Symptoms And Diagnosis In Lymphoma

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Symptoms And Diagnosis In Lymphoma
Symptoms And Diagnosis In Lymphoma

Video: Symptoms And Diagnosis In Lymphoma

Video: Symptoms And Diagnosis In Lymphoma
Video: Hodgkin’s Disease (Lymphoma); Diagnosis & Treatment 2024, March
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Lymphoma: Symptoms & Diagnosis

Lymphomas develop from abnormal lymphoma cells, a subset of the white blood cells. There are around 100 different types of lymphoma - and the possible symptoms are also diverse. Typical symptoms do not always occur, but there are some warning signs.

The diagnosis results from a physical exam, imaging tests, and the removal and examination of a tissue sample. In addition, various diagnostic steps are necessary to determine the exact form and stage of the disease.

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  • How is lymphoma manifested?
  • How is the diagnosis made?
  • What other examinations will be carried out?
  • How are the disease stages classified?
  • Whom can I ask?

How is lymphoma manifested?

In many cases, a lymphoma develops within a lymph node. This is where the pathological lymphocytes accumulate and grow and multiply. Lymph node swelling, e.g. in the neck, chest, armpit or groin area, is therefore often the first change that is noticed by those affected. Often, swollen lymph nodes are initially not ascribed great importance, because they also occur in the context of harmless infections. However, if the lymph node swelling is present without infection or does not subside within a short time, this can be a warning sign. Malignant lymph nodes are typically not painful and have a rubbery consistency.

Because lymphocytes are sometimes excessively produced in the bone marrow in lymphoma, the production of all other blood cells can be impaired. A deficiency in red blood cells (erythrocytes), healthy white blood cells (leukocytes) and platelets (thrombocytes) develops. The possible consequences are, for example, anemia, which manifests itself as tiredness, poor resilience or a racing heart. Due to the lack of healthy white blood cells, the immune defense is reduced and infections are common. The lack of platelets can lead to an increased tendency to bleed.

In addition, fever (over 38 ° C) for no other identifiable cause, night sweats and unwanted weight loss can all be possible signs of lymphoma. This combination of symptoms is known as the B symptoms and occurs mainly in Hodgkin lymphoma.

The other symptoms depend on the organs and tissues in which the lymphoma cells have settled. Often there is an enlargement of the spleen or liver and thus pressure pain in the abdomen. Itching is another possible symptom with lymphoma. Lymph node swelling in the chest area can cause irritable coughs, heartburn and shortness of breath. In skin lymphomas, the skin changes are the first symptoms; multiple myelomas are noticeable as bone problems.

Typical symptoms do not always appear or are recognized as such. Some lymphomas are discovered only by chance when investigations are done for other reasons. People often only become aware of the signs of lymphoma after diagnosis.

How is the diagnosis made?

The first step is a detailed anamnesis interview, during which the doctor finds out about the respective complaints. This is followed by a physical examination, which also involves palpating the lymph nodes.

A blood test is also one of the diagnostic measures. Among other things, the sedimentation rate and the number of red blood cells, white blood cells and platelets are determined (small blood count) and the composition of the various types of leukocytes and their appearance is analyzed (differential blood count).

In many cases, a tissue sample is required to confirm the diagnosis. To do this, a suspicious lymph node or suspicious tissue is removed in a small surgical procedure; Depending on the location, this procedure is performed under local anesthesia or brief general anesthesia. Usually it can take place on an outpatient basis. If there is a suspicion of a lymphoma within the gastrointestinal tract, a gastroscopy or gastroscopy can be carried out for clarification and tissue removal. a colonoscopy may be necessary. The sample taken is then examined in fine tissue (histologically, immunohistochemically). Some forms of lymphoma (e.g. CLL, multiple myeloma) are diagnosed from the blood without the need to examine the bone marrow.

