Patient, male, 49 years old. He was admitted to the hospital from the outpatient clinic with a proposed anal fistula due to a “scrotal mass for one year”. The patient had a history of diabetes mellitus, no fever and no ulceration during the course of the disease. He was surgically excised by the doctor (details unknown) and postoperative pathological examination: lymphoma.
The patient’s history was incomplete; 2, the examination was not careful, the fistula should be able to detect the fistula tract, if necessary, ultrasound, CT, MRI and other tests should be done to confirm the diagnosis, not all perianal masses are caused by anal fistula: teratoma, sebaceous cyst, epidermoid cyst, tumor can be caused; 3, the diagnosis can not be confirmed intraoperatively can be made frozen section. Zhang Qing, Department of Anorectal Medicine, Anqing City Hospital of Traditional Chinese Medicine
Learn about lymphoma
Lymphoma, also known as “lymphoma”, is a malignant tumor originating from lymph nodes or other lymphatic tissues, and is one of the ten common malignant tumors in China. It is one of the ten most common malignant tumors in China. It is mostly seen in middle-aged and young people, with more male patients than female. The disease can be divided into two major categories, Hodgkin’s disease and non-Hodgkin’s lymphoma, according to their cellular components. Its malignancy varies and is caused by malignant proliferation of the lymphoid tissue cell system, mostly in the lymph nodes. Causes
Lymphoma
1.Immune deficiency such as AIDS, organ transplantation, rheumatoid arthritis, etc.
2.Viral infection such as HTLV, HIV, EBV, etc.
3.Chemical carcinogens such as pesticides and hair dyes
4.Other such as radiation exposure and after treatment of Hodgkin’s disease
5.Long-term acidic body is the common cause of lymphocytic carcinoma
Causes of disease: 1.
It has been proved that lymphoma in some animals is caused by viruses, and it is now believed that human lymphoma tissue proliferative disease is also related to viral infection.
2.Immunodeficiency Animal experiment proves that animals with thymectomy or receiving anti-lymphatic serum, cytotoxic drugs and radiation can make their immune function in a long-term low state and have a high incidence of tumor.
For example, Hodgkin’s disease often has triple or tetraploidy, and lymphoma and follicular lymphoma often have chromosomal changes. The relationship between drugs and lymphoma development has been tentatively demonstrated. Enlarged lymph nodes: These include superficial and deep lymph nodes and are characterized by progressive, painless, hard, pushable lymph nodes that do not adhere to each other in the early stages but may fuse in the late stages and are ineffective with anti-inflammatory and anti-tuberculosis therapy. Superficial lymph nodes are more common in the neck, followed by the axillae and the abdominal sulcus. Deep lymph nodes are more common in the mediastinum and parietal aorta. Local compression symptoms caused by enlarged lymph nodes: mainly refers to deep lymph nodes, such as enlarged mediastinal lymph nodes, compression of esophagus may cause dysphagia; compression of superior vena cava causes superior vena cava syndrome; compression of trachea causes cough, chest tightness, dyspnea and cyanosis.
Clinical manifestations
Lymph node enlargement
Lymph node enlargement is the characteristic feature of this disease. Painless and progressive enlargement of superficial lymph nodes is often the first manifestation, especially in the cervical lymph nodes, followed by the axillae, and less frequently in the groin or on the talus. Hodgkin’s disease starts in the cervical lymph nodes in 60% to 70% of cases, with more left than right. Enlarged supraclavicular lymph nodes suggest that the lesion has spread, with the right side coming from the mediastinum or both lungs and the left side often from the retroperitoneum.
Signs of extra-nodal lesions
(1) Liver and spleen Invasion of the liver parenchyma may cause enlargement. About 25% to 50% of non-Hodgkin’s lymphomas have liver involvement on biopsy, especially in follicular or diffuse small lytic non-Hodgkin’s lymphomas. Most splenic infiltrates arise from abdominal lymph node lesions via lymphatic vessels.
(2) Thorax In non-Hodgkin’s lymphoma, pleural effusion occurs in about 25% of cases, which may be due to mediastinal involvement and lymphatic obstruction in addition to tumor infiltration.
(3) Bone Malignant lymphoma invading the bone may have localized pain on pressure and pathological fracture.
(4) Skin Specific skin lesions are most often seen in T-cell adult leukemia Fobart’s syndrome or mycosis fungoides, with a variety of manifestations, including masses, subcutaneous nodules, infiltrative plaques, ulcers, papules, and macules, often first seen on the head and neck. Herpes zoster also occurs in Hodgkin’s disease, accounting for 5%-16% of cases.
