Bone marrow involvement in Hodgkin's lymphoma. Prices for MRI and CT scan of the spine. Bone damage due to lymphoma. Diffuse large cell lymphoma

Lymphoma, like all solid tumors, is manifested by the presence of a primary form of the tumor focus. However, lymphoma can not only metastasize, but also spread to all systems of the body with the simultaneous development of a condition that resembles lymphocytic leukemia. In addition, there is lymphoma without enlarged lymph nodes. It can primarily develop in various organs (lungs, brain, stomach, intestines). This lymphoma belongs to the extranodal forms.

There are two types of lymphoma. This is a large group of non-Hodgkin's lymphomas and Hodgkin's lymphoma. Microscopic examination revealed specific Berezovsky-Sternberg cells, which indicate the diagnosis of Hodgkin's lymphoma, and if they are absent, then the diseases are classified as non-Hodgkin's lymphomas.

Lymphoma causes

To date, it has not yet been possible to establish the specific causes of various forms of lymphoma. To date, many toxic substances have been studied regarding their involvement in the formation of pathological diseases. However, there is no convincing evidence that these substances can provoke the occurrence of lymphoma.

There are suggestions of a connection between certain risk factors and the likelihood of developing these pathologies in a certain category of people. This group includes people who have had or have close relatives with lymphoma; suffering from autoimmune diseases; have undergone stem cell or kidney transplant surgery; working with carcinogenic substances; infected with Epstein-Barr, AIDS, hepatitis C, T-lymphotropic type and herpes viruses; containing the bacteria Helicobacter pylori. Thus, infection of the body with various bacteria and viruses, the nature of professional activity can cause the appearance of lymphoma in humans.

The risk of developing the disease is also greatly increased in people with weakened immunity, which is due to a congenital or acquired defect.

Lymphoma symptoms

All clinical manifestations of the disease will depend on its type and location. Hodgkin's lymphoma includes five types of malignant pathologies and almost thirty subtypes of non-Hodgkin's lymphomas.

Lymphoma of the first type is distinguished by a variety of clinical symptoms, which are characterized by lesions of different types of lymph nodes and organs. All symptoms of the disease are divided into general manifestations of the disease and local ones. In almost every third patient with this pathology, a general picture of lymphoma is revealed, which includes a rise in temperature, profuse night sweats, weakness throughout the body, pain in the joints and bones, fatigue, loss of body weight, headaches and itching of the skin. One of the earliest signs of the disease is a change in temperature in the body.

Lymphoma at the very beginning of progression is characterized by the fact that the temperature remains at low-grade levels, and a characteristic increase begins to occur in the evening. As the lymphoma continues to progress, the temperature reaches several degrees, and at night patients experience chills, which turns into profuse sweating.

One of the symptoms of lymphoma is considered to be general weakness of the patient, which reduces the ability to work and may appear even before the disease is diagnosed.

Lymphoma of the skin manifests itself as a characteristic symptom in the form of skin itching with varying degrees, which can appear long before lymphatic damage to organs and nodes. Therefore, it can remain the only confirmation of the disease for a long time. Itching is a generalized spread throughout the patient's body with possible localization in some parts, such as the anterior surface of the thoracic region, on the head, limbs, including the feet and palms.

When examining patients, it is possible to diagnose various lesions of the lymph nodes with diverse localizations. In almost 90% of pathological foci are located above the diaphragm, and the remaining 10% are noted in the lower parts of the lymph collectors.

As a rule, 70% of lymphoma, which refers to Hodgkin's lymphoma, manifests itself with enlargement of the cervical lymph nodes, which are characterized by an elastic consistency and lack of adhesion to each other and to nearby tissues. On palpation they are absolutely painless, and the skin of the tumor conglomerate is not changed, without redness or infiltrates. Also in 25%, lymphoma can affect the supraclavicular lymph nodes, which are generally never large. About 13% occur in lesions of the lymph nodes in the areas of the armpits, which, with their anatomical structure, contribute to the rapid spread of the pathological process to the mediastinal parts of the lymphatic system, as well as to the lymph nodes located under the chest muscle with transition to the mammary gland.

Mediastinal lymphoma manifests itself in 20% of lymph nodes. Clinically, this is manifested by pathological changes not only in the lymph nodes, but also in the processes of compression and their growth into other organs and tissues. At the onset of the disease, a slight dry cough is noted, which is accompanied by pain in the thoracic region. These pains can be of different localization and appear constant and dull, which can intensify during a deep breath or cough. Sometimes patients complain of troubling pain in the area of ​​the heart, stabbing in nature, and a bursting feeling in the thoracic region. This is explained by the enlargement of the lymph nodes, which begin to put pressure on the nerve endings and the heart or their germination. In this case, mediastinal lymphoma can spread to the pericardium, lungs and bronchi. After this, patients feel slight shortness of breath, which develops during physical activity or normal walking. And with further progression of the disease, i.e. growth of lymph nodes, shortness of breath becomes much worse. If the mediastinal lymph nodes increase to a significant size, vena cava syndrome in the upper section may develop. Although there are cases of asymptomatic occurrence of this pathology, which is accidentally diagnosed during a routine X-ray examination of the chest organs.

Retroperitoneal lesions of the lymph nodes are extremely rare and account for about 8% of cases. Most often, such lesions cause the development of gastric lymphoma. The onset of the disease is characterized by an asymptomatic course and only with a slight increase in the lymph nodes in this area, pain and numbness of the lumbar region, flatulence and constipation appear. When drinking alcohol, even in small quantities, the pain in this area increases somewhat.

Lymphoma, which affects the lymph nodes in the inguinofemoral and iliac regions, occurs in 3% of cases, but has a poor prognosis and a malignant course. The changes that occur in these lymph nodes cause cramping or constant pain in the lower abdomen. Frequent signs of damage to these lymph nodes are impaired lymph drainage, heaviness in the limbs, decreased skin sensitivity inside and in front of the thighs, and swelling of the feet.

Sometimes doctors diagnose splenic lymphoma, which is considered a rare pathology with a relatively benign course and a high life expectancy for patients when compared with other forms. Lymphoma can involve the spleen in the tumor process in 85% of cases. When this organ is affected by pathology, its enlargement is noted as the only sign of the disease, which is determined by ultrasound or using radionuclide testing. However, its normal size does not mean that there are no changes or vice versa.

Pulmonary lymphoma in the primary form is very rare, so some authors question its occurrence. However, in 30% of cases the lungs are affected by an anomaly and join the tumor process. Malignant cells can enter the lung tissue through lymph or blood from pathological foci as a result of the formation of lymphadenitis with a direct transition of the process from the lymph nodes of the mediastinal sections to the lung tissue. Clinically, this is manifested by cough, shortness of breath, chest pain and, in some cases, hemoptysis. If the lymphoma involves the lung tissue in limited quantities, then there is a slight cough, and all other signs are completely absent. Damage to the pleura, which is accompanied by effusion in the pleural cavity, is characterized by specific changes in the lungs.

In about 30% of cases, lymphoma affects the bones. There is lymphoma with primary and secondary bone damage as a result of germination from pathological foci of nearby structures or through the blood. Most often, lymphoma involves the spine, then the ribs, sternum and pelvic bones. It is very rare to observe pathological changes in the tubular bones and skull bones. But if this happens, then patients complain of characteristic pain. When the tumor is localized in the vertebrae, pain manifests itself as radiating pain, which intensifies when pressure is applied to the vertebrae. With lesions of the vertebrae of the lower thoracic and upper lumbar regions, numbness in the legs and twitching appear. With further progression of the process, paralysis and paresis of the lower extremities are revealed, and the functions of organs located in the pelvic area are also disrupted.

Lymphoma affects the liver in 10%. And pathological damage to an organ can be either single or multiple. Symptoms of such changes manifest themselves in the form of nausea, heartburn, heaviness in the right side of the hypochondrium and an unpleasant taste in the mouth. In such patients, signs of jaundice of various origins are detected, and this aggravates the prognosis of the disease.

Brain lymphoma is not marked by specific changes, and such lesions are detected in 4% of cases.

In addition, there are tumor lesions of other tissues and organs. This may be lymphoma of the thyroid gland, breast, heart muscle, or nervous system.

Lymphoma can proceed either aggressively or indolently, but sometimes a highly aggressive course is observed with rapid spread of the malignant tumor. Non-Hodgkin's lymphomas are characterized by an aggressive course with high malignancy. Low-grade lymphoma has an indolent course. The prognosis of these lymphomas differs in common features. Lymphoma with an aggressive course has more opportunities for recovery, but indolent forms are considered incurable pathologies. In addition, they are well treated with polychemotherapy, radiation and surgery, but still have a pronounced predisposition to relapses, which very often result in death. At any stage, this lymphoma can develop into diffuse large B-cell lymphoma with subsequent damage to the bone marrow. This transition is called Richter syndrome, which indicates survival of up to twelve months.

Malignant lymphoma usually first affects the lymph tissue and then the bone marrow. This is what distinguishes it from leukemia.

Lymphoma, which belongs to the non-Hodgkin group, occurs in the peripheral and visceral lymph nodes, thymus, lymphoid tissue of the nasopharynx and gastrointestinal tract. Much less often it affects the spleen, salivary glands, orbit and other organs.

Lymphoma can also be nodal and extranodal. It depends on where the tumor was originally located. But since malignant cells spread very quickly throughout the body, malignant lymphoma is characterized by a generalized location.

Malignant lymphoma is characterized by enlargement of one or more lymph nodes; the presence of extranodal lesions and the general onset of the pathological process in the form of weight loss, weakness and fever.

lymphoma in children photo

Lymphoma stage

Using stages, it is possible to determine the possibility of penetration and spread of a malignant neoplasm in the human body. The information obtained helps to make the right decision in prescribing an appropriate therapeutic treatment program.

Based on the generally accepted Ann Arbor classification, four stages of the malignant process are distinguished.

The first two stages of lymphoma are conventionally considered local or local, while the third and fourth stages are widespread. To the numbers (I, II, III, IV), if patients have the main three symptoms (night sweats, fever and weight loss), the letter B is added, and if they are absent, the letter A is added.

In stage I lymphoma, one area of ​​the lymph nodes is involved in the tumor process;

In stage II lymphoma, several areas of the lymph nodes are affected, which are localized only on one side of the diaphragm;

In stage III lymphoma, lymph nodes located on both sides of the diaphragm are affected;

At stage IV, lymphoma spreads to various somatic organs and tissues. In case of massive damage to the lymph nodes, the symbol X is added to the stage.

B cell lymphoma

This lymphoma refers to aggressive forms of the disease, in which the structure of the lymph node is disrupted and cancer cells are located in all areas.

B-cell lymphoma is one of the most common types of non-Hodgkin lymphomas with high malignancy, diversity of morphological characteristics, clinical symptoms and their sensitivity to treatment methods. This can be explained by the fact that B-cell lymphoma can develop both primarily and transform from mature cell non-Hodgkin lymphomas, for example, from follicular lymphoma, MALT lymphoma. Pathological cells are characterized by phenotypic features of centroblasts or immunoblasts as a result of the expression of B-cell antigens. In 30% of cases, a cytogenetic abnormality is observed, which is called a translocation (14; 8). In B-cell lymphoma, gene rearrangement occurs (in 40%) or its mutation (in 75%).

The first two stages of the disease can be diagnosed in one third of patients, and the remaining cases are disseminated and extralymphatic zones are involved in the pathological process.

B-cell lymphoma is formed from immature B-lymphocyte precursor cells. This disease consists of several forms, which include Burkitt's lymphoma, lymphocytic leukemia of chronic etiology, diffuse large B-cell lymphoma, immunoblastic large cell lymphoma, follicular lymphoma, B-lymphoblastic precursor lymphoma.

