Lymphoma (Lymph Cancer)
Lymph cancer, the incidence of which increases with age, is a disease that affects men and women equally. Lymphoma can manifest itself with different symptoms. Among the symptoms of lymphoma; Influenza that does not go away for a long time, dry cough reminiscent of asthma, swelling of one of the tonsils are the points that must be taken into account. Despite the increasing risk factors and the increase in the incidence of the disease in recent years, very successful results have been obtained in the treatment of lymphoma. Lymphoma is a type of cancer that responds well to drugs and a marrow transplant. With today's treatments, success rates can reach over 90 percent in some lymphoma subtypes. In cases where there is no response to treatment, in addition to special drugs that target only cancer cells, which are called "smart drugs"; stem cell transplantation is also among the important options for the control of lymphoma disease.
What is Lymph Cancer (Lymphoma)?
Blood cancers is an expression used synonymously with all cancers that originate from the bone marrow, where blood is produced, or that originate from the blood. Lymphoma accounts for 50 percent of blood cancers. lymphoma; It is divided into two as Hodgkin Lymphoma and Non Hodgkin Lymphoma. Non Hodgkin lymphomas are seen approximately 8 times more than the other.
Two important types of lymphoma cancer also have subtypes. Non Hodgkin lymphoma has at least 40-50 subtypes. There are 6-8 subtypes of Hodgkin lymphoma. All of these have different clinical course, response to treatment, and drugs used in their treatment. For this reason, after the diagnosis of lymphoma is made, it is necessary to accurately determine the subtype of the disease. Accordingly, the search for the best hospital in the treatment of lymphoma becomes very important. Hospitals with oncology centers with experienced and expert staff should be preferred.
What causes lymphoma?
Although there is no clear answer to the question "What causes lymphoma?" , certain risk factors can be mentioned. As in all types of cancer, the use of cigarettes and other tobacco products is shown as one of the most important causes. In addition, exposure to chemicals such as benzene and pesticides can be said to be the cause of lymph cancer. In addition, the disease may be encountered more frequently in rheumatic diseases and immunodeficiency cases. Some viral infections that significantly affect the immune system are also an important cause of lymphoma . For example, lymphoma can be seen due to some infectious diseases such as hepatitis C, HTLV 1, HIV, AIDS.
Daily environmental factors lymphoma causes not very prominent in the rankings. However, lymphoma is a little more common in agricultural workers, especially those engaged in greenhouse cultivation. It is necessary to know that factors such as uncontrolled spraying, walking around the sprayed greenhouses without wearing masks and clothes, and inhaling the sprayed air in the greenhouse are effective. Otherwise, it should not be thought that the pesticide on the vegetables that come to the house is a factor. Those working in paint producing industries also bear the same risk if the necessary precautions are not taken. Besides; It is not possible to show household chemicals such as bleach, detergent, deodorants or mobile phones as a reason with the current information. Anyone who leads an active life without gaining weight has an advantage against many diseases. However, there is no information that obesity has a direct effect on lymphoma. It should not be forgotten that being overweight is a risk factor for all types of cancer.
Lymph Cancer (Lymphoma) Symptoms
The first thing that comes to mind when it comes to the symptom of lymphoma is that the patient has noticed a mass growing in his body. This mass can pressurize some areas. Lymph cancer manifests itself as a clinical symptom with the pathological enlargement of the glands called “lymph glands”. Because the place where the tumor mass grows is predominantly the lymph nodes. For this reason, most of the patients come to the hospital, realizing that the lymph nodes are enlarged in the neck, armpit and groin areas. One of the symptoms of lymphoma is that the patient's immune system does not work adequately, so that he may show flu-like symptoms. Influenza is a disease that is expected to recover within a week from its onset. In addition, the time may be longer when sinusitis and lung infections occur.
Types of lymph cancer (lymphoma)
Significant advances have been made in hematological cancers in recent years. These developments include a better understanding of the biological characteristics of blood cancers, advances in diagnosis and success in treatment. Many drugs used in the treatment of many diseases in hematology have shown their effectiveness in new clinical studies, among which drugs with a very interesting mode of action and targeting cancer cells have come to the fore.