(5) Tonsils, mouth, nose and pharynx Lymphoma invading the mouth, nose and pharynx is 96% of diffuse prolymphocytic and histiocytic non-Hodgkin’s lymphoma. Localized masses and enlarged submandibular lymph nodes are seen clinically.
(6) Kidney Renal enlargement, hypertension, and urea nitrogen retention are also seen.
(7) Neurological symptoms caused by central nervous system involvement are seen in about 10% of non-Hodgkin’s lymphomas, especially diffuse prolymphocytic, small anaplastic and large cell lymphomas.
(8) Other lymphomas may also infiltrate the pancreas and cause malabsorption syndrome.
Symptoms
Lymphoma is a malignant tumor which mainly manifests in the lymphatic system, and is a malignant proliferative disease originating from the lymphatic reticular system
Lymphoma
Lymphoma is a malignant proliferative disease of the lymphatic reticular system. About 60% of lymphoma is first found in the swollen lymph nodes in the neck, which start as a single enlargement and gradually increase in number and size. Lymphoma can occur in lymphatic tissues throughout the body, such as the lower jaw, jaw, anterior neck, supraclavicular region, axilla, groin, mediastinal cavity or abdominal arteries, and sometimes in the organs, causing pressure symptoms. If lymphoma invades the bone marrow, it may cause pallor, fever, abnormal bleeding and other pancytopenia, and sometimes abnormal lymphocytes may be seen in the peripheral blood.
The disease is equivalent to “stone gangrene”, “yin gangrene”, “malignant gonorrhea”, “malignant nucleus”, “loss of glory”, and “lymphoma”. “The disease is caused by cold and phlegm stagnation. The disease is caused by cold and phlegm stagnation, qi and phlegm stagnation, and liver and kidney yin deficiency.
The clinical manifestations are very inconsistent due to different sites and extent of lymphoma cell invasion. The primary site can be either in the lymph nodes or in the lymphatic tissue outside the lymph nodes. However, in general, there are three manifestations as follows.
(i) Local manifestations
(1) Enlarged lymph nodes: including superficial and deep lymph nodes, characterized by progressive and painless enlarged lymph nodes, hard, mostly pushable, not adherent to each other in the early stage, but fused in the late stage, and ineffective in anti-inflammatory and anti-tuberculosis treatment. Superficial lymph nodes are mostly found in the neck
Lymphoma
The superficial lymph nodes are mostly found in the neck, followed by the axillae and the abdominal sulcus. In the deep part, mediastinum and para-abdominal aorta are the most common. (2) Local compression symptoms caused by enlarged lymph nodes: mainly refers to deep lymph nodes, such as enlarged mediastinal lymph nodes, which can cause dysphagia due to compression of esophagus; superior vena cava syndrome due to compression of superior vena cava; cough, chest tightness, dyspnea and cyanosis due to compression of trachea.
(B) Systemic symptoms
(1) Fever: the fever pattern is mostly irregular, between 38-39C for many years, some patients may have continuous high fever, or intermittent low fever, a few have periodic fever. (2) Wasting: most patients have the manifestation of weight loss, reducing more than 10% of the original weight within 6 months. (3) Night sweats: sweating at night or after sleep.
(3) Extra-nodal lesions
Lymphoma may invade various tissues and organs throughout the body. For example, liver and spleen infiltration may cause enlargement of liver sign; gastrointestinal infiltration may cause abdominal pain, bloating, intestinal obstruction and bleeding; lung and pleural infiltration may cause cough and pleural effusion; bone infiltration may cause bone pain and pathological fracture; skin infiltration may cause skin scratching and subcutaneous nodules; tonsil and mouth, nose and pharynx infiltration may cause swallowing difficulty, nasal congestion and nasal button; nervous system infiltration may cause spinal cord compression and cranial neuropathy, etc. Once a patient has the above symptoms and signs, he/she should go to the hospital for examination to determine if he/she has lymphoma. Complications
Lymphoma
(1) Gastrointestinal tract Loss of appetite, abdominal pain, diarrhea, abdominal masses, intestinal obstruction and bleeding, etc.
(2) Hepatobiliary Invasion of the liver parenchyma may cause pain in the liver region.
(3) Bone Clinical manifestations include localized skeletal pain and secondary symptoms of nerve compression.
(4) Skin Non-specific damage commonly includes pruritus and itchy rash. Pruritus is more common in Hodgkin’s disease (85% of cases).
(5) Tonsils and mouth, nose and pharynx Clinical difficulties in swallowing, nasal congestion and epistaxis in cases of lymphoma invading the mouth, nose and pharynx.
(6) Others Lymphoma may also infiltrate the pancreas, and malabsorption syndrome may occur.
