A variety of tumors, affecting mainly the lymphatic system, called lymphoma or Hodgkin’s lymphoma. The lymphatic system consists of lymph nodes, joined together by a system of small blood vessels. Lymphocytes are white blood cells, the main component of the immune system of the human body. In the case of disease, neoplastic lymphocytes begin unrestricted share, the products of this process inhabit the lymph nodes or internal organs, disrupting their work.
Only distinguish about 30 types of the disease. They are different symptoms, course and prognosis. Among the most common disease Hodgekin and neocicindela lymphoma. Hodgkin’s lymphoma (it is also called Hodgkin disease), the name was introduced by the who in 2001. For the first time this pathology was first described in 1832 by Thomas Hodgkins. In Russia she meets 2 times per 100 thousand people. Men suffer more often women.
Vulnerable people of almost all ages. Before there was a hypothesis that the first peak of the surge in the incidence, including lymphomas of the skin
had for a period of 15-40 years, the second at the age of 50. However, recent studies have shown that after 50 years the risk is small, because the main part of the histological preparations after retrospective analysis was carried to the second form of the disease negotinska. Previously the disease was considered incurable. Today, with early diagnosis, it can be treated successfully or achieve sustained remission.
Why there is this form of disease, still is uncertain. May hurt some family members but not in all cases it is due to hereditary factor. According to the International morphological classification, adopted in 2001, dependent on immuno-morphological characteristics, distinguish 4 histological variant of the classic form of the disease, including the diagnosis of lymphoma of the stomach
- mixed-cell the most common variant, up to 50 % of cases
- nodular or knotty sclerosis to 45 %
- lymphoid depletion up to 10 %
- lymphoid saturation to 6 %.
According to the International classification, there are four stages of lymphoma
- stage – in this period there is a loss of any one group of lymph nodes, extralymphatic organ or tissue
- stage – affects two or more groups of lymph nodes, which are observed on one side of the diaphragm
- stage is multiple lymph nodes on both sides of the diaphragm
- stage (1) affected the lymphatic structures in the upper abdomen
- stage (2) processes apply to Nizhny abdomen
- stage IV occurs diffuse lesion of the internal organs.
Stage occur type A or B. type A, the process is asymptomatic, without any signs of intoxication. For disease type In characteristic causeless weight loss 10 %, fever, when the temperature rises above 38 degrees Celsius, it occurs at night sweating.
The reasons for the development of Hodgkin’s disease is still not understood. Among the precipitating factors are called common for all ionizing radiation, chemical carcinogens, bad ecology. Scientists say that in some cases, to the development of tumors involved the virus. For example, the researchers found that Burkitt’s lymphoma in the vast majority of cases – 95 % – develops on the background of infection with the virus Epstein-Barr. The first such relationship was identified in 1971. Quite often physicians, patients with this disease detect genetic abnormalities – disorders of chromosome apparatus of cells. But most of the disease causes a combination of several factors.
There are a number of clinical manifestations characteristic of this disease. Patients increase the size of the lymph nodes in the armpits, groin, neck. If the infections this process is accompanied by painful sensations, that in this disease they are not. The size of the nodes does not decrease even after treatment with antibiotics. If the node is enlarged without apparent reason up to 1 cm, and within a month has not decreased, the patient needs a biopsy.
Sometimes patients complain of a feeling of pressure in face and neck, feeling of fullness in the abdomen, shortness of breath, bursting pain in the lower back. This is due to enlarged lymph nodes, liver, spleen. Other symptoms of disease are fever, sweating, weakness, weight loss, disturbances in the digestive system. Sometimes the disease manifests itself as cutaneous lesions, which can be both common and limited.
Approximately 25-35 % of patients Hodgkin’s disease is accompanied by pruritus. It might be in the region of affected lymph nodes or in the form of extensive dermatitis on all body. Itching leads to insomnia, loss of appetite, causes mental discomfort and is a cause of disorders.
Early stage of the disease, including lymphoma of the brain, pass almost unnoticed. Over time, the process extends to all the internal organs, then manifest pronounced symptoms of intoxication. In General, the disease is characterized by clinical signs such as lymphadenopathy, most often cervical-supraclavicular (60-75%) usually on the right side. If increased peripheral lymph nodes, it does not cause deterioration of the patient. Metastatic lymph nodes are characterized by mobility, photoelasticity, they are not soldered to the skin. In rare cases, patients complain of pain, which sometimes manifests itself after drinking alcohol.
