Lymph gland cancer

introduction

Lymphatic cancer describes the degeneration of cells in lymph nodes and lymphatic tissues, such as in the lymphoid tissue in the intestine, spleen, or brain.
There are two types of lymph gland cancer: Hodgkin lymphoma and non-Hodgkin lymphoma, the latter being significantly more common (approx. 85% of lymph gland cancers). They are all noticeable through painless swelling of the lymph nodes and mostly also through the so-called B-symptoms, consisting of decreased performance, night sweats and unwanted weight loss. The diagnosis is confirmed by a tissue sample and with a combination of chemotherapy and radiation therapy the chances of recovery are quite good.

Synonyms

Lymph node cancer, (malignant) lymphoma, Hodgkin's disease, non-Hodgkin's lymphoma

English: lymph node cancer, lymph gland cancer, lymphoma

definition

Lymph gland cancer is a not so rare type of cancer, which is caused by the malignant degeneration of cells from the lymphatic system emerges and to the Group of lymphomas is counted. To the Lymphatic system belong to the Lymph nodesthat are scattered all over the body and connected to one another by lymphatic vessels that Pharynx (Tonsils), the Bone marrow, of the Thymus, the Spleen, as well as lymphatic tissue in the intestine (MALT), lungs (BALT) and brain.

Types of lymph gland cancer

Depending on the type of cell from which the malignant neoplasms originate, there are roughly two groups of lymph gland cancer:

• Hodgkin's lymphoma (also called Hodgkin's disease), which is named after its discoverer and in which so-called Hodgkin cells and Sternberg-Reed cells can be identified under the microscope
• The very heterogeneous group of non-Hodgkin lymphomas, which include Burkitt's lymphoma and Waldenström's disease.

In Hodgkin's disease, there is a further subdivision into four sub-forms, which differ in their histological (i.e. tissue-like) appearance and with regard to the prognosis: The most common (around 60% of cases) is the nodular-sclerosing type.
Non-Hodgkin's lymphomas represent a large group with over twenty different lymph gland cancers, which differ primarily in the cells of the cancer's origin.

Symptoms of lymph gland cancer

Lymph gland cancer is typical of painless, enlarged lymph nodes that cannot be linked to an infection. They can occur in different parts of the body and usually persist over a longer period of time. They are often palpable on the neck, in the armpits or in the groin. Enlarged lymph nodes in the neck area are the most common.

Read more here: Swollen lymph nodes

Chest lymphomas are often not noticed until an X-ray is taken. If the enlarged lymph nodes are close to the respiratory tract, irritable coughs and coughs can occur during exercise. Enlarged lymph nodes in the abdomen are less common and are noticeable by a fever.

Furthermore, a combination of three symptoms is classic for this disease. Doctors refer to this triad as B symptoms. It includes:

• Fever over 38 degrees Celsius
• Unintentional weight loss of over 10% of the initial weight in the last 6 months
• Night sweats

Fatigue and tiredness can also occur. Enlargement of the spleen is typical in later-stage lymphoma. In some cases, this can be felt below the left costal arch and the enlargement can cause pain. The patients also describe itching that can appear all over the body.

You can find more information on this here: Symptoms of lymph gland cancer

Symptoms of Hodgkin Lymphoma

The liver can also be enlarged in the course of the disease, especially in Hodgkin's lymphoma. This is noticeable by a pain in the right upper abdomen, which is triggered by the swelling of the organ.

Another, less common symptom that is characteristic of Hodgkin lymphoma is what is known as alcohol pain. The enlarged lymph nodes are painful when consuming only small amounts of alcohol.

Symptoms of Non-Hodgkin Lymphoma

If the disease is very advanced, non-Hodgkin lymphomas can affect the bone marrow. This is displaced so that the destruction of the bone marrow cells can lead to bleeding, increased infections or anemia.

In addition, masses can occur in the ear, nose and throat areas, on the skin, in the entire digestive tract and in the central nervous system. These are classified in the Ann-Arbor classification as an infestation of a region outside of the lymph node.

Multiple myeloma is a subtype of non-Hodgkin lymphoma. Here the bones are often attacked and become porous. This disease can be noticed with back pain and spontaneous fractures.

