Lymphatic System and Immune System

Medical Terminology for Cancer

© Copyright 1996-2013

9: The Lymphatic and Immune Systems

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Contents

Functions of the lymphatic system
Components of the lymphatic system
Circulation of tissue fluids
The Immune System
Cancer Focus
Roots, suffixes, and prefixes
Related Abbreviations and Acronyms
Further Resources

Functions of the lymphatic system

The key functions of the lymphatic system:

• Drains excess fluids and proteins from tissues all around the body and returns them back into the bloodstream.
• Removes waste products produced by cells.
• Fights infections.
• Absorbs fats and fat-soluble vitamins from the digestive system and transports these into the bloodstream.

Components of the lymphatic system

Immage source: Wikimedia License: CC-BY-3. 0

Lymph Lymph is a fluid that circulates throughout the body in the lymphatic system. It forms when tissue fluids/blood plasma (mostly water, with proteins and other dissolved substances) drain into the lymphatic system. It contains a high number of lymphocytes (white cells that fight infection). Lymph that forms in the digestive system called chyle, this contains higher levels of fats, and looks milky white. Lymph vessels Walled, valved structures that carry lymph around the body Lymph nodes Small bean-shaped glands that produce lymphocytes, filter harmful substances from the tissues, and contain macrophages, which are cells that digest cellular debris, pathogens and other foreign substances. Major groups of lymph nodes are located in the tonsils, adenoids, armpits, neck, groin and mediastinum. Thymus The thymus is a specialized organ of the immune system, located between the breast bone and heart. It produces lymphocytes, is important for T cell maturation (T for thymus-derived). Spleen The spleen is an organ in the upper left abdomen, which filters blood, disposes of worn-out red blood cells, and provides a ‘reserve supply’ of blood. It contains both red tissue, and white lymphatic tissue. Different parts of the the spleen specialize in different kinds of immune cells.

The major (encapsulated) lymphatic organs are the lymph nodes, thymus and spleen. In addition the lymphoid tissues include:

Mucosa-associated lymphoid tissue (MALT)

These are bundles of lymphatic cells, called lymphatic nodules, located within the mucus membranes that line the gastrointestinal, respiratory, reproductive, and urinary tracts. These nodules contain lymphocytes and macrophages which defend against invading bacteria and other pathogens that enter these passages along with food, air, or urine. These nodules can be solitary or grouped together in clusters.

Major clusters of lymphatic nodules include:

• Tonsils: these are clusters of lymphatic tissue under the mucous membrane lining of the nose, mouth, and throat. Lymphocytes and macrophages in the tonsils provide protection against foreign substances and pathogens that enter the body through the nose or mouth.
• Adenoids: A cluster of lymphatic tissue that hangs from the upper part of the back of the nasal cavity. Adenoids get bigger after birth but usually stop growing by the age of 7. Like the Tonsils, they can be removed without significantly increased risk of infections.
• Peyer’s patches: these are clusters of lymphatic nodules in the mucosa that lines the ileum of the small intestine. They play an important role in defending against the large number of pathogens that enter the gastrointestinal system.

Circulation of tissue fluids

Fluid in the spaces between tissues is called interstitial fluid, or ’tissue fluid’. This provides the cells of the body with nutrients (via the blood supply) and a means of waste removal. Lymph is formed when the interstitial fluid is collected through tiny lymph capillaries (see diagram), which are located throughout the body. It is then transported through lymph vessels to lymph nodes, which clean and filter it. Lymph then flows on to the lymphatic ducts, before emptying into the right or the left subclavian vein, where it mixes back with blood.

Blood is enriched with oxygen (by the respiratory system) and nutrients (by the digestive system), which are circulated all around the body (by the cardiovascular system). Some fluid (blood plasma) leaks out into the tissues via tiny capillaries, contributing to interstitial fluid, which eventually drains back into the lymphatic system.

The Immune System

The immune system includes a variety of defenses against viruses, bacteria, fungal infections, and parasites (such as thread worms). The lympatic system is part of the broader Immune System.

Innate immune system

This are the non-specific, unchanging lines of defenses which include:

• Physical and chemical barriers to pathogens.
• Producing cytokines and other chemical factors to recruit immune cells to sites of infection.
• Activates the complement cascade to identify bacteria, activate cells and to promote clearance of dead cells or antibody complexes.
• Identifies and removes foreign substances present in organs, tissues, the blood and lymph, by specialised white blood cells.
• Activation of the adaptive immune system, through a process known as antigen presentation.

Adaptive immune system

Adaptive (or acquired) immunity is where immunological memory is made after an initial response to a new pathogen, leading to an enhanced response to future exposure to that same pathogen. This process of acquired immunity is the basis of vaccination. This is essential because bacteria and viruses are continually adapting and evolving in an ‘arms race’ with our immune systems. Features of the adaptive immune system include:

• Recognition of specific “non-self” antigens, during the process of antigen presentation.
• The generation of responses tailored to destroy specific pathogens or pathogen-infected cells.
• Development of immunological memory, in which each pathogen is “remembered” by signature antibodies or T cell receptors. These memory cells can be called upon to quickly eliminate a pathogen should subsequent infections occur.

