Non-Hodgkin lymphoma - a cancerous tumor etiology, in which the lymphoid cells are hemopoietic stem histogenetic onset.Non-Hodgkin's lymphoma is a neoplastic heterogeneous group, and if we compare it with Hodgkin's disease, the patients with this diagnosis are cured only in 25% of cases.
This malignant disease differs from other forms of malignant tumors of various properties of a biological nature, its clinical manifestations, morphological structure and outlook.Since 1971, at the suggestion of Billroth, this tumor disease became known as malignant or non-Hodgkin's lymphoma.
Non-Hodgkin lymphoma causes
At this point, has not been fully elucidated the causes of the pathological education.It is believed that viruses, ionizing radiation and chemical carcinogens as risk factors that may lead to the formation of cancer.
Non-Hodgkin lymphoma is the sixth in mortality among malignant tumors.According to statistics, women suffer from it in the ratio of 10: 100,000 people
In addition, there is a definite connection between age and histological type of the disease.For example, children and adolescents often suffer from aggressive lymphomas, among which occupies a special place small cell lymphoma, which develops from the cells of Burkitt lymphoma and lymphoblastic and large- diffuse origin.But after 60 years, people often suffer from non-Hodgkin's follicular lymphoma with different degrees of malignancy.
also suggests that Epstein-Barr virus may be the causative factor in the disease.Immunosuppression and the incidence of diseases have a certain relationship, especially after transplantation of somatic organs.
Non-Hodgkin lymphoma symptoms
clinical picture of the disease is divided into two types of flow: aggressive and indolent.Sometimes you can find for highly aggressive tumors in which the tumor process is gaining rapid generalization.
Non-Hodgkin lymphoma with a high degree of malignancy occurs, as a rule, very aggressive.The rest of the non-Hodgkin's lymphoma, which is characterized by low-grade proceed with a long, chronic, but a spontaneous manifestation (indolent).
aggressive non-Hodgkin's lymphoma can be cured, while the indolent chance for a cure is not there.Such disease sensitive to standard methods of treatment, however, it has a strong tendency to relapse, which in the future becomes a cause of death.Seventy percent of patients with indolent non-Hodgkin lymphomas after any treatment live no more than seven years.
sometimes indolent non-Hodgkin lymphoma may flow spontaneously go to a high degree of malignancy and become diffuse large, which later reached the bone marrow.This transformation, called Richter's syndrome, causes a sharp worsening of prognosis.Patients then live for about a year.
When non-Hodgkin lymphoma primarily affects lymphoid tissue, and then the bone marrow, which distinguishes it from leukemia.The disease can occur at any age with the content in normal lymphoid tissues.First of all it concerns the visceral and peripheral lymph nodes, gastrointestinal tract, lymphoid tissue in the nasopharynx and thymus.Sometimes non-Hodgkin's lymphoma affects the tissues of the orbit, salivary glands, spleen, lungs and other organs.
all non-Hodgkin's lymphoma in their localization subdivided into nodal (localized in the lymph nodes), and extranodal spreading to tissues and organs through hematogenous and lymph through.Therefore, they are initially localized generalized.Thus, indolent non-Hodgkin's lymphoma at the time of diagnosis in 90% considered already disseminated.
When highly aggressive lymphoma clinical symptoms is very fast, so when handling patients have been generalized cancer.
for non-Hodgkin lymphoma is characterized by diverse clinical picture, as with any other disease.However, having a specific lesion lymphoid tissue, there are three types of clinical symptoms with the malignant disease.Firstly, it is a symptom of lymphadenopathy in which increasing one or more nodes.Secondly, there eksranodalnaya tumor that has clinical picture of the affected organ (for example, it may be gastric lymphoma, conjunctiva, skin, central nervous system, etc.).Thirdly, there is a general weakness, a feverish rise in temperature, rapidly lost weight in systemic manifestation of the pathological process.
In certain cases, the clinical picture of non-Hodgkin lymphoma is characterized by the simultaneous defeat of the lymph nodes and other tissues and systems.
mainly in non-Hodgkin's lymphoma for nearly 45% of patients with extranodal form characteristic lesions.And 80% have aggressive defeat.
Among the most common locations extranodal non-Hodgkin lymphoma are considered the gastrointestinal tract (10-15%), head and neck (10-20%).For bronchopulmonary tumor process is typical of 40-60% and then, as a secondary manifestation.
At the end of the twentieth century increased the number of primary diagnosis of non-Hodgkin's lymphoma of the CNS.They make up 1-1.8%.Very rarely, this lymphoma affects the kidneys and the bladder (0.2 to 1%).
For diagnosis, during the survey, it is important to exclude the presence or absence of extranodal lesions character and tumor infiltration in the bone marrow.
Nehodzhinskaya lymphoma stage
Classification of Non-Hodgkin Lymphoma is set on the basis of morphological structure and grade.There are three levels: low, intermediate and high.But the stages - four.
staging NHL is carried out in accordance with a modified classification.
first stage (I) non-Hodgkin lymphoma seen a single lymph node or a single tumor without local displays.
second stage (II) non-Hodgkin's lymphoma lesion includes multiple nodes or manifestations extranodal nature only one side of the diaphragm with local or without symptoms.This step in the B-cell forms and CCL is divided by another resectable, with which it is possible to remove the tumor and unresectable, has no such possibility.
