lymphoma

Lymphoma cancer: description

Lymphatic cancer (formerly called lymphosarcoma) affects the lymphatic system. The lymphatic system is an important part of the body’s defense system. It consists of the lymphatic organs such as the spleen and bone marrow and the lymphatic vessels with intervening lymph nodes. The lymphatic system serves the maturation and imprinting of a certain type of white blood cells, the lymphocytes (= lymph cells). There are two major types of lymphoid cells that have different roles. The T lymphocytes recognize and mark foreign substances such as viruses and bacteria so that they can be destroyed. The B lymphocytes produce antibodies that are used to fight pathogens and foreign bodies.

The lymph nodes filter the tissue fluid (lymph) and are an important part of the immune system. The spleen is also an important immunological organ and additionally breaks down old or defective red blood cells (erythrocytes).

Malignant lymphoma is particularly noticeable in the lymph nodes and spleen. However, lymphatic cancer can also spread beyond the lymphatic system and affect other organs as it progresses.

Lymphoid cancer occurs when a lymph cell degenerates and becomes a cancerous cell. These may be either spleen tissue, lymph nodes or degenerated white blood cells such as B lymphocytes or degenerate T lymphocytes. The cells differ in appearance and function from healthy lymphoid cells and are no longer able to repair themselves. As a result, the defective lymphoid cells proliferate and displace healthy cells of blood formation. Since the lymphocytes can no longer fulfill their normal functions, a deficiency of lymphoma can develop, mainly due to the lack of functional antibodies (antibody deficiency syndrome).

Generally, men are more likely to be affected by lymph node cancer than women. About two-thirds of the patients are male. The age of onset depends on the type of lymphoma cancer. There are forms that occur primarily in people over the age of 50 years. Other forms such as Hodgkin’s lymphoma or certain non-Hodgkin’s lymphomas can also affect children and young people. Unfortunately, childhood lymphoma is not uncommon. Malignant lymphomas are the third most common cancer among children and adolescents with a share of 12%.

There are many different types of lymphoma cancer. There are two large groups to which the diseases are assigned. The so-called “Hodgkin’s lymphoma“(Hodgkin’s disease) and the”Non Hodgkin Lymphomas“.

Lymphoma cancer: Hodgkin’s disease

Hodgkin’s disease often affects young people. You can find detailed information about this disease in the review Hodgkin’s disease.

Lymphoma cancer: Non-Hodgkin’s lymphoma

About 85 percent of all cases of lymph node cancer are non-Hodgkin’s lymphomas. Read all about it in the article Non-Hodgkin’s lymphoma.

Lymphoma cancer: symptoms

Read all about the typical signs of lymph node cancer in the article on lymphoma.

Lymphoma cancer: causes and risk factors

The exact causes of lymphoma cancer are not yet known. However, physicians have identified various lymph node cancer risk factors. In the individual disease case, however, it usually remains completely unclear how the lymphoma developed. In addition, the risk factors for the different forms of lymphoma cancer differ.

Chemical substances, radiation exposure or viruses can contribute to the degeneration of cells and their inability to repair themselves. The degenerated lymphoid cells then accumulate in a lymph node or other lymphoid organ, which swell due to the increased cell division. For the different types of lymphoma cancer doctors assume the following risk factors.

Risk factors for Hodgkin’s lymphoma:

This form of lymph node cancer is caused by infection with the Epstein-Barr virus (EBV) benefits. The Epstein-Barr virus is mainly responsible for the so-called Pfeiffer’s glandular fever (Infectious Mononucleosis). A documented infection seems to significantly increase the risk of Hodgkin’s lymphoma according to scientific studies. In 50 percent of the patients, the EB virus can be detected in the lymphoma cells.

Currently it is also discussed whether a HIV (Human Immunodeficiency Virus) infection increases the risk of Hodgkin’s lymphoma. This seems likely because people with HIV infection have a significantly higher risk of cancer due to the weakened immune system. Also, chemotherapy or the use of drugs that are intended to weaken the immune system (immunosuppressants), promotes the development of Hodgkin’s lymphoma.

