Mediastinal neoplasms are divided into malignant and benign. The first group includes lymphomas - tumors formed from lymphoid tissue. Mostly they are diagnosed in people of the most able-bodied age - from 20 to 40 years.
The concept of
The term mediastin denotes a complex anatomical structure located between the thorax and the thoracic spine. In the mediastinum are located the most important organs of the human body, blood vessels, nerves.
Any atypical formation of the mediastinum, not removed in time, disrupts the work of a number of located organs. Malignant tumors are dangerous because they can germinate into the tissues of the respiratory system, digestion, vessels and nerve endings. Such changes significantly disrupt the functioning of vital systems and create certain difficulties in the treatment process.
Primary mediastinal lymphomas are mainly localized in the anterior part of this anatomical structure and are divided into two types - Hodgkin's and non-Hodgkin's lymphoma.
Hodgkin's lymphomas( lymphogranulomatosis) grow from T or B lymphocytes. For a long time this form of the disease is asymptomatic. With a significant increase in the tumor, general symptoms of cancers appear first, weight loss, weakness, night sweats, periodic temperature rise. Among patients with this type of lymphoma, more people under 30 years of age, the progression of the disease is slow.
Patients with non-Hodgkin's lymphomas are more among the elderly. This type of lymphoma is divided into:
- To the Reticulosarcoma.
- Giant cell lymphoma.
Non-Hodgkin's lymphomas are distinguished by an aggressive course, the tumor quickly penetrates into the tissues by a number of organs and vessels with it and causes a disturbance in their normal functioning.
The exact causes of lymphoma formation in the mediastinum, as well as other lymphoid tissue tumors, have not been established.
The factors predisposing to the disease include:
- Food is predominantly food containing chemical additives.
- Prolonged contact with carcinogens in various industries.
- Effect of pesticides. These substances can be found in plant products, so people who grow crops are also affected.
- Radiation radiation. The risk of developing lymphomas after radiotherapy, prescribed for cancer of various types, is not ruled out.
- Decreased immune defense.
- Congenital and acquired autoimmune diseases.
- The elderly.
Over the past decades, there has been a trend towards an increase in the number of patients with non-Hodgkin's lymphomas worldwide, especially among the elderly.
Symptoms of mediastinal lymphoma
Lymphoid formations in the mediastinum at the beginning of their growth practically do not give any clinical picture. To detect this type of neoplasm at the first stages is most often managed by a random way, for example, when an x-ray is taken about pneumonia, bronchitis, or after fluorography.
With the spread of lymphoma to the respiratory system, including the lungs, patients complain of:
- Difficulty breathing and shortness of breath.
- Pain that increases with breathing.
- Cough, in advanced stages sputum is excreted with an admixture of blood.
If lymphoma compresses the spinal cord or sprouts into it, numbness in the limbs, paresis, impaired motor activity occurs. A tumor that compresses or spreads to the esophagus and trachea leads to discomfort when swallowed food.
The compression of the venous trunk with neoplasm leads to a number of symptoms characteristic of such a violation. They include frequent headaches, dizziness, shortness of breath, chest pain. Compression of veins in the mediastinum leads to their swelling in the cervical region and this affects the appearance of puffiness and cyanosis of the face, this arrangement of the lymphoma often increases blood pressure.
Left-sided localization of lymphomas in the mediastinum leads to a symptomatology, which, by its manifestations, can resemble angina pectoris.
If the boundary sympathetic trunk is involved in the pathological process, then the affected person has the structures of the eye and the autonomic nervous system affected. This is manifested by the lowering of the upper eyelid on the side of the tumor localization, the examination reveals the westernization of the eyeball and the dilatation of the pupil, attention can be paid to excessive hyperemia on one side of the face, impaired sweating.
If the lymphoma is located next to the laryngeal nerve, then over time there is an increasing hoarse voice.
Mediastinal lymphomas may manifest themselves with general symptoms, especially in the last stages of malignant formation. These attributes include:
- Periodic increase in body temperature.
- Increasing night sweats.
- Weakness, irritability.
- Decreased appetite and accordingly developing leanness.
- Weakened immunity. A sign of this disorder are frequent colds and infectious diseases, their long and severe course.
Tumors from the lymphoid tissue are also manifested by a specific manifestation - skin itching, which is especially intense with large neoplasm. With lymphomas in most patients, lymph nodes in the groin, under the armpits, in the abdominal cavity increase, but when feeling, they do not cause pain.
If a malignant neoplasm of the mediastinum is suspected, the physician should conduct and prescribe a number of laboratory and instrumental examination methods.
A standard examination plan for a patient with suspected mediastinal lymphoma includes:
- Blood tests, urine tests. Evaluation of the composition of these biological fluids can identify the inflammatory process and indicators indicating a change in the functioning of internal organs. In malignant formations, the amount of an element such as lactate dehydrogenase changes.
- Biopsy of tumor-like proliferation. This study is necessary for the detection of cancer cells.
- Puncture of the spinal cord. Investigations of cerebrospinal fluid are necessary to determine the presence of cancer cells in the spinal cord.
- Ultrasound and radiography are assigned to detect changes and metastases in the organs of the abdominal cavity, in the lungs, bronchi, trachea, esophagus.
- Endoscopy. This study allows you to assess the condition of the bronchi and larynx.
The biopsy data are considered to be the most indicative, the structure of the tumor and the degree of malignant process are determined by them.
Methods of treatment
Patients with mediastinal lymphomas are treated individually in each case. There are several basic methods of treating lymphomas, these are:
- Chemotherapy. This method consists of taking medications that destroy all cancer cells. Its advantages include the fact that chemotherapy affects the entire body and thus destroys even uncovered cancerous foci. Standard drugs for the treatment of lymphomas are drugs such as Vinblastine, Dacarbazine, Doxorubicin. To these drugs can be added a drug from the group of monoclonal drugs - Rituximab. This scheme of treatment is more effective. Chemotherapy has many negative aspects, but, unfortunately, without this method of treatment, a lethal outcome is inevitable. In the fourth stage, the life of patients is maintained only with the help of chemotherapy drugs.
- CRT.This method is deciphered, as electron beam therapy. Prescribe CRT with accurate detection of localization of lymphomas in the mediastinum and usually combine irradiation with chemotherapy.
- Biological therapy is currently used increasingly. A special feature of this method is the preparation of a drug for the destruction of lymph from the patient's own cells. The mechanism of action of this drug is to block the blood vessels that feed the formation, which leads to the death of the tumor.
- The surgical method of treatment is used relatively rarely and only in the early stages. When the tumor grows, vitally important systems and organs are affected and during the operation it is possible to disrupt their structure, therefore at the last stages surgical intervention is not appointed.
In addition to the basic treatment, patients are prescribed painkillers, drugs aimed at reducing the symptoms of pathology. After the course of treatment, it is necessary to be inspected several times a year. Prophylactic examination will allow to notice the recurrence of lymphoma in time.
To predict how the life of a patient with mediastinal lymphoma after the treatment will proceed, just one doctor can not exactly.
The prognostic prognosis for mediastinal lymphoma is made taking into account the location of the tumor, its stage, the effect on a number of located organs, the age of the patient. If the disease is detected in the early stages and treatment is performed on time, then almost 90% of people perfectly live without relapse of pathology for at least 10 years.
Video on Diagnosis and Treatment Strategies for Mediastinal Lymph: