Hodgkin lymphoma considered unusual, since the malignant cells represent less than 1%, and the tumor consists mainly of inflammatory cells and connective tissue fibers. This pattern is due to the influence of cytokines (biologically active substances), synthesized Reed Berezovsky cells.
What is this disease?
Hodgkin - a kind of a tumor, usually affecting the lymphatic system of the body, consisting of a joint between the small vessels of lymph nodes. As a result, the permanent division of the affected lymphocytes of new cells pass on somatic organs and lymph nodes, while respecting their proper functioning. The disease was first described in 1832 by Thomas Hodgkin. Until 2001 it was called limfogranulozom or Hodgkin's disease. This pathological process affects people of any age. Moreover, statistics show that women suffer from this disease is much less than men.
On a very frequent question "lymphoma - a cancer or not?" Can be answered briefly and clearly: "Yes." The term "cancer" is a carbon copy of the Russian language (ie, a literal translation), the Latin word "Cancer" (crab). On the original language of science - Latin, so called from ancient times all the internal tumor, asymmetric and irregular angular shape having at palpation and accompanied intolerable gnawing pain.
Therefore, the term "Cancer" (or in the literal Russian translation - "cancer") was fixed for all malignant tumors. And in the broader concept is often transferred to any neoplastic process, although employed colloquially combination "blood cancer" or "cancer lymph" jar hearing professional as cancer - malignant tumor cells of epithelium. Accordingly, the more correct will be called malignant lymphoma tumors than "cancer" term.
Causes
While experts are not able to definitively identify the specific causes of Hodgkin's disease. Some scientists inclined to viral diseases. They believe that the root cause of Hodgkin's lymphoma is the Epstein-Barr virus, triggers the development of cell changes and mutations at the gene level.
In addition, experts have identified several factors provoking pathology:
- Radiative forcing;
- Living in adverse environmental conditions;
- Working with or carcinogenic chemicals like pesticides, benzenes, herbicides, organic solvents, etc;
- The presence of a family history of the ancestors with abnormalities of the lymphatic system (confounding factors) th
On the occurrence of lymphoma often reflected dosage anticancer drugs used in chemotherapy, or hormone-based agents. Furthermore, affect the availability pathology may autoimmune diseases such as lupus, rheumatoid arthritis and other forms.
Contrary to popular assumption, the genetic factor has special significance in the formation of lymphomas. Although in the case if the lesion was detected in one of identical twins, it will be and the other twin.
Classification
WHO identifies several types of Hodgkin's lymphoma:
- Mixed-cell type. It occurs in 20 percent of cases of granuloma. Suffice aggressive form, but the outlook is still favorable;
- Nodular sclerosis. The most commonly diagnosed form of - 80 percent of patients who often are cured;
- Hodgkin's Lymphoma with a large number of lymphocytes, and a rare form of the disease;
- Nodular lymphoma. Another rare type of disease occurs most often in teenagers. Symptoms do not manifest themselves, has a very slow flow;
- Dystrophy lymphoid tissue. A very rare form, about 3 percent of cases. It is difficult to recognize, but also a poor prognosis.
Symptoms Hodgkin's lymphoma
The main symptom of Hodgkin - lymphadenopathy. The growth of lymph nodes occurs gradually and painlessly. When the increase becomes noticeable eye, the patient suddenly finds dense rounded painless education mostly in the neck or above the collarbone. May increase and lymph nodes located in other areas - axillary, inguinal.
Lymph nodes located in the abdominal and thoracic cavity, is determined not by eye but gives the symptoms caused by compression of internal organs - cough, shortness of breath, pain. The disease manifests itself common to all lymphomas symptoms - weakness, night sweats, periodic increase in temperature.
stage
Classify stage Hodgkin lymphoma in accordance severity and extent of the tumor lesion.
- At stage 1, in almost all cases, clinical symptoms are absent. The disease is usually detected by chance during examination for another reason. In one group of lymph nodes, or one nearby organ marked tumor growths.
- In step 2 Hodgkin's lymphoma tumor process extends over several lymph node groups above phrenic partitions detected granulomatous formation in nearby structures.
- Stage 3 is characterized by extensive formation of enlarged lymph nodes on both sides of phrenic septum (diaphragm) with the presence of multiple granulomatous inclusions in various tissues and internal authorities. Almost all patients diagnosed tumors in the spleen tissue and organ structure hepatic hematopoiesis.
- On stage 4 lymphoma marked the development of neoplastic processes in many structures, modifying and maintaining their functional activity. In more than half of patients in parallel there is an increase of lymph nodes.
The nature of the clinical symptoms of Hodgkin's lymphoma is very diverse, but for a long time no pathology can manifest itself that becomes part of the reason for late diagnosis.
