Non-Hodgkin's lymphomas: causes of development, symptoms, stages, diagnosis, treatment

Causes and risk group

There are many factors that can provoke the development of an oncological process in the lymphatic system. At the same time, experts believe that a combination of several pathogenetic factors is necessary for the formation of a tumor. Let's list them:

• heredity;
• diabetes;
• Vitiligo disease;
• donor organ transplantation;
• immunodeficiency;
• herpetic infection;
• hepatitis;
• Epstein-Barr virus;
• constant contact with carcinogens;
• ionizing radiation;
• uncontrolled use of medications, in particular antidepressants.

Most often, people over 40 years of age, mostly men, experience the disease. This risk is due to many years of alcohol and nicotine abuse, as well as chronic pathologies that have led to the development of immunodeficiency in the body.

Causes

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

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

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Follow the link https://stoprak.info/vidy/onkologicheskie-zabolevaniya-krovi/limfaticheskaya-sistema/pecheni-klinicheskaya-kartina-lechenie-vyzhivaemost.html photo of liver lymphoma.

Symptoms

Diffuse large B-cell lymphoma is an aggressive tumor. This is because B lymphocytes are cells that play an important role in the immune system. Their goal: to find foreign elements in the body and use appropriate signals to inform other cells about this and block infectious factors.

Lymph nodes, as the main links of immunity, are most sensitive to any changes that occur in the human body. Large B cell lymphoma fundamentally disrupts this mechanism, stopping the transmission of danger signals to the defense system. The diffuse form allows the tumor to spread unhindered throughout the body.

As a rule, the doctor determines the first signs of pathology during palpation. Less commonly, ultrasound and radiography are required - in this case, the diagnosis is confirmed instrumentally.

The main symptoms of the disease are increased sweating and unexplained weight loss. Sometimes hyperthermic syndrome is observed at night, accompanied by profuse sweating. The growth of lymph nodes itself is accompanied by the following symptoms:

• swelling of the face and limbs;
• bloating;
• liver enlargement associated with liver damage;
• numbness and cramps in the arms and legs;
• dizziness, general weakness.

The disease progresses quickly, so treatment will be effective only in the early stages. In this case, a positive prognosis is possible in 85% of patients.

Symptoms of non-Hodgkin's lymphoma

The appearance of this disease in the early stages can be suspected by the painful swelling of one or more lymph nodes. Most often they are found in the groin, armpits or neck.

The following symptoms may also occur:

:

• Unexplained weight loss;
• Loss of appetite;
• General weakness;
• Fever and night sweats.

Symptoms and signs

There are several typical signs of non-Hodgkin lymphoma.

Such symptoms, along with swelling of the lymph nodes and the appearance of pain in them, require immediate consultation with an experienced specialist. The greatest attention should be paid to the following symptoms and signs, which may indirectly indicate the development of NHL in a patient:

• Unexplained increase in body temperature above 38°C. This symptom is always accompanied by fever and night sweats. It is these signs that are protective and indicate that the immune system is trying to eliminate the emerging source of infection;
• A fairly common symptom indicating the development of non-Hodgkin lymphoma is facial swelling. It occurs due to compression of the ureter by enlarged lymph nodes located in the abdominal cavity. This leads to impaired urinary flow and secondary renal failure;
• Another typical sign that may indicate the development of NHL is anemia. It occurs due to internal bleeding accompanying the mutation of lymph cells located in the gastrointestinal tract.

Ann Arbor System Classification

The stages and nature of diffuse large B-cell lymphomas are discussed using the Ann Arbor grading system. Let's look at it in the following table.

In formulating the diagnosis, the doctor notes in which organ or group of lymph nodes the malignant process arose, the stage of the disease and the possible prognosis.

Varieties and forms

B-cell lymphoma is a type of non-Hodgkin lymphoma (NHL), in which tumor formations attack all organs and tissues.

NHL uniforms

Determined by the following criteria:

By cell structure

• small-flying;
• large cell.

According to the rate of cancer cell reproduction

Indolent . They form slowly and are prone to relapse.

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• lymphocytic small cell;
• follicular small cell;
• follicular mixed;
• diffuse small cell;
• lymphoma of the mantle zone.

Indolent forms can mutate into Richter syndrome - damage to the spinal cord.

In this case, the patient can live for about a year.

Aggressive . Cancer cells multiply quickly , affecting all tissues and organs. The patient lives only a few months.

• follicular large cell;
• mixed diffuse;
• diffuse B-cell large cell;
• diffuse immunoblastic.

Highly aggressive . The most difficult prognosis.

The patient lives up to several weeks.

Has 3 forms:

• diffuse small cell with split nuclei;
• Burkitt's lymphoma;
• lymphoblastic.

According to the place of formation and proliferation of tumors

• extranodal - occur on any organ;
• nodal - cancers begin in the lymph nodes;
• diffuse - on the tissues of blood tubes.

Types of B-cell lymphoma

Small cell lymphocytic. It is also chronic lymphocytic leukemia - a blood cancer characteristic of people over 60 years of age .

Refers to the slow form of the NHL.

Prolymphocytic B-cell leukemia is an aggressive malignant disease. Originates in lymphocytes, but without tumors. It is determined by an enlarged spleen and an excess of leukocytes. Diagnosed in patients over 65 years of age.

Lymphoma of the spleen - affects the lymphoid matter of the organ. At the initial stages there are no symptoms.

Hairy cell leukemia is a rare disorder in which the bone marrow produces too many lymphocytes. Cancer cells appear “hairy” under a microscope. It develops asymptomatically for a long time.

Lymphoplasmacytic lymphoma is a large cancer of the peritoneum. It is asymptomatic, so it is most often detected in advanced stages. Minors are susceptible to it.

Plasma cell lymphoma is a blood cancer caused by a malfunction of plasma cells.

It attacks the body of people who have crossed the 50-year mark.

MALT lymphoma is a rare disease that affects the lymph of the gastrointestinal tract, thyroid gland, thymus gland, salivary glands, and genitourinary tract. Diagnosed in patients over 60 years of age.