Cells of the Immune System

There are many different cell types and sub-types involved in the immune system. Some of the main types include:

• Lymphocytes: are white cells which circulate between blood and lymph. They play an important role in fighting infection. There are many kinds of lymphocytes; the main types are T cells, B cells and natural killer cells. Lymphocytes initially develop in the bone marrow. Some migrate to the thymus, where they mature into T cells ; others mature in the bone marrow as B cells.
• Neutrophils: are the most abundant type of white blood cells and are an important part of the innate immune system. Neutrophils are a type of phagocyte (cells which engulf and then digest, cellular debris and pathogens). They are normally found in the blood stream, but are quickly recruited to the site of injury or infection following chemical signals such as Interleukin-8.
• Macrophages: are another type of phagocyte and have a role in both the innate and adaptive immune systems. They attack foreign substances, infectious microbes and cancer cells. Macrophages also stimulate lymphocytes and other immune cells to respond to pathogens.
• Dendritic cells: are antigen-presenting cells which act as messengers between the innate and adaptive immune systems. They are usually located in tissues in contact with the external environment such as the skin, linings of the nose, lungs, stomach and intestines. In response to pathogens they migrate to the lymph nodes where they interact with T cells and B cells to initiate the adaptive immune response.

Antigens and Antibodies

Antibodies (also known as an immunoglobulins) are Y-shaped proteins produced by B-cells,that bind to specific antigens on the surface of foreign objects such as bacteria and viruses. This identifies and ‘tags’ the foreign object as ‘non-self’, signalling other immune cells to attack them.

Hormones and the Immune System

There are several hormones generated by the immune system. These hormones are generally known as lymphokines. Steroids and corticosteroids (components of adrenaline) suppress the immune system.

Cancer Focus

Metastatic spread of cancer via the lymph nodes

Lymph nodes close to the primary tumor are often the first site of metastases (spread of cancer). Lymph node metastases are rarely life threatening, but their detection is a prognostic factor for many types of cancer as it shows the tumor has developed the ability to spread. Tumor cells may travel via the lymphatic system and spread to to lymph nodes and distant organs.

Sentinel Lymph Node Biopsy

A dye is injected near the primary tumor to identify the position of the sentinel lymph node (the first lymph node to which cancer cells are most likely to spread as the lympatic system drains fluid away from the tumor). The sentinel node is surgically removed and a pathologist checks for the presence of cancer cells. SLNB is most frequently used to help stage breast cancer and melanoma. It is a less extensive operation compared to standard lymph node surgery.

Immunosuppression

This is reduced activity or efficiency of the immune system and its ability to fight infections and other diseases. Certain diseases such as AIDS or lymphoma can cause immunosuppression. It is also a common side-effect of anticancer chemotherapy, leading to cancer patients having an increased risk of infections during treatment.

Lymphoma

A general term form for malignant disease of the lymphatic tissue characterized by abnormal, uncontrolled cell growth. There are a number of types of lymphoma, including Hodgkin Lymphoma, with most other types classed together as Non-Hodgkin Lymphoma.

Hodgkin Lymphoma

A malignancy of the lymphatic tissue that occurs most often in males, and the peak incidence is between ages 15 and 35. It is characterised by progressive, painless enlargement of the lymph nodes, spleen, and general lymph tissue. In Hodgkin Lymphoma Reed-Sternberg cells (a specific type of lymphocyte) become abnormal and grow in an uncontrolled way.

Internet Resources for Hodgkin Lymphoma

Non Hodgkin Lymphoma (NHL)

NHL is cancer of the lymphatic tissue, that does not involve abnormal Reed-Sternberg cells (a specific type of lymphocyte). There are many different types of NHL. Some grow very slowly, whilst others grow quickly and need aggressive treatment.

Internet Resources for NHL

AIDS related lymphoma

Incidence of non-Hodgkin’s lymphoma has increased in parallel with the AIDS epidemic. Lymphomas affecting HIV infected people are mostly of the aggressive B-cell types (diffuse large cell, B-immunoblastic, or small non-cleaved Burkitt’s / Burkitt’s like lymphoma) which are less common in non-HIV infected lymphoma patients. The HIV virus is not thought to a direct cause of lymphoma, rather it weakens the body’s defences and may increase susceptibility to other infections such as the Epstein-Barr and HHV-8 viruses which are associated with these types of lymphomas.

Internet Resources for AIDS related Lymphoma

Waldenstrom’s Macroglobulinemia

This is a rare malignant condition, involving an excess of beta-lymphocytes (a type of cell in the immune system) which secrete immunoglobulins (a type of antibody). WM usually occurs in people over sixty, but has been detected in younger adults.