B-cell lymphomas develop at a rapid rate. Depending on the location, different types of symptoms appear. The first place is taken by enlarged lymph nodes, which do not cause pain. They can form on the neck, arms, armpits, head, or in several areas at the same time. The disease also develops in cavities, where it is very difficult to determine the enlargement of the lymph nodes. The disease then spreads to the spleen, liver, bones and brain.

At the same time, there is an increase in temperature, weakness, sweating at night, weight loss, and fatigue. Symptoms of B-cell lymphoma progress over two to three weeks. If the clinical picture is characteristic, it is necessary to consult a specialist and conduct a diagnostic examination to exclude or confirm the diagnosis.

Lymphoma treatment

For the treatment of lymphoma, traditional methods of treating oncological diseases are used, which include radiation and polychemotherapy, as well as their combinations.

When choosing treatment methods, the stages of lymphoma and risk factors that contribute to the development of the pathological process are taken into account. The most important risk criteria include lymph areas altered by lesions (more than three); at stage B - erythrocyte sedimentation rate 30 mm/h, at stage A - 50 mm/h; extranodular lesions; extensive damage to the mediastinum; at MTI 0.33; with massive splenomegaly with diffuse infiltration; lymph nodes - more than five centimeters.

Treatment of patients diagnosed with lymphoma begins with the prescription of polychemotherapeutic drugs. And only patients with the first stage (A) receive radiation irradiation of the affected area with a total dose of 35 Gy. Almost all patients with an intermediate and favorable prognosis are prescribed polychemotherapy ABVD in the form of a standard regimen, and with an unfavorable prognosis - BEACORR. The first regimen includes intravenous administration of drugs such as Dacarbazine, Bleomycin, Doxorubicin and Vinblastine. The second regimen includes: Bleomycin, Prednisolone, Etoposide, Cyclophosphamide, Vincristine, Doxorubicin and Procarbazine.

The group with a favorable prognosis includes the first two stages of lymphoma without risk factors. Such patients begin to be treated with two courses of ABVD. After completion of polychemotherapy, radiation is administered three weeks later. The intermediate prognosis group includes the first two stages with at least one risk factor. For such patients, four courses of ABVD are initially carried out, and after completion, radiation irradiation of the primarily affected areas is undertaken after a few weeks. The group with an unfavorable prognosis includes the last two stages (III, IV) of the pathological process. Here, treatment begins with BEACORR or ABVD with a mandatory rest of two weeks. Then radiotherapy with irradiation of the affected skeleton is also prescribed.

In the treatment of patients with indolent and aggressive forms of the disease, they try to achieve the main goals, such as maximizing patient survival and improving their quality of life. Success in solving these problems depends on the type of lymphoma itself and the stage of its progression. For the localized course of malignant pathology, an important point is tumor eradication, increased life expectancy, and possible cure. In case of a generalized process, rational treatment is prescribed in the form of anticancer therapy and palliative treatment, which are associated with improved quality of life and increased life expectancy.

The terminal stage of lymphoma is characterized by a palliative therapy program, for which improving the quality of life of patients remains important. The basis of palliative care includes: psychological support, spiritual, social, symptomatic and religious.

Lymphoma of a malignant form and aggressive nature with a favorable prognosis is cured in 35%. It is characterized by individual prognosis using a tumor score or based on MPI assessment. According to the MPI system, each unfavorable sign is one point. When summing up the prognostic scores, the course of the disease is determined, favorable or unfavorable. With a total score from zero to two, this is lymphoma with a favorable prognosis, from three to five – unfavorable, from two to three – uncertain. When identifying a significant number of patients with an uncertain prognosis, a more complete assessment of the tumor scale is used, which includes parameters such as stage and general symptoms, size of the tumor lesion, LDH and microglobulin levels.

Unfavorable signs on this scale are considered to be the last two (III, IV) stages, B-symptoms, the size of the lymphoma is more than seven centimeters, the level of LDH is increased by 1.1 times, and the level of microglobulin is exceeded by 1.5 times. Patients whose prognostic total scores exceed three are classified as patients with a poor prognosis, and those with less than three are classified as having a favorable prognosis. All this data is used to prescribe individual treatment.

For the treatment of patients with aggressive forms of lymphomas with a favorable prognosis, chemotherapy is prescribed in the form of an ACOP or CHOP regimen. It includes drugs such as Prednisolone, Doxorubicin, Vincristine (Oncovin), Cyclophosphamide. The main goal of polychemotherapy is to achieve absolute remission in the first stages of therapy, as this is associated with improved overall survival. In partial forms of regression of a pathological neoplasm, polychemotherapy is always supplemented by radiation irradiation of the affected areas.

The problematic treatment group includes elderly patients, for whom the effect of therapy is characterized by age dependence. Until the age of forty, complete remissions are 65%, and after sixty – about 37%. In addition, toxic mortality can be observed in up to 30% of cases.

To treat older patients, rifuximab is added to chemotherapy drugs, which almost triples the average survival rate. And for patients under 61 years of age, consolidating telegamma therapy and PCT using the R-CHOP regimen are used.

Recurrent treatment of aggressive lymphomas, which are characterized by a generalized course of the disease, depends on many factors. This concerns the histology of the tumor, previous therapy and sensitivity to it, response to treatment, the patient’s age, general somatic status, the condition of certain systems, as well as the bone marrow. As a rule, treatment of a relapse or progressive process should include previously unused drugs. But sometimes in the treatment of relapses that developed a year after absolute remission was achieved, using the initial treatment regimens can give good results.

Lymphoma in the second stage of the disease, with large tumor sizes, with lesions in more than three areas, with a B-cell form and with unfavorable MPI values, has a greater risk of developing early relapses.

In medical practice there is such a thing as therapy of despair. This type of treatment is used for patients with primary refractory forms and with early relapses of malignant anomalies in the form of increased doses of polychemotherapy. Remissions in despair therapy occur in less than 25% of cases, and they are very short-lived.

Prescribing high-dose therapy is considered an alternative in the treatment of severely ill patients. But it is prescribed if the general somatic status is good.

Lymphoma with an aggressive course can be treated with high-dose therapy at the first relapse of tumor pathology.

The prognostic factor for low-grade indolent lymphoma is the stage of the disease. Thus, the staging of the pathology is determined after trephine biopsy of the bone marrow as a result of its strong involvement in the disease process.

Today, lymphoma in indolent form does not have specific standards for treatment, since they are absolutely equally sensitive to known methods of treating cancer, and as a result there is no cure. The use of polychemotherapy leads to short-term positive results, and then the disease begins to recur. The use of radiation as a stand-alone treatment is effective for the first or first (E) stage of lymphoma. For tumors of five centimeters, the total dose is up to 25 Gy per pathological focus and this is considered sufficient. In the last three stages of the pathological disease, polychemotherapeutic drugs are added to radiation exposure of 35 Gy. Sometimes in 15% of cases, indolent lymphoma may unexpectedly regress. Then they begin treatment with standard regimens. The monochemotherapeutic drug Chlorbutin with Prednisolone can be used. They will also use polychemotherapy in the form of a CVP regimen, which includes Cyclophosphamide, Vincristine, and Prednisolone.

The final therapy is radiation, prescribed according to indications. Interferon is used as maintenance therapy.

Lymphoma prognosis

Five-year survival is achieved using modern methods of polychemotherapy, as well as radiotherapy. For example, in patients with a favorable prognosis, such results can be achieved in 95%; with an intermediate – in 75% and with an unfavorable prognosis – in 60% of cases.

Lymphoma

Lymphoma is a group of hematological diseases of the lymphatic tissue, which are characterized by enlarged lymph nodes and damage to various internal organs, in which there is an uncontrolled accumulation of “tumor” lymphocytes.

Lymphoma - what is it?

To give a brief definition, lymphoma is cancer of the lymph nodes. It belongs to a group of oncological diseases that affect cells that support the functioning of the immune system and form the lymphatic system in the body - a network of vessels through the branches of which lymph circulates.

Oncological disease of lymphatic tissue - lymphoma, what kind of disease is it? When the lymph nodes and various internal organs begin to increase in size, “tumor” lymphocytes accumulate in them uncontrollably. These are white blood cells that support the immune system. When lymphocytes accumulate in nodes and organs, they disrupt their normal functioning. In this case, cell division goes out of control of the body, and the accumulation of tumor lymphocytes will continue. This indicates the development of an oncological tumor - that’s what lymphoma is.

The term “malignant lymphoma” combines two large groups of diseases. The first group of diseases was given a name - lymphogranulomatosis (Hodgkin's disease), the other group included non-Hodgkin's lymphomas. Each lymphoma disease in both groups belongs to a specific type. It differs significantly in its manifestations and approaches to treatment.

The majority of the population does not know whether lymphoma is cancer or not? In order not to encounter it personally, you need to learn about this disease from our article and apply preventive measures. If there is reason to suspect lymph node cancer from these two groups of diseases, then early recognition of symptoms will help begin treatment in the early stages.

When tumor formations arise from lymphocytes, their maturation goes through several stages. Cancer can develop at any stage, which is why the disease lymphoma has many forms. Most organs have lymphoid tissue, so a primary tumor can form in any organ and lymph node. Blood and lymph transport lymphocytes with the abnormality throughout the body. If there is no treatment, then as a result of cancer progression, the sick person may die.

Human lymphatic system

Lymphomas are simple, high-quality and malignant

Malignant lymphomas are true neoplasms of systemic lymphoid tissue. The occurrence of simple lymphoma is influenced by reactive processes. Simple lymphoma consists of a limited infiltrate of lymphoid cells. They have pronounced light-colored reproduction centers, like lymphatic follicles.

Simple lymphoma occurs due to:

• chronic inflammatory process in tissues and organs;
• regeneration processes of lymphoid tissue;
• phenomena such as lymph stagnation.

Simple lymphoma is formed when a high degree of immunological tension occurs in the body. Benign lymphoma is an intermediate form between lymphomas: simple and oncological.

Qualitative lymphoma, what kind of disease? It is characterized by slow and asymptomatic growth of tumors in the lymph nodes:

The nodular-shaped neoplasms have a dense consistency to the touch. Chronic inflammation can trigger the growth of high-quality lymphoma. Histological examination characterizes it as a simple lymphoma in the lung area against the background of nonspecific chronic pneumonia. It is impossible to distinguish the sinuses of the lymph nodes, since their place is taken by hyperplastic lymphoid tissue, so this lymphoma is mistaken for a tumor.

Oncological lymphoma develops against the background of a systemic disease of the hematopoietic apparatus; it can be limited or widespread.

Lymphoma in children and adolescents is a disease included in both groups of malignant tumors. Children suffer especially hard from lymphogranulomatosis - Hodgkin's lymphoma. In the study of pediatric oncology, 90 cases of lymphoma are annually recorded in patients under 14 years of age, 150 cases in patients under 18 years of age - this accounts for 5% of all oncology in children and adolescents.

Lymphomas practically do not develop in children under 3 years of age. Adults get sick more often. Among the most common 5 forms of the disease in children, 4 forms are classified as classical Hodgkin's disease. These are lymphomas:

• non-classical, lymphocyte-enriched;
• mixed-cellular forms;
• nodular forms;
• with an excess of lymphocytes;
• with a lack of lymphocytes.

The main complications of childhood lymphoma are:

• oncology of the brain: brain and spinal;
• compression of the respiratory tract;
• superior vena cava syndrome;
• sepsis.

Radiotherapy has severe negative effects. The child has:

• consciousness is confused;
• treatment is accompanied by skin burns;
• limbs weaken and headache;
• due to frequent nausea and vomiting, loss of appetite, weight loss;
• rashes and tumors appear.

