I. What is lymphoma?
Lymphocytes are the health guards of human body, they resist the invasion of foreign bacteria and viruses, remove the aging and necrotic cells in the body, and maintain the “neatness and order” of the internal environment of the body. Lymphocytes are a “multi-ethnic family” with at least three major lineages: lymphocytes from the thymus called T cells, lymphocytes from the bone marrow called B cells, and some cells that are “natural killers” called NK cells. When these lymphocytes mature, they leave the family and move into society, migrating to lymph nodes and other lymphatic tissues throughout the body, including the spleen and tonsils. The bean-shaped lymph nodes are located in clusters around the areas where lymphatic vessels converge and around the veins, creating the “Great Wall” that protects the body’s health. In addition, lymphatic tissues and organs other than hair, nails and cornea, such as gastrointestinal tract, bronchi, urinary system, reproductive system, skin, thyroid gland, etc. are also widely distributed and are another barrier to protect human health.
Lymphocytes by nature are in a never-ending battle, and the lymph nodes and lymphatic tissues almost all over the body are their battleground. Therefore, from the time we are born to the end of our lives, these two main battlefields are filled with fierce fighting. With such a harsh environment and intense work pressure, it is not surprising that lymphocytes undergo qualitative changes. The malignant change of lymphocytes is called lymphoma.
Figure 1 Distribution of lymph nodes in normal human body
Figure 2 Normal human lymph node morphology diagram
What are the clinical manifestations and symptoms of lymphoma? How to detect and diagnose early?
Lymphocytes can be malignant in their birthplace (thymus, bone marrow) or in their fighting positions (lymph nodes, spleen, tonsils and lymphatic tissues of other tissues and organs throughout the body), so the clinical manifestations are complex and diverse, and it is not an exaggeration to describe them as “changing in many ways”.
The most typical manifestation of lymphoma is painless enlargement of lymph nodes in superficial areas with smooth surface and tough texture, which feels like a ping-pong ball when touched, or the hardness of the tip of the nose. The neck and supraclavicular lymph nodes are the most common, followed by the axillary and inguinal lymph nodes. There are also patients with deep lymph node enlargement as the main manifestation, such as mediastinal, abdominal and pelvic lymph node enlargement, the onset of which is relatively insidious, and the lymph node enlargement is often more obvious when detected.
For example, large mediastinal lymph nodes may compress the superior vena cava, resulting in obstruction of blood return and manifesting as swelling of the face and neck, chest pain and difficulty in breathing; large lymph nodes in the pelvis and abdomen may compress the gastrointestinal tract, ureter or bile duct, resulting in intestinal obstruction, hydronephrosis or jaundice, and causing abdominal pain and distension.
Lymphoma can also invade organs other than the lymphatic system and manifest as invasion, destruction or compression of the corresponding organs and obstruction, such as lymphoma of the gastrointestinal tract, which behaves like stomach or intestinal cancer and can cause abdominal pain, gastrointestinal ulcer, bleeding, obstruction and compression; skin lymphoma is often misdiagnosed as psoriasis, eczema and dermatitis; invasion of the skull and brain can cause headache, blurred vision, speech disorder, confusion, personality change and paralysis; invasion of the skeleton can also cause headache, blurred vision, speech disorder, confusion, personality change and paralysis. Invasion of bones may cause bone pain and fracture; Invasion of nasopharynx may cause nasal congestion, runny nose and nasal bleeding, similar to the performance of nasopharyngeal cancer.
4.Lymphoma is a systemic disease, so in addition to the above local symptoms, about half of the patients may also have systemic symptoms such as fever, night sweats, fatigue, emaciation, loss of appetite, rash, itching and anemia.
As we can see, if the main manifestation of lymph node enlargement is superficial, it may alert us to early detection, but deep lesions often have symptoms only when they grow to a larger size, so it is difficult to diagnose early. It is good to know that the stage of lymphoma is not as important as other malignant tumors. The stage is only one of the factors that determine the prognosis, but the type of pathology and the sensitivity of tumor cells to chemotherapy regimens are more important, so there is no need to feel desperate and frustrated because the disease is found late.