Symptoms in Children

Hodgkin's lymphoma is also a disease that can occur in childhood. In children, the symptoms are similar to those in adults.

Here, too, painless lymph node swellings and the B symptoms are represented. However, children with swollen lymph nodes and fever should not directly think of lymph gland cancer, as these symptoms are also typical of a simple infection. If the lymph node swelling or a dry cough persists over a longer period of time, a doctor should be examined.

causes

Concrete causes for the development of lymph gland cancer are still unknown. It is believed, however, that several factors must come together for a malignant lymphoma to develop.

Causes of Hodgkin's Lymphoma

In Hodgkin's disease, abnormal B cells develop, whose job is normally the production of antibodies. These cells belong to the group of lymphocytes and play an important role in the pathogen-specific immune defense of our body.

The problem with these abnormal cells is that, unlike healthy B cells, they do not simply perish at some point, but as multinucleated giant cells continue to produce abnormal, incompletely functional B cells. What causes the cells to degenerate in this way has not been finally clarified. However, influencing factors are:

• Various environmental influences
• Genetic parameters
• Disturbed immunological processes

Causes of Non-Hodgkin Lymphoma

In non-Hodgkin lymphoma, the degeneration can affect all subtypes of lymphocytes that are responsible for the defense against foreign organisms:

• B cells (as in Hodgkin's lymphoma)
• T cells
• Natural killer cells (NK cells)

In the case of this lymph gland cancer, too, the causes are ultimately unclear. However, the Eppstein-Barr virus (EBV), among others, is brought into connection. However, around 90% of all adults have antibodies against this virus in their blood and must therefore have come into contact with it in the course of their life.

However, only a small proportion of them actually develop lymph gland cancer and, conversely, there are also some patients without antibodies against EBV. It is therefore out of the question as the sole trigger.

You can also find more information here: Epstein-Barr Virus

Other viruses such as HIV, as well as genetic influences, autoimmune diseases (such as Sjögren's syndrome), chemical substances (e.g. insecticides) or bacterial infections (e.g. with the pathogen Helicobacter pylori are discussed as possible causes of the disease.

diagnosis

It is not uncommon for lymph gland cancer to be discovered by accident during a routine examination. The diagnosis begins with a detailed physical examination. A tissue sample (biopsy) is then taken from the swollen lymph node and examined microscopically.

Various imaging techniques can be used to more accurately estimate the spread of the cancer:

• Computed tomography (CT)
• Magnetic resonance tomography (MRI)
• Skeletal scintigraphy
• Positron Emission Tomography (PET)
• Ultrasonic

For example, it could be used to identify whether the bone marrow or liver is infected, or whether the cancer has already spread and metastases can be seen.

Read more about this under: Diagnosis of lymph gland cancer

Histological examination

With the help of the histological examination of the removed tissue, it is possible for the doctor in many cases to make an exact statement about the type and classification of the lymph gland cancer. Sternberg-Reed giant cells and Hodgkin cells, for example, are considered clear evidence of Hodgkin's disease. Liver and bone marrow are also tissues that can be used for biopsy.

Blood count

The blood count in Hodgkin lymphoma shows an absolute decrease in the number of lymphocytes, which are a subgroup of white blood cells. This reduction is only detectable in about a quarter of the patients in the early stages of the disease, and in almost all patients in the later stages.

In about a third of the patients, the eosinophilic granulocytes, which also belong to the white blood cells, are also increased. In addition, the sedimentation rate is increased, which is a non-specific inflammation parameter.

In non-Hodkin lymphomas, the main aim of the blood count is to see whether there have already been changes in the bone marrow, which can be seen in the number of blood cells. In addition, special biochemical methods in the blood can be used to find out which non-Hodgkin lymphoma is most likely.

Read more about the examination method here: Blood count

Ultrasonic

In lymph gland cancer, ultrasound is mainly used to examine the abdomen in order to look for enlarged lymph nodes along the large vessels. Lymph nodes in the areas of the neck, armpit and groin can also be examined using ultrasound, but there is no advantage here compared to the palpation examination.

therapy

Therapy of Hodgkin lymphoma

In Hodgkin's lymphoma, the therapy approach is always to cure the disease and eliminate the tumor cells within three months. The therapy is always based on chemotherapy and radiation.

