Non-Hodgkin lymphoma

Non-Hodgkin lymphoma

Overview

Non-Hodgkin lymphoma is a type of cancer that affects the lymphatic system. The lymphatic system is made up of organs, glands, tubelike vessels and clusters of cells called lymph nodes. It's part of the body's germ-fighting immune system.

Non-Hodgkin lymphoma happens when germ-fighting cells in the lymphatic system grow out of control. The cells can form growths, called tumors, throughout the body.

Non-Hodgkin lymphoma is a broad group of lymphomas. There are many subtypes in this group. Diffuse large B-cell lymphoma and follicular lymphoma are among the most common subtypes. The other broad group of lymphoma is Hodgkin lymphoma.

Advances in diagnosis and treatment of non-Hodgkin lymphoma have helped improve the prognosis for people with this condition.

Types of non-Hodgkin lymphoma

There are more than 70 subtypes of non-Hodgkin lymphoma. Healthcare providers classify them based on the type of lymphocyte affected:

B-cell lymphoma. These cancers arise from B cells. B cells make antibodies that fight infection-causing germs. B-cell lymphomas account for about 85% of all NHL diagnoses.

T-cell lymphoma. These cancers arise from T cells. T cells target germs and other foreign cells and help B cells make antibodies.

Providers classify B-cell and T-cell lymphomas as either aggressive or indolent. Aggressive non-Hodgkin lymphomas spread faster than indolent non-Hodgkin lymphomas. Aggressive NHL often requires more intensive treatment.

Symptoms

The most common symptom is painless swelling in your neck, armpits or groin. This is a sign of swollen lymph nodes in those areas. Other signs and symptoms depend on where the lymphoma cells are. Additional NHL symptoms include:

Persistent fatigue

Chest pain

Cough

Trouble breathing (dyspnea)

Belly (abdominal) pain or swelling

Feeling full even when you haven’t eaten much

Unexplained fever (especially a fever that stays above 103 degrees Fahrenheit or 39.5 degrees Celsius for two or more hours after home treatment or that lasts longer than two days)

Drenching night sweats (so intense that it soaks your sheets)

Unexplained weight loss (losing 10% of your total body weight over six months)

It’s important to remember that many conditions share these symptoms. Having one or more doesn’t necessarily mean you have non-Hodgkin lymphoma. Still, it’s a good idea to contact a healthcare provider anytime you notice changes in your body that last for several weeks.

B symptoms

Healthcare providers consider whether you have B symptoms when they diagnose lymphomas. B symptoms include fever, night sweats and unexplained weight loss. These help your provider classify the type of non-Hodgkin lymphoma you have and determine the best treatments.

Causes

The cause of non-Hodgkin lymphoma often isn't known. This cancer starts when germ-fighting white blood cells called lymphocytes develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do.

DNA gives healthy cells instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give other instructions. The DNA changes tell the cancer cells to make more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

In non-Hodgkin lymphoma, the cancer cells often build up in the lymph nodes. They also can build up in other parts of the lymphatic system.

Non-Hodgkin lymphoma can affect the:

Lymph nodes.

Lymph vessels.

Adenoids.

Tonsils.

Spleen.

Thymus.

Bone marrow.

Rarely, parts of the body that aren't part of the lymphatic system.

Non-Hodgkin lymphoma types

Non-Hodgkin lymphoma most often begins in the:

B cells. B cells are a type of lymphocyte that fights infection. B cells make antibodies against foreign invaders. Most non-Hodgkin lymphoma arises from B cells. Subtypes of non-Hodgkin lymphoma that involve B cells include diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma and Burkitt's lymphoma.

T cells. T cells are a type of lymphocyte that kills foreign invaders directly. Non-Hodgkin lymphoma happens much less often in T cells. Subtypes of non-Hodgkin lymphoma that involve T cells include peripheral T-cell lymphoma and cutaneous T-cell lymphoma.

Treatment depends on whether non-Hodgkin lymphoma arises from B cells or T cells.

Risk factors

Factors that may raise the risk of non-Hodgkin lymphoma include:

Medicines that lower the immune response. Taking medicines that manage the immune system after an organ transplant might raise the risk of non-Hodgkin lymphoma.

Infection with certain viruses and bacteria. Certain infections seem to raise the risk of non-Hodgkin lymphoma. Viruses linked to this type of cancer include HIV and Epstein-Barr virus. Bacteria linked to non-Hodgkin lymphoma include the stomach ulcer-causing bacterium Helicobacter pylori.