3. Is lymph node enlargement, lymphadenitis or lymphatic tissue hyperplasia lymphoma?
Although the environment of human existence is not ideal and lymphocytes are under a lot of pressure, fortunately, they are a group of strong warriors and very few of them have qualitative or malignant changes. The incidence rate of lymphocytes is usually 2-5 per 100,000 people, and is only the 8th-10th among malignant tumors. Moreover, lymphocytes function as the body’s guards, and lymph nodes and lymph tissues are the battlefield, therefore, every normal person will have enlarged lymph nodes and lymph tissues repeatedly throughout his or her life. In particular, the bilateral submandibular and inguinal lymph nodes, whose function is to monitor and counter inflammatory reactions in the oral cavity and nasopharynx, and the latter to monitor and counter inflammatory reactions in the bilateral lower extremities and vulva, are almost inevitably subject to more or less frequent infections and inflammatory reactions in these areas throughout our lives, so it is not surprising that lymph node enlargement occurs to varying degrees. In most cases, the enlarged lymph nodes will return to normal size after the inflammatory reaction is eliminated, but in the case of long-term, chronic inflammatory stimulation, the enlarged lymph nodes may not completely return to their original appearance. However, the lymphocytes in these lymph nodes are good in nature and have not undergone malignant transformation, so they are called benign lymph node diseases, such as chronic lymphadenitis, lymph node tuberculosis, nodular disease, etc. In this case, the enlarged lymph nodes are often mild, soft in texture, painful to the touch, and effective in anti-inflammatory or anti-tuberculosis treatment.
In fact, the transformation of lymphocytes from benign to malignant is a process from quantitative to qualitative change, therefore, some lymph node lesions may be between benign and malignant, and it is difficult to make a definite diagnosis, or they may be an abnormal proliferation of lymphatic tissue. However, after a certain period of time, some lesions may turn into malignant lymphoma completely, or from low-grade malignant lymphoma to more malignant lymphoma, which may be life-threatening and require active treatment.
Lymph nodes are also the body’s “cleansing filters”, and all kinds of malignant tumors may have lymph node metastasis in the corresponding lymphatic drainage areas when they progress to a certain degree. These are called metastatic lymph node cancer or lymph node metastasis, which are completely different from what we usually call lymphoma in terms of disease nature and treatment. Therefore, swollen lymph nodes need to be differentiated from metastatic lymph node cancer. In case of metastatic lymph node cancer, no matter what kind of tumor metastasizes to lymph nodes, the treatment of the primary tumor should be the fundamental principle, for example, if lung cancer metastasizes to lymph nodes, the lung cancer itself should be treated.
4.How to differentially diagnose benign and malignant diseases of lymph nodes?
Lymphoma is more difficult to diagnose than other tumors because of its different sites of development and various clinical manifestations. The most common differentiation is the enlargement of lymph nodes caused by benign diseases, in addition, it is also necessary to differentiate from metastatic cancer of lymph nodes. In this case, the main basis is pathological diagnosis, which means looking for malignant cells under the microscope. The doctor’s rich medical experience, high level of examination and diagnosis, visual and tactile examination, and fine examination and laboratory tests can help to suggest the correct diagnostic direction, the possible disease type and the most appropriate diagnostic means, but in no way can they replace pathological diagnosis.
Thus, pathological diagnosis is the “gold standard” for the diagnosis of lymphoma and all malignant tumors. Regardless of the depth, location, size, shape and hardness of the lesion, pathological biopsy must be performed to diagnose or exclude lymphoma. Superficial lymph nodes can be excised and biopsied; deep lesions need to be biopsied by ultrasound or CT-guided coarse needle aspiration; gastrointestinal, nasopharyngeal and respiratory lesions can be biopsied by endoscopy; thoracic or pelvic and abdominal lesions can be biopsied by lumpectomy, and if necessary, open abdomen or open chest is needed for pathological tissue. Although it is troublesome, it is indispensable to confirm the diagnosis of lymphoma. Even if you have had lymphoma in the past, you should try to take tissue for pathological diagnosis when you have swollen lymph nodes again and consider recurrence, both to clarify whether lymphoma has recurred and because some types of lymphoma may undergo pathological transformation into other types of lymphoma, and the treatment and prognosis may change.
