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Non-Hodgkin's lymphomas are cancers of the lymphatic system, the treatment of which - as in the case of other cancers - depends on the stage of development and form of the disease. In addition, different treatments are used for children and for adults. Find out how to diagnose and treat non-Hodgkin's lymphoma and the prognosis.

Non-Hodgkin lymphoma (NHL), or lymphoproliferative neoplasms, is a group of malignant neoplasms of the lymphatic system, i.e. the system whose main task is to protect the body against infections and diseases.

These cancers arise from abnormal lymphocytes, cells that are responsible for the body's defenses, multiplying without control.

In Poland, about 8,000 new cases of lymphoma are found every year, and this number is constantly growing.

In the world, over 1 million people suffer from one of several dozen types of non-Hodgkin's lymphoma, and 200,000 dies because of him. Unfortunately, everything indicates that this number will be even greater.

All because, according to data from the World He alth Organization (WHO), the number of lymphatic system cancer cases increases by 4-5 percent every year.

In Poland, non-Hodgkin's lymphoma ranks 6th among cancers (in terms of incidence). They most often affect people between the ages of 20 and 30 and those aged 60-70.

Non-Hodgkin's lymphoma - causes

The essence of the disease is the abnormal growth of cells in the lymphatic system. Abnormal lymphocytes begin to form from blood cells and they continue to divide.

After some time, their excess leads to the formation of a tumor in the lymph nodes, because this is where this process takes place most often.

However, sometimes cancer cells may pass through the lymph nodes or the bloodstream to other organs (such as the spleen, bone marrow, liver, and lungs). In a new place, the lymphoma cells continue to divide and a new tumor is formed.

In most cases, the reasons for this are unknown. Much more is known about the risk factors for developing non-Hodgkin's lymphomas, which are:

  • weakened immune system - incl. people taking medicationsimmunosuppressants (e.g. after transplantation), HIV-infected, congenital immunodeficiency
  • autoimmune diseases, incl. rheumatoid arthritis, Hashimoto's disease
  • Previous anti-cancer treatment - prior radiotherapy or chemotherapy
  • some viruses, bacteria, parasites e.g. hepatitis C virus (HCV), bacteriaHelicobacter pylori(increases the risk of developing MALT lymphoma in the stomach), Epstein-Barr virus (EBV), human T-lymphocytotropic retrovirus, i.e. HTLV-1 (increases the risk of developing ATL lymphoma), protozoan of the genus Plasmodium (in Africa, Burkitt's lymphoma is common in patients with malaria, which is caused by this parasite)
  • chemical compounds, especially herbicides, insecticides, aromatic hydrocarbon derivatives, solvents, wood and cotton dust. Therefore, workers in the chemical, rubber and wood industries as well as food processing are more exposed to cancer
  • the presence of the disease in the family (however, the risk of falling ill in this case is small)

Non-Hodgkin's lymphoma - types

Non-Hodgkin's lymphomas are divided into aggressive and chronic. The latter develop slowly and do not require treatment for a long time, but are usually not cured permanently. In turn, the aggressive form of cancer of the lymphatic system develops much faster and requires immediate treatment. Fortunately, there is a cure in this case.

The most commonly diagnosed non-Hodgkin's lymphoma is small B-cell lymphoma, usually in the form of chronic lymphocytic leukemia (CLL for short or more commonly CLL).

It is 25 percent. of all leukemias, with about 70 percent. lymphoid leukemias, and 7 percent. all lymphomas.

The next places are "diffuse" large B-cell lymphoma (DLBCL), multiple (plasmocytic) myeloma and follicular lymphoma.

Less common variations are:

  • extranodal marginal lymphoma - MALT
  • mantle cell lymphoma
  • Burkitt's lymphoma
  • large B-cell mediastinal lymphoma
  • marginal zone nodal lymphoma
  • small B-cell lymphoma
  • lymphoplasmocytic lymphoma (Waldenstrom's macroglobulinemia)
  • peripheral T-cell lymphoma
  • cutaneous lymphomas (including mycosis fungoides and Sézar's syndrome)
  • large T cell anaplastic
  • lymphoblastic lymphomas (mostly T-cells, but can also be B-cells)

Non-Hodgkin's lymphoma - symptoms

Most often, the first symptom of non-Hodgkin's lymphoma is a painless swollen gland in one area of ​​the body, such as the neck, armpits, or groin.

Lymphomas are most often located in the lymph nodes. However, in some cases, the disease can start to develop outside of the lymph nodes, most often in other organs of the lymphatic system - the spleen, tonsils, bone marrow and blood, although they can be located in less common places - the stomach, breast, heart, and even nose.

Remember, however, that enlarged lymph nodes are much more likely to be caused by an infection than by lymphoma.

Some people have additional symptoms related to the location of the lymphoma:

  • nasal congestion with hearing loss, breathing difficulties, leakage of mucus from the nose (if the cancer has developed in the nasopharyngeal cavity)
  • cough, difficulty swallowing, or shortness of breath (suggest that the lymphoma is located in the chest)
  • indigestion, abdominal pain and weight loss (lymphoma likely developed in the stomach or intestine)
  • bruising or bleeding with reduced resistance to infection (lymphoma has probably developed in the bone marrow, which produces blood cells. As a consequence, the levels of blood cells in the body can drop);

In addition, general symptoms may appear, such as:

If these symptoms persist despite treatment and persist for more than 2-3 weeks, it is advisable to consult an oncologist

  • low-grade fever or fever, appearing at different times of the day (appear and disappear for no apparent reason)
  • nagging, drenching night sweats
  • weight loss
  • fatigue
  • persistent itching of the skin

Sometimes patients do not have any general symptoms and feel fine.

