symptoms

Other possible symptoms of lymphoma are much more specific and are related to the presence of neoplastic masses. Among them are:

  • enlargement of the lymph nodes (usually they are larger than 2 cm, the nodes enlarged by lymphoma typically do not hurt, and the skin above them is unchanged; in the course of the disease, the nodes may grow into bundles)
  • ailments related to the infiltration of various organs by the lymphoma (e.g. abdominal pain related to the enlargement of the spleen or jaundice resulting from liver involvement)
  • symptoms resulting from bone marrow infiltration (e.g. anemia).

The symptoms of lymphoma are determined by several factors, including where the tumor masses will be located in the body.

For example, patients who have cancer in the chest area may experience shortness of breath, cough or a non-specific feeling of tightness in the chest.

In the case of one of the types of lymphoma, a rather interesting symptom is pain in the lymph nodes, which may appear after … drinking alcohol.

The number of lymphoma patients is increasing. However, new therapies are still beyond the reach of Polish patients

Lymphomas - diagnosis

In the diagnosis of lymphomas, both laboratory tests, as well as imaging and histopathological tests are important.

They are performed, among others peripheral blood counts (in which anemia and leukocytosis may be detected), as well as measurements of lactate dehydrogenase activity and tests to determine the function of the liver and kidneys.

Imaging tests are extremely important - usually, initially such tests as computed tomography, magnetic resonance or PET-CT are performed, which allow to determine whether the disease has spread.

Apart from those already mentioned, histological and immunohistochemical examinations are extremely important in the diagnosis of lymphomas. They can be performed after collecting the affected lymph node - it is recommended that the examination should not include a fragment, but the entire lymph node. Sometimes bone marrow tests are also ordered - e.g. bone marrow aspiration biopsy.

In a patient with suspected lymphoma, not only tests are performed to confirm or rule out the diagnosis. Patients are also ordered other analyzes - e.g. echocardiography or lung function tests - the results of which have an impact on the planning of the treatment course.

Lymphomas - stage of advancementdiseases

All the aforementioned tests are important not only because they allow for a final diagnosis - their conduct also allows to determine how advanced the patient's disease is.

For this purpose, the so-called the Ann Arbor scale (now modified), which distinguishes four degrees of lymphoma:

  • degree I: occupation of one node or one group of contiguous nodes or the presence of one extra-nodal lesion without the involvement of nodes
  • stage II: involvement of more than two groups of lymph nodes on the same side of the diaphragm or changes in nodes with the involvement of an organ close to the nodes
  • stage III: lymph node involvement on both sides of the diaphragm or lymph nodes above the diaphragm with simultaneous involvement of the spleen
  • stage IV: involvement of the extra-lymphatic organ with simultaneous involvement of the nodes.

The extension of this classification concerns Hodgkin's lymphoma. There, next to the step, two letters are also used: A and B.

The letter A in this case means that the patient does not have general symptoms.

The letter B is added to the grade of Hodgkin's lymphoma when the patient is struggling with any of the conditions such as a fever above 38 degrees C for no apparent reason, weight loss exceeding 10% (which occurred within 6 months), or night sweats.

Lymphomas - treatment

There are basically two methods of treating lymphomas: chemotherapy and radiotherapy. However, not all diagnosed patients receive treatment immediately. Whether the therapy is started depends on the type of diagnosed lymphoma.

Diseases from this group can be divided into three groups:

  • lymphomasslow (e.g. chronic lymphocytic leukemia)
  • lymphomasaggressive (e.g. mantle cell lymphoma)
  • lymphomasvery aggressive (e.g.absorbsk Burkitta).

In the case of the former, the diagnosis is often made randomly - patients are usually of advanced age and may not have any general symptoms.

Here, the "watch and wait" principle is often used - it is based on the fact that the patient is under the constant observation of doctors, and the treatment is initiated only when the disease progresses.

It is by no means a neglect of the patient -lymphomasslow lymphomas are difficult to heal completely, additionally, treatment with chemotherapy can sometimes have more negative effects than benefits, thereforethey start only when it is really needed.

The treatment of aggressive and very aggressive lymphomas is much different. In their case, therapy is started as soon as possible. Here, however, there is quite an interesting relationship: these diseases can be very rapid (lymph nodes can become significantly enlarged in just a few days), but often these neoplasms are very sensitive to chemotherapy.

Lymphomas - prognosis

The type of disease determines the prognosis of a patient with lymphoma.

Patients with indolent non-Hodgkin's lymphoma rarely have a chance of a full recovery - although it is possible to achieve remission stage in them, although the disease may recur. It is worth emphasizing here, however, that the survival time in the case of these lymphomas, even without treatment, may reach even several years from the diagnosis of the disease.

In the case of aggressive non-Hodgkin's lymphomas, it is possible to obtain complete cure in up to half of all patients.

As for Hodgkin's lymphoma, here are the best treatment effects: permanent recovery is possible in up to 9 out of 10 patients diagnosed with this disease.

About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

Read more articles by this author

About the authorMonika Majewska A journalist specializing in he alth issues, especially in the areas of medicine, he alth protection and he althy eating. Author of news, guides, interviews with experts and reports. Participant of the largest Polish National Medical Conference "Polish woman in Europe", organized by the "Journalists for He alth" Association, as well as specialist workshops and seminars for journalists organized by the Association.

Read more articles by this author

Category:

Oncology