Non-Hodgkin's malignant lymphomas. Non-Hodgkin lymphoma symptoms and treatment methods for the disease. High-grade non-Hodgkin's lymphomas

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, consisting of lymph nodes (small closed collections of lymphocytes) connected by a system small vessels.

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

Men develop non-Hodgkin's lymphoma much more often than women, and 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. The cause is believed to be penetration viral infection into the human body or due to suppression of the immune system, especially after organ transplantation. Epstein-Barr virus probably causes Burkett's lymphoma, a type of non-Hodgkin's lymphoma.

Course of the disease Non-Hodgkin lymphoma

Variants of non-Hodgkin's lymphomas (lymphosarcoma) 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.

Intermediate grade non-Hodgkin's lymphomas:

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

Non-Hodgkin's lymphomas high degree malignancy:

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

Mycosis fungoides, reticulosarcoma (according to modern concepts most of the latter is represented by lymphoid tumors and a minor one - by histiocytic variant), plasmacytoma, unclassified lymphomas.

For nodular lymphosarcoma characterized by the formation of pseudofollicular structures, which, unlike true follicles, are determined both in the cortical and medulla layers of the lymph node, are large in size, have unclear contours and a relatively monomorphic cellular composition.

The diffuse type of growth is characteristic of all variants of non-Hodgkin lymphoma. Diffuse lymphocytic lymphosarcoma characterized by a total proliferation of cells such as small lymphocytes infiltrating the walls blood vessels, which leads to 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, pattern of peripheral blood, bone marrow and etc.).

Diffuse lymphoplasmacytic lymphosarcoma characterized by a combined proliferation of lymphoid and plasma cells; plasmatized lymphocytes are also found. Changes in this variant of lymphosarcoma are similar to the picture found in Waldenström's macroglobulinemia; the disease is often combined with various types monoclonal gammopathies.

Diffuse prolymphocytic lymphosarcoma is characterized by the proliferation of cells larger than small lymphocytes, having round or irregularly shaped nuclei (“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, the 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 ensures practical recovery of most patients in stage I of the process.

In diffuse lymphoblastic lymphosarcoma, proliferations of lymphoblast-type cells are detected, among which there are macro- and microgenerations. Cells with nuclei of a brain-like (twisted, convolutional) shape can be detected. They are more often observed in children when the process is localized in the lymph nodes of the mediastinum and are usually of 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 characterized by massive proliferation of large mono- or multinucleated cells with a large centrally located nucleolus and an abundant zone of basophilic cytoplasm. A large number of mitoses and dying cells are detected. 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 It is distinguished by a monomorphic proliferation of blast cells of the lymphoid type with hyperbasophilic, often vacuolated narrow cytoplasm. Against this background, a typical, although non-specific, feature is the presence of large macrophages, which create a picture of a “travelled palate”. There is an opinion about the proximity of Burkitt lymphoma cells to partially blast-transformed B lymphocytes. Unlike other forms of non-Hodgkin lymphoma, the tumor is primarily localized

extranodal.

At reticulosarcoma(histiocytic lymphoma), a relatively rare tumor, reveals proliferations of cells with morphological and functional signs 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. Some cells exhibit the ability to phagocytose. The cells are characterized by high activity of nonspecific esterase, the ability to secrete lysozyme, and the absence of specific markers.

Non-differentiable 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 also used. Thus, some authors propose to subdivide lymphosarcoma depending on the primary localization of the process; The term “lymphocytoma” emphasizes the benign nature of extramarrow tumors, consisting predominantly of mature forms of small lymphocytes (or lymphocytes and prolymphocytes), forming a structure of nodular growth. Therefore, they are separated from low-grade non-Hodgkin lymphomas into a separate group of lymphoid tumors.

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

Symptoms of Non-Hodgkin's Lymphoma

For all morphological variants of non-Hodgkin's lymphomas, there is equally frequent involvement of both lymph nodes as a whole and their individual groups, Waldeyer's lymphoid ring and gastrointestinal tract. More frequent primary lesions of the retroperitoneal lymph nodes and abdominal cavity, bones and soft tissues are observed in lymphoblastic, spleen - in prolymphocytic variants. The pathological process, regardless of the morphological variant of the disease, in most cases does not first spread to the areas adjacent to the lymph nodes. Damage to adjacent groups of lymph nodes more often occurs with the lymphoblastic variant.

Early extranodal metastasis, metastasis to the bone marrow, involvement of the liver and spleen in the pathological process are somewhat more common in the prolymphocytic variant, and bone marrow damage and leukemia are more common in the presence of cells with a round and split nucleus. However, with blast variants, bone marrow involvement and an increase in the size of 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 a split and round nucleus is 70 and 53%, respectively. With the prolymphocytic-lymphoblastic variant from large cells with a split nucleus, survival rates are close to those with blast variants and amount to 14-21 months.

Survival rates in I-II stages non-Hodgkin's lymphomas with a high degree of malignancy with primary lesions of the gastrointestinal tract are significantly superior to 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 lymphosarcoma. Somewhat more often, primary damage to the spleen is detected in the prolymphocytic variant. More often, with splenic lymphoma, involvement of the bone marrow in the pathological process is noted. However, with 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 lymphomas. The prognosis for this primary localization is determined by the morphological variant. Damage to the nervous system is observed, as a rule, in blast variants of non-Hodgkin lymphomas.

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

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

Generalization of the process occurs on average in 3-24 months. Bone marrow damage can also be detected with a normal hemogram (in 47% of patients it is unchanged 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 more than 5 years).

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

With a rare lymphoplasmacytic cytological variant clinical syndromes The course of the disease is determined by the location of the tumor, the extent of the process, and often by the amount of IgM in the blood serum.

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

Lymphoblastic variant quite heterogeneous in its morphological (with a twisted, untwisted nucleus, macro-, microforms) and immunological (T- and B-phenotype) characteristics, most often found in children. Lymph nodes of various locations are affected. The disease is characterized by the rapid growth of tumors and the involvement of new anatomical zones in the process. More often than with other lymphosarcoma, the hemogram shows initial cytopenia and a T-cell phenotype of lymphocytes.

Burkitt's lymphoma of B-cell origin is classified as a lymphoblastic type of lymphosarcoma. Its classic variant is manifested mainly by bone damage (especially lower jaw), kidneys, ovaries, lymph nodes of the retroperitoneal areas, lungs, parotid salivary glands. Bone marrow is rarely involved in the process. In localized forms, the prognosis is favorable with long-term remissions up to 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 and lungs; in 50% of cases - leukemia. The disease is more often detected in boys in 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's ring, etc. Cytopenia is often detected, leukemia - in rare cases. The disease progresses quickly, the five-year survival rate of patients is 21-32%, however, removal of a solitary tumor can contribute to long-term remission and even cure. Immunoblastic lymphosarcoma as a secondary process is described in multiple myeloma, Waldenström's macroglobulinemia, and other lymphoproliferative diseases.

Mycosis fungoides is a malignant lymphoid tumor, always initially arising in the upper layers of the dermis, consisting of polymorphic T-helper cells. The first manifestation of the disease may be nonspecific inflammation. The diagnosis is verified according to histological and 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, while the “lymphoblastic” phase represents true malignant transformation. Sezary syndrome, characterized by the appearance in the hemogram of lymphoid cells with a brain-like nucleus, is considered as the leukemic phase of mycosis fungoides.

The histiocytic variant of malignant non-Hodgkin lymphoma is very rare. Its clinical picture is varied. Metastases can be found in many organs. Leukemia and bone marrow involvement are rare, and cytopenia is common.

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

It is proposed to include the non-Hodgkin lymphoma that has also been described in recent 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, and sometimes signs of hemolysis. Histologically, a triad is characteristic: proliferation of small vessels, proliferation of immunoblasts, deposition of PAS-positive amorphous masses in the walls of blood vessels. The number of eosinophils and histiocytes varies, but sometimes the number of the latter is noticeably increased. There may be giant cells and small foci of necrosis. A number of researchers regard the changes described above not as malignant lymphoma, but as reactive, associated with disturbances 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 and lymph nodes are slightly enlarged normal sizes or slightly enlarged. In the blood there is a normal or close to normal number of leukocytes with a predominance or normal content of mature lymphocytes. The platelet level is within normal limits; in some patients, their number may decrease to 1*10 9 /l-1.4*10 9 /l after 7-10 years. More often, only a slight tendency towards a decrease in the level of hemoglobin and the number of red blood cells is detected; reticulocytes fluctuate between 1.5-2%. Bone marrow biopsy reveals isolated proliferates consisting of mature lymphocytes; Histological studies of an enlarged lymph node and other affected organs help verify the diagnosis. Malignancy of lymphocytoma with transformation into lymphosarcoma or chronic lymphocytic leukemia is not obligatory, and if it occurs, it often occurs after many months or years.

Diagnosis of the disease Non-Hodgkin 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 ( 18%), increased ESR (13.5%). Differential diagnosis should be carried out with chronic lymphocytic leukemia, infectious mononucleosis, nonspecific lymphadenopathy. It often takes months from the period when the first signs of the disease appear until a true diagnosis is made.

Primary extranodal lesions can occur in any organ where there is lymphoid tissue. Only 15 cases of isolated liver damage have been described, but metastatic damage is found in more than 50% of patients. 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 histological examination of lymph nodes or other tumor formations, their cytological (imprint, punctate), cytochemical and immunological studies are mandatory. WITH diagnostic purpose and to estimate the prevalence pathological process examine punctate and bone marrow biopsy.

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 detected. The tumor substrate consists predominantly of mature lymphocytes (or lymphocytes and prolymphocytes), forming a nodular growth structure. After a long time, transformation of lymphocytes into lymphosarcoma or chronic lymphocytic leukemia is possible.

Treatment of 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, and the presence of other diseases.

The fundamental method of treating 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, it is justified in combination with chemotherapy or as palliative irradiation of tumor formations. How independent method Radiation therapy for non-Hodgkin's lymphomas can be used only in clearly proven stage I of the disease in non-Hodgkin's lymphomas of low malignancy, when bones are involved 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 generalization of the process.

Elderly patients with low-grade non-Hodgkin lymphomas, as well as in the presence of severe concomitant diseases monochemotherapy (chlorbutin, paphencil, cyclophosphamide, etc.) can be used. In case of primary damage to the spleen, regardless of the morphological variant of the disease, splenectomy is performed, followed by a course of chemotherapy. In case of isolated damage to the stomach, the combined treatment program includes its resection. For skin lesions, chemotherapy is used, including prospidine and spirobromine.

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

For generalized stages of low-grade non-Hodgkin's lymphomas, the programs TsOP, TsOPP, BATsOP, 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 lymphomas also depend on timely use of hematological resuscitation, immunocorrection and antibacterial therapy.

Since hematopoiesis remains intact in some patients for some time, it is possible to conduct polychemotherapy on an outpatient basis, which, with 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 is carried out. When stable remission is achieved, treatment is stopped.

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

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

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

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

Prevention of non-Hodgkin's lymphoma

To date, there is no known method by which the occurrence of non-Hodgkin's lymphoma could be prevented. Most people with non-Hodgkin lymphoma have not been exposed to known risk factors.

06.04.2017

What is non-Hodgkin's lymphoma? An oncological disease that occurs in the lymphoid cells of hematopoietic germs.

If we compare it with lymphogranulomatosis, the survival rate of patients is only 25% of all diagnosed cases.