Important

In the event of a cold, flu or other infections, the lymph nodes in, for example, the neck or jaw, become palpable and may hurt.

Such painful, enlarged lymph nodes, especially if accompanied by a cough, runny nose or fever, are usually not associated with cancer, and are evidence of the body's fight against infection.

Lymph nodes also enlarge in response to local inflammation.

The lymph nodes are a cause for concern:

  • painless ( although some patients suffer from lymph node pain after drinking alcohol)
  • with a diameter greater than 2 cm
  • hard
  • felt in one or more parts of the body
  • growing slowly (except for Burkitt's and diffuse large cell lymphoma - in these cases they grow quickly)
  • grown into bundles
  • over which the skin remains unchanged (it is not red or warm, as is usually the case with an infection)

In addition, the presence of a tumor in the extra-nodal area should be a cause for concern.

Then it is recommended to visit the doctor as soon as possible.

Non-Hodgkin's lymphoma - diagnosis

If non-Hodgkin's lymphoma is suspected, the basic and decisive diagnostic test is a biopsy, which in this case involves taking the entire enlarged lymph node (most lymphomas begin to develop in this place) for histopathological examination.

The procedure is performed under local or general anesthesia. The waiting time for the biopsy results is about 2 weeks.

If the test results show lymphoma, your doctor will order further tests to see if the disease has spread to other parts of the body. They will also allow to determine the stage of the disease development, thanks to which the doctor will be able to plan an effective treatment method:

  • blood tests
  • computed tomography
  • magnetic resonance imaging - the test is sometimes used to diagnose lymphoma in the head, neck, bones and brain, as it gives a more detailed image than tomography
  • PET / CT imaging - a combination of computed tomography and positron emission tomography - the test is used in the diagnosis of some types of lymphomas
  • taking a bone marrow sample - allows you to determine the presence of lymphoma cells in the bone marrow; bone marrow samples are usually collected from the hip bone

Non-Hodgkin's lymphoma - treatment

  • mild in the early stages of development

The most frequently used radiation therapy is the affected lymph nodes. Treatment usually works. In the event of a relapse, chemotherapy can be given to control the disease for years.

  • mild at an advanced stage of development

There is chemotherapy or chemotherapy with administration of a monoclonal antibody. Then the lymphoma usually shrinks and symptoms disappear.

Patients, depending on the type of lymphoma, tolerance and treatment effects, may require from 3 to even 12 treatment courses, with one course of chemotherapy followed by a 2-4 week rest period.

For one in three peoplebenign non-Hodgkin's lymphoma becomes aggressive

The treatment with the monoclonal antibody is then continued (so-called maintenance treatment). Following intravenous administration, monoclonal antibodies bind to B lymphocytes, including lymphoma cells, and destroy them.

Lymphoma may come back after a few years. Then treatment is applied again until the symptoms disappear. In this way, the cancer is under control even for decades, while maintaining a good quality of life.

  • aggressive non-Hodgkin's lymphoma

The most common treatment method is chemotherapy (often in combination with a monoclonal antibody).

Radiation therapy may be used after the end of chemotherapy, especially if the cancer is in one area of ​​the body or if the lymph nodes were significantly enlarged prior to chemotherapy.

More intensive therapy may include high-dose chemotherapy with stem cell transplantation.

Transplantation of own peripheral blood stem cells or bone marrow is used to accelerate the recovery of the hematopoietic system after chemotherapy or radiotherapy given in doses much higher than usual.

This therapy is usually used in children whose lymphoma is almost always aggressive. In the case of children, radiation therapy may be necessary additionally.

Important

Benign lymphomas usually develop slowly, so there is often no need to start treatment as soon as it is diagnosed. Then, active observation is enough, i.e. regular check-ups with a doctor.

However, in the case of aggressive forms, treatment is started immediately after the diagnosis of the cancer.

Other treatment methods:

If the cancer has also spread to the brain, your doctor may order the administration of cytostatics directly into the cerebrospinal fluid or intra-arterially into the brain tumor.

Lymphomas originally called extra nodal cells that develop outside of the lymph nodes (most often found in the palatine tonsils, stomach, intestines, brain, testes, ovaries, skin and bones) can be removed with surgery.

Antibiotics are sometimes used in the treatment of benign lymphoma, e.g. in the treatment of MALT lymphoma.

Non-Hodgkin's lymphoma - side effects

Immediately after receiving chemotherapy, the body is especially susceptible to all kinds of infections. They are very dangerous, therefore any symptoms of infection that begin after administration of chemotherapy (runny nose, cough, sore throat) require medical attention. In addition to the decline in immunityof the organism with varying intensity and frequency, the following may appear: nausea and vomiting, loss of appetite, fatigue, hair loss, diarrhea and constipation.

Side effects with radiotherapy are often less severe and are usually limited to the site of the irradiation.

Non-Hodgkin's lymphoma - prognosis

In the case of low-grade (indolent) lymphomas, survival without treatment is from several to several years.

Source:

  1. Institute of Hematology and Transfusion [access: 19.01.2015]. Available on the Internet: http://www.ihit.waw.pl/leczenie-chloniakow-nieziarniczych.html
  2. "Lymphomas - I want to know more" - a guide prepared by the Association for the Support of Lymphoma Patients "Sowie Oczy".

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Category:

Oncology