Non-Hodgkin’s lymphoma (NHL) is a malignant tumor that affects lymphoid tissue. There are a variety of different forms of non-Hodgkin’s lymphoma with different prognoses. Swollen lymph nodes and so-called B symptoms (fever, night sweats, weight loss) are typical for non-Hodgkin’s lymphoma. Men are more likely to get sick than women. The average age of onset is around 60 years. The therapy depends on the degenerated cell type and the stage of the disease. Read all important information about non-Hodgkin’s lymphoma here.
Non-Hodgkin’s lymphoma – description
The term “non-Hodgkin’s lymphoma” does not describe a single disease, but rather is an umbrella term for a variety of forms (non-Hodgkin’s lymphoma), which differ significantly, especially in terms of their prognosis. Basically, a non-Hodgkin’s lymphoma is a malignant tumor that affects the lymphoid tissue. The tumor can theoretically occur anywhere in the body where lymphatic tissue is located (bone marrow, thymus, spleen, lymph nodes, tonsils, lymphoid tissue in the digestive tract). Most commonly, non-Hodgkin’s lymphoma develops in the lymph nodes. The lymph nodes work like small filters in the lymphatic system, in which also degenerated lymphoma cells (lymphocytes) “get stuck” and multiply there.
The lymphatic system plays a crucial role in the immune system. Lymphocytes (lymphocytes) are white blood cells (leukocytes) that can recognize and label harmful foreign substances (such as pathogens). Physicians distinguish B and T lymphocytes. While B lymphocytes are responsible for the production of antibodies, T lymphocytes directly attack pathogens in the body. Non-Hodgkin’s lymphoma can be both degenerate B and T lymphocytes.
Non-Hodgkin’s lymphomas are classified according to their malignancy and the type of cell from which the lymphoma originates. For example, there is B-cell non-Hodgkin’s lymphoma and T-cell non-Hodgkin’s lymphoma, which is a bit less common. In addition, a distinction is still between the low-malignant (less malignant) and the highly malignant (malignant) non-Hodgkin’s lymphoma. For example, B-cell non-Hodgkin’s lymphoma may be either low-grade or high-grade. The same applies to a T-cell non-Hodgkin’s lymphoma.
The low-grade non-Hodgkin’s lymphoma are by far the most common (70 percent of cases). This form of cancer is less vicious. Low malignant non-Hodgkin’s lymphoma usually grows slowly and is often symptomless at first. The term “low malignancy” is somewhat misleading, however, because in these lymphomas due to the slow cell division, the therapy is usually significantly worse than the malignant non-Hodgkin’s lymphoma. Therefore, healing is often possible only in the early stages.
Both highly malignant non-Hodgkin’s lymphoma the degenerate cells divide especially quickly. Their growth is aggressive and they displace healthy cells. However, the highly malignant non-Hodgkin’s lymphoma respond to the treatment much better than low-grade malignant, so that a cure can be achieved in all disease stages.
Non-Hodgkin’s lymphoma – classification of various forms
There are many different non-Hodgkin’s lymphoma forms. This review lists the major non-Hodgkin’s lymphomas:
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B-cell non-Hodgkin’s lymphoma |
T-cell non-Hodgkin’s lymphoma |
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low malignant |
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highly malignant |
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Non-Hodgkin’s Lymphoma – Symptoms
Non-Hodgkin’s lymphoma symptoms vary depending on the course of the disease. Typical, however, are permanent painless enlarged lymph nodes, especially in the neck area. But it can also affect other lymph nodes, for example in the armpit, the groin, the chest and the abdomen.
Swollen lymph nodes are by no means always an indication of cancer. They also occur temporarily in infections. Then, however, they hurt easily during palpation and the swelling decreases noticeably a few days after the infection.
The painlessly enlarged lymph nodes in non-Hodgkin’s lymphoma, on the other hand, increase in size as the disease progresses. They are difficult to move under the skin – unlike enlarged lymph nodes due to infections.
The non-Hodgkin’s lymphoma symptoms include, in addition to the enlarged lymph nodes, other complaints, which are under the term Summarizes B symptoms, B symptoms are a combination of three typical symptoms that can commonly occur with cancers, but also with chronic infections. The B symptoms often go in spurts. The symptoms can disappear for a few days and then reappear.
B symptoms:
- fever: Fever above 38 ° C without obvious cause such as an infection.
- night sweats: Heavy sweating during the night causes those affected to wake up “soaking wet”, change their pajamas and move to bed.
- weight loss: A weight loss of more than ten percent of body weight in the previous six months.