Diagnostics
Diagnosis Hodgkin lymphoma conducted as follows:
- It is determined by the growth rate of the lymph nodes;
- establish "alcoholic" painful zones in the places of defeat;
- investigate the history of the presence of symptoms of intoxication;
- ENT doctor examines the nasopharynx, tonsils;
- excisional biopsy is carried out from the earliest appeared lymph node. It is removed completely from the condition of absence of mechanical damage;
- carefully palpated: all peripheral LU Group (submandibular and cervical-supraclavicular, subclavian and axillary, iliac and inguinal, popliteal, and femoral, ulnar and occipital), the liver and spleen.
Histological examination confirmed the diagnosis, since only in the presence of specific description Berezovsky-Reed-Sternberg cells and accompanying diagnosis is considered diagnostic cells final. According to the clinical picture, radiograph, presumably histological or cytological diagnosis of imprisonment without describing the cells would be considered controversial.
For histological studies do not take inguinal LN, if they are involved in other groups. The initial diagnosis is not determined only by a biopsy.
Therefore, a list of diagnostic procedures continues:
- by indications - bone scan;
- CT neck, chest, abdomen and pelvis;
- Bone x-rays (for complaints of pain patients and detect changes in the scintigram);
- biochemical blood analysis method for creatinine, bilirubin, urea, total protein, AST, ALT, LDH, alkaline phosphatase;
- study of blood type and Rh factor, total blood analysis, including the presence levels of red blood cells, platelets, hemoglobin, leucocyte formula, erythrocyte sedimentation rate;
- study the number of thyroid hormones, if struck by cervical lymph nodes and neck irradiation is planned;
- scintigraphy with gallium;
- Bone marrow biopsies performed trepanobiopsy wherein the wing of the ilium, because cytology finally confirms the diagnosis;
- Ultrasound peripheral LN: cervical, supraclavicular and subclavian, axillary, inguinal and femoral, abdominal and pelvis. At the same time examine the liver, spleen, para-aortic and iliac LUyu
If the finally determined Hodgkin's lymphoma, diagnosis is formulated specifying step B symptoms (if any), bulky disease zones extranodal involvement zones and spleen. The most significant risk factors that determine the prognosis of the disease are:
- A - the massive defeat of the mediastinum to the mediastinal-thoracic index (MTI) ≥ 0,33. MIT is determined with a ratio of the maximum width of the mediastinum and the chest (the thoracic vertebrae level 5-6 zone);
- B - extranodal involvement;
- C - ESR ≥ 50 mm / h in step A; SOE≥ 30 mm / h in step B;
- D - defeated three lymph areas and more.
Treatment of Hodgkin's lymphoma
Treatment depends on the type and stage of development of lymphoma. On the tactics of treatment and affect the overall health of the patient and concomitant disease.
The aim of therapeutic measures - in complete remission (disappearance of symptoms and signs of the disease). If a complete remission can not be achieved, the doctors say about partial remission. In this case, the swelling decreases and ceases to amaze new tissue.
Treatment of Hodgkin's lymphoma include:
- medical methods (immunotherapy and chemotherapy)
- radiotherapy (irradiation).
Sometimes use, and surgical methods of treatment. In the early stages of the disease Hodgkin lymphoma using chemotherapy and radiotherapy. In the later stages of applied chemotherapy, radiotherapy and immunotherapy.
- Chemotherapy for Hodgkin's lymphoma involves receiving special drugs that destroy cancer cells. Today, doctors prescribe tablets and intravenous injection. To increase the chances of recovery, use several different drugs. The combination preparation is a specialist, based on the individual patient.
- Radiation therapy to successfully destroy cancer cells in the lymph nodes or internal organs. Irradiation is subjected to all areas of the body, which presumably could spread cancer cells.
- Immunotherapy is designed to support the human immune system. At home, you can use the traditional treatments of cancer.
Forecast
Hodgkin's disease, which is most common from lymphomas, among the most favorable projected. In identifying Hodgkin's lymphoma in the first or second step, conducted clinical recovery after treatment occurs in 70% of patients.
The development of the disease reduces a favorable outcome. Stage 4 of the disease makes poor prognosis. However, as always in the prediction in medicine, we must not forget that we are talking about a unique personality in her body. Simple transfer of statistics may not be true when determining the outcome of the disease.
These are not measurable factors such as faith, hope, perseverance - have an impact on the resistance of the body and give its favorable results, increasing the effectiveness of the treatment.
prevention
Clear guidance on the prevention of the disease does not exist. It is recommended to protect yourself from viruses and HIV, exposure to carcinogens, as well as the time to detect and treat different types of herpes.
Hodgkin's disease - cancer of the lymphatic system. Fortunately, it has a very high cure rate - more than 90 percent in the second stage. This requires only a vigilant and pass an annual medical examination.
