Low or high immune function may lead to this malignant tumor!

Author: Song Yuqin, Chief Physician, Peking University Cancer Hospital

Reviewer: Duan Yanlong, Chief Physician, Beijing Children's Hospital, Capital Medical University

Hodgkin is the name of a British physician who discovered a disease in which tumor tissue contains a type of RS cell. Later, the disease was named after him, Hodgkin's lymphoma.

All other types of lymphoma, except those that meet the diagnosis of Hodgkin's lymphoma, are called non-Hodgkin's lymphoma.

In my country, there are approximately 80,000 to 100,000 patients with Hodgkin's lymphoma and non-Hodgkin's lymphoma each year, of which about 10% are Hodgkin's lymphoma and the rest are non-Hodgkin's lymphoma. Non-Hodgkin's lymphoma is the most numerous and complex type of lymphoma.

As long as it is named lymphoma, including non-Hodgkin's lymphoma and Hodgkin's lymphoma, it is a malignant tumor, but the degree of malignancy varies. It is mainly divided into low-grade malignant (indolent), intermediate-grade malignant, and high-grade malignant lymphoma.

1. What causes lymphoma?

As the name suggests, lymphoma is a tumor that comes from lymphocytes. Lymphocytes include B cells, T cells, and NK cells. They are the most important immune cells in the human body. When certain factors cause problems with the human immune system, lymphocytes may become malignant.

One of the most common factors that lead to a decline in the immune system is infection, such as HIV infection, viral infection, etc. There are also certain external stimuli, such as biochemical factors, physical factors, radiation factors, pesticides, chemical products and many other factors, which may damage the human immune system and cause immune cells to become malignant.

Age is also a factor. When you reach a certain age, the immune system will decline, and immune cells will age and become malignant. As the population ages, the incidence of malignant tumors of the lymphatic system will also increase.

In addition, factors such as irregular lifestyle, poor rest, and high stress may also cause the immune system to fail to be repaired and induce lymphoma, which may be one of the reasons for the increasing incidence of lymphoma.

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The above factors are all due to decreased immune function or attacks on the immune system, which lead to lymphoma.

On the contrary, an overactive immune system may also cause lymphoma. The most obvious example is autoimmune diseases such as Sjögren's syndrome, rheumatoid arthritis, and Hashimoto's thyroiditis.

Because the body's own lymphocytes cannot recognize the thyroid gland, parotid gland and other organs, they mistakenly attack these organs continuously. In the process of attack, the lymphocytes become malignant lymphoma. In addition, because the immune system of patients with autoimmune diseases is hyperactive, they often need to suppress the immune system with immunosuppressive drugs. In the process of suppression, the immune function is reduced, and it is also easy to get lymphoma.

Therefore, this is a very important reason why patients with autoimmune diseases are prone to lymphoma. The probability of patients with autoimmune diseases getting malignant tumors of the lymphatic system is 40 times higher than that of healthy people.

2. What are the symptoms of lymphoma?

No one type of lymphoma has particularly typical symptoms.

Common manifestations are: First, lymphoma itself can cause symptoms such as fever, night sweats, and weight loss, and one-third of patients will have itching symptoms; second, lymph nodes progressively swell and may even compress the airways, gastrointestinal tract, and even large blood vessels; third, when the lesions grow to a certain extent, or because of the location of the lesions, they may invade some very important organs, or cause obstruction, bleeding, perforation, etc.

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Therefore, lymphoma can have many manifestations, including systemic symptoms, symptoms of local lymph node enlargement, and compression and obstruction symptoms caused by large masses, etc.

3. How is lymphoma diagnosed?

The first step is the doctor's palpation, because patients usually feel the lump themselves and then go to the hospital for treatment, so the doctor's palpation is very important.

If the lymph nodes feel soft, like the lips, and are relatively flat, it is often caused by inflammation. If the lymph nodes feel round, like a ping-pong ball, and tough, like the tip of the nose, it is considered a malignant tumor of the lymphatic system. Another type of lymph node is large, fixed, and hard, like the hardness of the forehead. It may not be a malignant tumor of the lymphatic system, but a metastasis from other tumors, called lymph node metastatic carcinoma.

Therefore, it is very important for the doctor to palpate. Palpation can roughly feel what it is, which is the first step.

The second step is to do further examinations, such as ultrasound or CT scans. For example, if the superficial lymph nodes are swollen, ultrasound examinations can show whether the structure of the lymph nodes is damaged or whether the blood flow is abnormal, to help determine whether the swollen lymph nodes are caused by inflammation or tumors.

The third step is to do a pathological examination if the lymph nodes do not feel good to the touch and the ultrasound or CT scan results are not good. Because the diagnosis of all tumors ultimately depends on pathology, biopsy is very important.

The biopsy tissue required to diagnose lymphoma is often large, either taking a complete and typical lymph node and cutting it off in its entirety, or taking a small piece of it. If the lymph node is located very deep, in the mediastinum, lung, or abdominal pelvic cavity, it is necessary to use a thick needle for puncture to obtain enough tissue.

Pathological examination can determine: first, whether it is lymphoma; second, what type of lymphoma it is; and third, where the cells originated.

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Therefore, the first step in diagnosing lymphoma is palpation by the doctor, the second step is ultrasound or CT examination, and the third step is pathological examination.