Some patients may be concerned that these punctures and biopsies may cause lymphoma cells to metastasize. Theoretically, this is possible, and it is reasonable to speculate. But logically, if it is lymphoma or other malignant tumors, even without puncture, malignant tumor cells will break through the envelope of the tumor lesion and invade the adjacent or even distant organs and tissues, and even without breaking through the envelope, malignant tumor cells will invade the rich blood vessels and lymphatic vessels inside the tumor and spread widely with blood and lymphatic fluid, which is the characteristic of malignant tumors. Moreover, soon after puncture or biopsy, if the pathological diagnosis is clear, most patients will receive treatment immediately. If no puncture or biopsy is done, the pathological diagnosis will not be correct and any treatment will be blind, which will lead to a high probability of misdiagnosis and mistreatment, which is not in accordance with medical standards and will cause great harm to patients.
If the pathological diagnosis is initially considered lymphoma, a variety of immunohistochemical stains are needed to further confirm the diagnosis. Even if the diagnosis of lymphoma is confirmed, pathological staging must be continued because there are nearly 70 known types of lymphoma, and the treatment and prognosis of the different types vary significantly.
Since the diseased lymph nodes and lymphatic tissues are the body’s health barrier, the “battlefield” for the body to defend itself against invaders and reorganize the internal environment, they are often “full of sores and indistinguishable from the enemy”, and it is sometimes difficult to distinguish between benign and malignant diseases, therefore, compared with other malignant tumors Therefore, compared with other malignant tumors, the pathological diagnosis of lymphoma is more difficult and easily misdiagnosed. This is due to the special mission of human lymphatic tissue and the limitations of today’s medicine, and even the best pathologists in the world are not able to make 100% correct diagnosis and staging. In doubtful cases, multiple experienced pathologists may be required to consult with each other. Even repeated biopsies are required to obtain satisfactory pathology. Although it is tedious and time-consuming, it is a necessary process with a high degree of responsibility for patients, and requires the understanding and patience of patients and their families.
V. What other tests are needed after the diagnosis of lymphoma? These tests are costly and time-consuming, is it necessary?
Lymphocytes, lymph nodes and lymphatic tissues are distributed all over the body, so lymphoma is a kind of systemic disease, which often starts with more than one lesion. Therefore, after the diagnosis of lymphoma is clear, a comprehensive assessment and examination of the location, number and size of lesions throughout the body should be conducted for two purposes: (1) to stage the disease: if the stage of the same type of lymphoma is different, the principles of treatment, course of treatment and prognosis often differ greatly; (2) to keep the basic data of the early stage of the disease, so that the efficacy of the treatment plan can be evaluated after treatment, whether to continue the original plan of treatment or to adjust the dose or prognosis. (2) to keep the basic data at the beginning of the disease, so that the efficacy of the treatment regimen can be evaluated after the treatment, whether to continue the original regimen or adjust the dose or change to a more effective one. The tests required vary by lymphoma type and site, but generally include ultrasound of superficial lymph nodes (including at least bilateral cervical, submandibular, supraclavicular, axillary, and inguinal lymph nodes), enhanced CT of the chest, enhanced CT or ultrasound of the abdominopelvic cavity, and bone marrow aspiration smear or biopsy. Sometimes nasopharyngeal, gastrointestinal and respiratory endoscopy, or lumbar puncture of the cerebrospinal fluid may be required to determine whether the central nervous system has been invaded, and if necessary, chemotherapy injections.