The child’s body will intensively get rid of carcinogens and radiotherapy products, so active hair loss occurs. In the future, the hair will grow back, but will have a different structure.

After chemotherapy, the following negative effects may occur:

• anorexia, nausea, vomiting, diarrhea and constipation;
• ulcers on the oral mucosa;
• with fatigue and general weakness, there is a risk of developing an infectious disease;
• bone marrow is damaged;
• hair fall out.

Classification of lymphomas

Hodgkin lymphoma and non-Hodgkin lymphoma are two large groups of malignant lymphomas that present differently clinically. Their course, response to therapy, the nature of the cancer cells and treatment are different. Moreover, all types of lymphomas can affect the lymphatic system, the main functional work of which is to protect the body from infectious diseases.

The structure of the lymphatic system is complex. The lymph nodes cleanse the lymph from all vital organs. The lymphatic system includes the thymus, tonsils, spleen, bone marrow with a large network of lymph vessels and lymph nodes. Large and main clusters of lymph nodes are located in the axillary fossae, pair and neck area. The number of clusters varies, only the axillary fossae contain up to 50 lymph nodes.

In addition to numerous types of lymphoma, the classification also includes subtypes, by studying which doctors determined how quickly lymphoma develops and developed certain treatment regimens for oncology and eliminating its causes. For example, lymphoma that affects the mucous membranes is caused by the infectious pathogen Helicobacter pylori, which can cause ulcers or gastritis.

However, some types of lymphoma appear for unknown reasons and develop cancerous pathologies in the lymphatic system. The state of the immune system is of great importance. Lymphoma (cancer of the lymph nodes) can be caused by:

• against the background of the immunodeficiency virus (HIV) with long-term use of drugs that suppress the immune system;
• during tissue and organ transplantation;
• autoimmune diseases, hepatitis C virus.

Hodgkin's lymphoma affects people under 30 years of age and after 60 years of age and gives a more favorable prognosis. The 5-year survival rate is approximately 90%. The survival prognosis for non-Hodgkin lymphomas depends on the type; there are about 60 of them. The average survival rate over 5 years is 60%, at stages 1-2 - 70-80%, at stages 3-4 - 20-30%. Non-Hodgkin's lymphomas are more common and occur more often after age 60.

Informative video: Hodgkin's lymphoma. Diagnosis at the bottom of a glass

Primary lymphoma can occur in any organ, such as the brain. Then patients will complain about:

• headache due to increased intracranial pressure, drowsiness, nausea and vomiting are signs of intracranial hypertension;
• epilepsy attacks;
• symptoms of meningitis;
• cognitive impairment;
• damage to the cranial nerves.

Primary lymphoma can also affect the serous cavities, central nervous system, liver, heart, and brain during HIV infection.

Secondary lymphoma manifests itself as a result of metastasis in any organ where the blood or lymph flow delivers the cancer cell.

The classification of non-Hodgkin's lymphomas includes more than 60 types of lymphomas. In non-Hodgkin's lymphomas, there are 2 types of tumors: B and T cell.

Informative video: Non-Hodgkin's lymphoma

Treatment for them varies, as they come in the following forms:

1. aggressive - rapidly growing and progressive with the presence of many symptoms. They should be treated immediately, which gives a chance to completely get rid of oncology;
2. indolent - benign chronic course of lymphomas with a low degree of malignancy. Permanent treatment is not required, but constant monitoring is necessary.

Causes of lymphoma

The original causes of lymphoma are not known to science. When studying a large number of toxins, there is no convincing evidence of their connection with this type of disease.

Some researchers believe that the diagnosis of lymphoma should be based on long-term exposure to insecticides or pesticides. Most scientists are confident that when lymphoma is diagnosed, the causes of the disease are manifested in a sharp decrease in immunity due to viral infections and long-term use of medications.

There may be other factors that negatively affect immunity: autoimmune diseases, organ and tissue transplantation with prolonged activation of the immune system create favorable conditions for the development of lymphoma. When transplanting organs such as liver, kidneys, lungs and heart, a conflict is possible between the transplant and the patient's body - that is, a rejection reaction is possible. Long-term use of medications to prevent conflict can worsen immunity.

AIDS reduces immunity due to the virus attacking lymphocytes, so patients with the presence of the virus are more likely to get cancer of the lymph nodes. If a person is infected with a lymphotropic T-cell virus (type 1), then an aggressive T-cell lymphoma develops. Recent studies have shown that the hepatitis C virus increases the risk of lymphoma.

Lymphoma - signs of the disease

The initial signs of lymphoma in adults are characterized by enlarged lymph nodes in the neck, groin and armpits. But there may be other symptoms of lymphoma:

• lung tissue is affected - there are manifestations of shortness of breath, cough and compression syndrome of the superior vena cava: the upper part of the body swells and breathing becomes difficult;
• lymphoma develops in the peritoneum, signs are manifested by a feeling of heaviness in the abdomen, bloating and pain;
• the inguinal lymph nodes are enlarged, then these first signs of lymphoma are accompanied by swelling of the legs.

If lymphoma cancer is suspected, symptoms include constant headaches and severe weakness, which indicates damage to the brain and spinal cord.

When diagnosed with lymphoma, symptoms of general intoxication are characterized by excessive night sweats, sudden weight loss, and indigestion. For no reason, the temperature with lymphoma will rise to 38ºC and above.

If cutaneous lymphoma is suspected, symptoms are as follows:

• the blood formula changes;
• regional lymph nodes increase;
• internal organs are involved in the process of germination of secondary tumors during metastasis at stages 2-4;
• the skin constantly itches, even to the point of scratching and abscesses when infected;
• the skin suffers from polymorphic rashes.

Diagnosis of lymphoma

• biopsy during surgical removal of the affected lymph node or other lesion with simultaneous immunohistochemical examination to establish the variant of the disease;
• determination of lymphoma and its spread to lymph nodes or other organs using ultrasound of the peritoneum, radiographs of the sternum;
• more accurate CT and innovative PET-CT.

If Hodgkin's lymphoma is suspected based on symptoms, how to diagnose it? It is necessary to carry out a differential diagnosis with B- and T-cell lymphomas from the large cell category. To confirm the diagnosis, stage and select adequate therapy:

1. According to the anamnesis, the symptoms of intoxication are clarified: fever, profuse sweat, weight loss;
2. carefully examine the patient, palpate: all peripheral lymph nodes (including subclavian, ulnar and popliteal), the abdominal cavity with the liver, spleen and the area of ​​the retroperitoneal and iliac lymph nodes;
3. perform a puncture and cytological examination of the lymph node to determine the affected node, the accuracy of the biopsy and create an examination and treatment plan;
4. An adequate biopsy of the affected lymph node and subsequent morphological and immunophenotypic study are performed.

It is important to know! In controversial cases, an immunophenotypic study of Hodgkin lymphoma is performed. Parasternal mediastinotomy or laparotomy is performed, as well as endoscopic surgery if mediastinal or intra-abdominal lymph nodes are enlarged in isolation. There are no clinical criteria for defining Hodgkin lymphoma. Therefore, histological verification should always be performed when Hodgkin lymphoma is suspected. This lymphoma is clearly visible on fluorography, although the full picture of changes in the tissue of the lungs and mediastinal lymph nodes may not be visible.

In laboratory conditions, a complete blood count is examined, lymphocytes in lymphoma are examined to determine their number and leukocyte formula. The level of hemoglobin, platelets and ESR are determined. Biochemical samples are taken to determine the level of alkaline phosphatase and lactate hydrogenase, indicators of liver and kidney function.

It is mandatory to:

1. X-ray of the chest in projections: frontal and lateral.
2. CT to detect: mediastinal lymph nodes invisible on x-ray, multiple pathological lymph nodes in the mediastinum, small lesions in the lung tissue and tumors growing into the soft tissue of the sternum, pleura and pericardium.
3. Lymphoma - diagnosis Ultrasound of the lymph nodes: inside and behind the peritoneum, spleen and liver will confirm or exclude damage in these organs and tissues. For the same purpose, questionable lymph nodes are examined by ultrasound after palpation. It is especially important to use ultrasound in places where it is difficult to palpate - under the collarbone and thyroid gland.
4. Radionuclide diagnostics for identifying subclinical lesions of the skeletal system. If there are complaints of pain in the bones, an X-ray examination is performed, especially if it coincides with areas of pathological accumulation of the indicator. The use of gallium citrate (64Ga) for scintigraphy of lymph nodes confirms their damage. This method is important after treatment has ended because early relapse can be detected. In this case, the initially large size of the mediastinal accumulation of the indicator in the residual mediastinal lymph nodes is revealed.
5. Trephine biopsy (bilateral) of the ilium - to confirm or exclude a specific bone marrow lesion.
6. Fibrolaryngoscopy and biopsy of altered structures - to determine whether Waldeyer’s ring is affected. A biopsy of the tonsil is carried out and a differentiated diagnosis is made with lymphomas of other forms, if the tonsils are often affected in them. MRI is preferable for CNS lesions.
7. PET - positron emission tomography with the short-lived isotope 2-1fluorine-18,fluoro-2-deoxy-D-glucose (18F-FDG), as a radiopharmaceutical, in order to clarify the volume of the lesion and the number and location of subclinical lesions before treatment. PET confirms the completeness of remission and predicts relapse with residual tumor masses.

As for diagnostic laparotomy with splenectomy, it is performed in patients who will be prescribed radical radiation therapy. In this case, an inspection of the lymph nodes inside and behind the peritoneum is carried out.

Lymphoma stages and prognosis

If lymphoma is confirmed, the stages will help determine how far the cancer has spread. Such important information is taken into account when developing a treatment regimen or program. They take into account not only the stages of lymphoma, but also its type, the results of molecular, immunological, cytogenetic studies, the age and condition of the patient, and concomitant acute and chronic diseases.

There are 4 stages of lymph node cancer: I, II, III and IV. By adding the letters A or B to the number, you can understand that lymphoma is accompanied by important complications: fever, severe night sweats and weight loss, or no symptoms. The letter A means the absence of symptoms, the letter B confirms their presence.

Stages I and II are considered local (local, limited); stages III and IV are considered widespread.

1. The first stage - one area of ​​the lymph nodes is involved in the lymphoma process. Treatment at this stage gives % positive results.
2. The second stage of lymphoma - two or more areas of lymph nodes on one side of the diaphragm are involved in the process - the muscular sheet that separates the chest from the abdominal cavity. For stage 2 lymphoma, the prognosis promises almost 100% cure if there are no metastases.
3. Lymphoma stage 3 - there is a prospect of recovery if the disease has not spread throughout the body and adequate treatment is carried out. Stage 3 lymphoma can spread to the peritoneum, central nervous system and bone marrow. Lymph nodes are affected on both sides of the diaphragm. Lymphoma stage 3, the prognosis for recovery within 5 years is 65-70%.
4. Lymphoma is the last, stage 4: the symptoms are the most aggressive. It is possible to develop secondary cancer of the lymph nodes on the internal organs: heart, liver, kidneys, intestines, bone marrow, since stage 4 lymphoma actively metastasizes, spreading cancer cells through the blood and lymph flow.

Lymphoma stage 4 - how long do they live?

A similar question is often asked, but no one will take the liberty of giving the exact number of years, since no one knows it. It all depends on the state of the body’s defenses, which fights cancer and intoxication after the drugs used. After using modern intensive techniques, stage 4 Hodgkin lymphoma - the prognosis for 5 years is encouraging for 60% of patients. Unfortunately, 15% of children, adolescents and old people experience a relapse.

Lymphoma gives a good prognosis after treatment of a non-Hodgkin tumor, up to 60% for 5 years. If lymphoma is diagnosed on the ovaries, central nervous system, bones, or mammary gland, life expectancy may not reach 5 years. It all depends on the form of lymphoma and the degree of its malignancy.

How long do people live with non-Hodgkin's lymphoma?

• more than 70% of patients - within 4-5 years with B-cell tumors of the marginal zone (spleen), MALT lymphomas (diseases of the mucous membranes), follicular tumors (diseases of low-grade lymph nodes);
• less than 30% of patients – with aggressive forms: T-lymphoblastic and peripheral T-cell lymphoma.

If the malignancy is high, then with complete remission the 5-year survival rate is 50%, with partial remission it is only 15%.

Chronic lymphocytic leukemia, lymphocytic lymphoma / lymphoma of small lymphocytes - the prognosis is favorable, up to 90-92%. Lymphoma cells arise from the same type of lymphocytes and develop by similar mechanisms; it is indolent and responds well to treatment. However, in 20% of cases, small lymphocyte lymphoma becomes resistant to therapy. It transforms into diffuse large B-cell lymphoma and becomes aggressive. This transformation is called Richter syndrome. It is difficult to treat. If transformation occurs 5 years (or more) after diagnosis, then the chances of survival increase.

Treatment of malignant lymphoma

Radiation therapy for lymphoma

The use of radiation therapy at stages I and II (30–50 Gy per lesion) gives a 10-year relapse-free survival rate from 54% to 88% of patients. Patients with non-Hodgkin's lymphoma are irradiated externally using high-energy sources. For patients in the first two stages, radiation therapy often becomes the main treatment method, but complete recovery from lymphoma occurs with the use of combination therapy, which includes chemotherapy and radiation therapy.

Radiation therapy is used as a palliative (temporarily relieving) treatment for damage to the spinal cord and brain. Rays reduce pain when nerve endings are compressed.

As for wait-and-see tactics until symptoms of intoxication or progression appear, this approach is not shared by all oncologists and even patients. Although ESMO clinical guidelines (2003) suggested that watchful waiting after initial treatment is advisable.

Side effects of radiation

Complications after irradiation appear:

• on the skin - minor changes;
• in the peritoneal area – enteropathy and indigestion;
• on the sternum - possible damage to lung tissue and difficulty breathing;
• lung area – possible development of cancer at the same location and difficulty breathing (especially in smokers);
• brain – headache and memory impairment even 1-2 years after irradiation;
• weakness, loss of strength.

Important! The side effects of chemotherapy are always worse after radiation is used.

Chemotherapy for lymphoma

Is lymphoma curable in domestic practice?

In clinics, treatment of lymph node cancer begins with chemotherapy, especially at stages III–IV in the presence of large tumor masses. Mono alkylating agents, vinca alkaloids (herbal antitumor agents with vinblastine and vincristine) or combined LOPP and COP are used.

Combination chemotherapy for lymphoma increases response rates and disease-free intervals, but overall survival with a median of 8-10 years is not affected. Chemotherapy with stem cell transplantation can give conflicting results even with molecular remissions.

If indolent (follicular grade I–II) lymphoma is detected, how to treat it? A progressive method is the introduction of a drug at stage 3-4 of monoclonal antibodies - MabThera (Rituximab). It induces up to 73% responses in monoimmunotherapy. The median time to progression is 552 days. In primary refractory forms and relapses, long-term remissions occur in 50%.

In accordance with domestic and foreign experience, the drug MabTher with chemotherapy (CHOP) began to be used for the treatment of indolent non-Hodgkin lymphomas. This combination is being further studied and high-dose chemotherapy for lymphoma is being used with stem cell transplantation or autologous bone marrow transplantation as a method to increase life expectancy in lymphomas. They are still considered fundamentally incurable (incurable), despite their slow development.

Chemotherapy for stage 1-2 follicular non-Hodgkin's lymphoma with the recombinant drug Alphainterferon increases survival and duration if this cytokine is used for a long time - months. This algorithm is not applicable to rare MALT lymphomas that involve the stomach. Here, eradication of the infection with antibiotics, H2 blockers, receptors, colloidal bismuth, and antiprotozoal agents is first required. Only resistant cases require standard chemotherapy for indolent or aggressive NHL.

The standard treatment for a large number of B-cell aggressive forms of lymphoma is considered to be combination chemotherapy for lymphoma according to the CHOP program (ACOP), consisting of 6-8 cycles. Two cycles are performed after achieving complete remission at 3-week intervals. They increase the effectiveness of the CHOP program to 75-86% of complete remissions, reducing the interval between cycles to 2 weeks. But on chemo-free days, the patient is supported with colony-stimulating factors G,CSF or GM,CSF.

The above tactics are not used to treat highly malignant mantle cell lymphoma, one of the aggressive B-cell NHLs. The median survival after using chemotherapy under the CHOP program is 2 years. Combined chemotherapy sessions with stem cell transplantation, auto- and allogeneic bone marrow transplantation promise to improve the results of treatment of aggressive NHL, if a regimen with high doses of chemotherapy was used from the very beginning. Chemistry can only be supplemented with immunotherapy using Rituximab and polychemotherapy according to the “Hyper, CVAD” - 1 program with the addition of hyperfractions of Cyclosphan, Doxorubicin, Vincristine and large doses of Cytarabine and Methotrexate.

It is much more difficult to develop general principles for the treatment of T-cell lymphomas with indolence and aggressiveness than B-cell lymphomas, since they have a variety of morphological, clinical, etc. extranodal variants and heterogeneity within one localization in the organ. For example, T-cell primary cutaneous lymphomas are indolent. Their treatment, except for the rare T-cell chronic lymphocytic leukemia/T-cell prolymphocytic leukemia (TCLL/PLL), is limited to the treatment of primary cutaneous NHL, including mycosis fungoides or its variant, Sazari syndrome.

Lymphoma treatment for mycosis fungoides differs at different stages:

• At stage IA (T1N0M0) local methods are used:

1. PUVA - therapy - long-wave ultraviolet irradiation with the presence of a photosensitizer and intratumoral administration of an aqueous solution with a low concentration of embiquin (mustargen, chlormethine);
2. BCNU (Carmustine);
3. electron irradiation.

• At stages IB and IIA (T2N0M0 and T1–2N1M0) and IIB (T3N0–1M0) and later, therapy is supplemented with long-term administration of the drug Alphainterferon. Or treatment is carried out with a selective activator of retinoid X-receptors - Bexarotene or a drug of recombinant diphtheria toxin (with CD25 expression) and Interleukin 2 (IL,2) Denileukin difitox, as a drug that has a turomocidal effect.
• At stages III and IV, cytostatic therapy is carried out and Prospidin, purine antimetabolites - Fludara, Cladribine, Pentostatin (for Sezary syndrome), Gemcitabine or combined chemistry according to the CHOP program are used.

If possible, high-dose chemotherapy with allogeneic bone marrow transplantation is used.

The principles of treatment for the main aggressive forms of T-cell NHL may not be identical. Peripheral T-cell lymphoma, the course of which is even more malignant than B-cell lymphoma, at stages I–III is treated with standard combination chemotherapy according to the CHOP program, or Bleomycin and Natulan are added to CHOP, which gives a good result. At stage IV, this approach or the VASOR program is less effective, and the response is worse.

Angioimmunoblastic T-cell lymphoma (angioimmunoblastic lymphadenopathy) can have a good response rate of 30% complete remissions after corticosteroid therapy alone, sometimes with the addition of alpha interferon. But combination chemotherapy gives a twice as high response rate, so the COPBLAM program in combination with Etoposide would be preferable.

For extranodal forms, these 2 subtypes of T-cell lymphomas are treated with high-dose chemotherapy and stem cells or bone marrow are transplanted. This is the primary treatment for them and for anaplastic large T-cell NHL, since it is highly sensitive to standard chemotherapy, steroids, as are aggressive B-cell lymphomas.

The use of the cytokine Alphainterferon in monotherapy for aggressive T-cell NHL has no effect even when combined with chemotherapy. Radiation for aggressive T-cell lymphomas, as an adjuvant treatment, is used for localized lesions if:

• the lesions are large and are not completely irradiated;
• primary extranodal foci in the skin, stomach, testicle, central nervous system.

Highly aggressive B-cell NHLs are treated like Burkitt's lymphoma, T-cell NHLs are treated like lymphoblastic lymphoma, using the therapy used for acute lymphoblastic leukemia, standard combined chemotherapy according to the CHOP or CHOP + asparaginase program and prevention of central nervous system damage (Methotrexate and Cytarabine are administered intrathecally). In this case, induction is first carried out, then consolidation of remission and long-term maintenance therapy are carried out.

Burkitt's lymphoma of any stage and localization is treated with combined chemotherapy, carried out according to the algorithms for acute lymphocytic leukemia with simultaneous prevention of central nervous system lesions (the brain is not irradiated). Or they carry out the same treatment as for lymphoblastic T-cell lymphoma. Combined chemistry (for children and adults) includes:

• Cyclophosphamide or Cyclophosphamide + Ifosfamide (alternating regimen);
• Cyclophosphamide + high-dose Methotrexate;
• Cyclophosphamide + anthracyclines;
• Cyclophosphamide + Vincristine;
• Cyclophosphamide + drugs – epipodophyllotoxins (VM,26) and Cytarabine.

Sometimes treatment tactics are limited to chemistry with Cyclophosphamide in high doses – g/m² and Methotrexate in moderate doses (systemically or intrathecally with Cytarabine).

There is no point in maintaining high-dose chemotherapy with autologous bone marrow transplantation or colony-stimulating factor drugs due to low results. For intracerebral lesions and testicular involvement, it is highly questionable to prescribe radiation therapy to optimal combination chemotherapy in the hope of improving treatment outcomes. The same thing happens when performing palliative resections of large tumor masses, which also prevents immediate chemotherapy.

Relapses also occur when complete remission is achieved after chemotherapy in all types of NHL: indolent, aggressive and highly aggressive.

The relapse-free period can last several months to several years, depending on the degree of malignancy of NHL and unfavorable prognostic factors, including MPI indicators.

Complications after chemotherapy

The consequences of chemotherapy for lymphoma arise due to the fact that antitumor therapy destroys normal cells along with tumor cells. Cells that quickly divide in the bone marrow, oral mucosa and gastrointestinal tract, and hair follicles in the scalp are damaged especially quickly.

The total and total doses of drugs and the duration of chemotherapy affect the severity of side effects. In this case the following appears:

• ulcers on the mucous membranes;
• baldness;
• increased susceptibility to infections with a reduced level of leukocytes;
• bleeding occurs due to a lack of platelets;
• fatigue – with a lack of red blood cells;
• loss of appetite.

In large lymphomas, due to rapid exposure to chemotherapy, tumor disintegration may occur - lysis syndrome. The decay products of cancer cells enter the kidneys, heart and central nervous system through the bloodstream and disrupt their function. In this case, the patient is prescribed a large volume of fluid and treatment of lymphoma with soda and Allopurinol.

To prevent antitumor chemistry from directly damaging the main vital organs and causing oncological leukemia, modern means of prevention are used:

• antiemetics;
• antibiotics;
• growth factors that stimulate the production of leukocytes;
• drugs against viruses and fungi

Until the immune system gains strength, it is necessary to avoid infectious complications by following simple preventive measures:

• patients and visitors must wear gauze masks, and hospital staff must wear masks and sterile gloves;
• thoroughly wash hands, as well as fruits and vegetables brought to the patient;
• Avoid contact with children who are carriers of infections.

Lymphoma - treatment after relapses

Early relapse of lymphomas begins 6 months after the end of treatment. This requires a change in the chemotherapy program. If the degree of malignancy is low, they switch to treatment programs for aggressive lymphomas, for example, changing the COP, Leukeran or Cyclophosphamide program to CHOP or regimens with anthracyclines. If there is no answer, they switch to combination chemistry regimens with Mitoxantrone, Fludara, Etoposide, Cytarabine and Asparaginase.

If the lymphoma relapses late, and occurs a year or more after initial treatment, then treatment regimens can be repeated for indolent and aggressive lymphomas. If a relapse occurs in large B-cell lymphoma after an anthracycline-containing first-line program, any “rescue” chemotherapy regimen is performed, then high-dose chemotherapy and hematopoietic support using peripheral hematopoietic stem cells are prescribed, including irradiation of the original lesion, or the “iceberg” type is used.

If only partial remission is achieved after first-line chemotherapy and there is no positive dynamics of the lesions after the first courses of standard therapy, the program is changed. Intensive “rescue” therapy is included, including bone marrow transplantation, immunotherapy with monoclonal antilymphocyte antibody drugs: Rituximab, MabTher. In monotherapy, they indicate long-term remissions in 50% of patients, but do not prevent repeated relapses.

First-line NHL without the risk of complications can be treated with a combination of Rituximab and combined chemotherapy according to the CHOP program or Fludara and Mitoxantrone.

It is important to know. For local relapses and primary refractory forms of NHL, radiation may be more promising for treatment than searching for an effective chemotherapy regimen.

Treatment of lymphoma with folk remedies

If lymphoma is confirmed, treatment with folk remedies is included in general therapy and used as prophylaxis. To reduce the side effects of radiation and chemistry, decoctions, infusions and tinctures are prepared from antitumor foods. Widely used: goji berries, mushrooms: chaga, reishi, meitake, shiitake and cordyceps. They are sold fresh by people who grow them at home. In dried form, they are sold in pharmacies and company stores, in markets.

Since oncology can be unpredictable, like lymphoma, treatment with folk remedies must be coordinated with an oncologist. For example, treating lymphoma with soda to facilitate complex therapy, replenishing the blood with alkali to make it more liquid and less acidic, and expelling fungi from the body is recommended by chemists and researchers: Professor Neumyvakin, Otto Warburg, Tulio Simoncini. German and Chinese doctors agree with them, having conducted multiple studies to identify the effect of bicarbonate on cancer patients

Important! Despite the opinion of scientists, it is impossible to treat lymphoma on your own, at your own discretion.

Treatment of lymphoma with folk remedies includes before and after chemotherapy or radiation. The use of herbs and plants is well described on the website in the article “Treatment of intestinal cancer with folk remedies,” as well as interesting and useful material about the treatment of cancer with folk remedies, you will find in the section “Traditional medicine for cancer.” To reduce intoxication of the body and increase immunity, you can use the recipes from these articles in agreement with your oncologist.

Nutrition, diet

Nutrition plays an important role during chemotherapy for lymphoma. It must be high in calories in order to replace the energy spent by the body fighting cancer and recovering from chemotherapy and radiation.

The diet during chemotherapy for lymphoma should ease the quality of life with low immunity, eliminate sudden weight loss and infectious diseases. Namely:

Every 2-3 hours you should eat without overeating and without annoying feelings of hunger. At the same time, dry snacks “on the run” with sandwiches are excluded;

To eliminate nausea and for better absorption of food, you need to give up fatty and fried foods, smoked, salted, peppered, preservatives, marinades, blue cheeses, fast foods, shawarma, hot dogs, pasties, etc.

You can have boiled, baked or steamed meat and fish dishes, pasteurized milk, goat, cottage cheese casseroles, dumplings, mousses, etc.;

If you are not allergic to honey or honey products, it is recommended to drink a glass of water with honey and pollen (1 tsp each) in the morning. It is recommended to drink tea, juices, compotes, and jelly with honey (to taste). If there is an allergy, then limit the amount of sugar.

Oncological tumors actively develop in a carbohydrate (sweet) environment. But it is not recommended to completely eliminate carbohydrates, since cancer cells will replenish energy from muscles and other soft tissues, weakening the body;

Water (still) in an amount of 1.5-2 liters/day reduces the toxic load on the urinary system. Compotes, teas with milk, broths, soups, jelly - this is considered food. It is not recommended to drink green tea - it neutralizes the properties of chemicals;

Alcohol: beer, vodka, sweet fortified wines adds toxins to a weakened body. However, doctors recommend drinking 50 ml of natural red wine between courses of treatment;

Vitamins for lymphoma support the functioning of the immune system and ward off infectious diseases. Most vitamins can be found in fresh vegetables, berries and fruits. In winter, dried fruits are preferable, but they must be thoroughly washed and compotes infused on them;

Boiled durum pasta always stimulates the appetite if you add boiled lean poultry or baked fish, or a vegetable salad with lemon juice instead of butter. The bread must be fresh. It is better to avoid buns, pastries, and cakes with cream, icing, and fatty fillings.

Meals after chemotherapy for lymphoma should also consist of fresh foods. You cannot reduce or increase calories. If nausea interferes with appetite, the body may go into saving mode. This leads to weight loss and decreased immunity. To exclude this, you need:

• “work up an appetite” in the fresh air and replenish calories with nuts, honey, chocolate or fresh sour cream;
• eat warm food, excluding hot and cold;
• drink water and other liquid foods: compote, jelly, fruit cocktail, juice one minute before a meal, or 1.5 hours after it;
• Chew food thoroughly, since the absorption of juices begins in the oral cavity (under the tongue);
• distinguish between roughage and raw vegetables and fruits;
• if you have diarrhea, consume more cereal porridges, especially rice, grated soups, eggs;
• cook food in a double boiler, chop and puree as much as possible to reduce the impact on the walls of the digestive system.

Lymphoma - treatment with immunotherapy (biotherapy)

When immunity decreases, the body can no longer produce protective substances, so they are used in immunotherapy. They destroy lymphoma cells and slow down their growth, activating the immune system to fight lymphoma.

White blood cells produce hormones to fight infection. Hormone-like substance – Interferon of various types stops cell growth and reduces lymphoma. It is used in combination with chemotherapy drugs.

Side effects during treatment with Interferon include:

• increased fatigue;
• increased body temperature;
• chills, headache;
• painful attacks in joints and muscles;
• changes in mood.

Monoclonal antibodies are produced by the immune system to fight infectious diseases. These monoclonal antibodies are produced in laboratories and used to kill lymphoma cells.

Surgical treatment of lymphoma

Certain types of lymphomas, such as gastrointestinal lymphomas, require partial surgical treatment. But now operations are being replaced or supplemented by other treatment methods.

Laparotomy is used - a surgical operation in which the abdominal wall is cut to gain access to the peritoneal organs. The purpose of laparotomy affects the size of the incision. To conduct a microscopic examination of tissue cancer, samples of organs and tissues are taken through an incision.

Treatment with bone marrow and peripheral stem cell transplantation

If standard therapy does not give the expected effect, then bone marrow or peripheral stem cell transplantation is used for lymphoma. This uses high doses of chemicals to kill resistant tumor cells.

Transplantation is performed with autologous (from the patient) and allogeneic (from the donor) bone marrow or peripheral blood cells. Autologous transplantation is not performed in cases where the bone marrow or peripheral blood is damaged by lymphoma cells.

Peripheral stem cells or bone marrow are removed from the patient before intensive chemotherapy or radiation begins. Then, after treatment, they are returned to the patient so that blood counts are restored. Leukocytes increase after 2-3 weeks, later – platelets and red blood cells.

Bone marrow transplantation

Early or late complications or side effects may occur after a bone marrow or peripheral stem cell transplant. Early effects are the same as when prescribing high doses of chemotherapy. Late ones are characteristic:

• shortness of breath due to radiation damage to the lungs;
• infertility of women due to damaged ovaries;
• damage to the thyroid gland;
• development of cataracts;
• damage to bones, which causes aseptic (without inflammation) necrosis;
• development of leukemia.

Treatment of chronic lymphocytic leukemia

Chronic lymphocytic leukemia and small lymphocyte lymphoma are considered different manifestations of the same disease; treatment is required for specific lesions of the skin. Lymphoma of small lymphocytes - leukocyte lymphoma (LML) or chronic lymphocytic leukemia (CLL) is contained in the structure of all lymphomas; when manifested, the disease can compete with the most common large B-cell lymphoma.

CLL and LML cells do not differ; they arise from the same type of lymphocytes and develop almost identically. However, CLL cells are found in the blood, and LML cells are found first in the lymph nodes. CLL cells originate in the bone marrow, and LML becomes generalized and then only involves the bone marrow.

With prolonged development, LML is treatable. For the first 1-2 years, patients do not need therapy, then cytostatic treatment is used. Then, histological transformation of LML into aggressive large B-cell lymphoma (Richter syndrome) or Hodgkin lymphoma is possible. Like follicular lymphoma, it is poorly treatable. The median remission-free survival is 8-10 years.

Symptoms may manifest as a monthly increase in lymphatic leukocytosis. First, the cervical, then axillary lymph nodes and other groups increase in size. The spleen will be normal or slightly enlarged. Leukocytosis will be less than 20x109/l for many years. There will be little nodular lymphatic proliferation in the bone marrow. Then, on the skin of patients with B-CLL, manifestations of staphylococcal and viral lesions are possible.

The generalization of the tumor process is completed by secondary specific skin lesions: infiltrated spots, plaques and nodes, often on the trunk, proximal limbs and face.

Treatment regimens for malignant lymphomas

Blocks 1-4 reveal treatment regimens in accordance with the stage of the disease and the functional status of the patient.

Informative video: lymphoma, what is it? Symptoms, treatment

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Lymphoma of the spine is from lymphoid tissue that develops outside the bone marrow. The disease can be diagnosed in people of different ages. But when it comes to gender, the majority of patients are men. Moreover, to this day, a clear classification has not been developed that would help to more accurately understand exactly how dangerous the disease is.

Causes

The reasons for the development of lymphomas remain unclear to this day. Moreover, there is not a single sign that would exist immediately in all patients with this diagnosis. However, there are some assumptions. For example, in people with HIV infection, as well as in those receiving immunosuppressive therapy, lymphoma develops most often.

Also, in most patients, certain changes were found in chromosome 8, which do not in any way affect the development and functioning of other organs.

There are several factors that can have a significant impact on the development of this disease. This is constant long-term work with pesticides and herbicides, taking certain medications, which is carried out without control, as well as exposure to a variety of types of radiation, including ultraviolet and x-rays.

Based on the degree of malignancy, these tumors are usually divided into 3 groups. The first category includes those that have a low degree of malignancy. The second is those that belong to the intermediate degree. And finally, the third group is a high degree of malignancy.

How it manifests itself

Symptoms of spinal lymphoma can be very different and depend on what type of tumor predominates at the moment. However, the first and most important sign that always attracts attention is damage to the lymph nodes, as well as the liver and spleen. Almost all lymph nodes are involved in the pathological process, regardless of their location.

At the very beginning, the enlarged lymph nodes become dense, but completely painless, after which some time passes, and they are already united in large groups with the appearance of the first signs of ulceration and the formation of fistulous tracts. During this period, symptoms such as:

1. Cough.
2. Dyspnea.
3. Feeling of a lump in the throat.
4. Swallowing problems.
5. Bluishness and puffiness of the face.
6. Swelling of the arms and legs.
7. Intestinal obstruction.
8. Jaundice.

After some time, the tumor begins to metastasize - mutant cells are spread throughout the body with the lymph flow.

Symptoms include worsening appetite and sudden weight loss, malaise, constantly elevated body temperature, poor sleep, sweating, apathy, and irritability. If bone marrow damage occurs, then symptoms such as anemia, frequent and severe infections, constant bleeding, especially nosebleeds, and the appearance of hematomas without bruises appear.

At the same stage, bone damage occurs, severe pain appears in the spine, the pelvic bones suffer, muscle atrophy begins, pain appears in the joints and bones, which does not go away even with rest.

Diagnostics

Lymphoma of the thoracic and lumbar spine is diagnosed using several methods. This is a puncture of an enlarged lymph node, which allows you to determine the degree of malignancy. X-ray examination, including CT and MRI. Ultrasound makes it possible to determine the location of tumors, as well as the presence or absence of metastases.

Blood and urine tests are required, and, of course, an analysis to identify markers of the tumor process.

Treatment

Treatment will depend entirely on how far the process has spread, as well as on the morphological examination of the cells. If it is a single tumor, then it is removed surgically. When the spleen is actively working, which destroys not only tumor cells, but also healthy ones, this organ is also removed.

Radiation therapy is one of the effective methods that can completely cure the disease. Can be used both along with surgery and independently. Chemotherapy using only one drug can also be very effective if given in a timely manner and in the absence of metastases.

And finally, bone marrow transplantation is a technique that allows you to restore the normal cellular composition of the blood.

Forecast

A good prognosis will be if the lymphoma turns out to be B-cell. In this case, after treatment, the 5-year survival rate exceeds 70%. If it is T-cell lymphoma, then the survival rate within 5 years will be only 30%. At the same time, spinal lymphoma has a high malignancy, and therefore the survival rate here will be minimal.

The term “lymphoma” is a collective name for many cancers that affect the lymphatic system. This is accompanied by an enlargement of the lymph nodes and damage to some somatic organs, which are capable of accumulating a huge number of lymphocytes. A tumor can form in any part of the body, since lymph circulates throughout the body.

What is lymphoma?

In short, lymphoma is... The disease affects cells that perform a protective function in the body and form the entire lymphatic system.

So what kind of disease is lymphoma? How does it manifest itself?

With the enlargement of lymph nodes and other internal organs, the process of accumulation of lymphocytes begins in them, which are responsible for the body’s immune system. Accumulating in nodes and organs, lymphocytes disrupt their normal functioning. There is a failure in the division of normal cells, and the accumulation of tumor lymphocytes does not stop, resulting in the appearance of a tumor - lymphoma.

Like all malignant tumors, lymphoma manifests itself by the formation of a primary focus of the disease. In addition, it can not only metastasize to other structures, but also spread throughout the body, accompanied by a condition similar to lymphocytic leukemia. There is a type of lymphoma that occurs without enlargement of the lymph nodes and initially develops in the structures of the brain, lungs, stomach and intestines.

Many people wonder whether lymphoma is cancer or not? The emergence of tumors from lymphocytes and the process of their maturation occurs in several stages. At any stage, the disease can become malignant, so lymphoma has many forms. Since lymphatic tissue affects almost all structures of the body, a tumor can form in any lymph node or organ. In addition to lymph, blood also contributes to the spread of abnormal lymphocytes. If left untreated, the disease becomes oncological and the patient may die.

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Causes

The exact reasons why the process of lymphoma development occurs are not known to science to this day.

There is an assumption that lymphoma occurs due to the influence of many toxic substances on the body, but there is no confirmation of this theory. The list of factors that can provoke the disease includes:

• Hepatitis C virus;
• HIV infection;
• T-cell leukemia virus;
• Mutagenic substances.

People whose professional activities involve close contact with heavy chemical compounds are at risk. People who come into contact with pesticides, as well as those who eat foods treated with chemicals, are also at risk.

According to doctors, the following can also affect the development of lymphoma:

• Hereditary diseases (including lymphogenesis);
• Autoimmune diseases;
• Drugs that suppress the immune system;
• Herpes virus;
• Bacteria Helicobacter pylori;
• Weakened immunity.

Types of lymphomas

Lymphomas are divided into 2 groups. The first group of diseases was named, the second included the so-called. Each type of disease is characterized by individual signs and manifestations, and their treatment methods differ. All types of lymphomas affect the lymphatic system, which performs the body's protective function against infections.

The lymphatic system has a complex structure. The lymph nodes cleanse the lymph that circulates throughout the body. The main components of the lymphatic system are the tonsils, thymus, spleen, bone marrow with a large number of lymph vessels and nodes. The main cluster of lymph nodes is concentrated in the armpits, neck and groin of the leg. Their number varies; there are more than 50 lymph nodes in the armpit.

Today, the following types of lymphomas are more common in medical practice:

Symptoms of the disease

The manifestation of the disease depends, first of all, on the form of the disease, the size and location of the tumor. Hodgkin's lymphoma covers 5 types of malignant tumors. The number includes over 30 types of diseases.

The first group of diseases is characterized by various symptoms, including lymph nodes and organs. Symptoms of the disease are characterized by both local symptoms and general manifestations of the disease. The most common signs of lymphoma are fever, sweating, joint pain, general malaise, headaches, fatigue, weight loss, and itchy skin.

Elevated body temperature is the first sign of lymphoma! An increase in body temperature is mainly observed in the evening and can reach 40 degrees. This is accompanied by chills, causing the patient to sweat profusely.

Skin lymphoma can be identified by itching of the skin, and itching can appear long before the lymph nodes are affected. It can spread throughout the body or appear in a specific area (usually on the extremities, including palms and feet, on the head, in the breast area, etc.).

Damage to the lymph nodes and organs can be diagnosed after examination by a doctor. In 90% of cases, oncological foci are located at a level above the diaphragm, the remaining 10% occur below.

Hodgkin's lymphoma in 70% of cases can be identified by enlarged lymph nodes in the neck, which are elastic and not adherent to each other and neighboring tissues. Lymphoproliferative lesions of the cervical lymph nodes are not accompanied by any special symptoms, the nodes do not hurt, and the skin around them is not red. Sometimes lymphoplasmosis affects small lymph nodes above the collarbone, and can affect the armpits. From them, in turn, the tumor is transmitted to the mammary glands.

Mediastinal lymphoma affects the lymph nodes in 20% of cases. The disease is characterized by compression and growth of lymph nodes into neighboring tissues. At the very beginning, the disease is accompanied by a dry cough, pain in the thoracic region, which is dull in nature and intensifies with a deep breath and coughing. There may be pain in the heart and a bursting feeling in the chest due to enlarged lymph nodes. This may be accompanied by metastases to the pericardium, lungs and bronchi. As the tumor grows, patients experience shortness of breath during exercise. When the tumor reaches an impressive size, “vena cava” syndrome may occur, but there are cases when the disease occurs without symptoms and is detected randomly during an X-ray examination.

Lymphoma in the abdominal cavity and retroperitoneal space is rare and accounts for no more than 8% of cases. In most cases, gastric lymphoma occurs, characterized by an asymptomatic course of the disease. As the tumor increases in size, lower back pain, constipation, or gas formation may occur.

Another rare type of lymphoma is inguinofemoral and iliac lymphoma, accounting for only 3% of all cases of the disease. The tumor carries a poor prognosis due to its malignancy. The manifestation of the disease is as follows: it causes constant and cramping pain in the lower abdomen, heaviness or swelling appears in the limbs, and the sensitivity of the skin in the affected area decreases.

In addition to malignant forms of lymphoma, there are also benign ones.

A very rare type of lymphoma of the spleen is lymphoblastoma. This benign tumor is characterized by a high survival rate of patients compared to other forms of the disease. The only sign of a lymphoblastic tumor is an increase in the size of the organ as a result of the accumulation of lymph fluid, which is detected by ultrasound or radionuclide testing.

Lymphosis of the lungs occurs in 30% of cases. Abnormal lymphocytes enter the organ through the blood and lymph flow. The disease is accompanied by chest pain, shortness of breath and cough. The tumor covers the lung and pleural tissue.

30% of cases are bone lymphoma. Primary and secondary tumors are distinguished depending on the type of lesion (tumor germination from neighboring lesions or its transfer with blood and lymph). The tumor can affect areas of the vertebral system (parts of the spine), ribs, breastbone and pelvic bones. Lesions of the skull bones and tubular bones are less common. When the vertebrae are damaged, pain appears when pressed, and a feeling of numbness and twitching of the limbs also appears. As the tumor progresses, it can cause paresis and paralysis of the lower extremities and disrupt the functioning of the pelvic organs (uterus, ovary).

In 10% of cases, lymphoma affects the liver. The disease occurs with symptoms such as nausea, vomiting, heartburn, pain in the right hypochondrium, and an unpleasant taste in the mouth. The disease can be confused with jaundice.

Brain lymphoma is characterized by damage to the lymphatic tissues of the brain and does not metastasize. It occurs more often in adults over 60 years of age. Symptoms of the disease include speech and vision impairment, drowsiness, headaches and memory loss. It is much more difficult to treat brain lymphoma due to its inaccessible location. Chemotherapy for brain lymphoma is the best treatment option, sometimes surgery is used.

In addition to those listed, there are other types of lymphomas (lymphofibroma, lymphotoma, immunoblastic lymphoma, lymphocytic leukemia of small lymphocytes, lymphadenoma, etc.).

When suffering from lymphoma, both an indolent course of the disease and an aggressive course can be observed. Non-Hodgkin lymphomas, characterized by a high degree of malignancy, proceed aggressively. They are easier to treat because they make themselves felt in the early stages. Indolent Hodgkin lymphoma is asymptomatic and is an incurable form. Chemotherapy and surgery are used to treat it. Radiation therapy for Hodgkin lymphoma is also relevant. Non-aggressive lymphomas are prone to relapse, which can be fatal.

Stages of the disease

There are 4 stages of progression:

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Therefore, the earlier the disease is diagnosed, the greater the chance of recovery. If timely assistance is not provided, the prognosis for the patient will be sad.

Diagnostics

The diagnosis of lymphoma can be made by performing the following types of examination:

• CT (computed tomography) and PET (positron emission tomography);
• Ultrasound of the abdominal organs;
• Chest X-ray;
• Biopsy when removing the affected lymph node to determine the form of the disease;
• Radionuclide diagnostics to detect bone lymphoma;
• Trephine biopsy – allows to detect bone marrow lymphoma;
• Fibrolaryngoscopy - a tissue biopsy of the tonsils, oropharynx, and larynx is performed if they are often affected.

If Hodgkin's lymphoma is suspected, procedures such as:

• They draw up a picture of the disease, specifying the symptoms (sweating, fever, weight loss);
• Palpation of all peripheral lymph nodes (ulnar, subclavian, popliteal), abdominal and retroperitoneal cavities, iliac lymph nodes.
• Puncture and cytological analysis to identify affected nodes and select the necessary type of therapy;
• Biopsy of affected lymph nodes.

Treatment

Lymphosis is treated using both traditional methods and traditional medicine. Among the traditional methods, chemotherapy and radiation therapy, or a combination of both, are widely used. When choosing a treatment method, the stage of the disease and risk factors are taken into account. Treatment of lymphoma begins with the use of chemotherapy drugs. Radiation therapy treats only the initial stage of the disease. In case of damage to the lymph nodes, lymphectomy and lymphomodulation procedures are performed. Both soft tissue lymphoma is surgically removed and carried out.

Another important question is which doctor treats lymphoma? Treatment of lymph node cancer is carried out under the supervision of an oncologist, hematologist, and in some cases the help of a surgeon is necessary.

If the prognosis is favorable, ABVD chemotherapy is prescribed. Drugs prescribed to treat the disease include Bleomycin, Dacarbazine, Vinblastine and Doxorubicin. The drugs are administered intravenously. If the prognosis is unfavorable, the BEACORR regimen with the drugs Prednisolone, Bleomycin, Cyclophosphamide, Etoposide, Doxorubicin, Vincristine, Procarbazine is prescribed. Diet after therapy plays an important role in restoring the body's strength.

