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– A diagnosis of lymphoma is terrifying. Meanwhile, most patients can be completely healed or they can live with lymphoma as a chronic disease for 20-30 years. However, you must first recognize the disease, learn to live with it and undergo the necessary treatment – says Prof. Wojciech Jurczak from the Department of Hematology in Krakow. Each year, approximately 8000 lymphomas are diagnosed in Poland. It is the seventh most common neoplastic disease.
– Has medicine made progress in the treatment of this cancer in recent years?
– Until 20 years ago, CHOP chemotherapy, invented in the 40s, was effective in 50-70% of patients. Today, in combination with biological drugs, it helps 20%. However, its cost has increased nearly 95 times. It should be emphasized that we are now able to help the great majority of patients: for example, Hodgkin’s lymphoma can be permanently cured in 65% of patients; intermediate-grade lymphomas in 75-20% of patients. Lymphomas with low dynamics allow, in turn, to live as with a chronic disease with appropriate therapy. I think diabetes, which is also a chronic disease, creates more limitations in everyday life than this type of lymphoma. A sick person may live 30-XNUMX years, despite the successive resumption of the process, which in this case does not mean a tragedy. They are somehow inscribed in the natural course of the disease.
We will expose lymphoma on September 15!
— Lymphoma is a multi-faceted disease?
– There are several dozen subtypes of lymphomas, including Hodgkin’s lymphoma, called Hodgkin’s disease, chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, and lymphoblastic lymphoma.
— So what connects these diseases into one disease entity?
– They all come from white blood cells – lymphocytes, which are part of the body’s immune system. Another common feature is that surgical methods are not applicable to their treatment.
– Is it worse for the patient’s prognosis that the problem cannot be solved with a surgical knife?
– If there are effective drugs to eradicate the disease, then the surgical knife is unnecessary. If there were such drugs for stomach cancer, no one would excise it.
– Do lymphomas metastasize?
– Patients are often concerned about this. In this neoplasm, the degree of their advancement does not matter much, because we use drugs that work throughout the body. What is important for the prognosis is the subtype of lymphoma and its sensitivity to treatment.
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— How is this disease manifested?
– The symptoms associated with lymphomas often resemble those of a common cold and are therefore ignored. In most cases, the disease is detected only in the advanced stage. Patients may notice enlargement of one or more lymph nodes, weight loss, night sweats, fever, or persistent itching of the skin. An additional difficulty in diagnosing lymphomas is that they can arise in internal organs, such as the digestive system. Then they give symptoms similar to other diseases, e.g. stomach ulcers. Therefore, it is very important to consult a doctor about any disturbing symptoms that persist for more than three weeks.
— Is lymphoma difficult to diagnose?
– Doctors can do it. A medical history is needed for a full diagnosis. The doctor must examine all available lymph nodes, determine their size, cohesiveness, mobility and determine if they are painful. However, in order to make a final diagnosis, a fragment of the suspected node should be surgically removed for histopathological examination. To determine the clinical stage, you need to perform a complete blood laboratory test, chest X-ray, abdominal ultrasound, CT scan of the chest and abdomen (and other locations), PET-CT, in some cases also a bone marrow scan bone marrow.
– The biggest problem is with patients over 70 years of age, when GPs seeing a tumor are afraid that little can be done for such a patient and do not take any action. Meanwhile, in many cases, mild treatment would suffice, even without the use of chemotherapy. A diagnosis should therefore be made in any patient with a life expectancy greater than a few weeks.
— Young people with Hodgkin’s disease are not always diagnosed quickly and correctly.
– That’s true. The healthier we live, the sooner we will recognize the symptoms of the disease. Exercise dyspnea will not be noticed by a young man who smokes and does not play any sports. The exerciser will quickly notice that his performance has decreased. Sometimes 2-3 years pass from the onset of the first symptoms to the diagnosis. For example, in Germany, when diagnosed, the diameter of the lymph nodes is usually a few cm. smaller. However, this does not reduce the chances of a cure, although it may mean greater intensity of the chemotherapy used. Taking into account the number of lymphoma subtypes, the examination of the specimens is performed by the best pathologists who have all the necessary diagnostic methods at their disposal, practically unavailable in private laboratories.
— How are lymphomas treated?
– With the help of chemotherapy and biological drugs, mainly the so-called monoclonal antibodies. Their production is a complicated process, but they allow the destruction of the lymphocytes from which lymphoma derives in a selective manner, without toxic damage to other cells.
– The mainstay of treatment, however, is chemotherapy. However, many patients in the Polish population cannot be treated with some cytostatics, e.g. with doxorubicin, the condition of the cardiovascular system is of great importance, as these drugs burden the heart. Poles fall ill and die of heart disease more often than other European citizens. There is a form of the drug called liposomal doxorubicin, which kind of bypasses the heart. Unfortunately, the National Health Fund does not refund such treatment in patients with lymphomas, although it allows its use in the case of breast cancer. Lymphoma patients who have atherosclerosis or heart failure cannot benefit from this treatment. This is not the only example of the lack of availability of modern medications in Polish lymphoma patients – restrictions apply to an even greater extent to targeted drugs with an alternative mechanism of action to cytostatics.
– Fortunately, many patients can be treated in clinical trials sponsored by, among others by pharmaceutical companies. Contrary to what some say, such studies allow patients to access effective therapies, the annual cost of which exceeds several hundred thousand zlotys. zloty. These are often drugs already approved for another, very similar type of lymphoma that is treated with the same chemotherapy regimens.
— Can we talk about prophylaxis in the case of lymphomas?
— We do not know the causes of these tumors, so it is difficult to prevent it. However, a healthy lifestyle allows for faster detection of the disease, because weakness in a healthy and fit body is easier to notice. In addition, good health condition allows you to apply a treatment that is somewhat aggravating the body. Therefore, healthy eating and doing sports are surely allies in the fight against lymphoma.