The suspected diagnosis is made by the interview (anamnesis) and the skin changes. A tie sample is taken from an affected area (biopsy) and examined microscopically. A reliable diagnosis is usually only possible when the tumors have penetrated deeper into the skin and there is an increase in lymphocytes and certain antibodies (class E immunoglobulins) in the blood.
Other examination procedures, such as ultrasound, X-ray, CT (computed tomography) and MRI (magnetic resonance imaging) may be used to detect involvement of internal organs.
Based on the results of the examination, mycosis fungoides is classified into different stages. These are important for therapy and prognosis:
– Stage I: Also called eczema stage. The cancer shows itself through the reddened, scaly patches. Lymph nodes are not enlarged. – Stage II: Also called plaque stage. Lymphnode swellings without cancer cells, skin conditions and nodules may be present. – Stage III: Almost the entire skin is affected. No cancer cells are yet found in the enlarged lymph nodes. – Stage IV: In addition to the skin, lymph nodes and/or internal organs are affected.
Treatment depends primarily on the stage of the disease at the time of diagnosis. Before starting therapy, it should be ensured that the patient will not suffer more discomfort from the treatment than from the disease itself.
Radiation therapy, chemotherapy and PUVA (light treatment) are considered to be effective therapeutic approaches.
PUVA (Psoralen and UV-A)
In the early stage (stage I) PUVA is used together with cortisone ointments. It is also called photochemotherapy. Normally used for the therapy of psoriasis. The drug psoralen is either applied directly to the skin or administered as a tablet and accumulates in the cancer cells. The skin is then irradiated with UV-A light, which destroys the cancer cells.
From the plaque stage, PUVA therapy alone is no longer sufficient. It is then usually combined with immunotherapy with interferon alpha.
Like all non-Hodgkin's lymphomas, mycosis fungoides is radiosensitive. In the case of limited tumorous skin changes, local irradiation with X-rays or electron beams may be sufficient to destroy the tumor. In more extensive skin involvement without further organ or lymph node involvement, whole skin radiation is possible. This is carried out in special clinics. If lymph nodes or organs are already affected, mycosis fungoides can no longer be cured. In this case, radiotherapy can be used palliatively, i.e. to alleviate symptoms, in order to improve the patient's quality of life.
The effect of radiotherapy is based on the fact that it destroys cancer cells. It is performed from the outside through the skin. Despite careful treatment planning, side effects can occur. These occur either immediately during the therapy (z.B. diarrhea, nausea, blood discharge through the intestine) or become noticeable only weeks or months after treatment. Chemotherapy is used for lymph node-. Organ infestation in advanced stages of disease to use. It aims to kill cancer cells throughout the body using cell growth inhibiting drugs (cytostatics). Cytostatic drugs are effective against rapidly growing cells, a property that is particularly true of cancer cells.
In order to achieve the greatest possible effect against the tumor cells and to reduce side effects, combinations of cytostatic drugs with different effects are often used. The treatment is carried out in several treatment cycles lasting several weeks. There are longer recovery periods between the individual cycles. Therapy cycles are usually repeated three to six times. How many cycles are necessary in a specific case depends mainly on how the patient tolerates the treatment and how the therapy affects the tumor.
The treatment with cytostatic drugs also affects normal tie, which renews itself quickly. This primarily affects the mucous membranes of the stomach and intestines, the hematopoietic system in the bone marrow and the hair roots. Possible side effects of chemotherapy are therefore nausea, vomiting, diarrhea, hair loss, increased susceptibility to infections and bleeding tendency. The side effects can be partially alleviated by concomitant measures or. Intercept or alleviate medication. As a rule, they disappear after the end of the therapy.
Course of the disease
Mycosis fungoides progresses very slowly over years to decades. If diagnosed before it has spread to internal organs and lymph nodes, the prognosis is good and patients can be cured. In later stages, the disease can be at least temporarily halted by treatment.
Follow-up care depends on the stage at which the tumor was discovered and how it was treated. For early-stage tumors, follow-up examinations at intervals of 6-12 months are useful. In advanced stages (III and IV), however, 4-6 weekly visits to the doctor are necessary to assess the success of therapy.