Nodal lymphoma is a high-grade tumor. They affect the organ due to many nodes.

Follicular lymphoma is a benign tumor formed by mature class B lymphocytes in the follicular areas of the lymph node. It is usually caused by immune diseases in people over 60 years of age.

Primary cutaneous follicular cell lymphoma is a tumor in the form of a dense node up to 4 cm in area in the neck, head or torso in people 50-55 years old. Outwardly it looks like a large plaque.

Diffuse large B-cell lymphoma - attacks any important organ. Appears on the skin in the form of small plaques or ulcers.

Less common types: extranodal marginal zone B-cell lymphoma, mantle cell lymphoma, primary mediastinal (thymic) large B-cell lymphoma, nodal marginal zone lymphoma, nodal marginal zone B-cell lymphoma, etc.

Watch a video on this topic

Stages

Diffuse large B-cell lymphoma is characterized by 4 stages of development. The division corresponds to the degree of spread of the malignant process.

Classification

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

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

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

The second form is more extensive, consisting of:

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

Types, types, forms

There are several types of B-cell neoplasms:

• marginal zone tumor;
• diffuse large B-cell lymphoma;
• large cell lymphoma;
• follicular tumor.

They differ from each other in morphological structure, clinical manifestations and response to the therapeutic actions taken, therefore these types of cancer lesions are usually considered as separate objects.

Large B-cell lymphoma accounts for 30% of all malignant lesions of the lymphatic system. The oncological process begins to develop in the lymph nodes, gradually spreading throughout the body. Less commonly, the tumor becomes extranodal, that is, it initially forms in the tissues of various organs - the stomach, thyroid gland, etc.

Large B-cell lymphoma, in turn, is divided into several forms:

• mediastinal;
• anaplastic;
• small cell.

Mediastinal - characterized by diffuse germination of cancer cells into lymphoid tissues. The main signs of the pathology: stromal-type sclerosis and many necrotic changes in the focus of the primary neoplasm.

Anaplastic - has a systemic nature. It is manifested by an increase in various groups of lymph nodes, while the oncological process usually spreads to the organs of the digestive tract, spleen and bone structures. Causes rapid death of the patient.

Small cell - quite rare. The disease is characterized by slow development and at the same time weak susceptibility to the effects of any therapeutic measures. This type of lymphoma can develop into a more aggressive tumor, which is characterized by rapid growth.

Depending on the affected area, large B-cell lymphoma is divided into the following subtypes:

• intravascular;
• primary cutaneous with involvement of the lower extremities in the oncological process;
• occurring against the background of Epstein-Barr viral infection;
• developed as a result of a pronounced inflammatory process;
• characterized by excessive synthesis of T cells and histocytes;
• affecting b-cells of the mediastinum.

Symptoms

The main sign of lymphoma is a noticeable enlargement of one or more lymph nodes or the appearance of a tumor (usually on the head, back of the head, armpits, neck, groin). Almost 90% of cases of malignant neoplasms are located above the diaphragm area. The remaining 10% is fixed in the lower sections of the lymphatic correctors. As the disease progresses, over a period of about three weeks, other disturbing symptoms are also noted and increase:

• significant unmotivated weight loss;
• fast fatiguability;
• severe night sweats;
• elevated body temperature for a long time;
• decreased appetite;
• progressive anemia;
• the appearance of petechiae;
• loss of sensation in the limbs or other parts of the body.

Depending on the location of the pathology, additional complaints appear:

• itching of the whole body (with cutaneous forms of lymphoma);
• upset stool and abdominal pain (with damage to the lymphoid tissue of the abdominal cavity);
• persistent cough, shortness of breath (if the lymph nodes are affected, changes are recorded in the sternum cavity, thymus gland, respiratory tract or lungs);
• pain in the joints (with bone lymphoma);
• nausea and vomiting on an empty stomach (if damaged by malignant degeneration of the intestine);
• migraines, blurred vision, cranial nerve palsy (with dissemination to the brain).

All similar symptoms can also appear in other diseases of the body, therefore differentiation from pathologies with similar characteristics when diagnosing is also important.

Diagnostics

To confirm the fact of the disease, the following examination methods are prescribed:

• Radiography. Helps identify changes in soft tissues and distant metastases in the body, including bone structures.
• Lymph node biopsy. The method is based on the collection of suspected tumor material for its further morphological analysis. Using this diagnostic method, it is possible to detect malignant cells in a biopsy sample and study their nature.
• Ultrasound. Determines the presence and size of the tumor, the fact of its invasion into neighboring organs.

• Spinal tap. Prescribed when an oncological process is detected in the bone marrow.
• PAT. It makes it possible to discern the structural structure of the tumor, study the activity of its cells, the nature of neighboring tissues and the likelihood of their damage.
• CT. Layer-by-layer determines the structure of the neoplasm and the degree of its spread throughout the body.
• MRI. It produces a three-dimensional image of healthy and atypical tissues, which allows for the most accurate assessment of them, and reveals the fact and nature of metastasis.
• General and biochemical blood tests. The first study demonstrates the level of ESR, leukocytes, platelets and red blood cells and the imbalance between them. The second determines discrepancies in the indicators of lipids, glucose and other components, which also indicate a pathological process in the body and require urgent further examination.
• Analysis for tumor markers. Nowadays, research on specific proteins of a protein nature, the so-called tumor markers, is gaining popularity. These substances are produced by the tumor itself or are the body’s response to the development of a malignant process. For lymphoma, a β2-microglobulin test is performed. This antigen is determined in cases of damage to lymphoid tissue - myeloma, lymphoma, non-Hodgkin's lymphoma and Hodgkin's disease. The concentration of this tumor marker increases with the severity of the cancer.

Based on the work done, the specialist sums up the results and makes a final diagnosis. The next step is to select the necessary therapeutic measures.