Internet Resources for Waldenstrom’s Macroglobulinemia

Cancer Immunotherapy

This is treatment to stimulate the patient’s own immune system to attack the cancer cells. Different approaches include: 1) cancer vaccination to train the immune system to recognise the cancer cells as targets to be destroyed, 2) giving therapeutic antibodies to recruit immune system cells to destroy tumor cells, and 3) cell based immunotherapy which is either transfusing immune cells (such as Natural killer Cells) or by administering cytokines (such as Interleukins) which activate the immune cells.

HPV Vaccination and Cervical Cancer

Human papillomavirus (HPV) is a common cause of infection. There are over 100 different sub-types of HPV. HPV types 16 and 18 cause 70% of cervical cancers and are also linked to cancers of the anus, vulva, vagina, penis, as well as the mouth and throat. Over time these can cause cells in the cervix to change, leading to precancerous conditions – cervical intraepithelial neoplasia (CIN), with a higher risk of developing cancer. Vaccination against HPV 16, 18 and other ‘high risk’ types of HPV reduces the risk of developing cervical and other HPV-related cancers.

Internet Resources for HPV Vaccination and Cervical Cancer

Lymphedema

Lymphedma is an abnormal build up of interstitial fluid due to problems in the lymphatic system. It can have many causes. In the context of cancer it is often a result of obstruction by a tumor or enlarged lymph nodes. It can also be a side effect of radiotherapy or surgery, which has damaged the lymph vessels.

Roots, suffixes, and prefixes

Most medical terms are comprised of a root word plus a suffix (word ending) and/or a prefix (beginning of the word). Here are some examples related to the Lymphatic and Immune systems. For more details see Chapter 4: Understanding the Components of Medical Terminology

component	meaning	example
aden(o)-	gland	Lymphadenopathy – disease of, or swelling/enlarged lymph nodes
immun(o)-	Immunity	Immunosuppression = reduced activation or efficacy of the immune system
lymph(o)-	Lymph	Lymphoma = tumour of lymphoid cells
lymphaden(o)-	lymph node	Lymphadenectomy = surgical removal of lymph node(s)
lymphangi(o)-	lymphatic vessels	Lymphangitis = inflammation or infection of the lymphatic vessels
splen(o)-	spleen	Splenomegaly = enlargement of the spleen
thym(o)-	thymus	Thymectomy = surgical removal of the thymus
tox(o)-	poison	Immunotoxicity = adverse effects on immune system function resulting from exposure to chemical substances.

Related Abbreviations and Acronyms

Further Resources (9 links)

 Immune System

National Cancer Institute
Detailed presentation and notes.

 Introduction to the Lymphatic System

SEER, National Cancer Institute
Part of a SEER training module for cancer registry staff.

 Lymphatic System – Self Test questions

WebAnatomy, University of Minnesota
Test your anatomy knowledge with these interactive questions. Includes different question types and answers.

 Mechanism of lymph node metastasis in prostate cancer

Future Oncol. 2010 May;6(5):823-36
Datta K, Muders M, Zhang H, Tindall DJ. Mechanism of lymph node metastasis in prostate cancer. Future Oncol. 2010 May; 6(5): 823-836. (full article available free on PubMed Central)

 Sentinel Lymph Node Biopsy

National Cancer Institute
Factsheet in the form of questions and answers, with references.

 The components of the immune system

National Library of Medicine
A section, with diagrams from: Janeway CA Jr, Travers P, Walport M, et al. Immunobiology: The Immune System in Health and Disease. 5th edition. New York: Garland Science; 2001.

Paul Andersen
Paul Andersen explains how your body protects itself from invading viruses and bacteria. He starts by describing the nonspecific immune responses of skin and inflammation. He then explains how we use antibodies to disrupt the function of antigens and mark them for destruction. He then explains both the homoral and cell-mediated immune response highlighting the importance of B and T lymphocytes. He finally describes the process of long term immunity.

 The Lymphatic System

Cancer Research UK
Short overview, with diagrams.

UCSF
Dr. Katherine Gundling, Professor, Division of Allergy and Immunology at UCSF presents an overview of the immune system, how it functions and what can go wrong.

This guide by Simon Cotterill

First created 4th March 1996
Last modified: 1st February 2014

The lymphatic system | Canadian Cancer Society

Diagram of the lymphatic system

Lymph is a clear fluid that contains lymphocytes, a type of white blood cell that fights germs, foreign substances and abnormal cells, like cancer cells. Lymph also has macrophages, another type of white blood cell that helps fight infection. Lymph collects some waste products, bacteria and damaged cells from inside the body’s tissues so that they can be removed from the body or destroyed. Lymph drains into lymph vessels that carry it to lymph nodes. Lymph nodes clean the lymph and add more lymphocytes to it.