Monoclonal antibodies, which have a low degree of toxicity, are also prescribed for the treatment of lymphoma.

Nodal lymphoma is difficult to treat in older people. Complete remission is observed before the age of 40 and is about 65%, after sixty years - 37%. Toxic mortality with lymph node disintegration is observed in 30% of cases.

Treatment for relapses of generalized, aggressive lymphoma depends on many factors. This is the patient’s age, his general health, sensitivity to drugs used during previous therapy. Repeated treatment should include additional drugs to achieve a positive result. The doctor will determine which medications should be used.

Lymphoma cannot be cured and the patient is treated to improve the quality of life. This includes spiritual, psychological and social support.

Treatment with folk remedies

Many people wonder: is it possible to cure lymphoma using traditional methods? Traditional medicine can promote a speedy recovery if used in combination with the main type of therapy. We should not forget that folk remedies can be used only after an accurate diagnosis has been established and with the approval of the attending physician. It is unacceptable to make a diagnosis without examining a doctor by reading the symptoms of the disease on the Internet.

To treat lymphoma, decoctions of plants such as:

Before starting treatment, you should consult your doctor, as certain components may have contraindications, allergic reactions and other complications may occur after taking decoctions.

Nutrition and diet

Proper nutrition plays an important role after tumor treatment with chemotherapy. The diet must be balanced, high in calories in order to replace the energy expended by the body to fight the tumor and restore its previous strength.

The diet should improve the quality of life, the patient’s condition, prevent a sharp decrease in body weight and infection with infectious diseases. To restore the body after chemotherapy, you should:

• Take vitamins to restore immune strength;
• Eliminate alcohol;
• Replace sugar with honey;
• Eat freshly prepared food;
• Drink more fluids;
• Include flour in your diet.

You should eat every 2-3 hours, but it is not recommended to overeat or eat food that does not give you pleasure. It is also not recommended to fast. Walking in the fresh air before meals will be beneficial.

Video: Lymphoma - what it is, symptoms and treatment

How long do people live with lymphoma? Forecast

With the use of modern treatment methods, the prospect of 5-year survival is observed in 95% of cases with a favorable prognosis. With an intermediate prognosis, such survival rate is about 75%, and with a poor prognosis, no more than 60%. Patients who ignore the symptoms of the disease and do not take any measures die from lymphoma.

From all of the above, we learned that lymphoma can be benign and malignant, its symptoms and how it is treated. Each variety has specific symptoms. Lymphoma is not contagious, so there is no prevention for it, like any other cancer. If you adhere to the right lifestyle, monitor your health and promptly consult a doctor for help, you can significantly reduce the risk of developing cancer. If you notice symptoms or still have lymphoma, it is confirmed by examination, then you should immediately begin treatment.

Lymphomas are a large group of tumor diseases of the hematopoietic tissue and lymphatic system. This type of hemoblastosis can occur in the bones both primary and secondary, and this happens quite often. There is an increasing trend worldwide in the number of people diagnosed with lymphoma. Mortality rates from this disease remain disappointing.

From the name it becomes clear that it affects the lymphatic system. It consists of an extensive network of lymphatic vessels and nodes through which lymph circulates. The lymphatic system is a complement to the cardiovascular system. Its function is to cleanse the cells and tissues of the body, maintain human immunity, and protect against viruses and bacteria. Certain enzymes enter the blood through lymph, ensuring communication between organs and tissues. In addition, it is in the lymphatic system that lymphocytes are formed. Their maturation also occurs in the bone marrow.

If for some reason the work of the genes responsible for the maturation of lymphocytes is disrupted, tumor cells appear. They do not perform the usual functions of lymphocytes and begin to divide uncontrollably, creating a neoplasm. Typically, lymphoma originates from B lymphocytes. First of all, it affects peripheral lymph nodes and organs that contain lymphoid tissue. Several cancerous nodes can merge with each other, forming conglomerates. Soon it spreads through the blood and lymph flow to other parts of the body. This process is called generalized; it is not considered metastasis. In most cases, at the time of diagnosis, lymphoma takes on a generalized form.

Tumor cells

Penetration into bone occurs due to:

• tumor growth from lymph nodes and blood vessels through anatomical structures;
• its metastasis through the bloodstream (hematogenously).

In such cases, they speak of secondary bone lymphoma. It usually appears in those parts of the skeleton next to which there are large groups of lymph nodes. After breaking through the capsule of the node, the tumor infiltrates into the surrounding tissues, affects the periosteum, and then the bone marrow.

With hematogenous spread, multiple foci often occur, localized in the red bone marrow. Lymphoma is a solitary tumor, that is, it forms separate nodes in organs. They can be seen on x-rays.

Tumors that initially develop in the bone marrow (primary bone lymphoma) are much less common. Some experts generally deny the possibility of primary skeletal involvement by lymphoma.

Classification of bone tissue lymphomas

Oncology distinguishes 2 large groups of lymphomas: non-Hodgkin lymphomas and Hodgkin lymphoma (another name is lymphogranulomatosis).

. White-skinned people aged 20 to 40 years are more often affected. Tumor cells of lymphogranulomatosis in most cases originate from B cells; malignancy of T lymphocytes is rarely observed. A characteristic histological feature is the presence of Berezovsky-Sternberg cells and Hodgkin cells, which are their precursors.

Hodgkin's lymphoma is divided into 4 histological types:

• lymphohistiocytic;
• mixed cell;
• lymphogranulomatosis with suppression of lymphoid tissue;
• nodular sclerosis.

Bone involvement occurs in 25-30% of patients, bone marrow - in 5%. It is always considered stage IV. The bones of the spine are predominantly affected (>50% of cases), then the ribs, sternum and pelvic bones. In rare cases, a lymphoid bone tumor develops in the skull.

. This is a large group of malignant tumor diseases of the lymphoid lineage of hematopoiesis. People of all ages suffer from non-Hodgkin lymphoma. Some types of this disease are more common in children, others - in old age. In general, they are more aggressive than Hodgkin lymphoma. The difficulty in diagnosing malignant lymphoma of bone tissue is that the original primary tumor may differ in cellular composition from the secondary neoplasm. Another difficulty is the frequent absence of a leukemic blood picture.

Non-Hodgkin's lymphomas include about 30 types of hematological malignancies. Their classification is constantly updated and improved. Damage to the bone marrow in this type of cancer occurs quite often, at different stages of the disease. The development of lymphomas of B-, T- and NK-cell origin is possible. The most common types of this disease are reticulosarcoma. Lymphosarcoma accounts for 15% of all hemoblastoses. It is characterized by rapid spread to surrounding and distant tissues and organs. The bone marrow is affected in 20% of cases. Reticulosarcoma most often forms in long bones. The tumor consists of histiocytes. Its clinical picture is similar to lymphosarcoma. Development occurs rapidly, the tumor metastasizes to distant organs and tissues. These processes are very difficult for the patient, with a sharp deterioration in the general condition.

Bone lymphoma: causes of its occurrence

Scientists cannot accurately answer the question of why lymph cells transform into cancer cells.

There are 3 main theories:

1. The causes of bone lymphoma are believed to be largely related to viruses. Thus, according to the results of epidemiological studies, people who have had infectious mononucleosis, the causative agent of which is the EBV virus, are more susceptible to the development of lymphogranulomatosis. This is confirmed by the similarity of lymphoid tissue cells in mononucleosis with tumor cells, as well as the presence of high levels of antibodies to EBV in most patients. Burkitt's lymphoma is also associated with the EBV virus, but the T-cell leukemia virus is associated with T-cell lymphoma. The viral origin of the disease is supported by the similarity of its symptoms to the inflammatory process. At the same time, the use of anti-inflammatory therapy for lymphomas has not yielded positive results. There is no absolute confirmation of the viral theory, but they cannot reject it either;
2. another version says that the cause of bone lymphoma lies in an immune conflict. It is based on the similarity of the clinical symptoms and morphological picture of these hemoblastoses with the immune reactions that occur during transplantation. Perhaps a tumor of the lymph nodes develops due to prolonged antigenic irritation;
3. the third theory points to genetic mutations. Scientists have identified chromosomal abnormalities that correlate with certain types of lymphomas.

Factors that create favorable conditions for the development of the disease include:

• immunodeficiency;
• antigenic stimulation;
• viral infections;
• influence of radioactive radiation.

According to statistics, men are 1.5 times more likely to suffer from lymphoma than women.

Symptoms and manifestations of bone lymphoma

In 90-95% of patients with secondary bone lymphoma, enlarged lymph nodes are present in one location or another. This phenomenon is called lymphadenopathy. Lymph nodes above the diaphragm are usually affected (especially the cervical ones). Sometimes - inguinal, axillary, submandibular, retroperitoneal, mediastinal lymph nodes. With lymphosarcoma, the elbow, chin and occipital areas are often affected.

They can grow to enormous sizes, but be painless. It is not uncommon for several nodes to be affected simultaneously. To the touch they can be soft or dense, mobile or immobile (especially when conglomerates form). With lymphogranulomatosis, pain on palpation is usually noted.

If the disease initially develops in the area of ​​the mediastinum and lungs, then the person suffers from shortness of breath, cough, and chest pain. In severe cases, lymphostasis occurs.

Signs of an abdominal tumor are bloating, pain in the abdomen or lower back. The abdominal form of lymphoma is severe, with high fever, severe weakness, and exhaustion.

Primary bone marrow damage is difficult to suspect due to the asymptomatic nature of the disease. It develops for a long time without pronounced manifestations, the lymph nodes do not enlarge.

Symptoms of bone lymphoma vary depending on the histological type and location of the tumor, but its leading manifestation is pain. Damage to the spine is accompanied by back pain that radiates to the pelvis and legs. The pain intensifies when pressing on the altered vertebrae. The neoplasm leads to limited joint mobility. Neurological disorders may also occur, such as numbness or twitching of the limbs, muscle weakness, swelling of the arms and legs. Compression of the spinal cord leads to paresis and paralysis of the legs, dysfunction of the pelvic organs.

The consequences of bone tissue lymphoma can be pathological fractures, but they are not typical for Hodgkin lymphoma.

Lymphoma of the ribs, in addition to pain, is manifested by the presence of swelling and the occurrence of a crunching sound upon palpation. The skin in the sternum area is hyperemic and tense.

Common symptoms of bone lymphoma:

• increase in body temperature. This sign is often the very first to appear. At the onset of the disease, the temperature may be low-grade, but as the tumor process progresses, a fever of up to 40 °C develops;
• general weakness (sometimes very pronounced, up to loss of ability to work);
• headache;
• sweating (especially at night);
• weight loss;
• loss of appetite;
• localized or generalized skin itching.

Damage to the bone marrow leads to its leukemia and impaired hematopoiesis, which is accompanied by the following symptoms:

• anemia;
• increased bleeding of mucous membranes;
• bruises on the skin.

An additional symptom of bone lymphoma can be infectious diseases that occur due to reduced immunity. More often, patients suffer from pneumonia, toxoplasmosis, herpes zoster virus, and candidiasis.

It may take a month, or maybe several years, from the appearance of the first symptoms of the disease to its progression. It all depends on the type of malignant neoplasm.

Diagnosis of the disease

In the diagnosis of bone lymphoma, the first step is to examine and palpate all accessible lymph nodes in order to identify pathological changes in them. The doctor must determine the number of changed nodes, their size and location. Pay attention to the condition of the skin and the degree of pain on palpation. If there are signs of bone cancer, the affected bones are probed.