In addition, routine blood tests, liver and kidney functions, blood glucose and lipids, lactate dehydrogenase, β2 microglobulin, blood sedimentation, electrocardiogram or cardiac ultrasound, and viral hepatitis, HIV, syphilis and other infections are also required. These items are mainly to determine whether the patient’s physical condition is able to tolerate chemotherapy? Are there serious functional defects in the heart, lungs, liver, kidneys and other important organs, and do they need other medical and surgical treatments to protect them? Do chemotherapy drugs and doses need to be adjusted? Are there any adverse factors affecting the prognosis, etc.? Therefore, after patiently obtaining the pathological diagnosis and before the initial treatment, there are many more tests waiting for lymphoma patients, which are more expensive and take longer, but they are also an important part of the correct diagnosis and process, directly related to whether the subsequent treatment can be carried out safely and smoothly, and a necessary prerequisite for the correct choice of treatment plan.
Patients can be assured that there is little difference in treatment and prognosis between stages I and II, and stages III and IV for most lymphoma types, and therefore it is safe to wait 1-2 weeks for a thorough examination before chemotherapy. Of course, for patients with severe symptoms or Burkitt’s lymphoma, treatment is needed as soon as possible.
Does lymphoma need to be treated immediately after it is diagnosed? How to choose the treatment plan?
According to the World Health Organization’s Pathological Classification of Tumors of the Lymphatic System, there are nearly 70 known pathological types of lymphoma, which can be broadly divided into two categories: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.
Hodgkin’s lymphoma accounts for about 10% of lymphomas, and is a group of malignant tumors with relatively good efficacy, divided into two categories and five types, namely type 4 classic Hodgkin’s lymphoma and nodular lymphocyte-dominant Hodgkin’s lymphoma. Among them, the nodular sclerosis and mixed cell type of classic Hodgkin’s lymphoma are the most common, with relatively simple and economical treatment options, better treatment results, and higher long-term survival probability. For Hodgkin’s lymphoma with limited stage (stage I-II, early stage) and no obvious adverse prognostic factors, a combination of chemotherapy and radiotherapy can be chosen, and ABVD chemotherapy alone can be chosen, with a 10-year survival rate of about 80%; however, for early stage patients with more adverse prognostic factors and advanced stage patients, the BEACOPP regimen is preferred, and radiotherapy can be combined if necessary. The 10-year survival rate can still reach 50-60%. Nodular lymphocyte-dominant Hodgkin’s lymphoma is the type of lymphoma with the best prognosis, with a 10-year survival probability of 95%, but unfortunately this type of lymphoma is very rare, accounting for less than 10% of Hodgkin’s lymphoma.
In China, non-Hodgkin’s lymphoma accounts for about 90% of all lymphoma cases, and the incidence is increasing year by year. Non-Hodgkin’s lymphoma is divided into two categories: B-cell lymphoma, which accounts for about 70%, is further divided into three major categories: highly aggressive, aggressive and inert lymphoma, and T/NK-cell lymphoma, which accounts for 30%, is mainly divided into two categories: highly aggressive and aggressive, while a few pathological types belong to low-grade malignant lymphoma. With the continuous development of basic and clinical research, the classification of lymphoma is being further refined and improved.
Diffuse large B-cell lymphoma is the most common type of non-Hodgkin’s lymphoma, accounting for about 40% of the cases. Patients with stage I-II lymphoma without risky prognostic factors can choose the chemotherapy regimen of Meroval + CHOP for 3-4 cycles, which can be combined with local radiotherapy depending on their condition, or 6-8 cycles of chemotherapy if radiotherapy is not indicated. patients with stage III-IV lymphoma with risky prognostic factors should undergo 6-8 cycles of chemotherapy. Meroval was the first immune-targeted therapy to be used in the clinic, and despite its high cost, it has improved the treatment efficiency and overall survival of diffuse large B-cell lymphoma by 15-20%, with little apparent toxicity, unlike conventional chemotherapy drugs. It was the application of Meroval that helped mankind realize the dream of targeted treatment of malignant tumors for the first time.