This disease is different from other forms cancers because it has a completely different biological character, completely different symptoms, structure and prognosis.

In 1971, the eminent German surgeon Theodor Billroth proposed calling this tumor neoplasm non-Hodgkin's lymphoma or cancer.

Causes of the disease

The causes and factors why non-Hodgkin's lymphoma may occur have not been determined. There is an assumption that this is due to viruses, radiation exposure or interaction with chemicals.

The onset of the disease begins when lymphocytes mutate, and the genetic indications of the cell change, but why this happens is not clear.

There are suggestions that pathology occurs in children due to the following reasons:

Congenital pathologies of the immune system.
Acquired HIV infection.
After an organ transplant, when one's own immune system is suppressed.
Presence of viral diseases.
Irradiation.
The influence of certain chemicals and various medications.

Non-Hodgkin's lymphomas are the sixth leading cause of cancer mortality. According to statistics, this disease affects men more often than women.

It can be noted that the disease is becoming more common. It affects older people. Although the risk of disease accompanies people who have crossed the line at forty years.

The patient's age and type of disease are interrelated. Aggressive non-Hodgkin's lymphoma is diagnosed in children and adolescents. It can be small cell, large cell lymphoma, tumors of diffuse or lymphoblastic origin. And if we talk about older people, they are more often diagnosed with follicular lymphoma, the degree of its development may vary.

In addition, there are suggestions that pathology may appear after somatic organ transplantation.

Signs indicating the onset of the disease

There are two types of disease, aggressive and indolent. In some cases, highly aggressive development of the disease is diagnosed. Then the tumor begins to cover an increasingly larger area of the body.

If non-Hodgkin's lymphomas with high malignancy are diagnosed, then the disease is too aggressive. Other types of non-Hodgkin's lymphomas, in which the degree of malignancy is much lower, occur over a longer period of time and can be chronic. However, they can manifest themselves spontaneously.

It should be noted that the type of disease that occurs in an aggressive form can be completely cured, but the type that is chronic and long-lasting cannot be cured.

Despite the fact that traditional treatment still helps, the difficulty is that it often recurs, and this already leads to the death of the patient. Patients diagnosed with non-Hodgkin lymphoma live up to seven years in seventy percent of cases. Life expectancy does not depend on the chosen treatment method.

In some cases, these cancer cells develop into a higher grade of malignancy, and this happens quickly and unexpectedly. After such degeneration, it becomes diffuse large B-cell, and subsequently can cover the bone marrow. If this happens, it greatly reduces the patient's chances of recovery, and life expectancy after this is approximately a year.

Non-Hodgkin lymphomas differ from leukemia in that they begin to develop in the lymphatic system and then affect the bone marrow. This diagnosis can be made to anyone at any age. At the beginning, the pathology occurs in the peripheral and visceral lymph nodes and the gastrointestinal tract. Sometimes it can be found in the spleen, lungs and other organs.

These lymphomas are divided depending on their location:

Nodal, those that are localized directly in the lymph nodes.
Extranodal.
Spreading through blood and lymph.

These neoplasms initially cover the entire body. Therefore, when diagnosing them, neoplasms are found in any area of the body.

When lymphoma occurs in a highly aggressive form, this means that the disease progresses very quickly, that is, it develops. Therefore, when the first symptoms appear and the patient goes to the clinic, it is discovered that almost the entire body is covered by the disease.

Symptoms

But on the other hand, this disease can develop in different ways, just like any other disease. But because it develops in lymphoid tissue, there are specific symptoms, and they are:

Lymphadenopathy is determined by enlarged lymph nodes.
The appearance of an extranodal tumor. Indicates defeat specific body. For example, it could be lymphoma of the stomach, central nervous system, or skin.
Weakness of the body.
Increased body temperature.
Sudden weight loss.

All these symptoms appear with systemic deterioration in health.

In some cases, non-Hodgkin's lymphoma exhibits symptoms that indicate that the disease has affected not only the lymphatic system, but also all organs, tissues and other systems of the body.

There is such a tendency for the development of the disease, in forty-five percent of patients, the disease proceeds in a slow, chronic form, and in the rest the course of the disease is aggressive.

Most often the disease is diagnosed in the gastrointestinal tract, head, and neck. But in the bronchi and lungs, mainly secondary manifestations of the neoplasm are detected.

At the end of the last century, diagnosing primary tumor processes in the central nervous system increased. It should be noted that in the kidneys and bladder pathology is rare.

During diagnosis, it is important to establish the presence or absence of an oncological process in the bone marrow.

Stages of the disease

Lymphoma is divided into classes according to its degree of malignancy and structure.

The degree of malignancy can be divided into three types:

Low.
Intermediate.
High.

But there are four stages of the disease:

The first stage is characterized by damage to one lymph node and one tumor that has not metastasized to neighboring organs and systems.
The second stage involves damage to several lymph nodes; one side of the diaphragm may also be affected. In this case, local symptoms may or may not appear. If the form of the disease at this stage is B-cell, then surgical removal of the tumor is possible. Although in some cases removal is still not possible.
The third stage, in this stage both sides of the diaphragm and the chest are affected. Metastases can also spread to the abdominal cavity. Bone marrow tumors may occur.
The fourth stage is the most severe stage, at which it no longer matters where the primary pathology is located. It is characterized by localization areas such as the bone marrow, central nervous system and skeletal bones.

Treatment of the disease

Before starting treatment, it is necessary to conduct additional examinations of patients.

The functioning of the heart should be checked; for this, an electrocardiogram and echocardiogram are prescribed. They also clarify how the disease affected internal organs, metabolic processes, and whether there is an infection in the body.

The main thing is that after the initial tests, their results are not lost anywhere, because they will be needed later if any changes occur during the treatment process.

In addition, the patient’s blood type should be established, because no method of therapy is complete without blood transfusion. Therefore, blood donation is scheduled to determine the group.