Types of disease diagnosis

Patients with diffuse large B-cell lymphoma are treated by an oncologist or hematologist. Diagnostic tests include:

• study of anamnesis;
• palpation of all groups of peripheral lymph nodes, liver and spleen and their ultrasound examination;
• computed tomography of the areas where groups of lymph nodes are located;
• general and biochemical blood test, blood test for HIV infection, hepatitis B- and C-type;
• bone marrow biopsy and myelogram.

In some cases, additional diagnostic procedures specific to each individual patient are required:

• if one testicle is affected, ultrasound of the second testicle and lumbar puncture;
• in case of primary damage to one of the sections of the gastrointestinal tract, all its sections are examined;
• in case of damage to the membranes of the brain and spinal cord - computer or magnetic resonance imaging of the affected area, examination by a neurologist, lumbar puncture;
• if the patient has complaints, an x-ray examination of the bones;
• if indicated, osteoscintigraphy;
• in the presence of malignant lymphomas - scintigraphy.

If the patient has complaints of discomfort in an organ or organs that have not been examined, then they also need to be examined.

The diagnosis is made based on a study of the structure of the tumor tissue. The earliest affected lymph node is suitable for examination. Moreover, during the operation it must be completely removed without damaging it. Inguinal lymph nodes are not taken for histological examination if there are affected nodes of other groups.

Data from a single biopsy are not enough to establish an accurate diagnosis, but for patients who require urgent treatment, cytological data can be used at the first stage.

Treatment

To combat diffuse large B-cell lymphoma, a set of standard techniques is used. Let's talk about them in more detail.

Radiotherapy. Based on the use of x-ray radiation. It is prescribed at any stage of the disease, but in the early stages it can be used as an independent method, provided that a therapeutic dose is created above 40 Gray. During the procedure, the rays should be directed directly to the tumor site with minimal involvement of healthy tissue in the therapy.

Polychemotherapy. Used in the first and second stages of the disease. At an early stage, when the tumor is just beginning to develop, at least 3 course approaches are necessary with the prescription of medications such as Vinblastine, Doxorubicin, Bleomycin and Dacarbazine. From the second stage of pathology, a minimum of 6 courses of polychemotherapy using Doxorubicin, Onkovin and Cyclophosphamide will be required.

Bone marrow transplantation. Prescribed in the absence of effectiveness of other therapeutic measures. The method is carried out using donor biomaterial obtained by aspiration from elements of the ilium or sternum. In addition, the procedure may involve stem cells taken from the liver of the embryo. Bone marrow is introduced into the patient's body intravenously, which improves its survival rate. The method is accompanied by immunosuppressive therapy using Prednisolone, Azathioprine and Cyclophosphamide.

Immunomodulators, antibiotics, antiviral and antitumor drugs. Thus, the approach to combating pathology can be multifaceted. The doctor decides which treatment option will be used. The choice of therapeutic action is influenced by the stage of the disease, the general health of the patient and the risk of possible complications.

Surgical interventions. For lymphomas, they are practically not carried out. Experts have noted that after surgery, the patient’s body gives a lower response to therapy than with chemotherapy and radiation.

Treatment of large B-cell lymphoma with folk remedies is excluded.

Treatment of non-Hodgkin's lymphoma in Israel

All therapeutic measures that make it possible to prolong the life of a patient with this pathology are compiled in Israeli clinics on an individual basis. An integrated approach is implemented for each patient. Many people are interested in what the treatment protocols are. That is why this issue should be examined in more detail.

Treatment protocol for non-Hodgkin's lymphoma

In case of NHL, which almost always manifests itself very aggressively, Israeli oncology centers use 3 ways to solve the problem:

• Bone marrow transplantation;
• Lumbar punctures (taking cerebrospinal fluid) and injecting antitumor antibodies in their place;
• A combination of chemotherapy and radiotherapy.

Several specialists take part in the development of the therapy protocol, starting with an oncologist and hematologist, and ending with a psychologist and physiotherapist. In Israel, it is possible to use the following protocols in the treatment of non-Hodgin lymphoma, which are prescribed by a specialist based on the results of the examination:

• Routine;
• With the use of biological chemotherapy drugs.

Medicines can be administered both on an outpatient basis and during hospitalization. Usually 6 courses of therapy are prescribed. After the third one, a PET scan is performed.

Chemotherapy for non-Hodgkin's lymphoma

During this procedure, several medications are used. Their use is carried out simultaneously, which makes it possible to destroy a larger number of cancer cells. The combination is necessary due to the fact that different drugs have different effects on malignant neoplasms. A big advantage of chemotherapy carried out in Israeli cancer centers is the use of drugs that have virtually no side effects.

Targeted therapy for non-Hodgkin's lymphoma

Thanks to it, lymphoma cells begin to destroy, and the rate of their development slows down. During targeted therapy for the treatment of non-Hodgkin's lymphoma, Israeli specialists use highly effective monoclonal antibodies. These are Mabthera, Zevalin, Alemtuzumab. Interferon is also used in the treatment of NHL in these clinics.

Recovery process

After discharge from the hospital, persons who have suffered from large B-cell lymphoma receive the first or second group of disability. Regular medical supervision and visits to an oncologist become mandatory in the life of every person with a history of this diagnosis, since the disease is associated with a high risk of relapse - up to 80% within 12 months after treatment.

There are no special rehabilitation measures for diffuse large B-cell lymphoma. If complications develop during the recovery period, they are treated symptomatically. In the future, it is recommended to lead a healthy lifestyle, avoid excessive exposure to ultraviolet rays and thermal physiotherapy.

Non-Hodgkin lymphoma prognosis

The prognosis for this pathology directly depends on the stage of the disease and the treatment provided. Recently, there has been an increase in patients with five- and ten-year survival rates.

Relapse of non-Hodgkin's lymphoma

Exacerbation of the disease indicates a significant deterioration in the prognosis. When non-Hodgkin's lymphoma relapses, especially in young patients, emergency brain transplantation is used. This significantly increases the chances of further continuation of life.

Non-Hodgkin's lymphoma, how long do they live?