Peripheral T/NK cell lymphoma is another major group of non-Hodgkin’s lymphoma, including several types, which are more common in China and other Asian countries, but unfortunately these lymphomas are less effective with the available chemotherapy regimens. The general reference is the chemotherapy regimen for diffuse large B-cell lymphoma, but because these lymphomas lack the therapeutic target of melphalan on the cell surface, melphalan cannot be used. Patients with effective treatment are prone to relapse or progression, therefore, most patients with stage III-IV, especially those with multiple adverse prognostic factors, are recommended to consider high-dose chemotherapy combined with autologous stem cell transplantation for consolidation after remission, and in some cases, even allogeneic stem cell transplantation. Despite intense treatment, most patients with T/NK cell lymphoma types still have low long-term survival rates, with five-year survival rates hovering around 30%, making them a “difficult” patient in lymphoma treatment and a focus of attention for lymphoma specialists worldwide. Because of this, more new drugs have been developed in this field, and a variety of clinical trials are underway, with encouraging preliminary results.
Inert lymphoma is also a major type of non-Hodgkin’s lymphoma and includes a variety of B-cell and a few T-cell subtypes. This group of lymphomas is slow to progress and can survive for long periods of time without affecting the patient’s quality of life, but it is persistent. Intensive treatment cannot cure this group of lymphomas, but less intensive chemotherapy can prolong disease-free survival and allow patients to live more optimistically and closer to a healthy life. Therefore, in the absence of more severe symptoms or discomfort, and in the absence of rapid disease progression, the duration of treatment can be postponed. However, some patients with inert B-cell lymphoma may progress to an aggressive type of lymphoma, which requires active treatment.
Even for the same type of lymphoma, the treatment may not be the same depending on the stage, location and prognostic factors, and age; blood picture, liver and kidney function, heart disease, diabetes, hepatitis, etc. may affect the choice of treatment plan and the adjustment of drug dosage.
Although the clinical manifestations are diverse, the treatment process is complicated, and early diagnosis is not easy, lymphoma has fortunately become one of the very few malignant tumors that can be cured, especially since the 1990s, the basic research, clinical diagnosis and treatment of lymphoma have become one of the most advanced fields among malignant tumors. Even in some cases with late stage and severe symptoms, the results are still relatively satisfactory after proper treatment.
7.What should I pay attention to during the treatment of lymphoma? How to cooperate with the doctor to complete the treatment successfully?
After all the examinations are completed, the doctor will decide whether to start treatment, what kind of treatment plan, and the approximate treatment plan according to the condition and type of pathology. At this point, communication between the doctor in charge and the patient and the family is very important. Both sides need to talk frankly about the disease, treatment plan, dosage, approximate treatment plan, cost, efficiency, possible adverse reactions, how to deal with adverse reactions, future relapse rate, possible treatment principles after relapse, etc.
With modern medical information flowing and frequent communication, the treatment planning, protocols and doses of many tumors in China are all based on international standardized treatment, and the treatment doses are calculated according to the patient’s height, weight and body surface area. Lymphoma is no exception. However, individual patients vary greatly, so appropriate adjustments will be made based on liver and kidney function, heart function, blood count, blood sugar and other comorbidities. During the course of treatment, prophylactic treatment is routinely provided for various common adverse reactions, such as antiemetic and drugs to protect liver and kidney function and heart function. Even so, some adverse reactions cannot be completely avoided. For example, almost all chemotherapeutic drugs have bone marrow suppression, hair loss, gastrointestinal reactions, liver and kidney damage, etc., but the degree of occurrence and focus are different. Therefore, in order to be safe and to start the next cycle of chemotherapy smoothly and on time, it is important to report any abnormalities to the doctor in charge and the doctor on duty, and to review the blood picture and liver and kidney function regularly as required.
It is impossible to achieve 100% efficacy of any chemotherapy regimen, and whether it is effective or not is mainly related to the individual differences of patients. The purpose of the evaluation is to assess the effectiveness of the chemotherapy regimen, and if the desired effect is not achieved, it may be necessary to increase the dose or change the new treatment regimen. The examination items are basically the same as the first examination items, and the focus of the review is on the area with lesions.
Is there no worry after the treatment of lymphoma? Can recurrence be prevented?