Treatment of non-Hodgkin's lymphoma

Whatever method is chosen for this, it is aimed at prolonging the patient’s life and improving its quality. However, it should be noted that the success of this goal will depend on the type of neoplasm and the stage of its development. If the tumor has clear boundaries, it can be easily removed, thus prolonging the patient’s life. Although then it is still necessary to undergo special treatment so that the disease does not recur.

In cases where the pathological process has affected the entire body, you should apply antitumor treatment with methods of maintaining life of human activity.

If the disease inevitably leads the patient to death, all methods of therapy are used that are aimed not only at prolonging life, but also at its quality.

Methods include:

Eliminate symptoms.
Spiritual help.
Social help.
Psychological support.

In almost forty percent of cases of treatment of aggressive lymphoma, if the prognosis was favorable, it ends in positive results.

Patients with aggressive forms, if the prognosis is favorable, are prescribed the usual drug treatment. For this, doxorubicin, Oncovin, cyclophosphamide, and prednisolone are prescribed intravenously. After this, chemotherapy drugs are prescribed to avoid remission of the disease. In addition, this is one of the methods of prolonging the life of the patient.

Malignant lymphoma, with partial remission, is treated with medications and irradiation of the localized pathology.

One of the difficult tasks is the therapy of older people. Because a positive result of treatment largely depends on the age of the patient.

For example, complete remission is achieved in treatment if the patient is under forty years old, this occurs in sixty-five percent of cases. After age sixty, this figure drops sharply to thirty-five percent. But there is also statistics on deaths from toxicity, it reaches thirty percent.

To treat patients who experience relapses of the disease when the entire body is affected, a special technique is used.

Its selection will depend on factors:

A type of neoplasm.
A treatment method that has been used previously.
The body's reaction to the treatment.
Patient's age.
General condition of the body.
Work of all body systems.
Bone marrow conditions.

It should be noted that if a relapse of the disease occurs, then you should not use the medications that were used to first treat the patient.

But if a relapse occurs after one year after the start of remission, then the therapy that was initially prescribed can be used.

During diffuse large cell lymphoma, and its large sizes, there is a high risk that relapses will occur. In this case, it is necessary to use medications with increased doses. Doctors call this treatment “despair therapy.” Complete remission is achieved only in twenty-five percent of cases, and even then it is not long-lasting. Then the patient is prescribed chemotherapy treatment using high doses of the drug, but for this the patient must have a high somatic condition.

Such treatment is possible at the first relapses, even if the disease proceeds in an aggressive state.

When the disease proceeds in a slow form, then any type of therapy can be selected. Because there is no standard treatment for such forms. After all, such tumors are sensitive to treatment, so recovery does not occur. In this case, conventional chemotherapy procedures are used. After such treatment, short remissions occur, which quickly end in relapses.

Irradiation is used only at the initial stage of pathology development. Starting from the second stage, in addition to irradiation, medications are also used.

If tumor lesions are detected in the bone marrow, then standard treatment regimens are used. Medicines such as chlorbutin with prednisolone are used. Chemotherapy procedures are carried out later.

This method of therapy can prolong the patient’s life, but it cannot guarantee that there will be much fewer relapses. The use of medications is not stopped until remission occurs. The final treatment is radiation, but it is used according to indications.

After treatment, the patient is prescribed interferon injections three times a day for one and a half years. This will support the patient’s weak immune system.

Recently, a drug such as rituximab has been used more often; it is a destructive drug for malignant cells of the pathological process. It can be used as a stand-alone treatment or in combination with other drugs.

Treatment with folk remedies

To treat non-Hodgkin's lymphoma, you can use infusions, tinctures, decoctions prepared from medicinal plants and mushrooms.

Infusions of wormwood, black henbane, and hemlock are considered good remedies.

If we consider mushrooms, we can use shiitake, reishi, birch chaga and many others. Mushrooms can prevent the spread of metastases, restore hormonal balance, reduce side effectsphenomena that occur after chemotherapy (nausea, baldness, pain).

If you take reishi and shiitake mushrooms, you can restore your blood formula and activate your immune system.

To remove tumor toxins from the body, you need to mix birch mushroom with snakeweed root (pre-chop). Then pour the mixture with vodka, cover and place in a dark place for twenty-one days. The tincture is ready, you should take forty drops six times a day.

How to prepare a decoction?

Grind and mix calendula flowers, plantain leaves, and agrimony herb. Add water and cookTen minutes. Then remove from heat and let cool at room temperature. You should drink it with the addition of honey and lemon.

Forecast

All n nonspecific lung diseases (NSLD), predicted by tumor scale orMannheim peritoneal index (MPI). Each negative symptom and sign receives one point, and at the end they are summed up.

For example:

From 0 to 2 – the prognosis is favorable.
From 2 to 3 - uncertain.
From 3 to 5 - unfavorable.

When the data has been calculated, the doctor selects suitable way therapy.

B-cell tumors have a positive prognosis, while T-cell tumors, on the contrary, have an unfavorable prognosis. The prognosis is greatly influenced by factors such as the patient’s age, type of tumor, stage of development and degree of damage.

The following pathologies are considered favorable: lymphomas of the gastrointestinal tract, salivary glands. K notfavorable include: lymphomas of the central nervous system, breast, bone tissue, ovaries.

Nutrition for lymphoma

There are several criteria for proper nutrition:

Moderately high in calories so that the patient does not gain excess weight and sufficiently varied. In other words, everything should be present in the diet: vegetables, fruits, meat, fish, herbs, seafood.
Reduce the amount of canned food, smoked meats, and salt.

Meals should be frequent, but the portion should be small. The approach to each patient must be individual.

People cannot eat bland food, so you can add a little caviar and olives to their diet. But in parallel the patient must take medicine, which will help remove sodium from the body.

