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Often times, lymphoma patients do not show disease. On the one hand, it’s good, because the disease allows you to function normally. On the other hand, it is bad – because you may not know about the growing lymphoma for a long time. In Poland, about 7 thousand. people a year, about twice as many as three decades ago.
Kasia Romanowska cleans her garden vigorously, wearing a colorful shirt, jeans and a hat with thick red hair underneath. Nobody would have thought that he has been undergoing oncological treatment for 17 years. Her story shows that a positive attitude and modern drugs can do a lot.
Kasia was 35 years old when she noticed a slight swelling in her groin – an enlarged lymph node. Besides, everything was fine – blood counts excellent, no fever, no increased sweating, nothing hurt her. When she came to an internist, he ordered an ultrasound of the lymph nodes. Examination showed that they are magnified. She was urgently referred to hospital. She had surgery really quickly, within a few days. Histopathology has shown that there are neoplastic cells in the excised nodes. – Turns out I have follicular lymphoma. It was a shock. I was afraid that my sons still go to school, and this is my end. Two weeks later I received my first chemotherapy – recalls Katarzyna.
It was 17 years ago. Chemotherapy was a great burden for Katarzyna’s body. She even knocked her off her feet. Katarzyna spent half a year on sick leave. She changed physically so that her husband, who had to leave for a week, did not recognize her when he returned. She had no hair, and her body was bloated like a balloon. Her well-being was terrible.
Oncologist prof. Cezary Szczylik told her that: “the approach to the disease is 80 percent. success. Don’t cry, just fight. Since then, Kasia has not given up.
The insidious face of lymphoma
Lymphomas, or cancers of the lymphatic system, account for about 5 percent. all cases of malignant neoplasms. Detection of an enlarged lymph node under the skin or in the subcutaneous tissue, e.g. when washing or shaving, is the most common symptom with which patients see a doctor. If they report at all. Because a neoplastic enlarged node (on the neck, submandibular, axillary, inguinal) usually does not hurt and many people may ignore its presence for a long time. But it may also happen – as explained by Dr. Ewa Paszkiewicz-Kozik from the Lymphatic System Cancer Clinic of the Institute of Oncology in Warsaw, that the disease gives absolutely no symptoms, even lymph nodes enlarged and perceptible (i.e. close to the skin).
The disease can take years to develop or it can strike unexpectedly and spread throughout the body in just a few days. In such situations, the lack of professional help can even lead to death. These very aggressive forms of lymphoma are more common in young people.
When to suspect lymphoma
A symptom of the developing disease may be fatigue, frequently recurring respiratory infections (flu, angina, bronchitis, inflammation of the ear, throat, larynx), common colds, skin infections, e.g. boils. A properly functioning immune system deals with these conditions. However, in the case of lymphomas, cancerous lymphocytes are defective and cannot effectively fight the infection. Sometimes patients have a fever, night sweats, lose weight quickly or suffer from itchy skin.
In the advanced stage of the disease, when the nodal mass is located, e.g. in the chest, it may cause shortness of breath by compressing the lung and mediastinum, if it additionally compresses the heart – palpitations, arrhythmias and failure appear. As a last resort, superior vena cava syndrome, characterized by swelling of the upper body, may develop. Enlarged lymph nodes in the abdominal cavity can compress the bile ducts and the liver, and cause jaundice. If, as it grows, the tumor compresses the kidneys or the ureter – it causes failure of this organ. In cases of pressure on the vessels, thrombosis may develop.
Vigilance is what counts
Lymphomas are a challenge for a family doctor, which is why vigilance is so important: a thorough medical examination, checking all groups of superficial lymph nodes, and examining the tonsils in the mouth. An enlarged lymph node does not have to immediately raise suspicions of neoplastic growth, but lymphomas and metastases of neoplasms from another organ, such as the lungs, must not be forgotten.