This question worries many patients. The life expectancy of a person with NHL depends on the type of pathology, the location of its source, the timeliness of treatment and the correctness of the selected treatment protocol. According to the latest statistics, 80 out of 100 patients with non-Hodgkin lymphoma survive more than a year, 65% more than 5 years and 54% more than 10 years after diagnosis.

Is it possible to give birth after non-Hodgkin's lymphoma?

Pregnancy does not affect the course of NHL, just as they do not affect it at all. If the pathology does not progress, all therapeutic measures can be postponed for the period of bearing the child. Symptomatic therapy is also used during pregnancy in patients with non-Hodgkin's lymphoma. With its help, it is possible to significantly improve the mother’s condition, on which the prognosis for the child largely depends.

Non-Hodgkin's lymphoma. Recommendations after treatment

This issue also worries patients. Many people who have undergone therapy after being diagnosed with non-Hodgkin lymphoma fall into a state of depression or anger at the world around them. Neither one nor the other is worth doing. Many patients with this diagnosis, after undergoing courses of therapy, live for many years with virtually no disruption to their quality of life. The only thing required is to follow the recommendations of the specialists who performed the treatment.

Diet

Any malignant disease is a deep stress for the body. Proper nutrition can enhance the effect of treatment methods and speed up the recovery period after the use of severe toxic drugs.

Diet in the early stages of large B-cell lymphoma. It has no specific specifics. She should just be healthy and complete. We list what recommendations should be followed during this period:

• exclude high-calorie foods to avoid gaining extra pounds;
• eat more fruits and vegetables, fish and poultry;
• minimize red meat dishes;
• add salt and spices to food sparingly;
• completely eliminate alcohol.

Thus, the diet in the initial stages of the disease has few restrictions. The diet meets the requirements of a healthy balanced diet.

Advanced form of lymphoma. When it comes to conducting multiple courses of radiation and polychemotherapy, serious problems arise in the immune system and metabolic processes. During this period, a person needs strength not only to fight the disease, but also for basic survival, since his body is exhausted from taking toxic drugs and pathology. In the later stages of diffuse large B-cell lymphoma, the following rules are recommended:

• frequent split meals at regular intervals in small portions;
• eat high-calorie foods with severe anorexia;
• chew food thoroughly and for a long time, even if it is pureed or semi-liquid;
• observe drinking regime;
• abstain from food during attacks of nausea and aversion to foods.

When planning a diet for a patient, it is important to take into account his general condition and wishes; this is the only way to establish a regimen and reduce the side effects that arise during chemotherapy. The basis of the diet in this case should be poultry meat and offal, low-fat fish, omelettes, water-based porridge, pureed soups and vegetables. Recommended drinks include weak tea, jelly, compote and freshly squeezed juice.

The rehabilitation period after chemotherapy and a preventive diet. It is built on similar principles. From this point on, it is aimed at restoring lost functions and alleviating pathological processes caused by intensive treatment, which is indicated for lymphoma. The diet should still consist of dietary meat, sea fish, dairy products, fruits, vegetables and grains. Alcohol, salty, canned and fried foods are strictly prohibited. Particular attention is paid to the drinking regime - it is recommended to drink at least 2 liters of liquid per day.

About the disease

Non-Hodgkin's lymphoma is a large type of malignant neoplasm, differing in cellular structure. One of the most common is B-cell.

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

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

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

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

There are two types of pathology:

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

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

Course and treatment of the disease in children, pregnant and lactating women, the elderly

Children. In childhood, diffuse large B-cell lymphomas are extremely rare. Moreover, the chances of a favorable outcome in children are 2 times higher than in adults, subject to timely diagnosis and treatment of the pathology. The main method of combating a tumor is polychemotherapy, the regimen and intensity of which is determined by the age of the small patient, the stage and degree of spread of the oncological process. Radiation exposure and surgical intervention in children are practically not used, with the exception of the development of associated complications, for example, when a tumor affects certain organ structures. Additionally, accompanying therapy is carried out aimed at the prevention and treatment of brain infections and central nervous system disorders, mucositis and other conditions. On average, the duration of therapy is from 2 to 5 months.

Pregnancy and lactation. If a woman of reproductive age is diagnosed with lymphoma, it is recommended to talk with her about the possibility of cryopreservation of eggs before starting any therapeutic actions. The fact is that courses of polychemotherapy and radiation in the future often become the cause of irreversible infertility. If the disease is diagnosed during pregnancy, then it does not need to be interrupted. In this case, it is recommended to use chemotherapy drugs that do not penetrate the placental barrier of the uterus and do not harm the baby. Gestation can be prolonged until 32 weeks of gestation, and chemotherapy can be resumed after delivery. If the diagnosis is made during lactation, the child is weaned and intensive treatment for lymphoma begins.

Advanced age. The development of pathology is mainly observed in old age. Therapy at this stage is complicated by the presence of concomitant diseases that make it difficult to prescribe an adequate fight against lymphoma in full. The choice of one or another treatment method is decided by the doctor individually.

Forecast

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

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

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

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

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Treatment in Russia and abroad

Large cell diffuse B-cell lymphoma is a dangerous disease that requires timely diagnosis and therapy. We invite you to find out how they are carried out in domestic and foreign clinics.

Treatment in Russia

Nowadays, most oncology centers are equipped with modern equipment and tools, which helps to introduce innovative technologies and increase the recovery rate among people faced with malignant lesions of the lymphatic system.

In Russian oncology centers, the basis of treatment for this disease is chemotherapy based on the ABCD principle. That is, it includes a regimen of the following drugs: Adriamycin, Bleomycin, Vinblastine and Dacarbazine. The course of therapy takes 4 weeks. On average, a patient requires 4-6 such courses, that is, treatment in the clinic will be at least 4 months.

As the disease progresses, the regimen can become more complicated, for example, in grade 3A and 4 confirmed diffuse large B-cell lymphoma, BEASSOR is used, which includes Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Vincristine, Prednisolone and Procarbazine.

For localized lymphoma, radiation therapy is performed. As a rule, after a course of chemotherapy and radiation, remission occurs in at least 60% of patients. If the methods are ineffective, the patient is prescribed palliative care or donor stem cell transplantation.