If a course of chemotherapy procedures is prescribed, it should not be taken after chemotherapy, especially if side effect There was vomiting and diarrhea, the body needed sodium.

The lymphatic system is one of the most vulnerable in terms of oncological diseases, organ. In this case, the pathology can either develop in the system initially or be acquired in nature, getting there from other departments.

The main manifestation of the anomaly is a pronounced increase in lymph node connections.

Non-Hodgkin's lymphoma is great view malignant neoplasms, different from each other in cellular structure. One of the most common is B-cell.

This form of the disease begins its formation in the cells of lymphoid tissue and quickly affects other systems and organs. Oncologists consider the unpredictability of the behavior of the tumor process to be one of its difficulties.

In addition, the disease is highly susceptible to spreading to extranodal areas of the human body.

The prognosis for eliminating the disease and full recovery directly depends on the histological form, the degree of damage to the body by cancer cells, the stage of the disease and its aggressiveness.

Almost all anomalies of this type are characterized cellular structure, although they may contain cancerous lymphoproliferative manifestations.

There are two types of pathology:

ordinary– have a good prognosis for a 10-year survival period, are well treated and have virtually painless symptoms. They are also called follicular;
aggressive– their development time is short, they are treated in combination, and only in the initial stages. Metastasizes quickly.

This form of lymphoma is characterized by frequent recurrence - it occurs a year or two, it would seem, after successful therapy. Such cases are especially often recorded at stages when the pathology is advanced and actively progressing. Moreover, if the tumor is classified as a normal type, it is prescribed re-treatment, which has a chance to be effective.

Classification

Almost always, the B-cell form copies the stages of normal differentiation and their complete identity with cells in a normal state. This point greatly complicates their timely diagnosis.

In this regard, at the beginning of the 2000s, the classification of pathology was revised. Now two of its forms are conventionally distinguished:

B cells that are in a pre-cancer state. This includes leukemia, as well as oncology, the development of which is caused by a genetic factor;
mature in– tumors.

The second form is more extensive, consisting of:

small cell leukemia;
prolymphocytic leukemia;
plasma tumors;
abnormalities of mucous lymphoid tissues;
follicular and nodular manifestations of the tumor;
diffuse B-cell lymphoma;
granulomatosis;
Epstein virus;
intravascular and anaplastic;
Burkett's anomaly;
pathology is not classified, with characteristics inherent in other forms of non-Hodgkin B manifestations.

Causes

Scientists all over the world are working on the concept of the true cause of this type of cancer. Unfortunately, so far it has only been possible to identify indirect factors that certain conditions can provoke the disease:

contact with aggressive chemical components– this often happens in hazardous industries. Once in the body, harmful toxic compounds tend to accumulate and create favorable conditions for the development of cancer processes;
bad ecology– the largest number of identified cases of the disease occur in large cities, where the level of pollution is several times higher than the norm;
viral manifestations, in particular Epstein syndrome– these diagnoses, especially in the chronic or untreated stage, can provoke cell mutation and cause the development of oncology;
high concentrations of ionizing rays– increased doses of such exposure destroy the normal structure of tissues at the molecular level. Cells begin uncontrolled, chaotic division, resulting in the formation malignant tumor.

Stages

Based on the degree of development and aggressiveness of the pathology, the following four stages are distinguished:

Stage 1– the disease is present only singly – in a separate group of nodal connections. This stage is considered the initial stage of tumor formation and does not carry irreversible processes for the body. The formation is immobile, well controlled and treated;
Stage 2– the anomaly grows, the structural content of lymphoid tissue changes dramatically, which affects the main organs on one side of the diaphragm. It is extremely important at this stage to begin high-quality therapy, before the pathology leaves the limits of its primary dislocation and begins to grow into neighboring parts of the human body;
Stage 3– the strongest increase and the highest degree of damage by cancer processes is observed in chest area and the peritoneal area. The process affects almost all the main systems of the body, its partial dysfunction begins;
Stage 4– irreversible moments are involved completely in the entire organism. The treatment is ineffective - the maximum that is given to the patient during the treatment process is a slight extension of the life threshold and symptomatic relief of the disease.

Symptoms

The main sign that experts pay close attention to when they suspect this type cancer, enlarged lymph nodes. To this are added neoplasms in the area of the cranial, occipital, often head, armpit area of the neck or groin.

As the abnormality progresses, the following symptoms appear:

significant mass deficit– sudden weight loss occurs in just a couple of months. Such changes in the body occur due to increased energy consumption when a double load falls on it;
chronic fatigue– it differs from ordinary overwork in that it is not provoked by anything and after waking up or good rest this feeling does not go away;
sweating at night– even during sleep, the body tries to overcome the disease, and most of its departments continue to work, consuming energy;
promotion general temperature – in this situation, the indicator is not too high, but it lasts for quite a long period of time and is poorly controlled by antipyretic drugs;
loss of interest in food– unable to cope with the increased load, the body spontaneously protects itself from additional functions associated with the processes of food digestion, and appetite sharply decreases.

In addition to the above signs, the presence of the disease may be indicated by:

itching– this happens if the pathology is concentrated in the skin B-cell tissues;
intestinal disorders– with lesions of the peritoneum. Often accompanied by pain of varying degrees of intensity;
shortness of breath and cough– in case of damage to nodes located in close proximity to the organs of the respiratory system;
joint pain– for bone non-Hodgkin B-lesions.