The patient is prescribed a general clinical blood test to determine the level of hemoglobin, red blood cells, platelets, etc. and a biochemical study, counting the amount of proteins, creatinine, urea, bilirubin, alkaline phosphatase, liver enzymes. With non-Hodgkin's lymphomas, lymphocytosis and leukopenia are usually observed, with lymphogranulomatosis - a shift in the composition of serum proteins (fibrinogen, globulin, C-reactive protein, haptoglobulin). All lymphomas are characterized by an increase in erythrocyte sedimentation rate (ESR), and in later stages - anemia.

An important point is to test for HIV infection and syphilis, since lymphoma may be the first sign of AIDS.

To clarify the extent of lymphadenopathy, ultrasound is used. The lymph nodes of various organs are checked: the abdominal cavity, liver, spleen. Computed tomography (CT) is used to examine the chest and abdomen in more detail. According to indications, magnetic resonance imaging (MRI) and positron emission tomography (PET) are prescribed. These types of tomography are very accurate; they allow you to scan the entire body at once and detect distant metastases. Radioisotope testing with strontium and gallium is very effective in detecting even the smallest bone tumors.

To confirm the presence of nodes in the bones, x-rays are prescribed. The X-ray picture of lymphogranulomatosis of bone is varied. Some have areas of bone destruction, others have compactions. Combinations of both processes are possible. These lesions can be single or multiple, with clear edges and blurred ones. When lymphoma grows from the outside, destruction of the cortical layer of varying depths is visible, which increases in size over time. Osteosclerosis is often found in the vertebrae. Damage to the ribs may be accompanied by swelling of the bone.

Such a variety of bone changes in Hodgkin lymphoma creates certain difficulties in making a diagnosis. It is not easy to distinguish it from primary bone tumors and metastatic cancer. Non-Hodgkin's lymphomas of bone are similar to Ewing's sarcoma.

To finally confirm the diagnosis of lymphoma, a puncture biopsy is performed, that is, puncture from the affected lymph node is drawn into a special syringe for cytological and histological examination, as well as immunophenotyping. But due to the small amount of material obtained, as well as the possibility of the absence of characteristic markers indicating bone marrow involvement in the process, there is a possibility of a false diagnosis. To obtain accurate results, they resort to open bone marrow trepanobiopsy. This analysis is more accurate.

If Berezovsky-Sternberg cells were found in the resulting sample, then a diagnosis of lymphogranulomatosis is made. Non-Hodgkin lymphomas are defined by clusters of differentiation (CD) and specific markers.

Additionally, diagnosis of bone lymphoma may include:

• skeletal scintigraphy;
• immunological studies.

Treatment of bone lymphoma

Bone lymphoma is treated by combining methods such as:

1. chemotherapy;
2. radiation therapy;
3. surgical removal of the tumor;
4. stem cell transplantation.

Removal of bone lymphoma is performed for single solitary tumors. Segmental resection or more extensive operations are performed, for example, sheath excision of the bone or amputation of a limb. Then, instead of the removed organs, prostheses are installed, and visual defects are eliminated by plastic surgery.

Spinal cord compression may require spinal surgery.

Polychemotherapy for bone lymphoma is the most effective. There are many chemotherapy regimens.

For the treatment of lymphogranulomatosis, the following regimens are used:

1. , Cyclophosphamide, Procarbazine, in combination with the glucocorticoside Prednisolone.
2. Doxocrubicin, Bleomycin.
3. Vinblastine, Chlorambucin, Procarbazine, Prednisolone.

For non-Hodgkin lymphomas, depending on the aggressiveness and prognosis for patients, the following combinations of drugs are used:

1. , Doxorubicin, Vincristine, .
2. Cyclophosphamide, Vincristine, Prednisolone.
3. Bleomycin, Doxorubicin, Cyclophosphamide, Vincristine, Prednisolone.

Only a doctor can select an adequate treatment regimen for bone lymphoma based on diagnostic data. Approximately 8 courses are carried out at intervals of 2 weeks. 3 weeks after the end of polychemotherapy, a cycle of radiation begins.

Elderly patients cannot withstand the burden of taking so many drugs at once, so they are prescribed monochemotherapy with one drug. For malignant bone lymphoma, an addition to chemotherapy is advisable. This is an antigen that leads to the death of CD-20 cells.

It is worth noting that in patients over 60 years of age, the ability to achieve complete remission is almost 2 times lower than in younger patients. Along with chemotherapy for bone lymphoma, stem cell transplantation is gaining momentum. Both your own and donor stem cells are transplanted. This operation in some cases leads to complete remission of the lymphoma. Cases of donor organ rejection cannot be ruled out.

Treatment of lymphomas with a combined chemoradiotherapy method can increase the survival rate of patients by 25-30%. The fact that lymphogranulomatosis of the skeleton belongs to stage IV makes the use of radiation therapy justified, although the opinions of specialists regarding its effectiveness differ. Some point to improvements in performance after the inclusion of radiation therapy, others believe that it serves only palliative purposes.

Various methods of local irradiation of bone lymphoma and affected lymph nodes are used, as well as radiotherapy and remote therapy. Recommended doses are 4000-4500 rad. Since the disease is usually generalized, irradiation is carried out on all areas of the lymph nodes, starting from the peripheral ones. Radiation and chemotherapy are carried out both before and after surgery for bone lymphoma. The choice of the optimal treatment option is individual.

The results of the studies showed that many patients with formal stage IVB of lymphogranulomatosis, as well as the initial stages of lymphosarcoma, after a course of irradiation, a complete remission occurred: the pain syndrome, neurological disorders subsided, and the bone structure was restored. Of course, at true stage IV of lymphogranulomatosis and non-Hodgkin lymphomas, radiation therapy alone is not enough. It should be used in combination with chemotherapy.

In advanced cases, radiation therapy for bone lymphoma will help alleviate the patient's condition and prevent complications such as fractures and compression of the spinal cord.

Symptomatic therapy includes:

• taking analgesics to relieve pain;
• treatment of anemia by blood transfusion or erythropoietin administration;
• taking antibiotics, antiviral or antifungal drugs to treat infectious complications of lymphoma;
• increasing immunity (interferon drugs are prescribed).

There are relatively few materials on the treatment of bone lymphoma, so there are hopes that more effective treatment regimens for this disease will be adopted in the future.

Recurrence of bone lymphoma

The frequency of relapses in lymphomas depends on:

• a specific type of disease (for example, indolent lymphomas, which respond well to treatment, often recur);
• response to first-line therapy;
• tumor size, number of affected lymph nodes and organs;
• stages of the disease;
• patient's condition.

Treatment of relapses should include new techniques. They use other drugs, regimens, dosages. High-dose chemotherapy with stem cell transplantation has shown high effectiveness. Again, it can only be performed on patients with good general somatic status. The addition of interferon-alpha to cytostatic drugs improves treatment results.

To monitor the condition of the tumor after treatment, blood tests and radiography are regularly performed, and, if necessary, CT or MRI. This allows cancer relapses to be detected early.

If progression of lymphoma is observed in the first year after the end of treatment, the prognosis is very unfavorable. If relapse occurs after 1-2 years of remission, then a favorable outcome is quite possible. Repeated relapses of bone lymphoma cause the patient's death.

Bone lymphoma: prognosis

The prognosis for bone lymphoma depends on:

• type of disease (with non-Hodgkin lymphomas the prognosis is much worse than with lymphogranulomatosis);
• number of tumor lymph nodes;
• localization of the disease;
• degree of prevalence of the process.

The prognosis for lymphogranulomatosis is 50-70% 5-year survival. For non-Hodgkin's lymphomas - 25-30% (on average). The type of lesion plays a role: if it is metastasis of lymphoma to the bone, then treatment will be more difficult than with a primary bone tumor.

Do not forget that with each relapse, the average survival rate decreases.

According to the clinical picture, aggressive and indolent non-Hodgkin lymphomas are distinguished. The first ones develop rapidly, but they have a good chance of cure (30-40%). These are follicular large cell lymphoma, diffuse small cell lymphoma, diffuse immunoblastic lymphoma, diffuse mixed lymphoma. Life expectancy with aggressive types of lymphoma is about 1 year.

Indolent forms: lymphocytic lymphoma with small cells, follicular with small cells, follicular mixed, lymphoma of the mantle zone, diffuse of small cells. They are characterized by a long course, but they cannot be cured. Nevertheless, 70% of patients with indolent lymphomas, according to statistics, live longer than 7 years. Highly aggressive non-Hodgkin's lymphomas also occur. These include Burkitt's lymphoma, T-cell leukemia, and lymphoblastic lymphoma. Life expectancy with such forms of the disease is calculated in months.

Informative video

Lymph nodes are painless, dense and mobile, often located in the form of conglomerates, there are no signs of inflammation. The enlargement of lymph nodes occurs gradually and asymmetrically. In 90% of cases, supradiaphragmally located groups of lymph nodes initially enlarge, in 60-80% - cervical ones, in 60% - mediastinal ones. Supra- and subclavian, axillary, as well as intra-abdominal and inguinal lymph nodes may be enlarged.

The following features are characteristic of mediastinal localization:

• the lymph nodes of the anterior and middle mediastinum are affected, rarely the thymus;
• the course of the disease for a long time may be asymptomatic;
• with a significant increase, characteristic symptoms gradually develop - obsessive nonproductive cough, superior vena cava syndrome (dilation of the veins of the neck, face), hoarseness, dysphagia, dyspnea;
• germination into the pleura, lungs, trachea, esophagus is possible with the development of corresponding symptoms (pleurisy develops more often, pericarditis occasionally develops).

Splenomegaly

The spleen in lymphogranulomatosis often enlarges, but not always due to tumor lesions (when the organ is removed, lesions are detected only in 26% of cases). Almost always, damage to the lymph nodes of the hilum of the spleen and para-aortic nodes is detected. Symptoms of hypersplenism do not develop even with severe splenomegaly.

Lung damage due to lymphogranulomatosis

The following features are characteristic of lung damage with lymphogranulomatosis:

• the lymph nodes of the mediastinum and/or the root of the lung are not affected;
• the localization and type of lesion are different - peribronchial, in the form of widespread foci, sometimes with decay;
• thickening of the pleura with the presence of effusion.

Accurate diagnosis is only possible using MRI.

Damage to the central nervous system

Damage to the central nervous system can develop in advanced cases of Hodgkin lymphoma, more often as a result of spread from the paravertebral lymph nodes along the nerve pathways and vessels into the spinal canal and intracranially, or due to dissemination.

Symptoms are caused by compression of the brain tissue by the tumor with the development of paresis and paralysis, the appearance of pain, convulsions, and increased intracranial pressure.

Damage to bones and bone marrow

Bones are rarely affected by lymphogranulomatosis; more often the process is localized in the vertebrae and hip joints.

The bone marrow is involved in the pathological process in 5-10% of cases. The lesion is diagnosed when foci of lymphogranulomatous tissue with single Hodgkin and Berezovsky-Sternberg cells are detected during histological examination of bone marrow obtained by trepanobiopsy. In aspiration material, cells specific for Hodgkin's lymphoma are almost never detected. Bone marrow damage, along with the frequent phenomenon of hemophagocytosis, can cause cytopenia.

Hodgkin's lymphoma is often accompanied by thrombocytopenic purpura with a typical clinical picture. Coombs-positive hemolytic anemia is observed, which at the onset of the disease can complicate verification of the diagnosis.

Biological activity syndrome

The syndrome of biological activity caused by the production of cytokines is important and pathognomonic for Hodgkin lymphoma:

• intermittent fever (with a rise in body temperature above 38 ° C), not associated with infection, not controlled by adequate anti-infective therapy;
• profuse night sweats;
• loss of body weight (when determining the stage, weight loss of more than 10% over the previous 6 months is taken into account).

There may be other symptoms (itching, weakness, anorexia) that are not taken into account during staging.