The cost of treatment depends on the status of the medical institution and the amount of assistance required. For example, at the “European Clinic” in Moscow, the price for a course of chemotherapy, including medications, is from 350 thousand rubles, a transplant of donor stem cells - from 1 million rubles.

Where can you get treatment in Russia?

• Sofia Oncology Center, Moscow. Uses a multidisciplinary approach to the treatment of individuals facing malignant diseases. Not only diagnostics and therapy of tumors are carried out here, but also post-clinical rehabilitation and social adaptation of patients.
• Medical, Moscow. Here you can get qualified help from oncohematologists who have sufficient experience in the fight against lymphomas. The clinic uses innovative treatment methods and modern drugs recommended by international medical communities.
• GBUZ "St. Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care" (oncology). A modern center that provides the necessary range of diagnostic and therapeutic procedures, many of which are unique to Russia.

Let's look at the reviews of the listed clinics.

Oksana, 45 years old. “Several lymph nodes became inflamed, the initial diagnosis was unspecified, a biopsy was not done immediately, and as a result the disease turned out to be advanced to stage 3A. An oncology examination confirmed lymphoma, and treatment was carried out here. I regret that I didn’t come here right away; the forecast would have been better. Don’t skimp on your health; go to large, qualified medical institutions.”

Angelina, 27 years old. “At the European Clinic, my father was treated for stage 2 b-large cell lymphoma. They said the prognosis is good, rehabilitation is now underway, we hope that dad will continue to live without this disease.”

Treatment in Germany

In German clinics, the fight against lymphomas is carried out in the classical way with the use of high-quality chemotherapy drugs, which are selected for the patient according to a special scheme in courses. In addition to this method, Germany uses radiotherapy and treatment with biological products, such as monoclonal antibodies, which specifically destroy tumor cells. The integrated use of several approaches increases the success of therapy.

Prices for lymphoma treatment in German clinics are higher when compared with Russian ones. At the same time, many experts insist that the “cost = quality” ratio in this country is quite acceptable. A course of chemotherapy in Germany will cost a patient from 5 thousand euros, a stem cell transplant - from 200 thousand euros.

Which clinics can I go to?

• State Hospital of Stuttgart, Department of Oncology and Hematology. A multidisciplinary medical institution, where the coordinated work of specialists in various fields will help to choose a unified concept in the fight against lymphoma and its complications.
• Oncology Center for Radiation Therapy, Hamburg. Has an excellent reputation in the field of treatment of oncological diseases of varying complexity. Innovative techniques are used here to guarantee success in the fight against lymphoma.
• Medical, Hamburg. One of the modern European clinics offering quality care to people with cancer.

Let's consider reviews about the listed medical institutions.

Anna, 35 years old. “My mother came to the clinic in Stuttgart with large B-cell lymphoma. Here she underwent treatment, after which there were immediate improvements, I think that it was not in vain that they decided to turn to German doctors.”

Maria, 41 years old. “In Germany, in Hamburg, they helped my sister with advanced lymphoma. Time will tell how effective it is; only 4 months have passed since the trip.”

Treatment of diffuse large B-cell lymphoma in Israel

Specialists in this country successfully treat lymphomas, and this is not a myth. In the early stages, the effectiveness of therapy reaches 95-100%, in the later stages - even with aggressive non-Hodgkin's lesions - the survival rate is 80%. All clinics are equipped with modern equipment and medicines, highly qualified doctors work here, which is why such success is achieved.

In the treatment of lymphoma in Israel, in addition to traditional methods - polychemotherapy and radiation, biotherapy and bone marrow stem cell transplantation are actively used. If indicated, affected elements of the lymphatic system are removed using endoscopic and radiosurgical approaches.

The cost of treatment depends on the status of the chosen medical institution and the range of necessary care. The average price for general oncology diagnostics in Israeli clinics is from 5 thousand dollars, 1 day of chemotherapy without drugs - from 1500 dollars, surgery using robotics - from 25 thousand dollars, treatment with stem cells - from 70 thousand dollars .

Which clinics can I go to?

• Oncological, Tel Aviv. The largest institution of this profile in the Middle East, created on the basis of the Institute of Hematology at the Rabin Clinic. Provides a wide range of diagnostic and treatment services to people with cancer pathologies, in particular lymphomas.
• Clinic "Assuta", Tel Aviv. It is included in the top 10 hospitals in Israel due to the achieved effectiveness in treating most cancer diseases.
• Medical, Tel Aviv. The largest public medical institution that provides a high-quality range of care to people with cancer pathologies of various stages and types.

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Vladimir, 37 years old. “Accompanied my father for treatment of lymph node cancer to Israel, Asaf HaRofeh MC.” I am grateful to the doctors for their help; the quality of the services provided is excellent.”

Inna, 45 years old. “I was cured of stage 2 lymphoma at the Assuta clinic in Tel Aviv. I completely trust the Israeli specialists, I think that my decision was not in vain.”

What is the essence of the disease?

Typical symptoms of lymphocytic lymphoma are dizziness and headaches

Waldenström's macroglobulinemia is a malignant disease of the lymphatic system. In lymphoplasmacytic lymphoma, malignant B lymphocytes (a subtype of white blood cells) multiply uncontrollably in the bone marrow, lymph nodes, or spleen.

A feature of this disease is that lymphoma cells produce “false” antibodies. These antibodies, called immunoglobulins, may be responsible for some of the symptoms of the disease in patients.

In Russia, from 4000 to 5000 patients suffer from Waldenström's disease. Every year there are about 3-5 new cases of the disease per 1 million people - that's about 240 new cases per year. Lymphocytic lymphoma is more common in older people. The average age at which the disease is diagnosed is 65 years. The disease affects men more often than women.

In the International Classification of Diseases, 10th revision (ICD-10), lymphoplasmacytic lymphoma is designated by code C88.0.