Lymphocytes fight disease and micro-organisms that cause infections, like bacteria, viruses, fungi and parasites. They are important cells in the body’s immune system. There are 3 types of lymphocytes:

• B cells (B lymphocytes) make antibodies to fight an infection.
• T cells (T lymphocytes) defend the body against disease and infection and control the immune response.
• Natural killer cells attack cells infected with a virus and abnormal cells, like cancer cells.

Lymph vessels are tubes that carry lymph through the body to lymph nodes and back to veins. The network of lymph vessels is similar to blood vessels (arteries and veins) that carry blood. Lymph vessels carry waste products, germs and damaged cells away from the body’s tissues.

Lymph nodes are small, bean-shaped masses of lymphatic tissue along lymph vessels. They store lymphocytes and filter waste, bacteria and damaged cells (including cancer cells) from lymph. The lymphocytes inside the lymph nodes also attack bacteria and viruses that they find in the lymph. This is why lymph nodes often get swollen when we are sick or fighting off an illness like a cold or the flu.

Lymph nodes are found in many parts of the body. The number of lymph nodes varies from one part of the body to another. Lymph nodes are located in groups, mainly in the:

• neck (called cervical lymph nodes)
• chest (called thoracic and mediastinal lymph nodes)
• armpit (called axillary nodes)
• abdomen (called para-aortic, peri-aortic and mesenteric lymph nodes)
• groin (called inguinal lymph nodes)

Tonsils are small masses of tissue at the back of the mouth and nose and at the top of the throat. Tonsils have many lymphocytes.

The adenoid (pharyngeal tonsil) is a single, small mass of lymphatic tissue in the back of the nose that contains lymphocytes. The adenoid is largest in children and starts to shrink just before puberty. Although it is often called “the adenoids,” there is only one adenoid.

The tonsils and adenoid help the body fight infection and protect the opening to the digestive system and lungs from bacteria and viruses.

The spleen is an organ in the abdomen, under the ribs on the left side of the body. It stores lymphocytes, filters the blood and destroys old blood cells. As blood passes through the spleen, lymphocytes attack any bacteria or virus or other types of harmful substances that can cause infection or illness.

The thymus is a gland in the middle of the chest behind the sternum (breastbone) that sits in an area of the chest called the mediastinum. T cells (a type of lymphocyte) mature inside the thymus. But the T cells in the thymus don’t respond to infection until they are released into the blood and the lymphatic system. The thymus starts to shrink during late childhood and adolescence, becoming very small in adults.

The lymphatic system also includes areas of the body that have high numbers of lymphocytes. These areas are called lymphatic tissue. They include the appendix and areas of the small intestine called Peyer’s patches. There are also areas of lymphatic tissue scattered in other parts of the digestive system and respiratory system. Like lymph nodes, lymphatic tissue helps remove waste, bacteria and damaged cells from lymph.

The bone marrow is where lymphocytes and other blood cells are made. The bone marrow is the soft, spongy area inside of most bones. Many of the blood cells in the bone marrow are immature and are called stem cells. Stem cells change and grow into different types of cells, including blood cells. Most blood cells grow and mature in the bone marrow. Most blood cells leave the bone marrow and move into the blood and other areas of the body once they are mature.

• Cancer Research UK. Lymphatic System and Cancer. Cancer Research UK; 2014: http://www.cancerresearchuk.org/about-cancer/what-is-cancer/body-systems-and-cancer/the-lymphatic-system-and-cancer.

• Cancer Research UK. How Cancer Can Spread. Cancer Research UK; 2014: http://www.cancerresearchuk.org/about-cancer/what-is-cancer/how-cancer-can-spread.

• Martini FH, Timmons MJ, Tallitsch RB. Human Anatomy. 7th ed. San Francisco: Pearson Benjamin Cummings; 2012.

• Young B, O’Dowd G, Woodford P (eds.). Wheaters’s Functional Histology. 6th ed. Churchill Livingston; 2014.

Lymphoma: symptoms, signs, treatment, prognosis

What is lymphoma?

Lymphoma is a lesion of the immune system and internal organs, in which altered cells accumulate that disrupt the functioning of tissues.

The tumor develops in the lymphatic system, which helps us fight infections and other diseases. The lymph circulating in it washes all the cells of the body and delivers the necessary substances to them, taking away waste. In the lymph nodes located throughout its network, dangerous substances are neutralized and excreted from the body.
The lymphatic system complements the circulatory system and helps fluids move around the body. Unlike blood, the speed of which is set by the “pump” – the heart, lymph slowly circulates on its own.

How does lymphoma develop?

Oncology begins with the appearance in the body of just one altered cell of the immune system. In total, there are 2 main types:

• B-lymphocytes : produce antibodies – proteins that protect the body from bacteria and viruses. It is in them that most lymphomas form.
• T-lymphocytes , one part of which destroys microbes and abnormal cells, and the second part helps to increase or slow down the activity of the immune system.

Almost all abnormal cells are detected and destroyed by our immune system, but some of them manage to survive. They gradually multiply, spread throughout the body, create tumors, accumulate in the internal organs and disrupt their work.

