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Lymphoma causes great fear among patients. Meanwhile, most cases of lymphoma have a better prognosis than … diabetes. What are the symptoms of this disease? What is worth knowing about it?
– Lymphomas are fearful. Why?
– Because it’s a very insidious tumor. It can develop almost asymptomatically for years or double its weight in less than 24 hours. There are several dozen subtypes of lymphomas, differing in their clinical picture. Some of them are occupied by lymph nodes, others are in the form of organ infiltrates, developing in the spleen, gastrointestinal wall, lung tissue, skin or the central nervous system, others are formed primarily in the marrow, with the presence of cancer cells in the peripheral blood.
You can get lymphoma at any age. Lymphoblastic lymphomas, Burkitt’s, or malignant lymphoma (also called Hodgkin’s lymphoma) often affect very young people. Other non-Hodgkin’s lymphomas, more common in the elderly.
However, medicine is getting better at dealing with them. Meanwhile, when someone finds out that he has diabetes, which is an incurable disease, no one feels very sorry for him. A man diagnosed with lymphoma may even take his own life. Meanwhile, most of the lymphomas, also in the advanced clinical stage, have a better prognosis than diabetes. It is known that a person with diabetes or lower-grade lymphoma will struggle with this condition all his life, but both of them can live a long and quite comfortable life. Paradoxically, in the case of aggressive, rapidly progressing lymphomas, most of the patients can be completely cured.
– Does patients’ fear of lymphoma delay their start of treatment?
– I was approached by a very young patient who had lymph nodes under her arms the size of a large orange. She delayed the visit to the doctor for a long time because she was terrified of seeing an oncologist. Fortunately, she was able to help her – she is now a dozen or so years after the bone marrow transplant, but procrastination was not a wise approach.
– What are the symptoms of lymphoma?
– Symptoms that indicate the presence of lymphoma are non-specific, therefore it is very important that all disturbing changes that persist for more than two weeks are consulted with a doctor. The most common symptom is severe enlargement of one or more lymph nodes in the neck, collarbone, armpits or groin. Characteristically, the enlargement of the nodes is not accompanied by symptoms characteristic of inflammation, such as pain, tenderness or redness. It is especially disturbing when the lymph nodes are still enlarged after 2-3 weeks of anti-inflammatory treatment. The physician should then order a complete blood count and biochemistry, and imaging tests such as chest tomography and abdominal ultrasound. In some cases, only the lymph nodes inside the body grow – in the abdominal cavity or in the chest, hence it can only be detected accidentally during tests performed in connection with other diseases or when they already cause serious ailments. Unfortunately, then the disease is usually very advanced. Other worrying symptoms include fatigue, night sweats, fever, frequent infections or weight loss by 10%, and persistent itching of the skin, often treated for many years by dermatologists as atopic dermatitis.
For example, Hodgkin’s lymphoma usually develops asymptomatically, as an enlargement of the mediastinal lymph nodes, is detected in Poland later than in Western European countries, because fewer people in our country regularly practice sports. The first symptom may be exertional dyspnea, which in young people will not appear while walking to the bus or after taking the elevator to the fourth floor. With regular efforts, they would have noticed such a change sooner.
– Do we know the causes of the formation of lymph?
– We know for sure that it is not hereditary or contagious. Although people who suffered from infectious mononucleosis are more likely to develop lymphoma, it is still only a dozen people / one hundred thousand a year (it is not even possible to express it as a percentage). Some associations between HIV infection, Helicobacter pylori and hepatitis C have also been found to increase the risk of developing lymphoma. Contact with certain chemicals may also be a contributing factor. People with congenital immunodeficiency, rheumatoid arthritis, after transplants and transfusions, radiotherapy or chemotherapy, asthma, allergy, celiac disease, and tuberculosis should also be vigilant.
– Does an early diagnosis of lymphoma influence treatment success?
For high-grade lymphomas, yes. Although in the case of Hodgkin’s disease – one of the best-prognosing cancers – it is not so obvious. Complete recovery is achieved in 95% of patients, practically regardless of the time of diagnosis. However, the later the process is diagnosed, the more intensive the treatment has to be and the more long-term side effects associated with it.
In the case of intermediate-grade non-Hodgkin’s lymphomas, 40-70% of patients can be cured. Paradoxically, the more malignant the lymphoma, the greater the chance of a cure. Medicine copes worse with low-grade lymphomas – subsequent recurrences of the process are somehow inscribed in the natural development of the disease. That is why the comfort and life expectancy (in most cases a dozen or more years) is more important than the often unsuccessful attempts to “uproot the disease”. Therefore, in the first stage of treatment, we observe the patient. Although a patient with chronic lymphocytic leukemia (the most common subtype of leukemia in Poland) sometimes has five or ten times more white blood cells than expected by the norm, we do not start chemotherapy without need. The patient does not suffer from the “morphology result” – this is not what we want to improve, especially since starting chemotherapy would encourage infections, even more frequent due to the disease. Postponing treatment until clinical symptoms appear, the appearance of large lymph nodes or the spleen is in this case well-established medical practice. The number of lines of chemotherapy a patient can undergo in a lifetime is limited to 6-7. Therefore, the treatment procedure must take this into account. I explain this to my patients that it is like a road on which snow is falling. We have six disposable snow plows available for the entire winter. If there is 3 cm of snow on the road, we do not use the plow right away, because the point is not that the road is perfectly cleared of snow, but that it is passable.
– So what influences the therapeutic success in the fight against lymphoma?
– Much of how we lived before we got sick. For example, a certain type of lymphoma is treated with chemotherapy and drugs that damage the heart. When it occurs depends on the general condition of the patient. However, in Poland about 20% of patients die 3 years after the end of therapy, 1/3 of which is due to circulatory failure. In Western Europe, such a frequency of cardiac complications is observed after 10 or 15 years. This is due to the lifestyle – diet, excess weight, smoking, lack of regular exercise. The patient’s condition also determines the choice of therapy. The record age is not decisive here – I remember my patient who, at 78 years old, qualified for a marrow transplant from an unrelated donor. But he was in such perfect shape that he played tennis four hours a day.
– The Association of Friends of Lymphoma Patients “Przebiśnieg” organized the campaign “Ask your loved ones about health” on the occasion of Grandma and Grandpa’s Day. They encourage you to ask them about their health when they make wishes. What is the treatment of lymphomas in the elderly in Poland?
Aggressive lymphomas without therapy allow the patient to survive for several to several months. Unfortunately, early diagnosis of lymphomas and prompt treatment initiation is our Achilles’ heel. This is the fault of both the patients themselves and GPs. Sometimes enlarged lymph nodes are treated for months with sequentially alternating antibiotics, anti-inflammatory and antipyretic agents. It also happens that doctors, although they suspect lymphoma or other neoplastic process, do not diagnose elderly patients. Basically: you are lucky anyway to have lived 70 years in good health. Meanwhile, in half of the cases, the diagnosis of chronic lymphocytic leukemia falls on the period between 65 and 70. It is therefore unethical and inconsistent with medical practice. The patient should be diagnosed regardless of age, which must of course be taken into account when selecting the optimal therapy. My office is on the first floor of a building with no elevator. One day, an 89-year-old patient with lymphoma visited me. I ask her if she has come with anyone. He replies yes with Duśek. Then, looking me straight in the eyes, he says, doctor, I must live, because who will take care of Duśek. My husband is 13 years older than me …
Text: Halina Pilonis