Complications and relapses

During the course of the disease and during treatment, the following complications may occur:

• lymphomatous meningitis;
• obstruction of the ureter on one or both sides;
• intestinal obstruction;
• nerve root paresis;
• compression of the spinal cord;
• damage to bone structures up to fractures.

The listed complications require urgent medical intervention of an appropriate nature.

In the first 12 months after treatment, relapses of the disease occur in approximately 80% of cases. Starting next year, the chances that the pathology will return are reduced to 5%. The secondary cancer foci that have arisen are eliminated with the help of recurrent therapy, using chemotherapy regimens such as Rituximab, Cytarabine, Dexamethasone and Cisplastin.

Complications

Most complications of non-Hodgkin lymphomas are associated with large tumor sizes, which gradually compress organs, leading to life-threatening conditions.

• Damage to mediastinal lymph nodes. Compression of the trachea and esophagus, development of compression syndrome of the superior vena cava, which is fraught with bleeding, cerebral symptoms and dysfunction of the auditory and oculomotor nerves.
• Damage to intra-abdominal and retroperitoneal lymph nodes. Intestinal obstruction, lymphostasis in the lower half of the body and legs, development of obstructive jaundice, compression of the ureter.
• Germination into the walls of the stomach and intestines. Bleeding and peritonitis.

Lymphomas with an aggressive course are characterized by the early appearance of metastases in the spinal cord and brain, as well as the liver and bones.

Prevention

There are no specific preventive measures for diffuse large B-cell lymphoma, since the exact factors leading to the development of the disease are unknown. Therefore, prevention should include general recommendations aimed at minimizing the risk of cancer pathologies. These include a balanced diet, giving up bad habits and avoiding stressful situations.

The sooner the disease is detected and treatment is started, the higher the chances of recovery. Modern treatment regimens, the latest medications and instrumental approaches allow achieving positive results in 75% of cases.

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Definition of small cell lymphoma

Non-Hodgkin's lymphoma is the most common type of lymph node cancer. They account for up to 80% of all diagnosed cases of this dangerous disease. Neoplasms arise from abnormal mutations of B-lymphocytes and T-lymphocytes, which form the basis of human immunity. A tumor can form in any organ that comes into contact with lymphoid tissue, lymph nodes, and bone marrow.

More than 40% of all non-Hodgkin lymphomas are small cell forms of the pathology. It is formed from small cells that are produced by the thymus gland or bone marrow.

The disease has a number of development and course features:

• more often diagnosed in patients aged 45–55 years;
• the majority of patients with small cell lymphoma are men;
• in 90% of cases it is found not only in the primary focus, but also in distant lymph nodes;
• symptoms of small cell lymphoma rarely appear before stages 2–3 and remain invisible for a long time;
• characterized by complex and lengthy treatment;
• often provokes severe complications: damage to internal organs, bone marrow and brain.

Small cell lymphoma is one of the most aggressive types of cancer. It quickly spreads beyond the lymphoid tissue, giving metastases. The neoplasm provokes a strong decline in immunity, against the background of which the patient is bothered by severe laryngitis, pneumonia with complications of the heart and blood vessels.

Mantle cell lymphoma

Mantle cell lymphoma (MCZ)
is a separate type of lymphoma, the exact identification of which is possible by comparing histological data with the immunophenotype and molecular genetics of the tumor.

There are two main cytological variants of LCM: typical (classical) and blastoid, characterized by a more aggressive course. In this regard, the classic variant is classified as indolent lymphoma, while the blastoid variant is classified as aggressive.

In general, LCM as a nosological form occupies an intermediate position between indolent and aggressive lymphomas and combines the worst features of these diseases: on the one hand, it is incurable with standard chemotherapy, on the other hand, it is characterized by a more aggressive course and a lower median survival of patients than indolent lymphoma.

The most common karyotype disorder is t(11;14)(q13;q32), which at the molecular level is characterized by juxtaposition of the bcl-1 locus on chromosome 11 with the Ig heavy chain gene sequence on chromosome 14. This leads to dysregulation and increased expression the cyclin D1 gene, which controls the cell cycle.

Characteristic immunophenotype: IgM+/IgD+, CD5+, CD10-, CD23-. In addition, the expression of pan-B cell antigens (CD19, CD20, CD22) is determined.

LCM usually occurs in older patients (median age 62 years). Men get sick more often. In most patients, at the onset the late stages of the disease are determined. The lymph nodes, spleen, bone marrow, Waldeyer's ring, and often the gastrointestinal tract are most often affected.

Causes of small cell lymphoma

Small cell lymphoma is a pathology in which abnormal lymphocytes form in the lymph nodes.

Among the most likely causes of cell malignancy are:

1. Genetic predisposition to cancer. When certain genes are mutated, the chances of getting a dangerous disease reach 40–50%. At the same time, the disease has a more aggressive and fast-acting form.
2. Chronic anemia. Reduced hemoglobin often negatively affects the overall composition of the blood and causes a weakening of the immune defense. A person more often suffers from viral and bacterial infections, and inflammation causes a neoplastic process in the lymphoid tissue.
3. Ataxia. With this pathology, the bone marrow can trigger the formation of malignant B-lymphocytes or T-lymphocytes.
4. Diseases causing immunodeficiency.
5. Consequences of exposure when working in hazardous conditions. Sometimes lymphoma appears after radiation therapy during treatment of other forms of cancer.

Predisposing factors include living in environmentally unfavorable conditions and working in chemical plants.

Diagnosis of lymphoma

Since non-Hodgkin lymphomas are characterized by heterogeneity and “universality” of symptoms, patients are not aware of the lesion and mistake pain symptoms for other diseases. Therefore, competent diagnosis is important to distinguish pathology from other cases.

Suspicion of this lymphoma is determined by anamnesis, external examination and examinations and tests carried out comprehensively and determining the signs of the tumor. After suspecting a disease, the doctor refers the patient to specialized specialists (usually an oncology clinic), who conduct additional examinations aimed at confirming the diagnosis.

