Overview Hodgkin lymphomas
Häufigkeit und Ursache
Mit 2 bis 3 Neuerkrankungen auf 100,000 Personen Pro Jahr (Inzidenz (More info über den Glossarbegriff Inzidenz)) ist das Hodgkin lymphoma relativ Selten. 1832 wurde diese Krankheit von Ihrem Namensgeber, Sir Thomas Hodgkin, Erstmalig als eigenständige illness beschrieben. Das Feingewebliche (Histologische) Merkmal of Hodgkin lymphoma sind die malignant Hodgkin-und Reed-Sternberg-Zellen. Der Nachweis dieser Zellen grenzt das Hodgkin-Lymphoma von der große Gruppe der Non-Hodgkin lymphoma und von Lymphknotenschwellungen mit anderer Ursache AB.
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Symptom
Das Hodgkin lymphoma zeigt sich durch schmerzlose Lymphknotenschwellungen, die sehr häufig zunächst am Hals oder hinter dem Brustbein (Mediastinum) zu finden sind. Allgemeine Symptome einer Bösartigen Illness wie Fieber ohne erkennbare Ursache, Ungewollter Gewichtsverlust und Nachtschweiß (B-symptom), aber auch Leistungsknick, Müdigkeit und Abgeschlagenheit können further Hinweise sein. Sind organ befallen, kann dies ebenfalls zu Beschwerden führen.
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Histology
Die Entnahme eines Vergrößerten Lymphknotens mit anschließender Untersuchung des Gewebes (Histology (More info über den Glossarbegriff histology)) ist für die Genaue Diagnosestellung erforderlich. Dabei Erkennt der Pathologist Typische Merkmale der Illness, wie etwa die charakteristischen Hodgkin-und Reed-Sternberg-Zellen of klassischen Hodgkin lymphoma.
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Diagnosis
Zur furtheren Diagnostik gehört die Erfassung der Krankengeschichte (Anamnese (More info über den Glossarbegriff Anamnese)) of the Patienten Erfasst und eine körperliche Untersuchung. Zur Erfassung der Genauen Ausbreitung im Körper werden furthere Untersuchungen wie Computertomographie (more Infos über den Glossarbegriff Computertomographie), Röntgenuntersuchung (more Infos über den Glossarbegriff Röntgenuntersuchung), Ultraschall (More info über den Glossarbegriff Ultraschall) sowie eine Knochenmarkpunktion (more Infos über den Glossarbegriff Knochenmarkpunktion) durchgeführt.
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Stadien und Risikofaktoren
Ein wichtiges Criterion für die Wahl der Behandlung ist das Stadium der Illness. Um dieses Bestimmen zu können, müssen die Ausbreitung of Tumors im Körper sowie das Vorliegen oder Fehlen definierter Risikofaktoren festgestellt werden. Die Stadien-Einteilung erfolgt dann gemäß der Ann-Arbor-TNM. (More info über den Glossarbegriff Ann-Arbor-TNM.)
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Der Hodgkin's Lymphoma Therapy
Die Behandlung bei Erstdiagnose eines Hodgkin lymphoma erfolgt durch zyklusweise (more Infos über den Glossarbegriff zyklusweise) und/oder Bestrahlung. Um die richtige Balance zwischen Wirkung und Nebenwirkung zu gewährleisten, kommt der Genauen Stadienerfassung besondere Bedeutung zu. Nach Möglichkeit solle die Behandlung stadienangepasst innerhalb von Studien stattfinden, um die große Therapiefortschritte der letzten Jahrzehnte Weiterführen zu können.
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Nebenwirkungen und Spätfolgen
Sowohl chemo-als auch Strahlentherapie verursachen Nebenwirkungen. Diese können direkt (akut), aber auch erst Jahre nach Therapieabschluss auftreten.
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Nachsorge
Die Nachsorge ingredient dem Rechtzeitigen Erkennen von Rückfällen und Zweittumoren. Eine frühzeitige Therapy kann deren Prognosis entscheidend Verbessern. Auch der Früherkennung von anderen Spätfolgen kommt im Rahmen der Nachsorge eine besondere Bedeutung zu.
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Heilungschancen und Ausblick
Das Hodgkin lymphoma (more info über den Glossarbegriff Hodgkin lymphoma) gehört heute auf Grund der Stadienangepassten Therapy und den beständigen Verbesserungen von Chema-und Radiotherapy zu den am besten therapierbaren bösartigen Erkrankungen. Selbst in Fortgeschrittenen Stadien ist das Hodgkin-lymphoma Häufig noch kurabel, so dass die Heilungsraten bei 80 bis 90 Prozent liegen. Rückälle der Illness Treten zu zwei Dritteln in den ersten Zwei bis zweieinhalb Jahren, fast alle innerhalb der ersten fünf Jahre nach Ersterkrankung auf. Nach dieser Zeit nimmt das Risiko ab jedoch sind auch späte Rückfälle in Seltenen Fällen möglich.