Every fifth patient the disease begins with lymph node enlargement of the mediastinum. In the early stages of the pathology revealed by fluorography. In the later stages it is diagnosed by the seals of considerable size. The disease is accompanied by cough, shortness of breath, pain behind the breastbone.
Very rare pathology begins paranormalnyh isolated involvement of lymph nodes (those located along the spine behind the peritoneum). Then there are complaints of night pain in the lower back. Approximately 5-10 % of patients the disease manifests itself acutely with fever, night sweats, rapid loss of weight. Small swollen lymph nodes appear later. For this form is characterized by early leukopenia and anemia.
When deployed forms there is a loss of all lymphoid systems. In 30% of cases in the first or second stage affects the spleen. Less often, changes occur in Algaerova ring of lymphoid tissue of the pharynx and tonsils.
In addition to the lymph nodes, most often changes in the lung tissue. There’s been infiltrated by growth of the mediastinal lymph nodes, the development of certain lesions, diffuse infiltrates, which is characteristic of large-cell carcinoma and lymphoma. The process may develop asymptomatic, in some cases accompanied by pronounced clinical symptoms.
When examined in the pleural cavities detect fluid accumulation. It is a sign of specific disease of the pleura. In the study the liquid in her reveal reticular and lymphoid cells, cells of Berezovsky-Sternberg. The pleura is affected with chlamydia with foci in the lung tissue or enlarged lymph nodes of the mediastinum. In such cases, the tumor can grow in the myocardium, esophagus, trachea, pericardium.
Quite often, the disease is localized in the skeletal system. According to statistics, it is possible to identify through x-rays 20% of patients. The most common clinical changes in affected vertebrae, rib cage, pelvic bones, sometimes bones. The development of the disease is associated with pain, x-ray detects the problem immediately. Rarely chlamydia can be identified precisely on the lesion of bone tissue. On the likely bone marrow failure evidenced by a low content of platelets and of leukocytes in blood, anemia. The course of the disease may be asymptomatic.
The liver has large compensatory possibilities. That is why the lose body discover later. On possible pathologies evidenced by the increase in body, increased activity of alkaline phosphatase, lowered levels of serum albumin. Lesions of the gastrointestinal tract are usually secondary. The system suffers because of the tumor from the affected lymph nodes. But sometimes diagnose lesions of the small intestine and stomach. Affected most often submucosa. In the Central nervous system disease affects mainly the spinal cord. Lesions are localized in the meninges, causing severe neurological disorders, which can result in paralysis.
Quite often when lymphomagenesis affects the skin. They appear scratching, allergic reactions, rarely – tumor formation. The disease affects other organs of the urogenital system (ovary, kidney), thymus, thyroid, mammary gland, and soft tissue.
For most patients with Hodgkin’s lymphoma characterized moderate leucocytosis. In the later stages can be traced to the decrease in the level of lymphocytes in the blood. The correct diagnosis can be established only after biopsy, histological analysis of the tissues of the lymph nodes. The diagnosis is substantiated if, in the course of the biopsy tissue was discovered specific multinucleated cells Sternberg. In controversial cases, immunophenotyping is carried out. However, the diagnosis cannot be made only on the basis of histological studies. A number of other tests. Including General and biochemical blood tests, chest x-ray (direct and lateral projection), CT scan, thyroid ultrasonography, abdominal, retroperitoneal lymph nodes, liver, spleen. Also need the results of trepanobiopsy of the iliac bone, which will rule out or confirm the involvement of the bone marrow and a bone scan and x-rays.
If lesions of the lymph nodes, often local, the disease is treated with radiotherapy. When generalized process, when the disease has progressed to 3-4 stages, apply the method of chemotherapy, in some cases in combination with radiation therapy. In modern Oncology there are two methods of radical radiation for this disease and multiple krupnopanelnoye.
When the sectional method is sequential exposure of relatively small areas of tumor development and areas which are undetectable in the survey. When krupnopanel radiation exposure rays at the same time subject areas pathological and subclinical spread. The exposure time of one zone reaches a month, the total dose of radiation is in the range of 36-40 Gy. The patient normally underwent radiation therapy developed special methods of prevention.
Side effects of treatment nausea, vomiting, temporary hair loss, infections, reduced blood counts. In the case of qualified medical assistance and the implementation of the recommendations of the treating doctors negative effects is minimized. This cancer was one of the first which proved the possibility of curing large numbers of patients. So, in the early 40-ies of survival was only 5%, and thanks to modern methods of treatment, 60% of patients after treatment live twenty years or more, and in the case of local stages this figure reaches 90%.