Chemicals. Certain chemicals, such as those used to kill insects and weeds, may raise the risk of non-Hodgkin lymphoma. More research is needed to find the possible link between pesticides and non-Hodgkin lymphoma.

Older age. Non-Hodgkin lymphoma can happen at any age. But it's most common in people 60 or older.

There's no way to prevent non-Hodgkin lymphoma.

Diagnosis

Non-Hodgkin lymphoma diagnosis often begins with an exam that checks for swollen lymph nodes in the neck, underarms and groin. Tests include imaging tests and removing some cells for testing. The tests used to detect non-Hodgkin lymphoma may depend on the cancer's location and your symptoms.

Physical exam

A healthcare professional checks for swollen lymph nodes in your neck, underarms and groin. The health professional also checks for a swollen spleen or liver.

Blood and urine tests

Tests of your blood and urine may help rule out an infection or other disease.

Imaging tests

Tests to look for lymphoma cells in other parts of the body may include CT, MRI and positron emission tomography, also called PET.

Lymph node biopsy

Your healthcare professional may suggest a lymph node biopsy to look for cancer cells. A biopsy is a procedure to remove a sample of tissue for testing in a lab. A lymph node biopsy involves removing all or part of a lymph node. In the lab, tests may show whether you have non-Hodgkin lymphoma and, if so, which type.

Bone marrow tests

Bone marrow aspiration and biopsy are procedures that involve collecting cells from the bone marrow. The cells are sent for testing.

In a bone marrow aspiration, a needle is used to draw a sample of the fluid. In a bone marrow biopsy, a needle is used to collect a small amount of the solid tissue. The samples most often come from the hip bone.

Lumbar puncture

A lumbar puncture involves removing some of the fluid around the spinal cord. This procedure also is called a spinal tap. A healthcare professional might recommend this test if there's concern that the lymphoma affects the fluid around the spinal cord. A lumbar puncture involves putting a small needle into the spinal canal in the lower back to withdraw the fluid.

Treatment

Non-Hodgkin lymphoma treatment often starts with medicines or radiation therapy. Medicines used for this cancer include chemotherapy, immunotherapy and targeted therapy.

The treatments your healthcare team chooses for you depend on your lymphoma. Your healthcare team considers the types of cells involved and how quickly the cancer is growing. Your team also considers your overall health and what you prefer.

If your lymphoma seems to be growing slowly and doesn't cause symptoms, you might not need treatment right away. Instead, you may have checkups every few months. The checkups help your healthcare team watch your condition and see if your cancer is growing.

Chemotherapy

Chemotherapy treats cancer with strong medicines. There are many chemotherapy medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.

For many types of non-Hodgkin lymphoma, chemotherapy is the first treatment. Sometimes it's combined with targeted therapy.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

People with certain types of non-Hodgkin lymphoma may have immunotherapy if other treatments haven't helped.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

For non-Hodgkin lymphoma, targeted therapy may be used alone. But more often, it's combined with chemotherapy. This mix may be your first treatment. It can be your second treatment if your lymphoma comes back.

CAR-T cell therapy

Chimeric antigen receptor T cell therapy, also called CAR-T cell therapy, trains the immune system cells to fight non-Hodgkin lymphoma. This treatment begins with removing some white blood cells, including T cells, from the blood.

The cells are sent to a lab. In the lab, the cells are treated so that they make special receptors. The receptors help the cells recognize a marker on the surface of the lymphoma cells. Then the cells go back into the body. There they find and destroy the non-Hodgkin lymphoma cells.

CAR-T cell therapy might be an option for certain types of B-cell non-Hodgkin lymphoma. It's typically used when other treatments haven't worked.

Bone marrow transplant

A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. These cells replace cells hurt by chemotherapy and other treatments. People with non-Hodgkin lymphoma may have a bone marrow transplant if other treatments haven't helped.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.

For certain types of non-Hodgkin lymphoma, radiation therapy may be the only treatment you need. This may be true if your lymphoma is in just one or two spots and grows slowly.

People with non-Hodgkin lymphoma also may need radiation after chemotherapy to kill any lymphoma cells that might remain. Radiation also can relieve symptoms and improve quality of life.

Type of Doctor Department : A hematologist or a medical oncologist.