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Studien der Deutschen Hodgkin Study Group (GHSG)
Die Behandlung von Hodgkin lymphoman wird vor Allem mit Hilfe von Klinischen Therapieoptimierungs-Studien weiterentwickelt und Verbessert. Daher sollten alle Hodgkin-Patienten im Rahmen von solchen Studien behandelt werden. Eine Übersicht über die aktuellen Studien der Deutschen Hodgkin Study Group (GHSG) Finden Sie yesterday:
Studien der Deutschen Hodgkin Study Group (GHSG)
Suche nach Studienzentren
Behandlungszentren, die an den Studiin der KML-Studiengruppen teilnehmen, Finden Sie im KML-Studienregister bei den Jeweiligen Studien.
KML-Studienregister
Literature
Vertiefende Fachliteratur finden Sie in den hier genannten wissenschaftlichen Artikeln und in Medizinischen Lehrbüchern.
Industry literature
Symptoms
In most cases, the first sign of Hodgkin lymphoma is a coarse ("rubbery"), painless lymph node swelling. The most common cause is the swelling of the lymph nodes of the neck (about 70 percent), the lymph nodes (more information about the glossary term lymph nodes) above the key leg, in the armpits or in the groins are less frequently affected.
At the onset of the disease, about one-third of the patients suffering from Hodgkin's lymphoma have a swelling of the lymph nodes behind the sternum (mediastinal lymph nodes), which can lead to obstruction of respiration, a feeling of pressure and constant irritation.
If only individual lymph nodes in the upper or lower abdomen are affected, pain, feeling of pressure or unclear cases can be pointed out. After alcohol consumption, enlarged lymph nodes can cause pain (so-called alcohol pain), which is very rare but relatively characteristic of Hodgkin's lymphoma.
In about one third of the diseases, additional non-specific general phenomena such as performance kink, fatigue, weakness and severe itching occur throughout the body. Special emphasis must be placed on the existence or absence of so-called B symptoms in the collection of the medical history, since these have a direct influence on the classification and therefore on the therapy.
B Symptoms include:
Strong night sweat (laundry must be changed)
Unwanted weight loss of more than 10% of body weight in the last six months and
Fever over 38 degrees Celsius with varying gradients that cannot be assigned to any other cause.
By multiplying the tumor cells in the lymph nodes, the immune system is disturbed and weakened in its equilibrium. This may result in an accumulation of bacterial, viral or fungal infections. If the disease has spread outside of lymph nodes in other organs such as bone or liver, this can also cause discomfort. For example, bone pain and fractures occur in bone infections. Infection of the bone marrow can lead to changes in the blood image. If the liver is insensitive, it can cause pressure in the upper abdomen by enlarging the organ and changes in the blood of the liver and bile levels.
Lymph node biopsy and tissue cut (histology) (Learn more about the Glossary term (histology))
The removal of the body's own tissue from a living organism is called a biopsy (more information about the glossary term biopsy). To ensure the diagnosis of lymphoma, the removal of a complete suspect lymph node is necessary.
For this purpose, a lymph node (more information about the glossary term lymph nodes) is selected, which is easily accessible and as large as possible. In most cases, the biopsy can take place in local anesthesia, but a general anesthesia may be necessary in case of infection in the chest or abdomen.
The lymph node is then histologically reworked, dyed and microscopically examined. The pathologist recognizes typical characteristics of the various diseases, such as the characteristic Hodgkin and Reed-Sternberg cells of classical Hodgkin lymphoma.
If possible, the diagnosis should be secured by a pathologist with special experience in the field of Lymphoma Diagnostics (reference pathologists in the KML). This is standard within the GHSG studies.
More about Histology
Histology of tumor cells
The neoplastic cells of Hodgkin lymphoma, the Hodgkin and Reed-Sternberg cells and their variants, are characterized by a typical morphology (appearance). The infiltrate of Hodgkin lymphoma contains only a few of these cells (about 1 percent), on the other hand, many non-malignant (further information about the glossary term malignant) cells such as T-lymphocytes (more information about the glossary term T-lymphocytes), B-lymphocytes (further Information about the glossary term B-lymphocytes), macrophages (more information about the glossary term macrophages) and eosinophilic granulocytes (more information about the glossary term granulocytes).
On the basis of a tissue examination, the diagnosis can be made and a Feingewebliche (histological) subdivision of the Hodgkin lymphoma is performed. According to the WHO classification (more information about the glossary term who classification) the classic Hodgkin lymphoma (approx. 95 percent of the cases) and the Nodular lymphocyte prädominante Hodgkin lymphoma (about 5 percent of the cases), which is used as a stand-alone Disease.