The disease can occur in any area where there is lymphatic tissue, the main areas of which are:

• Lymph nodes are small, pea-sized organs that are collections of cells of the immune system, including lymphocytes. There are more than 500 of them in the human body.
• Spleen located under the lower ribs on the left side of the body. It produces lymphocytes, stores healthy blood cells and filters out damaged ones, and destroys germs and foreign substances.
• Bone marrow – Spongy tissue within certain bones. New blood cells are formed here, including some lymphocytes.
• Thymus, or thymus gland – a small organ located behind the upper part of the sternum in front of the heart. It is the maturation and development of some lymphocytes.
• Tonsils or tonsils – collections of lymphatic tissue in the back of the throat. These organs help produce antibodies, proteins that prevent inhaled or ingested microorganisms from multiplying.
• Digestive tract: The stomach, intestines, and many other organs also contain lymphatic tissue.

Is lymphoma a cancer?

Official medicine in Russia and some other countries calls cancer cancer – life-threatening neoplasms that develop in epithelial cells contained in the skin or mucous membranes and lining the inner surface of organs.

Lymphoma is not a cancer, but an oncological disease. It is formed from lymphocytes, and its cells can also divide uncontrollably, accumulate in tissues, disrupting their work, and create additional foci of disease in various parts of the body.

Types of lymphomas

Doctors distinguish 2 of their main classes:

• Hodgkin’s lymphoma, or Hodgkin’s lymphoma : most often begins in the lymph nodes of the upper body – on the chest, neck or armpits. It usually spreads to various lymph nodes through the lymphatics, but in rare cases, in advanced stages, it enters the bloodstream and spreads to other parts of the body, such as the liver, lungs, or bone marrow. This diagnosis is made when special cells are detected in the body – Berezovsky-Reed-Sternberg, which are altered B-lymphocytes.

• non-Hodgkin’s lymphomas include all other types of the disease – there are about 30 of them. Each of them has its own special features: the location of the primary tumor, the structure and rate of development.

Causes of lymphomas

Doctors and scientists do not know exactly why the disease begins to develop in the human body. They only know about the factors that increase the likelihood of each type of cancer.

For Hodgkin lymphomas they look like this:

• Epstein-Barr virus , which causes infectious mononucleosis – damage to lymphoid tissue, including adenoids, liver, spleen and lymph nodes. In some patients, parts of the virus are found in Berezovsky-Reed-Sternberg cells, but in most patients there are no signs of it.
• Age : Diagnosis can occur at any age, but is most common in 20-year-olds and people over 55.
• Gender : The disease is more common among men than among women.
• Heredity and family history : increased risk for siblings and identical twins Identical twins develop from a single egg fertilized by a single sperm. They are only one sex, have the same genes and are extremely similar in appearance. patients with Hodgkin’s lymphoma. The reason for this is not exactly known – perhaps the whole point is that members of the same family in childhood suffer the same infections, or have common inherited gene changes that increase the likelihood of developing this type of oncology.
• Weakened immune system . The chances of getting this diagnosis increase in people with HIV infection and disorders of the immune system, which develop, among other things, due to the use of drugs that suppress it, which is often required after organ transplantation.

The list of such factors for non-Hodgkin’s lymphomas looks different:

• These include exposure to radiation , including doses received during radiation therapy for other types of cancer.
• Miscellaneous substances including herbicides and insecticides that kill weeds and insects, as well as chemotherapy drugs.
• Age : As a rule, the older the person, the higher their risks – in most cases the disease occurs at the age of 60+, but some of its types also occur in young people.
• Malfunctions of the immune system – affects the chances of developing all types of lymphomas.
• Some viruses can affect the DNA of lymphocytes, in which all information about our body is encrypted, and transform them into cancer cells.
• Infections that constantly stimulate the immune system and force our natural defenses to work in an enhanced mode also increase the risk of getting a difficult diagnosis.
• The presence of close blood relatives – parents, children, brothers or sisters with this diagnosis also increases the likelihood of developing the disease.
• Some studies have shown that breast implants, especially those with a rough surface, can cause anaplastic large cell lymphoma. It develops on the skin, in the lymph nodes or scar tissue formed at the site of the incision.

Symptoms and signs of lymphoma

As a rule, in the early stages, this type of oncology does not manifest itself in any way, and its owner feels good and is unaware of the disease – almost all of its symptoms appear later, in advanced stages.

One of the most common signs is the appearance of swelling on the neck, in the armpits, groin or above the collarbone , which is an enlarged lymph node. Usually such a neoplasm does not hurt, but over time it often increases, and new bumps appear next to it or in other areas of the body.

Lymphomas that begin to develop or grow in the abdominal cavity can cause edema or abdominal pain, nausea and vomit . Such sensations arise due to the enlargement of the lymph nodes or internal organs, such as the spleen or liver, or the accumulation of a large amount of fluid.