Risk factors for non-Hodgkin’s lymphomas

Similar factors play a role in the development of non-Hodgkin’s lymphoma as in Hodgkin’s lymphoma. Infection with Eppstein-Barr virus is also considered a risk factor in this form of lymphoid cancer. In addition, one seems Gastric mucosal inflammation, caused by the bacterium “Helicobacter pylori”, favoring a gastric mucosa (MALT = mucosa associated lymphoid tissue lymphoma) to be.

People with one HIV infection has a thousandfold increased risk develop a non-Hodgkin’s lymphoma. Even harmful substances such as aromatic hydrocarbons (such as benzene), chemotherapy, radiation or prolonged suppression of the immune system by drugs (immunosuppressants) increase the risk of non-Hodgkin’s lymphoma.

Lymphoma cancer: examinations and diagnosis

The right contact for suspected lymphatic cancer is your family doctor or a specialist in internal medicine and oncology. Swollen and painless lymph nodes can have different causes – so it does not necessarily have to be lymph node cancer. However, if the painless swelling of the lymph nodes persists for weeks and symptoms such as fever, night sweats and unwanted weight loss, you should urgently consult a doctor for clarification. He will conduct a detailed survey (anamnesis) of the complaints. Possible questions from your doctor can be:

• Have you lost weight in the last few months? (More than 10 percent of the initial weight in the last six months is noticeable.)
• Have you recently woken up at night because you were “bathed in sweat”?
• Did you have a fever more often in the past and felt weak?
• Did you notice painless enlarged lymph nodes (for example, on the neck, under the armpits or on the groin)?
• Do the swollen lymph nodes suffer from alcohol consumption (indicative of Hodgkin’s lymphoma)?

Physical examination

As part of the physical examination, the enlarged lymph nodes can be felt. If they are enlarged due to the disease, also the enlarged spleen under the left costal arch or an enlarged liver under the right costal arch can be felt.

Further investigations

Blood test and immunohistochemistry

A crucial diagnostic tool in lymph node cancer is the blood test. In a lymphoma blood count, altered numbers of blood cells can be detected. The proliferation of degenerated lymphoma cells displaces the other cells of the blood, leading to anemia, platelet deficiency (thrombocytopenia) and functioning immune cells (leukopenia) in the lymphatic gland. Typical of Hodgkin’s disease is an increase in the so-called eosinophilic granulocytes (eosinophilia).

The function of the kidney and the liver can also be determined in the blood picture. This shows how much the lymphatic gland cancer has already affected other organs. Furthermore, in the blood, increased levels of inflammation can be noticed, which are manifested above all by increased blood sedimentation.

The blood can also be examined by immunohistochemistry. This means that the blood cells are analyzed for specific features on their cell surface. Antibodies and certain chemical substances are used to identify these surface features (hence “immunohistochemistry”). With the immunohistochemical examination it can be distinguished in non-Hodgkin’s lymphoma whether degenerated B or T lymphocytes were the origin of the lymphoma. B lymphocytes carry the surface feature “CD20”, T lymphocytes “CD3” on their surface.

Tissue sample (biopsy)

Using a tissue sample (biopsy) can be determined for sure what type of lymph node cancer it is. As a rule, the surgeon removes a complete lymph node (lymph node extirpation), which he examines under the microscope. If the suspicion of a malignant lymphoma is confirmed, further imaging procedures become necessary.

The removal of a tissue sample is necessary for the diagnosis. Only with a precise assessment of the cells under the microscope can a reliable diagnosis of lymph node cancer be made. In addition to the examination of lymph nodes, biopsies can also be taken from other tissues. For example, if a skin lymphoma is suspected, a sample is taken from the skin, and if a suspected MALT lymphoma is suspected, a sample is taken from the gastric mucosa.

Imaging procedures

An X-ray, an ultrasound examination or a computed tomography (CT) help to classify the lymph node cancer and its stage. Some patients require additional bone marrow examination. Usually, the iliac crest is punctured with a needle under light sedation and some bone marrow is aspirated. The bone marrow is then examined under the microscope.

Staging (to Ann-Arbor)

The lymph node cancer (malignant lymphoma) is classified by means of the examination results in one of four stages of the so-called Ann Arbors classification (“staging“). This classification was originally developed for Hodgkin’s lymphoma, but is now also used for non-Hodgkin’s lymphoma. In the classification, a lymphoma is assigned to one of the four stages based on the extent of its spread in the body. The precise staging is very important, since then also the therapy plan is directed and an estimate can be made with regard to the prognosis.