Apart from the morphology, which – as Dr. Ewa Paszkiewicz-Kozik points out – in approx. 90% of in patients at an early stage of the disease, blood counts are normal. It is worth doing OB. and determine the enzyme LDH, which is often elevated in people with lymphomas. In addition, liver enzymes, urea, creatinine, sugar levels, etc. should be checked. But the final answer will be provided only by histopathological examination.
To determine the advancement of the lesions, it is necessary to perform computed tomography of the chest and abdominal cavity. In many cases, the oncologist or hematologist then orders further tests, including an examination of the bone marrow taken from the plate of the iliac bone, and positron emission tomography (PET).
There are no symptoms and the disease is there
You have to remember that the lymph nodes do not have to be palpable – some of them are hidden in the body, especially in the abdomen and chest. It happens, especially in obese people, that the lymphoma may be 20 cm long and is not palpable during a medical examination.
Therefore, it is not uncommon for lymphoma to be diagnosed by chance, such as during a chest x-ray, ordered for some other reason. When mediastinal nodes are affected by a lymphoma, radiographs show a dilated shadow of the mediastinum. Enlarged lymph nodes in the abdominal cavity are shown by ultrasound.
Sometimes the detection of a lymphoma with a growth typical of tumors does not always require oncological treatment. Initial observation is enough, and only the appearance of new enlarged lymph nodes or the growth of the present nodes is an indication for the initiation of therapy.
You can live normally
Although lymphomas are tricky and there is little you can do to prevent them, Katarzyna’s example shows that you can live a long and normal life with these cancers. Better and better statistics are the confirmation – currently, among patients with follicular lymphoma, more than half of patients live for over 20 years since the diagnosis. Also, much more than 50 percent. patients with aggressive lymphomas have a chance of a complete recovery.
A dozen or so years ago, doctors had only a few types of cytostatics at their disposal. Currently, the number of drugs is much greater. Lymphomas are diagnosed more and more accurately, with about a hundred of their subtypes being differentiated. The prognosis and length of survival depend on the type of lymphoma.
The main treatment of lymphomas is immunotherapy and multi-drug chemotherapy. The type and schedule of treatment depends on the severity of the disease, i.e. the extent of lymph node involvement on one side (stage 1 and 2) or on both sides of the diaphragm (stage 3), infiltration in the parenchymal organs and bone marrow involvement (stage 4). Even in patients with advanced disease (stage III or IV), complete recovery or many years of remission are possible.
New methods of treatment
We owe a great improvement in the treatment of lymphomas to immunotherapy – the use of monoclonal antibodies whose task is to destroy specific types of cancer cells and stimulate lymphocytes in such a way that they themselves or with the help of their own immune cells take the fight against cancer. In the treatment of lymphomas such as diffuse large B cell lymphoma, follicular lymphoma, endocrine lymphoma, mantle cell lymphoma, Burkit’s standard of care is the combination of monoclonal antibodies with chemotherapy.
In Katarzyna’s case, the disease recurs regularly, which means the need to re-chemotherapy – usually six infusions up to four weeks. Since Katarzyna has already received all possible therapies, during her last relapse, one of the new drugs, approved in the USA, given to her by a pharmaceutical company, was used.
It is a targeted therapy – so it precisely hits the diseased lymphocytes. The therapeutic substance is the new anti-CD 20 monoclonal antibody, more modern than its prototype. It is a type of protein that recognizes and binds the CD20 antigen, found on the surface of diseased B lymphocytes. destroyed by him.
Importantly, these new drugs do not cause hair loss or extreme weakness in patients. Many patients receive them on an outpatient basis and can go to work as usual. Also, remission periods last longer – the last one with Katarzyna lasted four years.
Currently, Katarzyna receives the so-called maintenance treatment, which means he is given a dose of medication every eight weeks. Every three months she tests the blood, the doctor checks her lymph nodes. Every year he undergoes a control tomography.
– I feel great. I forgot what a disease is – Katarzyna assures. She believes that one day her disease will be curable and that there will be no further relapse.