Diagnostics

To confirm or refute this diagnosis, as well as to obtain detailed clinical picture progression of the anomaly, applicable the following types body examinations:

inspection– the initial stage of diagnosis. Most often, it is after a visual examination of the patient and palpation of the lymph nodes that the doctor can most likely diagnose this form tumors;
biopsy of lymph nodes with subsequent studies– a tissue fragment is taken from the problem area, which will subsequently be subjected to in-depth microscopic study. A biopsy is a mandatory analysis, without which a final diagnosis of oncology cannot be made;
laparoscopy- refers to surgical methods detecting anomalies. By introducing a special device inside, you can not only qualitatively examine the pathology, but also take a fragment of the material for analysis. For this form of cancer, such a study is prescribed in almost 100% of cases;
thoracoscopy– an endoscopic version of the internal examination of parts of the body, providing information about the location of the tumor, its size and shape;
bone marrow puncture– the most informative research method. Used when it comes to lymphomas associated with brain activity. Despite the apparent complexity, the procedure, when carried out correctly, is not considered dangerous.

Treatment

To eliminate the anomaly, the following treatment methods are used:

chemotherapy– the main way to influence the tumor in this situation. Based on the use of cytostatics. It is carried out in doses, in courses. Prescribed both autonomously and comprehensively to enhance positive dynamics;
radiation therapy- as an independent option it is used infrequently - only at the stages of formation of education, and then only on condition that it is precisely confirmed, otherwise the moment will be missed and time will be lost. Its use is justified only as a local method of eliminating cancer manifestations;
monoclonal antibodies– a product reproduced in laboratory conditions. These components are actively used in oncology to neutralize the activity of cancer cells. Indicated for both complex effects and resistance to chemotherapy;
peripheral stem cell transplantation– the procedure is carried out when, against the background of alternative methods of eliminating the problem, recurrent processes arise, and transplantation is the only chance to save the patient’s life.

Forecast

If treatment is carried out in a timely manner, the prognosis for overcoming the 10-year threshold, taking into account the stage of the disease, is as follows:

at stage 1- more than 93% of patients;
on 2- up to 50%;
by 3- about 30%;
by 4– less than 8%.

If the tumor condition is ignored for a long time and there is no timely diagnosis the prognosis is very pessimistic - only 4% of patients with non-Hodgkin B-cell lymphoma are given a chance to live 10 years.

The prognostic role of cancer-testis gene expression in patients with B-cell lymphomas is discussed in this video:

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What is non-Hodgkin's lymphoma?

Non-Hodgkin's lymphoma is a whole group of more than thirty related diseases that do not have the characteristics of Hodgkin's disease.

Non-Hodgkin lymphoma symptoms

The most common symptom of non-Hodgkin's lymphoma is a painless swelling in the lymph nodes, usually in the neck, armpits, or groin. Lymph nodes, pea-sized lumps, are located throughout the body. They contain white blood cells that help fight infection.

The swelling is caused by a certain type of white blood cell, known as lymphocytes, that collects in the lymph nodes. It is highly unlikely that you have non-Hodgkin's lymphoma if you have swollen lymph nodes, as these glands often swell in response to infection.

Some people with non-Hodgkin's lymphoma also have other more general symptoms. These may include:

night sweats;
unintentional weight loss;
high temperature (fever);
persistent cough or feeling of suffocation;
persistent itching of the skin all over the body.

Other symptoms depend on where the enlarged lymph glands are in the body. For example, if they affect your stomach, you may experience abdominal pain or have an upset stomach.

There are cases where people have abnormal cells in their bone marrow. This may lead to: constant fatigue or increased risk infections. Excessive bleeding occurs, such as nosebleeds, heavy periods, and blood spots under the skin.

When to see a doctor?

You should see your primary care physician if you have any of the symptoms listed above, especially if you have persistently swollen tonsils without any other signs of infection. Although the symptoms are unlikely to be caused by non-Hodgkin's lymphoma, it is better to be on the safe side and get checked.

Diagnostics

Once non-Hodgkin's lymphoma is diagnosed, tests are performed to determine the stage and extent of the disease. Treatment and prognosis for patients with non-Hodgkin's lymphoma depend in part on the stage of the lymphoma.

Tests used to make a diagnosis include:

Physical test.
Biopsy of enlarged lymph nodes or other abnormal areas.
Blood tests.
Imaging tests such as CT scan.
Bone marrow aspiration and biopsy (not always done).
Spinal tap (not always done).

Stages

The staging system is most often used to describe the grade of non-Hodgkin's lymphoma in adults. The stages are described by Roman numerals I-IV (1-4). Lymphomas that affect an organ outside the lymphatic system have an E addition to their stage (eg, stage IIE), while those affecting the spleen have an S addition.

Stage I

Lymphoma of only 1 lymph node or lymphoid organ, such as the thymus (I).
Cancer is found in only one organ area outside the lymphatic system (IE).

Stage II

Lymphoma is found in 2 or more groups of lymph nodes on the same side (above or below) of the diaphragm (the thin strip of muscle that separates the chest and abdomen). For example, this could include nodes in axillary area and neck, but not a combination of axillary and inguinal nodes (II).
Lymphoma extends from one group of lymph nodes to an adjacent organ (IIE). It may also affect other groups of lymph nodes on the same side of the diaphragm.

Stage III

Lymphoma is found in the lymph nodes on both sides (top and bottom) of the diaphragm.
Cancer may also spread to an area or organ near the lymph nodes (IIIe), the spleen (IIIS), or both (IIISE).

Stage IV

The cancer has spread outside the lymphatic system to an organ that is not in close proximity to the affected node.
The cancer has spread to the bone marrow, liver, brain or spinal cord, or pleura (the thin lining of the lungs).

Other modifiers may also be used to describe lymphoma.

Large tumors - This term is used to describe tumors in the chest that extend one-third across the width of the chest, or tumors in other areas that are at least 10 centimeters (about 4 inches) across. This is usually indicated by adding the letter X. Each stage can also be designated A or B. A B is added (stage IIIB, for example) if a person has any of the symptoms listed below:

Losing more than 10% of body weight during the previous 6 months (without dieting).
Unexplained fever.
Night sweats.