The most common cancers in hematology are lymphomas, which are lymph node cancers. We divide these diseases into two large groups as Hodgkin lymphoma and non-Hodgkin lymphoma (English: Non-Hodgkin lymphoma). Non-Hodgkin's lymphomas constitute a basket in which a large number of diseases with different biology and processes are collected, the treatments of which are completely differentiated today.
Hodgkin Lymphoma
Hodgkin Lymphoma is manifested by enlarged lymph nodes. Hodgkin lymphoma symptoms in some patients ; It is seen as weight loss, night sweats, recurrent fever. Computed tomography and bone marrow biopsy are usually required to determine the stage of the disease.
Hodgkin lymphoma is one of the cancer types with high treatment success today. At each stage, treatment is carried out by targeting the complete eradication of the disease. Hodgkin lymphoma in the worldThere are some groups that work to record advances in the treatment of the disease and carry out large-scale studies, one of which is the German Hodgkin Lymphoma Study Group (GHSG). Factors called risk factors are important in the patient-specific treatment of the disease. In patients with early stage and no bad risk factors, a short-term ABVD chemotherapy and radiation therapy is sufficient. However, if the disease is advanced, a much more effective treatment (escalated BEACOPP protocol) may be required to completely eradicate the disease and prevent its recurrence. If it has relapsed, high-dose chemotherapy and autologous stem cell transplantation are often the best treatment option for complete eradication of the disease.
Non Hodgkin Lymphoma
Non-Hodgkin lymphomas are divided into 3 large groups: Indoline (slowly progressive) lymphomas, aggressive (rapidly progressive) and very aggressive (very rapidly progressive) lymphomas. The course of these diseases and their treatment vary greatly .. Non-Hodgkin lymphomas are also divided into 2 groups in terms of immunological cell type: B-cell and T-cell lymphomas. Generally, T-cell lymphomas have a worse prognosis than B-cell lymphomas. Therefore, more intensive and effective treatment methods are chosen in the modern treatment of T-cell lymphomas. While the chemotherapy protocol named CHOP was given to most of the Non Hodgkin lymphomas in the past, today more effective treatments specific to the disease, varying according to the subgroup of the disease, are applied. It is even possible to treat some types of lymphoma with antibiotic agents without the use of chemotherapy. For example, some types and stages of lymphomas that occur in the stomach or eyes can be completely eliminated with antibiotic treatment. In order to choose the most appropriate treatment to be offered to the patient, the subgroup of lymphoma, The stage and prognostic factors should be known exactly. Choosing a fully equipped oncology center is very important in this sense.
The Most Common Types of Non-Hodgkin Lymphomas
Slowly progressive lymphomas
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Follicular lymphoma
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Chronic lymphocytic leukemia
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Immunocytoma
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Rapidly progressive lymphomas
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Diffuse large B-cell lymphoma
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The majority of T lymphomas
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Mantle cell lymphoma
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Very rapidly progressive lymphomas
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Burkitt lymphoma
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Lymphoblastic B lymphoma
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Lymphoblastic T lymphoma
Slowly Progressing (indolen) Lymphomas
The disease is usually diagnosed in stage III or IV. If the disease is diagnosed in stage I or II, treatment is done with the aim of eliminating the disease with radiation therapy. In advanced stages, chemotherapy is applied in certain cases, if it is not necessary, the patient is followed without treatment (in English "wait and see"), because in these cases, starting treatment before necessary does not provide an advantage to the patient. In B-cell indolene lymphomas, a drug called Rituximab, which targets the CD20 molecule on B-lymphoma cells, increases the effect of chemotherapy and significantly affects response rates and response times.