Other special laboratory tests

Once the diagnosis is made, further examinations are carried out in order to be able to assign the disease to a subgroup. This is of great importance for the appropriate therapy planning. With genetic tests, the chromosomes and the DNA of the lymphoma cells can be examined and genetic changes can be determined. For B-cell series lymphomas, the blood is tested for certain antibodies that are produced by the lymphoma (for example, in multiple myeloma). Using molecular genetic methods (e.g. immunophenotyping), individual features of the lymphoma cells, such as surface structures, can be identified.

What other examinations will be carried out?

In order to assess whether the lymphoma cells have spread in the body and which organs are affected, further diagnostic steps follow (spread diagnosis, staging). This includes:

  • Computed tomography with contrast agent; this can be used to assess the colonization of cancer cells in lymph nodes and organs. If the patient is intolerant to the contrast medium, a magnetic resonance tomography can be performed instead of the CT.
  • The PET-CT is a further examination possibility. With it, the metabolism of tissue can be made visible and possible tumor activity can be assessed.
  • X-rays or magnetic resonance imaging (MRI) can be used for lymphomas that have an increased risk of tumor growth in the bones (e.g., multiple myeloma). In addition, an X-ray of the chest provides information about any accumulation of tumor cells behind the breastbone (mediastinal tumor); this is a common finding in Hodgkin lymphoma.
  • Bone marrow puncture: a small amount of bone marrow is removed from the pelvic bone and then examined under a microscope. It is analyzed whether abnormally changed blood cells can be detected and to which cell row they can be assigned (so-called cytomorphology and cytochemistry). Bone marrow aspiration takes place under local anesthesia and in most cases can be done on an outpatient basis.
  • Lumbar puncture: With some forms of lymphoma there is a risk that abnormal cells will also settle in the central nervous system. As part of a lumbar puncture, cerebral spinal cord fluid (liquor) is removed and examined for the presence of lymphoma cells.
  • Stomach and colonoscopy: for further clarification of MALT lymphomas in the stomach or small intestinal mucosa.
  • An ECG and cardiac ultrasound examination as well as a lung function test and thyroid diagnostics are also carried out to assess the general state of health.

Not all of these examinations are carried out on every patient; the attending physician will inform you which individual steps are necessary.

How are the disease stages classified?

The test results are used to assess how far the diseased cells have spread in the body. Depending on this, the stage of the disease is determined (staging).

Hodgkin's lymphomas and most non-Hodgkin's lymphomas are divided into stages according to the so-called Ann-Arbor classification. The anatomical distribution of the affected lymph node regions in the body is based on:

  • Stage I: only one lymph node region is involved.
  • Stage II: two or more lymph node regions are involved, but only on one side of the diaphragm.
  • Stage III: two or more lymph node regions on either side of the diaphragm are affected.
  • Stage IV: diffuse involvement of several organs or tissues.

Certain risk factors also play a role (e.g. how much has the rate of sedimentation changed? Is there a large tumor behind the breastbone?). Taking all factors into account, the disease is finally divided into three stages: early (limited) stage, middle (intermediate) stage and advanced stage.

For some forms of lymphoma (e.g. CLL, multiple myeloma) different staging systems apply.

Forecasting systems

In the case of malignant diseases, therapy planning is not only adapted to the stage of the disease, genetic factors and other test results, but also to the general health of the person affected. This includes, for example, whether there are comorbidities, whether there are severe complaints, how limited the patient is in everyday life, whether there is a need for care, etc. There are various scales for a uniform assessment of these factors, such as the Karnofsky index or the ECOG status. Ultimately, these scales can also be used to estimate the course of the individual disease, because the following generally applies: the fitter the patient is, the better the prognosis.

Whom can I ask?

The first symptoms of a lymphoma are rather unspecific and often lead to the treating family doctor first. As soon as a lymphoma is suspected, further clarification should be carried out by a specialist in internal medicine specializing in hemato-oncology. The treatment of the lymphoma takes place in a specialized center.

A list of oncolgic centers and departments across Austria can be found here.

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