These symptoms usually mean that the disease is progressive. If a person has any symptoms, more intensive treatment is recommended. If there are no B symptoms, the letter A is added to the stage.

Types of Non-Hodgkin's Lymphoma

Classifying non-Hodgkin's lymphoma (NHL) can be quite confusing (even for doctors) because there are so many types that several different systems have been used. The most recent World Health Organization (WHO) classification system. The WHO system of lymphoma groups is based on how they look under a microscope, the chromosome characteristics of the lymphoma cell, and the presence of certain proteins on the surface of the cells.

The more common types of lymphomas are listed below depending on whether they are B-cell or T-cell lymphomas. Some rare forms of non-Hodgkin's lymphoma are not discussed here.

Diffuse non-Hodgkin lymphoma B-cell lymphomas make up the majority of non-Hodgkin lymphomas. This is the most common type of lymphoma in the United States, accounting for about 1 in every 3 cases. The cells look quite large when viewed under a microscope. Diffuse large B-cell lymphoma (DLBCL) can occur in any age group but occurs primarily in older adults (mean age 60 years). It usually begins with a rapidly growing mass deep inside the body, such as in the chest or abdomen.

It can develop in the lymph nodes, for example, in the neck, groin, armpits. It can also start in other areas such as the intestines, bones or even the brain, or spinal cord. About 1 in 3 cases of lymphoma are localized to only one part of the body. Lymphomas are easier to treat when they are localized than when they spread to other parts of the body. Genetic tests have shown that there are different subtypes of DLBCL, even if they look the same under a microscope.

These subtypes have different responses to treatment and different prognosis outcomes. Large cell non-Hodgkin lymphoma is a fast-growing lymphoma but often responds well to treatment. Overall, about 3 out of 4 people will not have any signs of illness after initial stage treatment, and many of these patients are cured by therapy.

Primary mediastinal B-cell lymphoma is a subtype of DLBCL in which the lymphoid cells are large but there is a lot of fibrosis (scar tissue) in the background. It accounts for about 2% of all lymphomas. About 2 out of 3 people with this lymphoma are women. Most of them are young - in their 30s. This lymphoma begins in the mediastinum (the area in the middle of the chest behind the breastbone).

This can cause breathing problems because it often puts pressure on the windpipe leading to the lungs. It can also block the superior vena cava (the large vein that returns blood to the heart from the arms and head), which can make the arms and face appear bulging. This is a fast-growing lymphoma but generally responds well to treatment.

Intravascular large B-cell lymphoma: In this rare subtype of DLBCL, the lymphoma cells are found only inside blood vessels and not in the lymph nodes or bone marrow. This is considered DLBCL.

Accounts for 1 in 5 diseases. Means that cells tend to grow in a circular pattern in the lymph nodes. Average age for people with this lymphoma is around 60. This is a rare type of lymphoma in very young people. This lymphoma occurs in many lymph node locations in the body, as well as in the bone marrow.

Follicular lymphomas are often slow-growing but difficult to treat. These lymphomas may not require treatment when they are first diagnosed. Instead, treatment may be delayed as long as the lymphoma is causing problems. Over time, about 1 in 3 follicular lymphomas develop into fast-growing diffuse B-cell lymphomas.

Chronic lymphocytic leukemia/ small lymphocytic lymphoma - these diseases are closely related. Many doctors believe that these are two versions of the name of one disease. The same type of cancer cell (known as a small lymphocyte) is seen in both chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL). Small Lymphocytic Lymphoma/(CLL) - Most commonly used to diagnose this lymphoma if it is only in the lymph nodes.

The only difference is where the cancer cells are found: in CLL the majority and in the bone marrow. In SLL, cancer cells are mainly in the lymph nodes and spleen. About 5%-10% of all lymphomas are SLLs.

Both CLL and SLL are slow-growing. CLL is much more common and tends to grow more slowly. Treatment is the same for CLL and SLL. They are usually not treatable with standard procedures, but depending on the stage and rate of growth of the disease, most patients live longer than 10 years. Sometimes these slow-growing lymphomas develop into a more aggressive type.

B-cell prolymphocytic lymphoma (B-PLL) is a very rare B-cell neoplasm composed of so-called prolymphocytes, usually involving the peripheral blood, bone marrow and spleen. The name "prolymphocyte" is actually a misnomer, since the tumor cells in this disease are mature, activated B cells. By definition, these prolymphocytes make up more than 55% of the cells in the blood and bone marrow.

B-PLL is extremely rare disease, comprising less than 1% of B-cell leukemias. Since the diagnosis has been modified to exclude cases of mantle cell lymphoma, atypical chronic lymphocytic leukemia (CLL), and PLL/CLL (defined as between 15-55% prolymphocytes), B-PLL has become increasingly rare. Affects mainly older people with an average age of 65 to 70 years.

Men and women equally. The vast majority of patients are Caucasian. Patients have a rapidly increasing white blood cell count greater than 100,000/µL and massive splenomegaly; anemia and thrombocytopenia are present in approximately 50%. Symptoms: fever, night sweats, weight loss are common.

Treatment of non-Hodgkin's lymphoma

Treatment options depend on the type of lymphoma and stage (grade), as well as other prognostic factors. Of course, no two cases are exactly the same. standard options Treatments are often tailored to each patient's situation.

The main types of treatment for non-Hodgkin lymphoma are:

Chemotherapy.
Immunotherapy.
Targeted therapy.
Radiation therapy.
Stem cell transplantation.
Rarely, surgery may be used.

Another important part of treatment for many people is palliative or supportive care. This may help prevent or treat problems such as infections, changes in blood cells, or some symptoms caused by lymphoma.

To treat stage 4 DLBCL, your doctor will most likely recommend chemotherapy.