People with non-Hodgkin’s lymphoma also report a general feeling of fatigue, Patients feel exhausted and are no longer able to perform well. Already everyday tasks are then perceived as physically exhausting. A constant tiredness despite sufficient sleep is typical for non-Hodgkin’s lymphoma.
Especially disturbing for the patients itching be in many body parts. The exact reasons for this are not yet known. The degenerated blood cells may release chemical substances near the sensitive skin nerves, triggering itching. About ten to 25 percent of patients are affected by this phenomenon.
In the advanced stage of non-Hodgkin’s lymphoma, the degenerate cells may also infect various other organs such as the spleen, liver, nervous system and bone marrow. Among other things, a massive enlargement of the spleen (splenomegaly) is typical. In addition, blood formation may be disturbed, which takes place in the bone marrow (pancytopenia). Consequences are anemia, a lack of functional white immune cells (leukocytes) and a lack of platelets (thrombocytopenia). This sometimes causes general weakness, frequent infections and bleeding.
Non-Hodgkin’s Lymphoma – Causes and Risk Factors
The causes of non-Hodgkin’s lymphoma have not yet been fully elucidated. In many cases, however, there is probably a connection between (mostly viral) infections and non-Hodgkin’s lymphoma.
Since seniors often develop non-Hodgkin’s lymphoma, old age is a risk factor for non-Hodgkin’s lymphoma. Non-Hodgkin’s lymphoma is ultimately triggered by changes (mutations) in the genetic material of a lymph cell. The mutation stimulates the abnormal growth of the cell and blocks the healthy functions. Cause of pathogenic changes in the nucleus is often an infection with the Epstein-Barr virus.
A degeneration of cells is generally a problem when the body’s defenses are weakened. This can be the case, for example, when a person is infected with HIV (HIV). HI viruses also appear to increase the tendency of cells to change. People with HIV infection are therefore estimated to have a thousandfold increased risk of developing non-Hodgkin’s lymphoma than immunoassay. Particularly common in HIV-positive people is a highly malignant B-cell Burkitt’s lymphoma on. Immune deficiency due to immunosuppressive drugs or toxic substances (pesticides, aromatic hydrocarbons such as benzene) can also contribute to the development of non-Hodgkin’s lymphoma.
A special form of lymphoma, the low malignant B-cell MALT lymphoma (Mucosa Associated Lymphoid Tissue) is clearly associated with colonization of the gastric mucosa by the bacterium Helicobacter pylori, In this lymphoma form, therefore, antibiotic therapy that eliminates the bacterium at an early stage of disease may be sufficient to cure the lymphoma.
Non-Hodgkin’s lymphoma – examinations and diagnosis
The right contact for suspected non-Hodgkin’s lymphoma is your family doctor or a specialist in internal medicine and oncology. Already by describing the symptoms, the doctor receives important information about your state of health. There are many other diseases that can cause lymph node swelling. These include other cancers, chronic infections such as tuberculosis, viral infections such as glandular fever. If you suspect non-Hodgkin’s lymphoma, the doctor will ask you about your history (anamnesis). Possible questions can be:
- Did you notice swelling of the neck?
- Have you recently been waking up in a sweaty night?
- Have you inadvertently lost body weight in the past six months?
- Do you have a fever frequently?
- Have you had frequent nose or gum bleeding lately?
Following the first conversation is usually a physical examination, In doing so, the doctor will search for enlarged lymph nodes, especially by careful palpation. Since non-Hodgkin’s lymphoma can also enlarge the liver and spleen, he will try to palpate the upper abdomen to assess their size.
blood test
The blood test is a quick and inexpensive way to diagnose non-Hodgkin’s lymphoma. The degenerate blood cells displace the healthy cells in the bone marrow during the course of the disease. Any anemia (anemia) can then be detected by a decreased hemoglobin level (Hb). Hemoglobin binds the oxygen in the blood itself. He is in the red blood cells, which transport the oxygen in his body with his help. The normal value for men is 14.0 to 17.5 milligrams per deciliter (mg / dl), for women 12.0 to 15.5 mg / dl. In addition, a lack of platelets (thrombocytopenia) and white defense cells (leukocytopenia) may develop during the course of the disease. These changes can also reveal a blood test. By a Immunohistochemical examination of the blood It is also possible to differentiate whether B or T cell lymphoma is involved.
tissue samples
Painlessly swollen lymph nodes should always be examined by the doctor. He checks by means of a tissue sample whether it is actually a non-Hodgkin’s lymphoma. To do this, he takes a complete lymph node (lymph node extirpation) and examines it microscopically. In some cases, a tissue sample (biopsy) is also taken from other potentially diseased tissues (stomach, skin, bone marrow).