Rapidly Progressive (aggressive) Lymphomas
Diffuse large B-cell lymphomas constitute a significant portion of aggressive lymphomas. Treatment is applied to completely eradicate the disease and consists of Rituximab and CHOP chemotherapy. In aggressive T-cell lymphomas, the addition of Etoposide to the CHOP protocol (CHOEP protocol) increases the success rate, as demonstrated by German and Scandinavian studies. Since the prognosis for most aggressive T-cell lymphomas is poor, high-dose chemotherapy and autologous stem cell transplantation after 6 cycles of chemotherapy play an important role in the permanent control of the disease. Mantle cell lymphomas, on the other hand, are an aggressive lymphoma equivalent, in which significant progress has been made in recent years. In young patients, drug therapy is prescribed first. In young patients, stem cells are collected from the patient after this treatment, high-dose treatment and stem cell transplantation give the best results. In elderly patients, maintenance therapy after chemotherapy prolongs life expectancy.
Very Rapidly Progressing Lymphomas
Another group is very aggressive lymphomas. The most important are Burkitt lymphoma and lymphoblastic lymphomas. These types of lymphoma are mostly seen in younger patients. Burkitt lymphoma is the fastest growing cancer in humans. The goal of treatment in these diseases is to eradicate the disease. However, this goal cannot be achieved with simple treatments. The disease can be permanently eliminated with chemotherapies consisting of many drugs and reminiscent of leukemia treatment.
Diagnosis and Treatment for Lymphoma
Lymphoma treatment begins with the diagnosis of lymphoma . For this, a biopsy must be taken first. Lymphoma can be diagnosed by looking at these cells under the microscope. However, this morphological evaluation is not sufficient to subtype the disease. Different tests are required to make a correct diagnosis. In addition, there are special tests that determine which type of lymphoma it is with special staining techniques.
Genetic Tests for the Treatment of Lymphoma
By analyzing the genetic structures of the cells determined to be lymphoma, the subtype is correctly identified. This result indicates that the treatment of lymphomaextremely important to its success. After the definitive diagnosis is made, it should be investigated whether the disease has spread to the body. For this, PET-CT is most often used. With this examination, it is shown in which part of the body the lymphoma is involved.
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For the treatment of lymphoma, patients can apply to the doctor at very different stages. In general, lymphoma is divided into 4 stages according to the prevalence. Stages of lymphoma are called stages 1 and 2 early, and stages 3 and 4 are more advanced. After the definitive diagnosis of lymph cancer is made, a special evaluation is made and the stage is determined. In other words, it is possible to see to what extent the patient can respond to which treatment with this scoring technique. A number of factors such as the patient's age, the level of the value called LDH in the blood, whether the disease is in an advanced stage, whether there is involvement in any place other than the lymph node, are brought together and scored. Accordingly, patients fall into the low or high risk group. If the patient has a high risk profile, the standardless likely to benefit from lymphoma treatments . Therefore, these patient groups may have to receive more severe treatments. If the risk profile is low, more standard treatments are preferred.
Chemotherapy in the Treatment of Lymphoma
Chemotherapy has an important place in the treatment of lymphoma . How and in what way chemotherapy is administered differs according to the condition of the disease. In addition to standard medicine methods that can be applied on an outpatient basis; High-dose chemotherapy is applied for inpatient follow-up in fast-progress and high-risk patients . In the treatment of lymphoma , chemotherapy intervals are usually 3-4 weeks, and a definite result is expected after 6 cycles of treatment. During this period, the response received through interim evaluations is also observed. These follow-ups are made after the second or third cycle.
Chemotherapy is one of the most used treatment methods in blood cancers, especially in the treatment of lymphoma . Different drug combinations are used according to each disease. The severity of the drugs also increases when the standards are exceeded and high doses are applied. Since these drugs are also harmful to healthy cells, which appear in many classical chemotherapy; After the treatment, problems may be experienced due to hair loss, disorders in the gastrointestinal tract, wounds in the mouth, loss of appetite, weight loss, weakness, and serious infections intervening. Since complications that may occur in this type of treatment can be foreseen in advance, necessary precautions are taken to ensure that the patient gets through the treatment period in the most risk-free way . In the treatment of lymphomaIn addition to chemotherapy, sometimes radiation therapy, that is, radiotherapy, is also used as a support. In cases where the disease is widespread, radiotherapy can be used to relieve the pressure in any area, even if it is not for treatment, in order to eliminate the pressure that the lymphatics may cause in any area.