Find out more here: Conducting chemotherapy

In stages I and II, two cycles of chemotherapy with four substances (ABVD scheme) are carried out simultaneously with local radiation of the lymph nodes. If certain risk factors are present, two cycles of another combination of 6 chemotherapeutic agents (BEACOPP scheme) are given in addition to radiation, followed by two cycles of the ABVD scheme.

If there is a large tumor in the chest area or a stage III or IV according to Ann-Arbor, treatment is first carried out with 6 cycles of the BEACOPP scheme before the irradiation and then the remaining tumor tissue is irradiated. However, the BEACOPP regimen should not be used in patients over sixty years of age.

You might also be interested in: Chemotherapy side effects

Therapy of non-Hodgkin lymphoma

In the group of non-Hodgkin lymphomas, a distinction is made between high and low-grade types, i.e. according to how malignant the respective sub-form of the lymph gland cancer is.

A low-grade non-Hodgkin lymphoma in stage I and II is only irradiated and can thus be cured. In stages III and IV of the low-grade malignancies, it can be assumed that the lymph gland cancer is spread throughout the body, so that the goal of therapy is only to alleviate the symptoms and improve the quality of life. This is either managed by actively monitoring the cancer or chemotherapy can be given. This is often not very effective because the low-grade forms only divide slowly and are therefore not a good target for chemotherapy.

The highly malignant non-Hodgkin lymphomas are treated in all stages with chemotherapy made from four different substances (CHOP scheme). The therapeutic goal here is always a cure.

Some special subtypes of lymph gland cancer are treated again with other therapy regimes, such as primary cerebral lymphoma, chronic lymphatic leukemia and multiple myeloma.

More information can be found here: Lymphatic cancer therapy

forecast

Prognosis of Hodgkin lymphoma

The prognosis for Hodgkin's lymphoma is very good. After five years, 80 to 90% of all patients are still alive without the disease having returned. In children, this rate is even higher, with over 90% disease-free surviving patients at five years.

Two thirds of the recurrences occur in the first year after completion of therapy, over 99% within the first five years. This means that structured follow-up care in the first five years after therapy is very important in order to detect a recurrence of the disease at an early stage.

However, the risk of a second cancer is increased by therapy with multiple chemotherapeutic agents and radiation. About 10-20% of patients get a second tumor in their lifetime, often 30 years later. Typical secondary tumors are:

• Breast cancer
• Thyroid cancer
• Acute myeloid leukemia

The presence of B symptoms indicates a worse prognosis.

Prognosis of non-Hodgkin lymphoma

The prognosis for non-Hodgkin lymphomas cannot be determined universally for all subtypes of this group. It depends largely on the behavior of the individual species. In the following, the prognoses for some common non-Hodgkin lymphomas are given.

1. Diffuse large-cell B non-Hodgkin lymphoma has a 5-year survival rate of 60% to 90% depending on the genetic characteristics. Have a negative impact on the prognosis:

• High age
• Bad general condition
• Ann-Arbor stages III and IV
• Involvement outside the lymph nodes

2. Follicular lymphoma has a median survival rate of approximately 10 years at the time of diagnosis.

3. Mantle cell lymphoma has an even poorer prognosis with a median survival time of around 5 years.

4. The prognosis of multiple myeloma depends on many factors. In the best case in young patients with optimal therapy, the survival rate after 10 years is 50%.

5. Burkitt's lymphoma leads to death within months if diagnosed late and if treatment is inadequate. If it is recognized and treated at an early stage, the chance of survival for the next 10 years is around 90%. If several organs are already affected when the diagnosis is made, this chance of survival drops to below 50%. Unfortunately, with Burkitt's lymphoma, secondary tumors often occur, which also has a negative effect on the prognosis.

6. Mycosis fungoides shows a good prognosis only in a very early stage due to its very slow growth. If the tumor shows a cross-border growth, the prognosis is very poor.