Imaging procedures
If the suspicion of non-Hodgkin’s lymphoma is confirmed by a tissue examination, the doctor uses imaging techniques to determine the spread of the disease. One X-ray photograph, one ultrasound and a Computed tomography (CT) help determine the non-Hodgkin’s lymphoma stage (“staging”).
Non-Hodgkin’s lymphoma – staging (after Ann-Arbor)
Depending on how far a non-Hodgkin’s lymphoma has already spread throughout the body, it will be allocated in one of four stages. The more lymph node regions are affected, the more advanced the stage and the worse the prognosis. Healing is usually possible in low-grade lymphomas in stage I and II, and in high-grade lymphomas in all four stages. Above all, non-Hodgkin’s lymphoma life expectancy and chances of recovery depend on the physical condition of the patient.
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stage |
Infestation of the lymph nodes |
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I |
Infestation of only one lymph node region |
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II |
Infestation of lymph nodes only on one side of the diaphragm: (chest or abdomen affected); |
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III |
Infection of lymph nodes on both sides of the diaphragm (both thorax and abdomen); |
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IV |
Involvement of one or more extralymphatic organs (brain, bone) independent of the pattern of involvement of the lymph nodes. |
In addition, a distinction is made depending on the originally degenerate cell type B-cell non-Hodgkin’s lymphoma or T-cell non-Hodgkin’s lymphoma. Based on this classification by stage and cell type, the treatment plan is created.
Non-Hodgkin’s lymphoma – treatment
Non-Hodgkin’s lymphoma therapy depends on the type of lymphoma and can therefore vary widely. In general, highly malignant lymphomas respond much better to the treatment than the low malignant ones. Therefore, a high-grade non-Hodgkin’s lymphoma in all stages of disease chances of healing, while in a low-grade non-Hodgkin’s lymphoma usually only in stages I and II possible. Since the chances of recovery in non-Hodgkin’s lymphoma depend particularly on the general physical condition of the patient, there are always pleasing exceptions.
Chemotherapy and radiation
One low malignant non-Hodgkin’s lymphoma (Stage I and II) can often be cured by radiation alone (radiotherapy).
At a highly malignant non-Hodgkin’s lymphoma as well as an advanced one low-grade non-Hodgkin’s lymphoma (Stage III and IV) is usually a so-called chemotherapy CHOP necessary. CHOP stands for the combination of various active substances (Cyclophosphamid, Hydroxydaunorubicin, Oncovin, Prednisolon). If non-Hodgkin’s lymphoma is already advanced, the watch-and-wait strategy may also be useful. This means that one does not treat the lymphoma with chemotherapy, but the course observed. This is possible in cases where the lymphoma is growing very slowly.
Antibody therapy
Certain B-cell non-Hodgkin’s lymphomas benefit by an additional Antibody therapy, This method is still relatively new. The medicine uses the fact that the cancer cells have certain proteins on their surface. The antibodies administered can recognize these proteins and form a complex with the defective cell, whereupon it is destroyed. Patients do not receive the antibody alone, but in combination with chemotherapy.
transplantation
Also one Bone marrow transplant or the transplantation of stem Cells from the blood can help some patients. However, these methods are not yet sufficiently secure to include them in the standard procedures.
Non-Hodgkin’s lymphoma – prognosis and disease course
The non-Hodgkin’s lymphoma life expectancy is very different. How well a patient responds to therapy depends on the nature of non-Hodgkin’s lymphoma. Highly malignant non-Hodgkin’s lymphoma respond much better to treatment than the slow-growing, low-grade non-Hodgkin’s lymphoma due to the high rate of cell division. In addition, the stage of the disease and the general physical condition have a significant influence on the prognosis. If the general condition of the patient is good, high-grade non-Hodgkin’s lymphomas can usually be cured at all stages. In the case of low-grade non-Hodgkin’s lymphoma, however, there is usually a chance of recovery, especially in stages I and II. In advanced stages, the prospect of complete healing is rather low. However, factors such as age or general condition of the patient also have a major influence on the individual prognosis.
Support Groups
The diagnosis of non-Hodgkin’s lymphoma unsettles those affected and their relatives once. Many concepts are unknown to them and many questions arise. These can sometimes better answer fellow sufferers than the attending physician. Do not hesitate to ask your doctor for a support group. In many regions there are group meetings for those affected. Another option is a non-Hodgkin’s lymphoma forum on the Internet that offers relatives and sufferers an opportunity to exchange about the Non-Hodgkin lymphoma allows.