Editorial diagnosis
The diagnosis of malignant lymphoma includes two aspects: one is to affirm the type of lymphoma, i.e. to affirm the diagnosis; the other is to determine the site and scope of lesion involvement, i.e. the clinical stage. Other examinations are blood, urine routine, liver and kidney function, blood biochemical examination, X-ray examination, B-ultrasound examination, CT examination, MRI examination, lower limb lymphography, 67Ga scan and other examinations.
If the diagnosis of lymphoma is confirmed, first of all, do not panic, you must make a judgment on how to treat according to the specific situation and consult in many aspects.
Lymphoma is a kind of cancer that originates from lymphatic tissues
The lymphatic system includes lymphatic tissues and organs such as the spleen and tonsils. It also includes lymph nodes, a type of white blood cell, and bean-shaped lymph nodes, which function to fight infections caused by germs.
Editorial Types
1. Non-Hodgkin’s Lymphoma {Non-Hodgkin’s Lymphoma
There are two types.
B-cell zB lymph nodes
T-cell zT lymph nodes
Each of the above types is subdivided into two types.
z1{Chronic lymphoma – very slow growing
z2 {aggressive lymphoma – very fast growing
When doctors explain lymphoma, they usually use these two terms.
2. Hodgkin’s Lymphoma
It is very similar to non-Hodgkin’s lymphoma, but it is still different. For example, an abnormal cell called a Reed-Sternberg cell {is born in the patient’s body. Unlike non-Hodgkin’s lymphoma, these cells spread through the body in a more sequential order.
Editorial Stages
The following are the various stages of lymphoma.
Stage 1: The lymphoma is confined to one lymph node or lymphatic region. This is called early stage cancer.
Stage 2: The lymphoma has invaded two or more lymph nodes or lymphatic areas but is still on the upper or lower side of the diaphragm. This is called local spread.
Stage 3: The cancer is scattered on both sides of the diaphragm (upper and lower sides). This is called “extensive” spread.
Stage 4: The lymphoma has metastasized to one or more organs of the body, including the bones, bone marrow, skin, liver and lungs. This is called widespread metastatic cancer.
Editorial Classification
According to the patient’s symptoms, lymphoma can be classified into the following three categories.
A. Those with no symptoms
B. Those with the following symptoms: fever, chills, night sweats (sweat soaking through clothes after waking up in the morning), itchy skin and weight loss.
C. Lymphoma that spreads directly from one lymph node to one organ.
Editorial Treatment
Can lymphoma be cured
Malignant lymphoma is a highly malignant tumor, and more than 90% of patients used to die within 1 year, but this malignant tumor also has the greatest progress in treatment, and after nearly half a century of research, most malignant lymphomas are now expected to be cured.
Thus, malignant lymphoma is not an incurable disease. This is mainly due to radiation therapy and chemotherapy, which are the main treatment measures for malignant lymphoma today and have been remarkably effective, especially in Hodgkin’s disease, where significant progress has been made and the overall 10-year survival rate has increased to more than 50%, the vast majority of which may have been cured.
Radiation therapy plus chemotherapy is highly effective
Most Hodgkin’s disease can be cured with either or both radiation and chemotherapy. Radiation therapy alone can lead to cure in more than 90% of patients with stage I or II disease. Treatment is administered on an outpatient basis only and takes about 4-5 weeks. The radiation sites are the involved lymph nodes and peripheral lymph nodes.
Significantly enlarged lymph nodes in the chest should be given chemotherapy before or after radiotherapy, and 85% of patients can be cured with this combined treatment.
The treatment of stage III Hodgkin’s disease varies with each case. If the patient is asymptomatic, radiation therapy alone may sometimes be given. Between 65% and 75% of patients can be cured. The addition of chemotherapy can increase the likelihood of cure to 75-80%. If the patient is symptomatic, chemotherapy or radiation therapy should be added. The cure rate for such patients is between 70-80%.
Combination chemotherapy is usually used for stage IV patients. Each chemotherapy cycle lasts for 1 month, and the total course of treatment is 6 months or more. Other combination chemotherapy regimens are available. Even in this advanced stage, more than 50% of patients can be cured.
Non-Hodgkin’s lymphoma often spreads throughout the body. For some patients, a complete cure is possible. In other patients, treatment can prolong life and improve symptoms for years. The likelihood of cure or long-term survival depends on the stage of the lymphoma and the site of dissemination. Of course, the decision to use chemotherapy can be difficult for both the patient and the physician. Although chemotherapy can greatly increase a patient’s chances of being cured, its side effects are significant. Chemotherapy drugs can cause transient or lasting sterility, increase the risk of infection, and cause hair loss. Leukemia can occur in some patients 5-10 years or more after radiation or chemotherapy. However, such treatment is still the best option for patients with malignant lymphoma.