In fact, hundreds of thousands or millions of tumor cells still remain in the body, which are difficult to be detected by ordinary CT, ultrasound, or even PET/CT and hematological examination. For example, in Hodgkin’s lymphoma and diffuse large B-cell lymphoma, although the efficiency of initial treatment is high and the rate of complete remission is also high, about 1/4 to 1/3 of cases will relapse. The relapse rate is even higher for peripheral T-cell lymphoma. The vast majority of inert lymphomas are incurable and will almost always relapse sooner or later.
What can be done to prevent recurrence? Data from clinical studies show that only for follicular lymphoma is there a positive conclusion that maintenance treatment with Merova alone, every 2-3 months, can delay relapse, but it is not known whether it can reduce the probability of relapse. For other types of B-cell lymphoma, the conclusions are not very definite and usually depend on the clinicopathological characteristics of the specific case and the course of treatment. For other types of lymphoma, there are no definite and effective measures to prevent relapse.
Therefore, it is important not to take lymphoma treatment lightly, and regular follow-ups are still needed. The risk of relapse is usually higher in the first two years after treatment, so the frequency of review should be higher, usually once every three to four months, then once every six months after two years, and once a year after five years, for life. For example, Hodgkin’s lymphoma may recur even 20 years after treatment, inert lymphoma may recur at any time because it cannot be cured, and Burkitt’s lymphoma rarely recurs one year after treatment.
The examination depends on the site of the disease and the type of pathology, but in general, the original site of the disease is the focus of the review, and other sites and hematological tests should also be taken into account.
PET/CT is an important medical examination which can show not only the size of tumor lesions but also the metabolic activity inside the tumor, especially for lymphoma. Lymph node hyperplasia? Especially in lymphoma, it is sometimes difficult to determine whether a slightly large lymph node is a normal lymph node, a lymph node hyperplasia or a lymphoma invasion. However, every medical test has its own limitations, and PET/CT is no exception, as it is highly sensitive but also has a certain rate of misdiagnosis. The use of PET/CT for staging and evaluation of Hodgkin’s lymphoma is currently recognized in the lymphoma community, and as a staging and evaluation tool for diffuse large B-cell lymphoma is also recognized, but the value of PET/CT for staging and examination of other types of lymphoma is still controversial, mainly due to the level of operation, judgment criteria and disease characteristics, and is generally not used as a routine test. The need for it depends on the clinical characteristics of the case. This controversy is expected to be resolved in 2013.
However, PET/CT is not usually used as a routine follow-up examination, and it is only considered when there is clinical suspicion of recurrence of the disease or when some B-cell lymphomas of low malignancy may be transformed into aggressive lymphoma, in order to judge the disease or to guide a more accurate localization biopsy of the lesion.
9. Does a poor initial treatment or a relapse mean that there is no hope for a cure?
Although the overall outcome and prognosis of lymphoma is better than most other malignancies, this refers mainly to patients who receive first-line treatment. If first-line therapy is not effective, though, patients who relapse are fortunate to have a 30-50% success rate with standardized therapy again for most lymphoma types, and even more so for some inert lymphomas. It is important to emphasize here, however, that even if second-line regimens are effective, it is difficult to achieve a cure with conventional chemotherapy. Patients may be effective with many regimens, but the lymphoma cannot be eradicated. Often, after several cycles of chemotherapy, the disease progresses again, and then the regimen is changed, which may still be effective, but soon progresses again. In a short time, the tumor will eventually overcome the body. Therefore, the first treatment plan after the diagnosis of lymphoma is the key to cure, and it is recommended to visit a regular and experienced treatment center.
Regardless of the type of lymphoma, the majority of patients will relapse after a change in the chemotherapy regimen. If relying solely on conventional doses of general chemotherapy, patients with aggressive non-Hodgkin’s lymphoma and Hodgkin’s lymphoma have little chance of being cured. Therefore, for this type of lymphoma, it is recommended to consider high-dose chemotherapy combined with autologous stem cell transplantation as soon as possible if the second treatment is effective in young patients. If necessary, allogeneic stem cell transplantation may even be required. Although repeated treatments are still effective in patients with inert lymphoma, the duration of effectiveness of most types becomes shorter, the frequency of relapse becomes higher, and the efficacy of treatment becomes worse.