Lymphatic cancer – staging according to Ann-Arbor

stage	Infestation of the lymph nodes
I	Infestation of only one lymph node region
II	Only on one side of the diaphragm: (Lymph nodes either in the chest or in the abdominal area affected): Infestation of two or more lymph node regions
III	On both sides of the diaphragm: (Lymph nodes in both the thorax and in the abdomen affected): Infestation of two or more lymph node regions
IV	Involvement of one or more extralymphatic organs (brain, bone) independent of the pattern of involvement of the lymph nodes.

Lymphoma cancer: treatment

Malignant lymphoma should always be treated in a specialized clinic. These are usually hematological-oncological or internistic stations of a university hospital. Depending on the stage of the disease, an individual treatment plan is created. Therapeutic options include chemotherapy and / or radiation. For the treatment of some malignant lymphomas, an additional antibody therapy is used. For symptom-free patients with slowly progressing lymphoma cancer, occasionally treatment may be discontinued if there is little chance of complete cure. However, the lymph node cancer must be closely monitored (“watch and wait”).

Chemo- and radiotherapy for lymphatic cancer:

Chemo- and radiotherapy is targeted against the cancer cells. Although healthy cells and cancer cells are damaged equally. But because cancer cells have lost their ability to self-repair, they die.

Lymph node cancer is classified by its growth behavior into malignant (high-grade) and low-grade (low-malignant). Paradoxically, the highly malignant lymphoma does not have a worse prognosis than the low-grade malignant. Although the highly malignant lymphomas grow much faster, the radiation and the chemotherapy have a much better effect due to the high rate of cell division. By contrast, the slow cell division in the cancer cells of low-grade lymphomas means that the therapy is not so effective.

In the early stages of lymphoma cancer radiotherapy is the focus because of the small spread in the body. It will proceed according to the “involved-field technique”. This means that if possible, only the affected areas of cancer are irradiated and the neighboring, healthy regions are spared from the irradiation.

In Hodgkin’s disease, in addition to radiotherapy, chemotherapy is used early in life. Because chemotherapy is cell toxins, some patients suffer from side effects such as diarrhea, nausea and hair loss. How well the therapy is tolerated depends on the stage of lymph node cancer and the general condition of the patient.

For detailed information on the treatment of various types of lymphoma, see Hodgkin’s Disease and Non-Hodgkin’s Lymphoma.

Other treatment options for lymphoma cancer:

The Antibody therapy is relatively new. The cancer cells have certain proteins on their surface (surface features). The antibodies administered can recognize these proteins and form a complex with the defective cell, whereupon it is destroyed. Thus, for the treatment of B-cell non-Hodgkin’s lymphoma, the antibody rituximab is used against the surface feature “CD20”.

Many lymph node cancer patients also benefit from one Bone marrow transplant, The stem cells can usually be obtained from the blood of the patient. This is followed by high-dose chemotherapy to completely kill the hematopoietic cells (including the cancer cells). Immediately thereafter, the previously collected stem cells from the blood are implanted into the patient. The goal is that normal blood formation without cancer cells is possible again.

Lymphoma cancer: disease course and prognosis

Whether lymph node cancer is curable depends on the stage and the histological form of the disease. For example, Hodgkin’s disease is treated at every stage with a curative approach. This means that there is a chance of healing at each stage. On the other hand, for example, in an advanced, low-grade non-Hodgkin’s lymphoma, healing is no longer possible in many cases. The Lymphoma Cancer Life Expectancy and the Lymph node-chances Accordingly, they can not be generalized. How well the patient responds to the therapy depends on the type and stage of the disease, as well as any complications.

Lymphoid cancer (malignant lymphoma) progresses very slowly in some patients, especially the low-grade forms. Thus, the lymph node cancer occasionally causes no or very little discomfort in early stages of the disease. The earlier lymph node cancer is detected, the better the prognosis and the more “gentle” the therapy. Fortunately, malignant lymphoma is often detected early, so healing is possible in many cases. A further limitation is that radiation and chemotherapy after years or decades lead to new cancers as a consequence of lymphoma Therapy can occur.