The classic Hodgkin lymphoma is divided into four histological subtypes:
The Nodular-sclerosing type
Fig.: nodular-sclerosing type 65% of cases
The mix
Fig.: Mixed-up 25% of cases
The Lymphozytenreiche Classic
Hodgkin lymphoma
Fig.: Lymphocyte classic Hodgkin lymphoma 4% of cases
The Lymphozytenarme Classic
Hodgkin lymphoma
Fig.: Lymphozytenarmes classic Hodgkin lymphoma 1% of cases
Image rights: Courtesy of the German Hodgkin Study Group (GHSG)
The histological subtypes of classic Hodgkin lymphoma do not have any influence on the choice of therapy nowadays. It is worth mentioning, however, that the "Nodular lymphozytenprädominante Hodgkin lymphoma" in Stage IA, in which only one lymph node region is affected, has such a favorable course, that in contrast to other entities in stage I a exclusive irradiation is done in the involved field.
Diagnostic procedures
Medical History and physical examination
History
Taking a medical history is the question of the medical record. The patient is questioned about the type, beginning and course of his current ailments. In addition, the patient's living conditions and pre-existing conditions are asked to detect possible risk factors for the current ailments. In case of suspicion of malignant lymphoma, the question of the existence of a B-symptoms is of great importance.
Physical examination
In the course of the physical examination (measurement of blood pressure and pulse, monitoring of the lungs, etc.), a particular value should be placed on the search for tactile enlarged lymph nodes when the disease is suspected of lymphoma. A manual examination of the liver and spleen is also important, as these organs are often (with) inattacking and then enlarged (Hepato-splenomegaly). The laboratory diagnostic examination of the blood is also essential in determining the stage of the disease (staging) (more information about the glossary term (staging)).
Imaging techniques
Computed Tomography (CT)
Computed tomography (more information about the glossary term computed tomography) is an imaging, X-ray diagnostic method in which the human body is radiated layer by layer in a recording process. Computers assemble the individual cross-layer images into one image. Thus, the representation of the soft tissue structures of the body is made possible and minimal density differences are detected e.g. due to tissues changes or tumors. The recordings are made in a fast-rotating X-ray tube with an approximately pencil-strong beam bundle. In X-ray diagnostics, CT has largely supplanted a number of invasive processes (which intervene in the body).
Sonography (more information about the glossary term sonography) (ultrasound diagnostics)
This imaging diagnostic method uses ultrasound (more information about the glossary term ultrasound) (1-10 MHz) According to the Echo graphing principle to represent the internal organs and is standard in lymphoma Diagnostics. Especially the abdominal organs and the neck buffeting are to be judged well by this examination. Especially in the case of liver and spleen, it is possible to collect important supplementary findings for CT. In contrast to the X-ray or CT, there is no radiation exposure.
Chest X-Ray
In particular, the heart and lungs can be assessed on an X-ray of the thorax. A broad participation of the lungs, effusions and large Mediastinaltumoren can be seen on the chest X-ray. A computer tomography (CT) is necessary for a more detailed detection of tumor expansion in the thorax. Nevertheless, the chest X-ray is part of obligatory diagnostics, as this examination determines whether the risk factor is ' large Mediastinaltumor '.
Positron emission tomography (PET)
The positron emission tomography (PET), like CT or magnetic resonance tomography, is an analysis of the cutting pattern. Not individual organs, but the metabolism of different tissues of the body are made visible.
In tumor diagnosis a sugar (FDG) marked with very low radioactive fluorine is typically used as a so-called "FDG Tracer". It is administered to the patient through a syringe in the vein. This marked sugar is implemented in the body almost exactly like normal sugar, but the consumption can be made visible from the outside by a special pet camera. Cells with a strong metabolism, such as tumor cells, usually have a high sugar turnover and therefore give a strong signal in the image created by the pet camera.
This makes it possible to better distinguish tumor tissue from healthy tissue. Depending on the treatment concept, the pet can be used for initial classification, during chemotherapy for Therapiemonitoring, after completion of chemotherapy for therapy control or for reasoned Rezidivverdacht. Clinical studies have shown the prognostic value of pet in Therapiemonitoring and Therapiekontrollee.
The individualization of the therapy is currently one of the main goals in Haemato oncology. The GHSG therefore investigates in ongoing studies whether a reduction or intensification of the therapy can contribute to the Behandlungsstratifizierung due to the Therapiemonitorings by means of pet.
Other procedures
Bone marrow biopsy
A bone marrow puncture is used to diagnose diseases and their spread in the bone marrow and the blood-imaging system. After a local anesthesia, a puncture is carried out by means of a special cannula (further information about the glossary term puncture) of the market area plate bone (e.g. sternum, pelvic comb). This is used for tissue removal in the context of a biopsy of the bone or bone marrow.
The bone marrow punch/biopsy is used to test whether there is an infestation by Hodgkin lymphoma and thus a stage IV.
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