Lymphoma – treatment, symptoms and prognosis
Lymphoma is a cancer of the lymphatic tissue, which has no analogues benign. Lymphomas are solid tumors, engaging usually the lymph nodes (nodal) and only in 1/3 of cases (extranodal) derived from lymphoid tissue of the tonsils, gastrointestinal tract, spleen. Lymphomas can affect any age. The reasons for their development are unknown, but there is a higher risk for immunodeficiency syndromes, radiation or conducted chemotherapy for other cancers. Lymphomas have almost identical clinical manifestation, and therefore their differentiation is possible only by lymph node biopsy with subsequent histological and immunohistochemical study, an expression of CD (Cluster Designation) - term to describe a group of leukocyte antigens, determining that the case of lymphoma is followed by typing of lymphoma as B, T or NK cell.
Lymph node, which is not affected by the applied anti–inflammatory and antibiotic therapy and is not reducing its size within 30 days, must be biopsied!
All lymphoid tumors come from only one transformed cell and accordingly are all monoclonal. Normal lymphocytes can be transformed into malignant cells at any stage of their maturation, and thus give rise to the neoplastic process, specific output stage.
Symptoms of non-Hodgkin lymphoma
• Swollen lymph nodes (Lymphadenopathy). More commonly affects the cervical lymph nodes.
• Fatigue, fever, weight loss, night sweats, skin manifestations (rash, itching)
• Often there is splenomegaly (enlarged spleen), much less hepatomegaly (enlarged liver).
Hodgkin lymphoma (Hodgkin’s Disease)
The most commonly occurs between 20 and 30 years of age. The etiology is unknown, but according to some researchers is associated with Epstein-Barr virus.
Symptoms of Hodgkin lymphoma
• Enlarged lymph nodes (Lymphadenomegaly). Almost always occurs in a single area or in one lymph node
• Night sweats
• Weight loss
• Chest pain
• Abdominal pain or heaviness
Morphology of Hodgkin’s disease
Characteristic of Hodgkin lymphoma is that this tumor is composed of normal reactive inflammatory cells (lymphocytes, eosinophils, histiocytes), among which are found malignant cells of Reed-Sternberg. The Shternberg giant cells are with abundant cytoplasm. Especially significant are the ”diagnostic” (or “classic”) type of cells ”mirror image”.Their nuclei look like beans with inverted concave parts to each other and have large nucleoli. Together the two nuclei look like the eyes of an owl. With progression of the disease occurs an involvement of the spleen (spleen purple) and the liver.
Conduct and prognosis of Hodgkin’s lymphoma
100% 5-year survival in stage I and II. Significantly more unfavorable is prognosis in stage III and IV. In any form the affection of the spleen, liver, bone marrow and other organs worses the prognosis.
Treatment of lymphoma
Although Hodgkin’s lymphoma is often primary isolated event or in a group of lymph nodes is established that at the moment of the diagnosis there is already a wide distribution in the body. Therefore, only systemic chemotherapy has a healing effect.
Hodgkin lymphomas often occur in one place and spread on the type of metastasis. So they can be treated with chemotherapy than and locally (by cutting or radiation).
Multiple myeloma and plasma cell dyscrasias
Common between different forms of plasma-cell madness (English crazy - insane) is the expansion of a single branch of immunoglobulin-secreting cells, resulting in increased serum levels of immunoglobulin or any of its fragments. Monoclonal immunoglobulin,which is found in blood in these diseases, is called M-component (from Myeloma). It has a molecular weight above 160,000 and is excreted in the urine only in glomerular injury. In some dyscrasias together with the synthesis of immunoglobulins are formed and light and heavy polypeptide chains. Light chains are known as a protein Bence-Jones. It passes through the kidney filter and is located in the urine.
Multiple myeloma is a primary multiple plasma-cell neoplasm of bone, which in the course of its development can be spread and extraosseous (outside bones). The diagnosis of the disease is placed in symptoms, associated with infiltration of organs (mostly bones) of tumor plasma cells and elevated levels of immunoglobulins in the blood and /or light chains in urine (protein of Bence-Jones). It concerns for monoclonal proliferation of B cells at different stages of their maturation. The reason for the start push is unknown. It could be prolonged antigenic stimulation, spontaneous mutation or chromosomal anomaly. Morphological diagnosis is based on the abnormal aggregates of plasma cells (15-90% of bone marrow cells). Between them are located and immature(atypical) plasma cells with dispersed chromatin, large single nucleons, mitoses and dual forms. Myeloma cells secrete lymphotoxin - osteoclast activating factor, and it in turn causes bone resorption. The most commonly affected are the spine, ribs, skull, pelvis, femur.