Immunotherapy Increases Lymphoma Treatment Success!
In the treatment of lymph cancer, one of the treatments that is frequently applied or applied together, apart from chemotherapy, is immunotherapy. A number of drugs called “monoclonal antibodies” developed for cancer cells are frequently used in treatment. The peculiarity of these drugs is that they adhere to lymphoma cells and then activate the immune system and destroy it through it. In the treatment of lymphoma, there are "monoclonal antibody" treatments that are applied together with chemotherapy and differ according to the type of each lymphoma. Such treatments increase the chances of success.
Lymphoma Drugs
There are treatments applied in lymphoma for the last 10-20 years, but their acceleration and awareness have been increasing in the last 10 years. Targeted therapies are not limited to “monoclonal antibodies” today. A number of other drugs and molecules that are not monoclonal antibodies have also been developed. These are called “targeted” or “smart drugs”. Targeted molecules thanks to smart drugs; It disrupts a number of mechanisms that are present in cancerous cells and not found in healthy cells. For this reason, when drugs are given to the patient, the cancer cell is affected very intensely and the healthy cells are minimally affected. The side effects of drugs used in targeted therapies are never the same as those of conventional chemotherapy drugs. Almost all patients suffer from hair loss, nausea, vomiting, does not experience problems such as loss of appetite. Side effects that are mild and can be easily controlled are also tolerated by the patients.
Most Effective Treatment Option in Lymphoma: Bone Marrow Transplant
Bone marrow or stem cell transplantation is frequently used in the treatment of lymphoma. There are two types of bone marrow and they are; It enables transplants made from the stem cell of the person called autologous and allogeneic, that is, using the stem cell of another person. The purposes of the two are different from each other. In general, the main purpose of bone marrow or stem cell transplantation is; Bone marrow or stem cell transplantation is not the initial treatment. As soon as the patient is diagnosed, bone marrow transplantation cannot be performed for the treatment of lymphoma . In the treatment of lymphomaFirst of all, it is aimed to destroy or suppress the disease with chemotherapy, immunotherapy and radiotherapy, then transplantation method is applied when deemed necessary according to the response received. In some diseases, even if standard treatment is given at the initial level and success is achieved in this, the disease will most likely recur after a while. In such patients, stem cell transplantation is performed to minimize the risk of recurrence.
Lymph Cancer Lymphoma Treatment: Autologous Stem Cell Transplantation
Even if the disease is eliminated with a standard treatment, cancer cells at an invisible microscopic level are left behind and these need to be destroyed with very high doses of chemotherapy. Due to this treatment, the bone marrow, which makes blood cells, is also affected. For this reason, before the lymphoma treatment, the patient's own stem cells are taken by various methods and stored by freezing after special processes. Then the patient received very high-dose chemotherapy is applied. After the treatment is finished, the patient's own bone marrow cells, which were previously stored, are transplanted to the patient. These cells settle in the bone marrow and begin to multiply there to produce blood. In other words, bypass is done and those cells are saved. However, autologous transplantation may not always be possible. Since their own bone marrow cannot be taken from patients with bone marrow involvement, first of all, their siblings or parents, who have a 25% chance of adaptation, are referred to the bone marrow bank, if necessary.
Good morale is very important during the treatment
Having a positive perspective of the patient and believing that he will recover is also important for the morale doctor, as it will help the treatment of lymphoma . Although morale alone is not effective in defeating lymphoma, it provides the patient's compliance with the treatment process. The more the patient adheres to the treatment of lymphoma and the more he believes that he will recover and survive, the chance of success naturally increases.