7. Sézary syndrome can show a favorable course over the years. But if a certain stage is exceeded, deterioration occurs very quickly, often with fatal outcome.

Stages

The stages in lymphatic cancer are based on the Ann-Arbor classification in 4 stages.

If only lymph nodes are affected, stages I-III are given the addition N. If other regions outside the lymph nodes are affected, the addition E (for extranodal) is added to the stage. In addition, the presence of B symptoms can be indicated with a B, while the absence of these symptoms is indicated with an A.

Stage I.

There is an affliction of a lymph node region or an affection of a neighboring region outside the lymph nodes (extranodal affection). In this case, the spleen would also be part of a lymph node region, as it is one of the organs of the immune system, just like the lymph nodes.For example, neighboring regions can be the chest wall, the pericardium or the lungs.

An extranodal infestation is caused by a migration of the lymph gland cancer to neighboring structures. It is important to distinguish whether the region outside the lymph nodes is affected due to proximity to the lymph nodes, or whether it is spread over longer distances. In the second case one would automatically speak of stage IV.

Stage II

In stage II, two or more lymph node regions or neighboring regions outside the lymph nodes are involved. These are collectively located either above or below the diaphragm. In stage II, for example, lymph nodes in the armpit and neck or in the groin and abdomen are affected.

Stage III

Stage III also involves two or more lymph node regions or other neighboring regions outside of the lymph nodes. Here the infected foci are located above AND below the diaphragm.

Stage IV

In the fourth stage, regardless of the lymph nodes, at least one organ that does not belong to the immune system is affected by lymph gland cancer. This means that, for example, if the liver is affected alone, it immediately leads to stage IV, regardless of whether the lymph nodes are also abnormal or not.

Chances of recovery

Chances of recovery from Hodgkin lymphoma

In Hodgkin's lymphoma, curative therapy is carried out in all stages, which means that the goal of therapy is to cure the disease in all stages. Thus the chances of recovery in this subgroup are also good.

Should the lymph gland cancer recur after the therapy has been completed (relapse), the chances of recovery change. These recurrences often occur within the first five years after completing initial treatment.

• In the event of a relapse within the first three months, the chance of recovery is only approx. 20%
• In the event of a relapse after the first three months, the chance of recovery is around 30%
• With even later recurrences, the chance of recovery is even around 50%

It can therefore be summarized that a relapse has a higher chance of recovery if it occurs late.

Chances of recovery from non-Hodgkin lymphoma

In the group of non-Hodgkin lymphomas the picture is somewhat more heterogeneous. A distinction must be made here whether the type of lymph gland cancer is highly malignant, i.e. rapidly growing, or a slowly growing, low-malignant subspecies.

The low-grade subspecies can only be cured in the early stages. Because the growth rate is very slow, chemotherapy is not as effective. In the later stages of the low-grade subgroup, there is hardly any chance of recovery and it is not seen as a therapeutic goal. However, a service life of decades can be achieved using modern therapy concepts.

The highly malignant non-Hodgkin lymphomas grow much faster than their counterparts and are therefore easily treatable with chemotherapy. A cure can be assumed here in the early stages. In the late stages, the chances of recovery are around 60%.

More information can be found here: Chances of recovery from lymphatic cancer

frequency

Lymph gland cancer is one of the 10 most common cancers in Germany and he can in principle in any age occur. Hodgkin's disease has two so-called age peaks: on the one hand, it is very common in especially young men in between 20-30 years and on the other hand in adults aged 50-60 years preferred before. Non-Hodgkin lymphomas mainly occur between the ages of 40 and 70. In Germany around 2000 people develop Hodgkin's and around 13,000 non-Hodgkin's lymphoma each year. Overall, women are affected somewhat more often than men and there is a certain territorial accumulation of cases.

history

British doctor and pathologist Thomas Hodgkin (* 1798) examined various diseases of the lymphatic system, including the Lymph gland cancer. Of the Hodgkin's disease (also: lymphogranulomatosis) was first described by him in 1832 and therefore named after him. The summary of everyone else malignant lymphoma to the group of non-Hodgkin lymphomas also dates from this period.