What happens in the lymphatic system
Lymph nodes are filters through which lymph passes and in which protective cells mature. In Hodgkin's lymphoma, one of the B lymphocytes acquires mutations and turns into a tumor cell, which does not die, but attracts many ordinary immune cells around itself. Because of this, the node enlarges and becomes dense, and the secreted substances cause fever, sweating and itching. The tumor spreads predictably - from one group of nodes to the neighboring one, which helps plan treatment.
- Reed-Sternberg tumor cells in a lymph node
- Consecutive damage to neighboring groups of nodes
- Possible involvement of the spleen and bone marrow
- Several histological variants of the disease
- The stage is determined by the number and location of affected areas
Symptoms
The first and often the only sign is an enlarged lymph node in the neck, above the collarbone or in the armpit: it is dense, mobile and does not hurt, and does not decrease after taking antibiotics. Some patients develop so-called general symptoms, which are taken into account when determining the stage: fever, night sweats and weight loss. Less commonly, the disease begins with an increase in nodes in the chest, and then a dry cough, shortness of breath and a feeling of pressure behind the sternum are disturbing. Sometimes a peculiar symptom occurs - pain in the node after drinking alcohol.
- Painless enlargement of lymph nodes
- Temperature above 38°C without infection
- Heavy night sweats
- Losing weight without changing your diet
- Itchy skin without rash
- Weakness and fatigue
- Dry cough and shortness of breath with damage to the mediastinal nodes
When an enlarged lymph node is not dangerous
Most enlarged lymph nodes are associated with infection: sore throat, caries, cat scratch, viral disease. Such nodes are usually painful, soft, appear quickly and decrease within 2-4 weeks after recovery. The opposite picture is alarming: the node grows slowly, is painless, dense, fused with the surrounding tissues, is larger than 2 cm in size and lasts longer than a month. Particular attention is paid to the nodes above the collarbone. It is impossible to distinguish one from the other without examination.
- Painful soft node due to infection - often reactive
- A dense, painless nodule that lasts longer than a month is a reason for a biopsy.
- A node above the collarbone always requires examination
- Multiple groups of enlarged nodes simultaneously
- Combination with fever, sweating and weight loss
- It is forbidden to heat the knots, do compresses and physiotherapy
Diagnostics
The diagnosis is made only by the result of a biopsy: the node is removed entirely or a fragment of it is taken, after which the pathologist finds the characteristic cells and specifies the variant of the disease. Puncture with a thin needle is not sufficient for this. Then the extent is determined: a CT or PET-CT scan of the neck, chest, abdomen and pelvis is performed, and the bone marrow is examined if necessary. Blood tests show anemia, accelerated ESR, changes in LDH and liver function tests, and also help exclude infections with a similar picture.
- Lymph node biopsy with histology and immunohistochemistry
- Ultrasound of lymph nodes
- CT scan of the chest, abdomen and pelvis or PET-CT
- Complete blood count, ESR, LDH, biochemistry
- Tests for HIV and viral hepatitis
- Bone marrow examination according to indications
- Echocardiography and assessment of pulmonary function before treatment
Treatment and observation
The basis of treatment is chemotherapy courses, to which, in limited stages, radiation therapy is added to the affected area. The regimen and number of courses are selected by the hematologist depending on the stage, age and risk factors, and an intermediate PET-CT allows one to assess the response and, if necessary, change the tactics. When the disease returns, high-dose therapy with transplantation of one's own stem cells, targeted drugs and immunotherapy are used. After completion of treatment, long-term monitoring is needed: relapse and long-term consequences of therapy are monitored.
- Course chemotherapy
- Radiation therapy to affected areas
- Interim PET-CT response assessment
- High-dose therapy with transplantation for relapse
- Targeted drugs and immunotherapy
- Discussion of fertility preservation before treatment
- Regular monitoring after completion of therapy