X. Is having lymphoma a lifelong stigma?
However, long-term complications and quality of life are important issues that cannot be ignored by long-term lymphoma patients, such as secondary tumors, cardiovascular disease, infertility, and psychological problems.
Patients with lymphoma have a significantly higher incidence of second tumors 10 years after treatment than the general population, and patients with chest radiotherapy have a higher chance of developing second tumors. Female patients should have monthly self-examinations of the breast and annual breast health checks. Patients who have received radiation therapy to the chest or axilla should undergo annual breast MRI screening 8 to 10 years after the completion of treatment or after the age of 40.
Some antineoplastic drugs and mediastinal radiotherapy can have cardiotoxic effects, increasing the risk of symptomatic or fatal heart disease in survivors, and most patients have other risk factors for heart disease, so patients with blood pressure and lipid abnormalities should be actively monitored and treated. Patients with progressive fatigue or chest pain should undergo a cardiovascular workup. In pregnant women, cardiac function should be monitored due to a significant increase in cardiac stress.
About 50% of long-term survivors of lymphoma have thyroid abnormalities, especially in women who have received radiation therapy to the neck and upper mediastinum. Hypothyroidism is the most common, and patients may experience depression. Hyperthyroidism and benign and malignant thyroid nodules are also common and are associated with radiation dose. Therefore, annual thyroid function tests should be performed in patients with treated lymphoma, and hormone replacement therapy should be routinely administered in cases of abnormalities, which may require lifelong medication.
Pelvic radiotherapy and chemotherapy with alkylating agents and methylbenzyl hydrazide are extremely toxic to the gonads, especially in adolescent patients who are more sensitive and vulnerable, and can lead to hypogonadism and infertility in both men and women.
Therefore, it is recommended that lymphoma survivors should be followed up regularly in professional oncology hospitals and continue for life.
Which groups of people are vulnerable to lymphoma? How to keep family members away from lymphoma? Will relatives be infected? Will children be inherited?
For example, lymphoma is the most common malignant tumor in patients with human immunodeficiency virus (HIV) infection, with an incidence rate 60-100 times higher than that of the general population; Hodgkin’s lymphoma, Burkitt’s lymphoma and nasal NK cell lymphoma may be related to EBV virus infection. HTLV-1 virus is closely associated with adult T-cell lymphoma/leukemia, H. pylori is a possible cause of gastric MALT lymphoma, hepatitis C virus is associated with splenic lymphoma, and Chlamydia psittaci infection is associated with the development of ocular appendage lymphoma.
Abnormalities in the immune function of the body, autoimmune diseases, long-term heavy application of immunosuppressive drugs after organ transplantation, and aging are likely to be important reasons for the marked increase in the incidence of lymphoma in recent years. Physical factors and chemicals such as radiation, pesticides, herbicides, hair dyes, heavy metals, and benzene may also be associated with the development of lymphoma.
Although there may be more than one lymphoma patient in a family, there is no clear genetic predisposition or familial clustering of lymphoma, which is a completely different concept from familial breast or colon cancers. In addition, as mentioned above, although the cause of lymphoma is likely to be related to some bacteria and viruses, the mechanism of tumor development is very complex, and infection is only one of the external factors. Therefore, as a relative of a lymphoma patient, the risk of developing lymphoma is not significantly higher than that of the general population.
However, if patients have received high-dose, multi-course chemotherapy, especially certain drugs that affect reproductive function, it is recommended that they avoid having children during treatment; for the health of their children and the well-being of their families, it is also recommended that they consider having children three years after the completion of treatment.
Reducing environmental pollution, maintaining good living habits, promptly treating certain chronic inflammatory diseases and improving the immune function of the body are common guidelines to reduce the incidence of not only lymphoma but also other malignant tumors, and deserve everyone’s attention in daily life.