A spleen that has changed in size can press on the stomach, causing loss of appetite and a feeling of satiety after a small amount of food .

Enlarged thymus Thymus, or thymus gland – a small organ located behind the upper part of the sternum in front of the heart. It is the maturation and development of some lymphocytes. or lymph nodes in the chest may put pressure on the trachea, which carries air to the lungs. This gives rise to cough , shortness of breath, pain or heaviness in the chest .

Brain lesions can cause headache, weakness, personality changes, thinking problems and convulsions .

Other types of disease can spread to tissues surrounding the brain and spinal cord, causing patient to experience double vision, face numbness , and speech impairment .

Skin lymphomas often present as itchy red bumps or bumps .

In addition, symptoms may include:

• weight loss;
• chills;
• night sweats;
• elevated temperature;
• severe fatigue;
• bloating;
• frequent or severe infections;
• easy bruising or bleeding.

Lymphoma diagnostics

Most patients see a doctor because they have certain signs of illness or feel unwell.
Specialists begin the examination with an examination and a survey – about family diagnoses, possible risk factors and other health problems. The lymph nodes and other parts of the body that contain lymphatic tissue are then examined, including the spleen and liver. After that, a number of studies are prescribed:

• Blood Tests : Measure levels of various cells in the blood, detect bone marrow damage, assess kidney and liver function, and detect infections and other disorders.
• Biopsy – taking a piece of suspicious tissue and sending it to the laboratory for examination. Depending on the course of the disease, doctors may need to take a biopsy of lymph nodes, bone marrow, cerebrospinal fluid (CSF) that bathes and protects the brain and spinal cord, and pleural fluid, which is found in the chest, or peritoneal fluid, which is found in the abdomen.
• Computed tomography, CT – allows you to identify foci of the disease in the abdominal cavity, pelvis, chest, head and neck.
• Magnetic – Resonance Imaging, MRI – Creates a detailed image of soft tissue. The method is usually used to study the spinal cord or brain.
• X-ray – helps to detect enlarged lymph nodes in the chest area or in the bones.
• Ultrasound, Ultrasound – used to examine enlarged lymph nodes or various organs such as the liver, spleen or kidneys.
• Positron – emission tomography, PET – can detect lymphomas in enlarged lymph nodes, even those that look normal on CT. In addition, it can be used to determine whether the disease is treatable.

The oncological center “Lapino-2” provides a complete diagnosis of lymphoma – quickly, without queues and loss of precious time, using the most modern equipment.
Our specialists lead the patient “from” and “to” – from examination to any treatment.

Stages of lymphoma

Immediately after the discovery of the disease, doctors determine its stage – find out how far it has spread and what tissues have been damaged. This information is extremely important for specialists, since it allows not only to understand the patient’s prognosis, but also to select the most appropriate treatment for him.

Stages of Hodgkin’s lymphoma:
I : abnormal cells found in only one group of lymph nodes or one lymphoid organ such as the tonsils.
II : they are present in 2 or more groups of lymph nodes located on the same side of the diaphragm. The diaphragm is the muscle that separates the chest cavity from the abdominal cavity., or spread from one damaged lymph node to an adjacent organ.
III : there are lymphoma cells in the lymph nodes on both sides of the diaphragm; or not only in the lymph nodes above the diaphragm, but also in the spleen.
IV : The disease has spread to at least one organ outside the lymphatic system, such as the liver, bone marrow, or lungs.

Stages of non-Hodgkin’s lymphomas:
I : altered cells are found only in 1 group of lymph nodes or one lymphoid organ, for example, tonsils; or in 1 area of ​​one organ outside the lymphatic system.
II : they are present in 2 or more groups of lymph nodes on 1 side of the diaphragm; either in the lymph nodes and 1 area of ​​a nearby organ, or in another group of lymph nodes on the same side of the diaphragm.
III : there are lymphoma cells in the lymph nodes on both sides of the diaphragm; or they are present both in the lymph nodes above the diaphragm and in the spleen.
IV : The disease has spread to at least one organ outside the lymphatic system, such as the liver, bone marrow, or lungs.

Lymphoma treatment

Treatment of lymphoma is not an easy task. To solve it, not one doctor is required, but a whole team of professionals in their field – a chemotherapist, radiologist, surgeon, oncologist, hematologist and others.
The Lapino-2 Oncology Center has all the necessary specialists – world-class doctors who carry out a complete diagnosis of the disease and any necessary therapy.

With us, you don’t have to retake tests, redo studies and wonder “what to do next?”. We fully guide the patient and give him a clear plan of action, following which he gets the best result possible.

To combat this type of cancer, several methods are used:

The main one is chemotherapy – drugs that destroy altered cells. They are taken as a pill or injected into a vein, enter the bloodstream, and are distributed throughout the body. Treatment is carried out in cycles, each of which lasts several weeks, followed by a period of rest, during which the body is restored.

