Non-Hodgkin's lymphomas

The group of non-Hodgkin's lymphomas (NHL) includes all malignant diseases of the lymphatic system, with the exception of Hodgkin's lymphomas. These heterogeneous diseases can differ greatly in microscopic structure (histological structure) and course.

Indolent non-Hodgkin's lymphomas - These are chronic diseases that are successfully stopped by treatment, but, as a rule, are not cured. Separately listed diseases in earlier nomenclatures, such as Waldenström's disease, fungoid granuloma and Cesari's syndrome, are now components of indolent (low-grade) NHL in the WHO classification and are further mentioned separately only if their treatment deviates from the main principles of treatment.

Indolent non-Hodgkin's lymphomas include but are not limited to:

• Chronic lymphatic leukemia (CLL)
• Hairy cell leukemia
• Multiple myeloma (often also called plasmacytoma)
• Lymphomas formed by cells of the germinal center (follicular lymphomas)
• Lymphomas of the stomach (MALT-lymphoma) and
• Skin lymphomas (cutaneous T-cell lymphoma)
• Chronic lymphatic leukemia (despite the word "leukemia" in its name) refers to low-grade, leukemic lymphomas based on recent molecular biology studies.

Aggressive non-Hodgkin's lymphomas are rapidly developing diseases in which it is necessary to achieve a cure already during the initial, often intensive treatment, otherwise the prognosis is unfavorable.

Aggressive types of lymphomas include:

• Large B-cell lymphoma, in one third of all cases of the most common malignant lymphomas, and
• Burkitt's lymphoma

Symptoms

The first symptom of non-Hodgkin's lymphoma (NHL) is almost always a painless enlargement of the lymph nodes. Lymph nodes enlarge as a result of multiplication of lymphocytes or accumulation of cells alien to the lymph nodes (usually malignant).

One of the properties of lymphomas is that when they are present, specific symptoms are not observed, and only minor symptoms are sometimes observed, which manifests itself against a background of less severe diseases. These symptoms include fatigue, loss of appetite, nausea or heartburn, and increased susceptibility to infections. General symptoms (so-called "B-symptoms"), i.e. an increase in body temperature, increased night sweats, or weight loss are found in about 20 % cases, i.e. much less often than in patients with Hodgkin's lymphomas.

In addition, in follicular and small cell lymphomas, and in rare cases in aggressive lymphomas, clinical symptoms appear, caused, for example, by infiltration of the bone marrow (if it is damaged) followed by anemia (“anemia”, impaired oxygen transport in the blood) or thrombocytopenia ( decrease in the number of platelets). Bone marrow infiltration occurs in about 40-60 % cases. Infiltration (lesion) of the skin in NHL occurs much more often than in Hodgkin's lymphoma (but in general, rarely), and damage to the liver and spleen is also more common.

Diagnostics

If malignant lymphoma is suspected, tests are done to confirm the diagnosis. If the presence of non-Hodgkin's lymphoma is confirmed, its type and extent of prevalence are determined.

Important research methods for the detection of non-Hodgkin's lymphoma are:

• Physical examination
• Blood tests
• Collection of lymph node tissue (biopsy)
• Bone Marrow Research
• Ultrasound examination of the abdominal cavity (sonography)
• Computed tomography (CT) or magnetic resonance imaging (MRI)

The decisive moment in confirming the diagnosis is a microscopic (histological) examination of the affected lymph node or affected tissues. It allows you to accurately determine the presence or absence of lymphoma in a patient, as well as a specific type of lymphoma. Under certain circumstances, it may also be necessary to examine the cerebrospinal fluid (CSF), a liver puncture, surgical intervention in the abdominal cavity (laparoscopy) or ossetoscintigraphy. Using modern methods of laboratory research, the type of lymphoma is determined. This makes it possible to predict malignancy, as well as the further course of the disease (response to therapy, risk of relapse). In addition, the type of lymphoma has a decisive influence on the choice of treatment.