Chemotherapy combined with Chinese medicine treatment
Chemotherapy for lymphoma is mainly combined chemotherapy, which is more effective than single drug chemotherapy. However, side effects occur along with the treatment and intensify with the deepening of treatment, among which the most obvious reactions are impaired digestive function and suppression of bone marrow hematopoietic function. Some patients may not be well controlled or may relapse after remission. Chinese medicine treatments such as strengthening the spleen and stomach, benefiting Qi and blood, and nourishing the liver and kidney should be combined with chemotherapy at the same time and after chemotherapy, which can better alleviate chemotherapy reactions and help chemotherapy proceed smoothly.
Adjuvant treatment of chemotherapy
If selenium-containing preparations are given to cancer patients during chemotherapy, it can not only improve the efficacy, but also reduce the toxic side effects caused by chemotherapy drugs, especially to the digestive tract and hematopoietic system. This can enhance the body’s tolerance to chemotherapy, the
Immunotherapy
Immunotherapy includes immunocell therapy and drug therapy. Immunocell therapy refers to separating the patient’s cells from the blood, using some cytokines in vitro to turn them into a kind of killer cells, and then transfusing them back into the blood, which can recognize the tumor cells and kill them. There is another kind of immunotherapy, such as interferon and interleukin II, which are called immunotherapy. Immunotherapy refers to the treatment that stimulates the body’s own immune system to fight against cancer. The immune system is the body’s own defense system against disease. Immunotherapy is also called biologic response modifiers or biologic therapies.
Alpha interferon is often used to treat granulocytic leukemia (HCL), chronic myeloid leukemia (CML), follicular lymphoma, multiple myeloma, and T-cell lymphoma affecting the skin.
The incidence of malignant lymphoma
Malignant lymphoma is an immune cell tumor of lymphatic tissue in lymph nodes and/or extra-nodal sites, derived from malignant changes in lymphatic tissue or tissue cells. Malignant lymph occurs mostly in the lymph nodes and can be multiple or single, and it can first occur in any site other than the lymph nodes and is called extra-nodal lymphoma. Since lymphoma is a neoplastic proliferation, its malignancy and course can be very different due to its histological characteristics, but its clinical manifestations are all very similar. Since lymphatic tissue has human immune function, malignant lymphoma is also a malignant actual tumor of the immune system.
The incidence of malignant lymphoma is higher in Europe, North America, Saudi Arabia and certain African countries than in most Asian and African countries. The incidence and mortality rate of the disease in China is low; however, due to the large population base in China, the actual total number of cases is estimated to be around 10,000 or 50,000 per year. Moreover, it often occurs in young adults. The distribution of malignant lymphoma in China does not differ much from ethnic, regional, urban and rural factors; the relationship with gender factors is slightly more male patients than female.
Malignant lymphoma is divided into two categories, Hodgkin’s disease (HD) and malignant lymphoma (NHL). Each category can also be divided into multiple subtypes based on histopathological features. The incidence ratio of Hodgkin’s disease and malignant lymphoma differs significantly. A statistical analysis of 4023 cases of malignant lymphoma by the editorial board of Chinese Cancer Control Research showed that Hodgkin’s disease accounted for 29,1% and non-Hodgkin’s lymphoma accounted for 70,9%.
Since the 1930s, the treatment effect of the disease has gradually improved. Later on, a rational and planned comprehensive treatment was adopted, and the efficacy was further improved. Hodgkin’s disease can be cured in 60% to 80%, and non-Hodgkin’s lymphoma can be in long-term remission in more than 50%. This has become an encouraging area of oncology research.
Alcohol consumption may reduce risk of lymphoma
U.S. researchers have found that drinking alcohol appears to reduce the risk of non-Hodgkin’s lymphoma in humans.
Researchers analyzed nine studies of 15,000 people from the U.S., U.K., Sweden and Italy, showing that alcohol drinkers had an approximately 27 percent lower risk of non-Hodgkin’s lymphoma than non-drinkers.
Lindsay Morton of the National Institutes of Health said, “We have a good understanding of the risk of non-Hodgkin’s lymphoma. Morton said, “Our comprehensive study of alcohol consumption and the risk of developing non-Hodgkin’s lymphoma shows that people who drink alcoholic beverages have a lower risk of non-Hodgkin’s lymphoma than those who do not.”
This study found that the risk of non-Hodgkin’s lymphoma was reduced in all drinkers, independent of the type of alcoholic beverage consumed, the amount of alcohol consumed, and the length of time consumed.