For example, R-CHOP chemotherapy regimen. This includes a combination of the drugs cyclophosphamide, doxorubicin, vincristine and prednisone, with the addition of rituximab, a monoclonal antibody. Treatment usually lasts about six months. To treat slow-growing follicular lymphomas, your doctor may prescribe rituximab and chemotherapy drugs.

The prognosis for stage 4 lymphoma will vary depending on a number of factors, including:

type of lymphoma;
affected organ;
patient's age;
general health.

Five-year survival rates for people with stage 4 vary depending on the subtype of NHL and other factors.

Informative video

Over the past decades, non-Hodgkin lymphoma has been increasingly diagnosed by oncologists around the world. The number of deaths from this disease has almost doubled. Compared to 1990, the increase is approximately 4% - 8% per year, depending on the region. Men are most often affected, and with age, the likelihood of this disease steadily increases for both men and women. In the Russian Federation, about 25 thousand people are registered with this diagnosis every year, so the question of what this disease is is arising more and more often.

Non-Hodgkin's lymphoma (NHL) is a group of diseases that combines about 80 different clinical course, cellular composition and prognosis of nosological forms. Main characteristics These diseases are malignant degeneration of lymphocytes with damage to the lymphatic system and internal organs, including, except.

Classification of the disease

ICD 10 classifies the disease non-Hodgkin lymphoma as follows:

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

Classification by cellular composition

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

. As the name implies, B lymphocytes, which are responsible for producing antibodies that are responsible for the humoral immune response, are affected.

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

Non-Hodgkin T - cell lymphoma. It is characterized by a malignant change and uncontrolled growth of T - lymphocytes, which are formed in the thymus and are responsible for the barrier (cellular) immunity of the mucous membranes and skin.

T - cell lymphoblastic, develops from precursor cells, young people 30-40 years old are most often affected, in 75% of cases men. The course is favorable only if the bone marrow is not damaged.
Extranodal NHL, formed from killer T cells, can develop at any age and can have varying degrees of aggressiveness.
Anaplastic large cell. It often occurs at a young age, but responds well to treatment.
Cutaneous T-cell lymphoma (Sezary syndrome), another name is mycosis fungoides. Occurs in patients 50-60 years of age; growth rate and prognosis often depend on concomitant and background pathology.
Angioimmunoblastic. It is characterized by a very aggressive course and unfavorable prognosis.
T-cell lymphoma with enteropathy. It is highly aggressive and has a poor prognosis. Occurs in patients with gluten intolerance.
T - cell non-Hodgkin's lymphoma, affecting the subcutaneous fat, another name is panniculitis-like. Poor prognosis due to poor sensitivity to chemotherapy.

Classification by disease aggressiveness

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

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

Possible causes of the disease

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

Infection . For example, the Epstein-Barr virus can trigger the development of Burkitt's lymphoma, follicular B-cell lymphoma. The T-cell leukemia virus provokes the development of T-cell lymphoma in adults. The bacterium Helicobacter pylori, which causes peptic ulcers, can also cause MALT lymphoma of the stomach. Lymphomas can also be caused by hepatitis C viruses, human herpes type 8 and HIV infection.
Chemical carcinogens and mutagens – insecticides, herbicides, benzenes.
Ionizing radiation.
Genetic diseases: Chediak-Higashi syndrome, Klinefelter syndrome and ataxia-telangiectasia syndrome.
Taking immunosuppressants, with concomitant pathology.
Autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis and etc.
Old age and obesity.

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

Symptoms of the disease

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

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

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

Generalized enlargement of lymph nodes
Enlarged spleen or splenomegaly
Lung and skin damage

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

Superior vena cava syndrome, with damage to the lymph nodes of the mediastinum, first manifests itself as hyperemia and swelling of the face.
When the thymus is damaged, the trachea is compressed, which is manifested by cough and shortness of breath.
Compression of the ureter by pelvic or retroperitoneal lymph nodes, which can lead to hydronephrosis and secondary renal failure.

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

Fatigue, weakness, decreased performance
Irritability, emotional lability, apathy.
Decreased appetite and weight
Increased sweating at night
Constant low-grade or febrile temperature
When the abdominal and chest cavity Pleural effusion and chylous ascites may develop.
Anemia, initially found in a third of NHL patients, subsequently develops in almost all forms.

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

Stages of the disease

There are four stages of non-Hodgkin lymphoma:

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

Unfortunately, at the first stage, the detection rate of lymphomas is extremely low; more often, the diagnosis is established already at stages 2-3 of the disease.

Establishing the stage of the process, the degree of aggressiveness and cellular form is important so that the prescribed treatment for non-Hodgkin lymphoma is as effective as possible.

Diagnosis of non-Hodgkin's lymphomas

Any diagnosis begins with interviewing the patient, collecting anamnesis, including family and professional, to identify genetic predisposition or contact with chemical carcinogens. General symptoms of intoxication are identified, which the patient should report to the doctor. An examination is carried out, which may reveal enlarged lymph nodes. In addition to enlarged peripheral lymph nodes, one of the first warning signs is often widening of the mediastinum revealed by radiography.

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

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

After full examination, which includes all of the above methods, the stage of the disease is established. If a diagnosis of non-Hodgkin lymphoma is established, the prognosis for life, the likelihood of cure and the rate of progression of the disease are determined by the International Prognostic Index (IPI), which includes the following five factors: general state the patient, the age of the patient, the stage of the disease, the presence of damage to internal organs, the level of LDH in the blood.

Favorable signs include:

The first and second stages of the process at the start of treatment.
The patient's age is up to 60 years.
Intact internal organs.
Good general health.
Normal LDH level.

And the unfavorable ones are:

Stages three and four.
Age over 60 years.
Widespread damage to lymph nodes and internal organs.
The patient is feeling unwell.
High LDH levels.