FREQUENTLY ASKED QUESTIONS ABOUT LYMPHOMA
Are Weight Loss and Night Sweats a Sign of Lymph Cancer?
Swelling of lymph nodes, which is one of the symptoms of lymphoma, can also be seen in the rib cage or abdominal cavity. It may not be directly noticeable how much the mass here has grown. However, the pressure created by this may cause complaints in the patient. Enlarged lymph in the rib cage can cause chest pain, dry cough, and shortness of breath. A mass growing in the abdomen negatively affects the functioning of the stomach and intestinal system. Abdominal pain, diarrhea, constipation and digestive disorders are also symptoms of lymphoma. Some patients may also have complaints related to the systemic effects of cancer, such as fever, weight loss, night sweats. If lymphoma is suspected clinically when the patient presents with these symptoms, he or she is examined for the presence of an enlarging and detectable mass. It should be checked whether there is any mass or lesion in the patient's body with imaging methods. However, lymphoma does not occur only with enlargement of lymph nodes. It can also affect the liver, spleen, gastrointestinal tract and lungs. Organ involvement may occur. Bone marrow may also be involved by these diseases. Because every tissue in the body has the potential to be affected by lymphoma.
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Symptoms of lymphoma; It can also occur in the form of allergic cough, asthma attacks and sinusitis. Because none of the signs and symptoms in lymphoma are specific to the disease. Many other diseases can have the same symptoms. Sometimes the symptom of lymph cancer can show itself similar to rheumatic diseases. The patient may apply to the hospital with rheumatic disease complaints and the situation may arise with the researches. In short, lymphoma can mimic any disease. Therefore, the symptoms of lymphoma should be considered.
One of the symptoms of lymph cancer is the enlargement of one of the tonsils rather than swelling of both. Risk of an asymmetrical growth becoming lymphomais higher. The tonsil is actually a lymphoid tissue. Like the lymph node, it is the lymphoid tissue located in the throat, inside the mouth, and is an organ of this system. There it can hold that area and lead to growth. Since the enlargement of the tonsils suggests an infection, the patient is given infection treatment. If there is no improvement despite the use of the drug in the expected period, for example 10 days, then other underlying causes should be investigated.
Can a Patient's Body Reject Someone Else's Stem Cells?
Transplantation of allogeneic stem cells, on the other hand, has some advantages and disadvantages. Although the basic philosophy seems to be the same according to autologous transplantation, even if the tissue compatibility is complete when the cells of a foreign person are transplanted, it can damage the patient's own tissues and organs due to undetected tissue incompatibilities. The transplanted donor-derived defense cells may perceive the patient's tissues as foreign and damage their organs. This can threaten the life of the patient. In order to prevent this, it is necessary to use drugs that suppress the immune system for a long time. Patients also have to deal with the side effects of these drugs. The good thing about bone marrow cells taken from someone else is that those lymphoid cells can also detect cancer cells in the patient and destroy them. For this reason, in allogeneic transplantations, some fine adjustments are made with those cells and drugs, and it is tried to ensure that the transplanted cells destroy the cancer cells of the patient, but also to prevent the harmful effects of the patient as much as possible. Maintaining this balance well reduces the chance of recurrence of the disease with a very successful allogeneic transplant.
What is the Lifespan of a patient with Lymphoma?
The clinical course of lymphomas is divided into two as fast and slow. Rapid-progressing lymphomas occur in a very short time. The mass may grow in a very short time and may manifest itself within months or even weeks. In slow-progressing ones, the growth rate of the mass is quite slow. It can encompass a process that can take months or even years. Lymphoma life expectancyis also variable. If rapidly progressing lymphomas are not treated, the patient may die within months or weeks. In slow-progressed ones, even if there is no treatment, the patient can live for a long time, even 15-20 years. For this reason, the treatment approach applied to the patient in two different lymphoma groups is also different. Since a life with rapidly progressing lymphomas will not be possible, the goal must be to eradicate the disease and complete recovery. For those with slow progression, regular follow-up is often sufficient.
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