Transplantation of bone marrow or stem cells from which blood cells are formed. The procedure allows you to prescribe higher doses of chemotherapy, sometimes together with radiation therapy, which makes the lymphoma more effective. Transplantation is possible not only from a donor, but also from one’s own, collected a few weeks before the intervention, the material.

Radiation therapy – the destruction of altered cells with the help of radiation. This method is suitable for most patients, and works especially well if the disease has managed to affect a small amount of tissue. It is used both alone and in combination with chemotherapy.

Immunotherapy – drugs that help a person’s own immune system better recognize and destroy abnormal cells. There are several types used for lymphomas. These include:

• monoclonal antibodies – proteins designed to attack a specific substance on the surface of lymphocytes;
• immune checkpoint inhibitors – drugs that prevent altered cells from disguising themselves as healthy ones;
• T-cell therapy: removal of immune cells from the patient’s blood and alteration in the laboratory, their reproduction and return to the body, where they seek out and destroy foci of the disease.

Surgery : often used to obtain suspicious tissue samples and determine their type, but rarely for therapy per se. In rare cases, surgery is prescribed for lesions of the spleen or other organs that are not part of the lymphatic system, such as the thyroid gland or stomach.

Prognosis and life expectancy in lymphoma

Each person’s outlook is individual and depends on many different factors, such as the type of disease, its stage, response to treatment, age, and overall health.

The presence of some of them indicates less favorable prognosis:

• fever, night sweats and weight loss;
• high ESR – erythrocyte sedimentation rateErythrocytes are blood cells that deliver oxygen to tissues and organs. – from 50 in people with the above symptoms, and more than 30 in everyone else;
• age over 45;
• male gender;
• high white blood cell countLeukocytes are blood cells whose main job is to fight infections. – more than 15 thousand;
• Hemoglobin Hemoglobin is a protein in blood cells that carries iron throughout the body. It retains the oxygen necessary for the work of all tissues. below 10.5;
• low levels of albuminAlbumin is a blood protein that carries various chemical compounds and is involved in metabolism. in the blood – less than 4.

To make approximate forecasts, doctors use a special term – “five-year survival rate”. This is a statistical indicator that says nothing about the chances of a particular person. It only shows the number of people with a particular type of disease at a particular stage who are still alive 5 or more years after diagnosis.

In patients with Hodgkin’s lymphoma, this figure is as follows:

• At the localized stage, while oncology is present in only one group of lymph nodes, in one lymphoid organ or tissue outside the lymphatic system, it is approximately 91%.
• At the regional level, in case of damage to structures located near the lymph nodes, two or more groups of lymph nodes located on one side of the diaphragm – about 94%.
• When the disease spreads to other parts of the body, such as the lungs, liver or bone marrow, or to the lymph nodes below and above the diaphragm – 81%.

For patients with different types of non-Hodgkin’s lymphomas – diffuse large B-cell lymphoma Diffuse large B-cell lymphoma is a whole group of tumors of the lymphatic system that develops from the B-cells of the thymus gland, or thymus. and follicular Lymphoma is the most common of the slowly growing types of the disease, accounting for 20-30% of all newly diagnosed non-Hodgkin’s lymphomas. it is 73% and 96%, 73% and 90%, 57% and 85% respectively.

What is lymphoma?

Diseases of the lymphatic system – news

June 16, 2018 Tsyba – a branch of the Federal State Budgetary Institution “NMITs Radiology” of the Ministry of Health of Russia will host Open Day , dedicated to the early detection of malignant diseases of the lymphatic system.

On the eve of this action, Doctor of Medical Sciences, Head of the Department of Drug Treatment of Malignant Neoplasms of the A. F. Tsyba Natalya Falaleeva,
spoke about the symptoms, diagnosis and treatment of tumor diseases of the lymphatic system.

Clinical oncology over the past decade has made great strides in understanding many issues related to the causes, diagnosis and treatment of diseases of a tumor nature.

This group of diseases also includes tumor diseases of the blood system or hemoblastoses (blood cancer, as patients say) – this concept includes acute and chronic leukemia, non-Hodgkin’s lymphomas (lymphosarcoma), Hodgkin’s lymphoma (lymphogranulomatosis), tumors of the histiocytic-macrophage system ( histiocytosis).

Tumor diseases of hematopoietic and lymphoid tissues account for approximately 8% of all malignant neoplasms, and together they are among the 6 most common types of malignant tumors. Mortality rates have declined sharply in the last decade as a result of improved efficacy of therapy.

One of the main reasons for the development of a number of tumors of lymphoid, hematopoietic tissues is a malfunction of the immune system, which leads to a loss of immunological control over chronic infection with oncogenic viruses and other infectious agents.

A relationship has been established between Epstein-Barr virus (EBV) infection and the incidence of Hodgkin’s lymphoma. The Epstein-Barr virus is also the cause of the development of the classic form of Burkitt’s lymphoma (LB). Other infectious agents also play an important role in the etiology and pathogenesis of NHL.