Tumor tissue examination

The main method for detecting lymphoma is analysis of tumor tissue. When a suspicious cavity contains fluid secreted by the body (for example, pleural effusion or ascites), the task is simplified by using this fluid for the sample. A puncture may be used to examine the bone marrow. In other cases, a tissue sample must be obtained surgically.

Next, the sample undergoes a series of tests to determine the presence of lymphoma and its form. Each cell is carefully examined. When the presence of a tumor is confirmed, the next step is taken.

Disease Research

To create a clear and realistic treatment plan, it is necessary to determine how far the tumor has developed. For the result, images of the affected organs are used, obtained in various ways - computed tomography, ultrasound, magnetic resonance imaging, positron emission tomography.

As an additional measure, a lumbar puncture (to obtain cerebrospinal fluid) and a bone marrow tap are performed to test these organs for cancer cells. Additionally, heart diagnostics are performed. Depending on the specific situation, doctors prescribe additional examinations to assess the general state of health and affected organs.

After such collection of data about the disease, a treatment plan and system is prepared. It requires careful consideration of the patient's health picture and the type and extent of the tumor. Some patients prefer to undergo treatment abroad, for example, in Israel.

Basic treatments for non-Hodgkin's lymphomas

• Surgery. Unfortunately, it has extremely limited use. Mainly for taking a biopsy and in some cases limited lymphoma to one organ, such as the stomach. But even in this situation, radiation therapy is often chosen.
• Radiation therapy. For some forms of non-Hodgkin's lymphoma, in the first and second stages, radiation therapy can be the main treatment, but most often it is used in combination with chemotherapy.
• Depending on the cellular form, immunophenotype and stage of lymphoma, polychemotherapy and radiation therapy programs are used in treatment. They mainly use rubomycin, vincristine, cyclophosphamide, chlorobutin, and many others.

Chemotherapy is carried out using combinations of various anticancer drugs. They are used in courses with an interval of 2 to 4 weeks, both in the department and on an outpatient basis, which depends on the stage of the lymphoma, general condition and the presence of complications from the polychemotherapy itself.

• Immunotherapy or biotherapy. Substances normally produced in the body are used. They can kill lymphoma cells, significantly slow their growth, or prime the patient's immune system to fight the lymphoma. Interferon drugs are used in combination with chemotherapy drugs and monoclonal antibodies. These are unique substances that are able to recognize and destroy foreign cells in the body. The invention of the technology for their production in the laboratory is one of the greatest achievements of medicine over the past few decades, for which the developers received a Nobel Prize.
• The bone marrow transplant method is used when there is no effect from standard treatment regimens. If this method is chosen, then high doses of chemotherapy and radiation therapy destroy tumor cells that are resistant to conventional treatment. Transplantation is needed because under the influence of high doses of drugs, not only tumor cells die, but also healthy ones.

Many people are interested in the question of how long people live with non-Hodgkin lymphoma. The answer depends on the aggressiveness of the disease and the stage at which it was detected. When treatment is started in the early stages, the prognosis is very favorable, with a five-year survival rate exceeding 80%. However, if stage 4 non-Hodgkin lymphoma is diagnosed, the prognosis is much worse, and the five-year survival rate, even with aggressive therapy, does not exceed 20%.

Since the exact cause of non-Hodgkin's lymphoma is unknown, there are no effective preventive measures. Only general recommendations for the treatment of viral infections associated with lymphomas and avoidance of contact with potential carcinogens and mutagens.

Signs, symptoms and manifestations

The initial stage of development of the disease occurs almost without manifestations, that is, asymptomatic. For this reason, it is rarely possible to identify pathology at an early stage. In later stages, some signs can be noted:

1. Dramatic weight loss.
2. Excessive sweating.
3. Enlarged lymph nodes (usually in the neck and armpits).
4. Weakness, lethargy, loss of appetite.
5. Fever (above 38°C), its etiology is unclear.
6. Headache.

All of the above symptoms are common, therefore it is quite difficult to identify non-Hodgkin lymphoma in the initial stages of development. But if you notice an increase in lymph nodes, you should definitely consult a specialist, because this phenomenon can occur against the background of a common cold or signal serious problems.

Specific symptoms:

1. Shortness of breath, chronic cough: if the lymph nodes in the chest area, the thymus gland and/or the pulmonary system are affected.
2. Slightly enlarged lymph nodes: they do not bother you, but they can be clearly felt.
3. Pain in joints and bones, with affected bones
4. Visual impairment, headaches, vomiting on an empty stomach, central nervous system disorders.
5. Frequent infectious diseases.
6. Diarrhea alternating with constipation, abdominal pain, vomiting and lack of appetite.
7. Anemia (lack of red blood cells) results in pale skin.
8. Petechiae (pinpoint bleeding on the skin) caused by low platelet counts
9. Aggressive lymphomas (Burkitt's lymphoma, lymphoblastic lymphoma) develop very quickly and general signs of the disease appear earlier.

Symptoms can be observed based on the location of non-Hodgkin lymphoma (for example, the first sign of damage to the lymph nodes of the small intestine may be intestinal obstruction or perforation of the intestinal wall).

If a person has one or more signs, this does not mean that he has non-Hodgkin's lymphoma. Most of these manifestations may indicate completely different, less serious diseases. In any case, if there is any suspicion, it is recommended to consult a specialist as soon as possible.

Types by aggressiveness

Another option for classifying neo-Dgkin's lymphomas is the division according to the aggressiveness of the process. This is very convenient for doctors, as it allows them to optimally select the course of treatment and observation tactics.

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

Clinical picture

Symptoms of Non-Hodgkin lymphoma are very varied and depend on the form of the disease and location. A common sign of malignant lesions of lymphoid tissues is enlargement of the lymph nodes (widespread or local) and pain in this area. This condition is accompanied by symptoms of damage to a specific organ or signs of general intoxication of the body.

T-cell forms often manifest themselves as follows:

• lymph nodes enlarge;
• there is an enlargement of the spleen and disruption of its function;
• lungs and skin are damaged.

