Definition – What is non-Hodgkin’s lymphoma
Non-Hodgkin’s lymphomas comprise a large group of different malignant diseases that have in common that they originate from lymphocytes. Lymphocytes belong to the white blood cells that are essential for the immune system. Colloquially, non-Hodgkin’s lymphomas and Hodgkin’s lymphoma are summarized under lymph node cancer. The division into these two groups is historically justified, but is still used today. The different non-Hodgkin lymphomas differ in their malignancy and in the cell of origin.
Causes
There are several known factors that can promote certain non-Hodgkin lymphomas. The first of these is cell damage. This can be caused by past irradiation or chemotherapeutic drug therapies in the context of previous cancer diseases.
Since these therapies do not exclusively have their effect in the tumor, healthy body cells are also damaged, which can lead to the development of non-Hodgkin’s lymphoma. Furthermore, excessive contact with benzenes, which were previously used as solvents, can lead to cell damage. In addition to these global causes, there are also causes that increase the risk of certain subtypes of non-Hodgkin’s lymphomas.
For example, infection with the Ebstein-Barr virus, which causes Pfeiffer glandular fever, or HIV infection can promote Burkitt lymphoma. Burkitt’s lymphoma is considered very aggressive and is caused by the so-called B-lymphocytes. Infections with bacteria, such as the bacterium Helicobacter pylori, can also promote a certain non-Hodgkin lymphoma. The infection triggers an inflammation of the stomach (gastritis) and in later courses it can develop into MALT lymphoma (Mucosa Associated Lymphoid Tissue).
Associated symptoms
The classic symptom of non-Hodgkin’s lymphomas is a lymph node that is swollen for a long period of time and does not hurt. These can be frequently palpated on the neck, armpit or groin. Another typical symptom is the B-symptom, which is a combination of the three symptoms fever, weight loss and night sweats.
In advanced stages, an enlargement of the spleen may occur, so that it can be palpable under the left costal arch. This enlargement can be accompanied by pain. Another late symptom is the decline of all blood cells.
This is caused by the fact that the progression of the disease causes damage to the bone marrow and thus limits the formation of blood cells. This then manifests itself with a number of symptoms, such as fatigue and weakness, as well as spontaneous bleeding. These can become noticeable with nosebleeds or bleeding gums.
In addition, there is a tendency to frequent infections, as the body’s defense cells are reduced and partially altered and thus functionless. In rare cases, space-occupying infections can occur, for example in the ear, nose and throat area, in the entire digestive tract or on the skin. Not all non-Hodgkin lymphomas show changes in the skin and depending on the subtype of non-Hodgkin lymphoma, different symptoms appear on the skin.
Chronic lymphatic leukemia, for example, can be accompanied by itching and chronic urticaria. Hives is manifested on the skin with redness and small localized swellings. In addition, large areas of the skin may be reddened (erythroderma) and skin fungus may occur.
These symptoms occur on the skin, especially in older patients. In the case of T-cell lymphomas, mycosis fungoides and Sézary syndrome in particular cause symptoms on the skin. Mycosis fungoides is characterized by reddened areas with scaling and pronounced itching.
These slowly develop into so-called plaques. A thickening of the skin is typical. In late stages, hemispherical skin tumors can be found, which show open areas on the surface.
Mycosis fungoides can develop into a Sézary syndrome with extensive redness, severe itching and excessive hornification of the hands and feet. The B-symptomatology describes a complex of three symptoms: fever, weight loss and night sweats. The definition of fever is not always consistent in the specialist literature.
As a rule, one speaks of a fever at body temperatures above 38 degrees Celsius. The fever must not be explainable by another illness, such as an infection. A weight loss of more than 10% of the original body weight within six months is also part of the B-symptoms.
The third symptom is night sweat.Night sweat describes waking up in the middle of the night covered in sweat. Often patients report that they have to change their pyjamas or bedding several times during the night. The term was coined by the Ann-Arbor classification.
With an addition “A” the mentioned symptoms are not present. If the addition “B” is used, the symptom triad is present in the patient. The presence of a B-symptom is in most cases more likely to be associated with a worse prognosis, as it is an expression of high disease activity of the tumor. After initiation of therapy, they usually decrease. If this is not the case, the therapy has to be reconsidered and possibly changed, since a persistent B-symptomatic response is more likely to indicate that the chemotherapy is not responding.
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