The third step (III) include non-Hodgkin's lymphoma tumors located on both sides of the diaphragm, in the chest, with the spread of a pathological process in the abdominal cavity, and epidural types of tumors.
fourth stage (IV) non-Hodgkin lymphoma last and most severe, in which is no longer dependent on the primary tumor site.At this stage non-Hodgkin's lymphoma is localized in the bone marrow and the central nervous system involving skeletal pathology.
Non-Hodgkin lymphoma treatment
in the treatment of patients with indolent and aggressive forms of NHL are trying to maximize survival and improve their quality of life.The success in achieving the objectives depends on the type of tumor and the stage of the disease.During the course of a localized pathological process important point is the complete destruction of the tumor, extending the life of patients and a possible cure.
Non-Hodgkin lymphoma treated in generalized localization methods of anticancer therapy with palliative care, which are aimed at increasing the duration life and improve its quality.
for the disease in the terminal flow of palliative treatment is carried out to improve the quality of life.For this type of treatment is help in the form of symptomatic therapy, spiritual, social, religious, and psychological support.
aggressive non-Hodgkin's lymphoma, with the existing favorable prognostic factors achieved cure in 40% of cases.
patients with aggressive NHL favorable prognosis assigned standard drug therapy scheme Asorey (CHOP), comprising intravenous administration on the first day of such drugs as doxorubicin 50 mg / m2, Oncovin at 1.4 mg / m2 and cyclophosphamide at 750 mg/ m2.As well appointed interior Prednisolone first to the fifth day to 40 mg / m2.Polychemotherapy courses of treatment carried out every three weeks to reach the absolute remission in the early stages and increase the survival rate.
Non-Hodgkin lymphoma is treated with partial regression of drug therapy with the addition of the components of radiation therapy to treat the affected areas.
particular problem in the treatment of elderly patients are.There is a certain dependence of the positive treatment of age.Complete remission is possible to reach up to forty years in 65% of cases, and after sixty - only 37%.Moreover, death from toxicity observed within 30%.
In 1996, the scheme was modified Hazor with increasing duration of therapy for up to eight days, and the division of the dosage of drugs (cyclophosphamide, doxorubicin) at two stages in the first and eighth days.Such a change in the circuit with positive results.In this case, elderly patients to chemotherapy Rifuksimab added, which increases the survival rate of three times.
for the treatment of patients with relapsed non-Hodgkin's lymphoma, which are mainly characterized by generalizovannostyu applied certain tactics.It primarily depends on the type of tumor and its type of treatment carried out previously, the reaction of the organism to first-line therapy of age category, general physical condition of the patient's urinary and cardiovascular systems, as well as the state of the bone marrow.
Generally, for the treatment of relapses and the progression of non-Hodgkins lymphoma do not use first-line agents.But if the disease develops after years of complete remission, it is possible to the original purpose of the scheme.
second stage of the disease, non-Hodgkin's lymphoma, diffuse large cell, unfavorable values of the IIP and the large size of the tumor are at greater risk for recurrence of the disease.
primary form of treatment for refractory patients and in patients with relapsed non-Hodgkin's lymphoma applied therapy with high doses.It is also called "therapy of despair."Complete remission achieved with this form of the disease may be less than 25% and it is brief.In this case, the patient is assigned to high-dose chemotherapy, but certainly good medical condition.
This method of treatment is used for patients with aggressive lymphoma at first relapse of the disease.
for the treatment of indolent lymphomas are no specific standards for the treatment.This is due to the sensitivity of the tumor to all methods of treatment and the onset of cure.Therefore, using the traditional method of chemotherapy.It leads to a brief remission, who are moving to relapse.
irradiation treatment as an independent non-Hodgkin lymphoma helps only at the first stage of the disease, or (IE).The total dose of 25 Gy is sufficient for the treatment of tumors of small size, and for the second, third and fourth steps necessary to radiotherapy (30-36 Gy) to add medicinal methods.
Any extranodal neoplastic lesions begin treatment with standard regimens.For this prescribed orally chlorambucil 5 mg in the first three days with the first day of prednisolone, 75 mg, in the second 50 mg and 25 mg on third.
Monohimioterapevticheskie courses repeated after 14 days.Or appoint scheme CVP: the first day of doing intravenous Vincristine 1.5-2 mg, from the first to the fifth day - intramuscular and intravenous cyclophosphamide 400 mg / m2 with oral prednisolone 60 mg / m2 for five consecutive days.Within three weeks should be a break between courses.The treatment of non-Hodgkin's lymphoma prolongs the life of patients, but does not increase disease-free.Drug therapy is carried out before a complete remission.And in conclusion - radiation therapy is indicated.
Administration of interferon subcutaneously 3 million IU three times a day for one and a half years, supports the immune system weakened organism.
Currently, organizations are increasingly adopting the drug rituximab, which has a disastrous effect on the cancer cells of the pathological process.It is used as a mono or in combination with other drugs.
Non-Hodgkin lymphoma forecast
Prognosis is estimated IIP or the scale of the tumor.Each unfavorable sign is placed 1 point followed by their summation.
If non-Hodgkin lymphoma is estimated from 0 to 2 points, the prognosis is favorable, from 3 to 5 - unfavorable course of the disease, from 2 to 3 - uncertain prognosis.When the data is prescribed appropriate treatment.
positive prognosis of the disease is possible with B-cell form, rather than in the T-cell.In addition, there are various factors: age, tumor type, grade and stage of the disease.
a favorable prognosis with a five year survival rate of non-Hodgkin lymphoma include the gastrointestinal tract, and the salivary glands of the orbit, and lead to negative non-Hodgkin's lymphoma, central nervous system, bones, ovarian and breast cancer.