Malignant Lymphoma

What Is Lymphoma?

The term lymphoma refers to an enlargement or swelling of lymph nodes and can be both benign and malignant. Malignant lymphomas are based on a strong increase in pathologically altered lymphocytes. These can be B or T lymphocytes or their precursor stages.

Lymphomas are divided into two groups: Hodgkin's and non-Hodgkin's lymphomas. Approximately 13 out of every 100,000 people in Germany develop lymphoma every year. Both younger (10-20 years) and older people (over 60 years) are affected.

The Causes of Malignant Lymphomas

In Hodgkin's lymphoma, a degenerated B-lymphocyte proliferates in a lymph node area. Non-Hodgkin's lymphoma can develop from B-lymphocytes, T-lymphocytes, and their predecessor stages. Lymphoma can occur in the lymph nodes, bone marrow and blood (leukemia).

The causes of Hodgkin's lymphoma are unknown, HIV and EBV infections can increase the risk, as can immunosuppressive therapies and toxic substances such as wood preservatives.

Non-Hodgkin's lymphomas are caused by certain genes being in the wrong place, e.g., on the wrong chromosome. This can be caused by congenital and acquired immune defects, immunosuppressants, and radiation, as well as radioactive substances. Infections with the HTLV, HIV, EBV, and Helicobacter pylori viruses, and toxic substances can also cause non-Hodgkin lymphoma. People suffering from AIDS have a 1000-fold increased risk.

Which Symptoms Are Caused by Lymphomas?

Hodgkin's lymphoma manifests itself particularly through enlarged lymph nodes in the head, neck, and chest area. Later, the malignant cells can spread throughout the lymphatic system and then also in the blood system. The lymphomas prevent the formation of healthy defense cells, which can lead to a weakened immune system, especially with regard to tuberculosis, fungal diseases, and viral diseases.

Typical is also the B-symptomatic:

• Fever,
• Night sweat
• Weight loss.

This can be accompanied by itching, neurological failures, and hormonal imbalances. In rare cases, alcohol consumption leads to painful lymph nodes. Basically, the lymph nodes are painless and clumped, in contrast to painful and movable lymph nodes in inflammatory processes.

Non-Hodgkin's lymphoma also leads to an enlargement of the spleen (breakdown of broken blood cells) and an increased bleeding tendency (suppression of other blood formations by too many lymphocytes in the bone marrow).

Diagnosis of Malignant Lymphomas

The first indications arise from the patient interview and the subsequent physical examination. In the blood count, the hematologist-oncologist (specialist for internal medicine with special training in blood diseases and cancer) can detect various specific changes. The diagnosis is confirmed by the removal and examination of lymph node tissue.

If non-Hodgkin's lymphoma is suspected, an additional genetic analysis is carried out. After diagnosis, the whole body is scanned for lymphomas. For this purpose, an ultrasound of the abdomen, x-rays of the breast, a computer tomography of the neck, breast and abdomen, and a bone marrow examination are carried out.

Treatment of Lymphomas

Lymphomas are generally treated with chemotherapy and radiotherapy. If there is still a desire to have children, sperm preservation can be considered before the treatment begins.

Depending on the spread of the lymphoma, certain chemotherapy regimens are available. The hematologist-oncologist administers various chemotherapeutic agents at certain intervals and in certain sequences. In the case of minor infestation, it might be abstained from radiotherapy after a certain period in order to minimize late damage.

According to the many different subtypes of non-Hodgkin's lymphoma, there are different treatment regimens, but these also include chemotherapy and radiation, and in certain cases stem cell therapy (bone marrow transplantation).

Healing Chances and Life Expectancy in Malignant Lymphoma

10% of the treated Hodgkin patients do not respond to their therapy. It comes to early relapses (recurrence of lymphoma within one year) in 15% of the cases, and to late relapses (recurrence after more than one year) in 15%.

The first two variants are associated with a significantly worse prognosis and require intensive follow-up therapy (high-dose chemotherapy and stem cell transplantation). The chances of recovery for a late relapse are 50%, for an early relapse between 20 and 30%.

Therefore, regular and detailed follow-up examinations by a hematologist-oncologist are extremely important. In particular, since even the strong chemotherapy and radiotherapy over time can be the cause of further lymphomas. Therefore, precise, patient-specific treatment is of great significance in order to administer as much as necessary, but as little as possible of potentially harmful radiation and chemotherapy. The different groups of non-Hodgkin lymphomas have different prognoses ranging from poor to very good.

Sources:

• www.lymphome.de/InfoLymphome/index.jsp
• www.krebsinformationsdienst.de/tumorarten/lymphome/
• Herold, Gerd: Innere Medizin. Köln, Eigenverlag 2012.
• Arasteh, K. ; Baenkler, H.-W. ; Bieber, C. ; et al.: Innere Medizin. Stuttgart, Georg Thieme Verlag KG 2009.