Many previous studies have shown that antioxidants in grapes, especially red grape skins, reduce the risk of non-Hodgkin’s lymphoma. But the researchers said the study found that just drinking alcohol, whether red or white, reduced the risk of non-Hodgkin’s lymphoma.
Healing
is related to the thoroughness of treatment, on the one hand
On the other hand, it is related to the daily care of patients after treatment, which can prevent recurrence to a certain extent and improve the body’s resistance to disease if properly cared for. In terms of diet, patients with lymphoma should eat light, easily digestible and nutritious food, avoid cold, greasy and spicy food, and quit smoking and drinking. They can also rely on traditional Chinese medicine with anti-tumor and spleen and kidney tonic effects.
Factors affecting the prognosis of lymphoma.
1.Age: The survival rate of Hodgkin’s disease patients younger than 50 years old is higher than that of those older than 50 years old. The prognosis of non-Hodgkin’s lymphoma children and elderly patients is generally worse than those aged 20-50 years old.
2. Gender: In patients with Hodgkin’s disease, women have a higher survival rate after treatment, while in non-Hodgkin’s lymphoma, there is little difference in prognosis between men and women.
3. Pathology: Among patients with Hodgkin’s disease, lymphocyte-dominant type has the best prognosis, with a 5-year survival rate of 94.3%. In non-Hodgkin’s lymphoma, follicular lymphocyte differentiation is good, with a 6-year survival rate of 61%; diffuse lymphocyte differentiation is poor, with a 6-year survival rate of 42%; lymphoblastoid lymphoma, with a 4-year survival rate of 30%.
4.Stage: In patients with Hodgkin’s disease, the 5-year survival rate is 92,5% for stage I, 86,3% for stage II, 69,5% for stage III, and 31,9% for EF.
5. Systemic symptoms: The prognosis of Hodgkin’s disease patients with systemic symptoms is worse than that of those without systemic symptoms, while for non-Hodgkin’s lymphoma, systemic symptoms have less impact on prognosis.
Observation of disease condition
1.Observation of systemic symptoms such as anemia, weakness, emaciation, night sweats, fever, itchy skin cancer, enlarged liver and spleen, etc.
2.Observation of the scope and size involved in the enlarged lymph nodes.
3. closely observe whether there are symptoms of compression caused by deep lymph node enlargement, such as cough, dyspnea and superior vena cava compression caused by mediastinal lymph node enlargement, and retroperitoneal lymph node enlargement may compress ureter and cause hydronephrosis
4. Observe the presence of skeletal infiltration and be alert to the occurrence of pathological fracture and spinal cord compression.
Symptomatic care
1, patients with fever according to fever care routine.
2.Give high-flow oxygen inhalation, semi-recumbent position and appropriate amount of sedation in case of respiratory distress.
3.Reduce the activity when the bone is infiltrated, prevent trauma, and treat the pathological fracture accordingly according to the fracture site when it occurs.
General care
1, early patients can be properly active, with fever, obvious infiltrative symptoms should be bed rest to reduce consumption, to protect the body.
2. Give high-calorie, high-protein, vitamin-rich and easy-to-digest food and drink more water. To enhance the body’s tolerance to chemotherapy and radiotherapy, and promote the excretion of toxins.
3, keep the skin clean, scrub with warm water every day, especially to protect the skin of radiotherapy irradiation area, avoid all stimulating factors such as sunlight, hot and cold, various disinfectants, soap, adhesive tape and other stimulation of the skin, underwear use absorbent soft cotton fabrics, should be wide.
4, radiotherapy, chemotherapy should be observed when the treatment effect and adverse reactions.
Health guidance.
1, pay attention to personal cleanliness and hygiene, keep warm and prevent various infections.
2.Strengthen nutrition and improve resistance.
3.Adhere to medical advice and follow up regularly.
Early signs
1. generalized lymph node enlargement: mainly in the neck, followed by axillary and inguinal lymph nodes, and mediastinal lymph nodes may be involved in the late stage.
2. splenomegaly: about 30% involve the spleen, mostly in the late stage, usually reactive hyperplasia, or granuloma formation.
3. Hematopoietic system: anaemia, associated with bone marrow involvement, and haemolytic anaemia in advanced stages.
4, digestive system: about 30% have gastric, pancreatic and intestinal involvement, and may have malabsorption and even ascites symptoms.
5, cardiovascular system: occasional exudative pericarditis.
6, liver damage: jaundice may result from liver damage.
7. bone metastases: about 5-15%, with bone pain.
8, renal involvement: about 13 have renal infiltration and severe renal failure.