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

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

At the same time, one cannot fail to note the symptoms that accompany any cancer. In non-Hodgkin's lymphoma, they begin to appear at stage 2 of the disease and gradually become brighter:

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

Features of the disease

Non-Hodgcon lymphomas include about 80 different diseases, which differ in aggressiveness and localization.

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

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

Severity and stage

Sluggish lymphomas are typical for older people

According to the degree of severity, they are distinguished:

• Slow growing (sluggish, indolent). Diagnosed in most cases in older people. Symptoms usually do not manifest themselves, and without treatment you can live 2–10 years or more.
• Aggressive. In children, predominantly aggressive types of NHL are detected. Tumors develop actively, without treatment the life expectancy is 2 - 10 months or more.
• Highly aggressive. Particularly rapid progression, life expectancy without treatment is 2 - 10 weeks or more.

The stage is determined by the number of lymph node groups involved

NHL stages:

• I. NHL is localized in 1 group of lymph nodes, if the tumor affects 1 non-lymphoid organ, the letter E is assigned, the stage will be designated IE.
• II. NHL in 2 groups of lymph nodes that are located above the diaphragm.
• III. The tumors affect the lymph nodes on both sides of the diaphragm.
• IV. Lymphoid and non-lymphoid organs are affected.

Letter designations for stages:

• a — an increase in lactate dehydrogenase and ESR is not observed;
• b — increase in lactate dehydrogenase and ESR;
• A - there are no signs of intoxication;
• B - there are characteristic signs of intoxication;
• E - damage to the lymphatic zone and adjacent tissues.

B cell form

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

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

1. Nodal and splenic. These species are characterized by slow growth.
2. Burkitt's lymphoma. According to medical statistics, this form of the disease most often affects men over 30 years of age. Doctors are in no hurry to give favorable prognoses: with non-Hodgkin Burkitt lymphoma, patient survival for 5 years is only 50%.
3. Follicular. In most cases, this cancer develops rather slowly, but can develop into a diffuse form, which is characterized by rapid development.
4. Marginal zone MALT lymphoma. This form spreads to the stomach and increases at a slow pace. With all this, it is extremely difficult to treat.
5. Primary mediastinal (or mediastinal). This disease most often affects women; the 5-year survival rate after treatment is 50%.
6. Lymphocentral small cell. Progression is slow, but the cure rate is quite low.
7. Primary CNS lymphoma.
8. Diffuse large cell non-Hodgkin lymphoma. This type refers to rapidly progressing cancers.

Follicular lymphoma

Follicular lymphoma (FL)
is one of the most common types
of non-Hodgkin lymphoma (NHL)
. According to the WHO classification, three types (gradations) of FL are distinguished based on the histological picture. With follicular lymphoma of the 1st type, 0-5 centroblasts are found in the field of view, with FL of the 2nd type - 6-15 centroblasts, follicular lymphoma of the 3rd type - more than 15 cetroblasts. FL types 1 and 2 are indolent lymphomas, follicular lymphoma type 3 is aggressive.

FL is the second histological group of NHL (after Burkitt lymphoma), in which an association has been established with a certain cytogenetic disorder t(14;18)(q32;q21), which leads to activation of the BCL-2 oncogene, the protein of which blocks programmed cell death (apoptosis ) B-lymphocytes of the follicular centers of the lymph node and increases the life expectancy of cells with this translocation.

Less common in follicular lymphoma are other quantitative (trisomy of chromosomes X, 2, 5, 7, 8, 9, 12, 17, 18, 20, 21; loss of sex chromosomes) and structural changes: deletion of 6q; isochromosomes i(17) (q10) and i(18) (q10).

Characteristic immunophenotype: CD19+, CD20+, CD22+, CD79a+, CD10+, CD5-

The disease occurs more often in older people (median age 55 years). Clinically, FL most often manifests as lymphadenopathy and splenomegaly. Localized stages (I and II) are rare, more often at the onset of the disease there is already a generalization of the process, including damage to the bone marrow, and then the picture of the peripheral blood resembles CLL.

The disease is characterized by relatively slow progression. Often, follicular lymphoma transforms into aggressive lymphoma (diffuse large B-cell lymphoma), which is accompanied by a clear clinical picture (rapid enlargement of lymph nodes with a change in their density, the appearance of symptoms of tumor intoxication and additional genetic damage). Extranodal FL is rare.

Types of non-Hodgkin T-cell lymphoma

T-cell lymphoma is a malignant disease in which uncontrolled growth of T-lymphocytes occurs. Their production occurs in the thymus and they support the cellular (or barrier) immunity of the skin and mucous membrane.

• Lymphoblastic form. Most patients with this diagnosis are young men under 40 years of age. A favorable treatment outcome is predicted only if the bone marrow is not involved in the process.
• Anaplastic large cell non-Hodgkin lymphoma. Most often, this disease occurs in young people, but with timely diagnosis, it is quite treatable.
• Extranodal NHL. This form of the disease affects killer T cells and its aggressiveness can vary.
• Sézary's syndrome (or cutaneous). This form is often called mycosis fungoides and occurs mainly in older people (50-60 years old).
• Lymphoma with enteropathy. It has been noted that this type of cancer is typical for people with gluten intolerance. It is characterized as extremely aggressive and difficult to treat.
• Angioimmunoblastic. This type is difficult to treat, and therefore doctors do not make favorable prognosis for life.
• Non-Hodgkin's lymphoma panniculitis-like. This type of cancer develops in the subcutaneous fat tissue. A characteristic feature of this form is considered to be low sensitivity to chemotherapy, which makes treatment ineffective.

Reasons for development

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

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

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

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

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

Stages of the disease

There are 4 stages of progression:

• Stage 1 – pathology is localized in a specific area and does not metastasize to other tissues and organs;
• Stage 2 – the disease affects more than two areas of the lymph nodes;
• Stage 3 – the symptoms of the disease become more pronounced, the lymph nodes enlarge and may affect a specific organ;
• Stage 4 is the terminal stage, at which damage to the liver, spleen, kidneys, stomach, and lungs is observed. Multiple lymphomatosis cannot be cured.

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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.