Adult T-cell lymphoma is associated with human lymphotropic virus type I (HTLV-I). Gastric MALT lymphoma can be caused by Helicobacter pylori infection, while cutaneous MALT lymphoma is initiated by Borellia burgdorferi.

Eradication from Helicobacter pylori in gastric MALT lymphoma leads to tumor regression, and in hepatitis C-associated follicular lymphoma, the appointment of antiviral therapy as the 1st line is a determining factor in treatment.

The risk of developing NHL is increased in patients with autoimmune diseases. The most important carcinogenic factor is exposure to ionizing radiation. Particularly significant is the role of ionizing radiation in leukemia and multiple myeloma. Along with ionizing radiation, electromagnetic radiation can be an unfavorable (provoking) factor. The carcinogenic effect of chemical factors has also been proven.

The risk of developing lymphomas is increased in occupations associated with exposure to the following substances: phenoxy herbicides, dioxin pesticides, chlorophenols, solvents. In many epidemiological studies of different years, the role of smoking in the development of acute leukemia has been proven. In the development of hematological tumor diseases, an important role belongs to genetic factors, for example, the development of leukemia is based on a mutation in a clonogenic hematopoietic cell, which is confirmed by the detection of numerous chromosomal aberrations, which in many cases have prognostic value.

Classification: Lymphomas are a group of heterogeneous diseases arising from cells of the immune system at different levels of maturation and from different zones of the lymphoid organs, have unique characteristics. It is they, together with some biological signs of the tumor (tumor growth rate, etc.), that determine the characteristics of the clinical course, response to treatment and prognosis.

Current classification of tumors of lymphoid tissue includes Hodgkin’s lymphoma and non-Hodgkin’s lymphomas.

Non-Hodgkin’s lymphomas, depending on the cell line, are divided into B-cell, T- and NK-cell tumors. Leukemias are a group of blood diseases of a tumor nature, in which the pathological process begins at the level of hematopoietic precursor cells, has a clonal character and is manifested by defects in cell proliferation and differentiation.

Leukemias are divided into acute and chronic, depending on the tumor substrate: in acute leukemias, the bulk of the cellular substrate is represented by immature (blasts) cells, in chronic leukemias – by mature and maturing elements.

Diagnosis: It is well known that the effectiveness of the treatment of any disease, and especially a tumor, depends primarily on early diagnosis and timely initiation of treatment in a specialized institution. Timely recognition of the disease largely depends on early treatment to the doctor. As clinical practice shows, the vast majority of patients with a tumor disease are admitted to the hospital during the period of clinical manifestations of tumor growth.

Timely clinical examination begins with a questioning of the patient and includes examination of the latter, as well as the use of a whole range of paraclinical (laboratory) examination methods, which can be divided into general, particular and special. General methods of examination make it possible to suspect the presence of a malignant disease and can serve as the basis for the use of private and special examination methods necessary for early recognition of a tumor and determining its extent. Obviously, the process of diagnosing hemoblastoses should end with cytological, cytochemical, histological, immunological, and in certain diseases (chronic myeloid leukemia, acute leukemia, histiocytic tumors, etc.) cytogenetic, cultural, electron microscopic examination of the tumor substrate.

Thus, for the diagnosis of acute leukemia, it is necessary to identify specific leukemia infiltration of the bone marrow with cytochemical, immunological, cytogenetic characteristics;

for lymphorganulomatosis – detection of diagnostic Berezovsky-Sternberg cells;

for lymphosarcoma – the presence of specific blast elements in the primary lesion;

for tumors of histiocytic-macrophage nature — detection of typical Langerhans cells and atypical aplastic elements of histiocytic nature.

Any malignant disease of the hematopoietic and lymphoid tissue clinically manifests with symptoms of a general nature (temperature reaction;

complaints of weakness and fatigue;

pallor of the skin;

flying pains in the bones, joints; polyadenia, etc.).

In other words, the malignancy of the process in the early stages can be leveled by the “masks” of various diseases. Due to the presence of general complaints in the absence of local clinical changes, the most common diagnoses are made and symptomatic, antibacterial, antipyretic, restorative treatment is prescribed, which is ineffective.

Unfortunately, it is still common in practice to prescribe thermal and physiotherapeutic procedures for local enlargement of peripheral lymph nodes, when the patient is diagnosed with reactive lymphadenitis or nonspecific lymphadenopathy only on the basis of a clinical examination.

Only if the prescribed treatment is ineffective and the patient is referred for a consultation in a specialized institution. All this takes a significant period of time (from several weeks to months), contributes to the progression of the tumor process and the late establishment of an accurate diagnosis; so for example the vast majority of patients with lymphosarcoma are initially hospitalized already at the stage of generalization of the process (III-IV stages of the disease).

Treatment

Over the past 15-20 years, approaches to the treatment of tumor diseases have changed significantly. Each newly admitted to a specialized clinic patient with oncological pathology should be considered only from the standpoint of a possible complete cure.