Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma (NHL) is a type of blood cancer that begins in a part of the immune system called the lymphatic system, which includes the lymph nodes, spleen and bone marrow. With NHL, a type of white blood cell (lymphocytes) grows too much.

It's not clear what causes NHL but infections, family history and some immune system conditions may increase your risk. If you’re diagnosed with NHL, you can turn to Banner MD Anderson Cancer Center for personalized treatment.

NHL refers to more than 70 cancers that affect different parts of the lymphatic system. It’s not the same as Hodgkin lymphoma. NHL has many subtypes, and they fall into two main groups.

Indolent (slow-growing) lymphomas

Since these types grow slowly, they may not cause symptoms for years. They can be harder to cure, but with treatment you can live with them for a long time. Subtypes of indolent lymphomas include:

• Follicular lymphoma: This is the most common type of indolent NHL. It starts in the lymph nodes and often spreads to the spleen and bone marrow. It usually affects older adults.
• Marginal zone lymphoma: This type of lymphoma can involve the spleen, lymph nodes or other organs.  It is usually associated with infections.
• Mucosa-associated lymphoid tissue (MALT) lymphoma: This rare type of marginal zone lymphoma usually develops in the stomach, digestive tract or other places that contain mucus. It's linked with chronic inflammation or infection due to H. pylori.
• Chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL): These two closely related forms of NHL usually develop slowly and may not need to be treated right away. CLL affects the blood and bone marrow, while SLL affects the lymph nodes.

Aggressive (fast-growing) lymphomas

These lymphomas can grow and spread rapidly but may respond better to treatment than indolent lymphomas. It’s important to start treatment quickly. Subtypes include:

• Diffuse large B-cell lymphoma (DLBCL): This is the most common type of aggressive NHL. It can happen at any age and can develop in the lymph nodes, spleen or other organs. Chemotherapy can treat it.
• Mantle cell lymphoma (MCL): A rare type of NHL that can be slow growing or aggressive. It’s usually more advanced when it’s diagnosed and needs intensive treatment.
• Burkitt lymphoma: This fast-growing lymphoma is more common in children and young adults and it may be linked to infections like Epstein-Barr virus (EBV). It may require intensive chemotherapy.

Other rare subtypes of non-Hodgkin lymphoma

Rare NHL subtypes include:

• T-cell lymphomas: T-cell lymphomas develop from a type of white blood cell called T-lymphocytes. They may be aggressive and can require specialized treatments.
• Peripheral T-cell lymphoma (PTCL): This rare and aggressive type of NHL also affects T-lymphocytes. It has a poor prognosis if it isn’t treated early.
• Anaplastic large cell lymphoma (ALCL): This rare type of T-cell lymphoma typically affects children or young adults. ALCL can sometimes be treated effectively but it can also be aggressive.
• Cutaneous T-cell lymphomas (CTCL): T-cell lymphomas that develop on the skin.  They can range from benign to very aggressive.  Treatment will vary on type of CTCL and area of skin involved.

Symptoms of non-Hodgkin lymphoma

Your symptoms could vary depending on the type of lymphoma you have, how advanced it is and other factors. Some common symptoms include:

• Swollen lymph nodes in the neck, armpits or groin
• Unexplained weight loss
• Fever or night sweats
• Fatigue or feeling tired even after you’ve rested
• Abdominal pain or fullness
• Chest pain or trouble breathing
• Itchy skin

If you notice any of these symptoms, contact a health care provider.

Causes and risk factors for non-Hodgkin lymphoma

You can develop NHL when your body produces too many white blood cells, but researchers don’t know why that happens.

While anyone can develop NHL, these factors may increase your risk:

• Being over age 60
• Being male
• Having conditions like HIV/AIDS or other medical conditions that may weaken your immune system
• Taking treatments like chemotherapy or immunosuppressive drugs 
• Having some viral infections, such as Epstein-Barr virus (EBV), human T-cell leukemia virus (HTLV) or H. pylori
• Long-term exposure to pesticides and solvents

Diagnosis of non-Hodgkin lymphoma

NHL can affect your lymph nodes, lymph vessels, adenoids, tonsils, spleen, thymus or bone marrow.

To diagnose NHL, your health care provider may:

• Ask about your medical history and symptoms
• Perform a physical exam and check for signs of swollen lymph nodes
• Order blood tests to assess your overall health and look for any abnormalities
• Suggest imaging tests such as ultrasound, X-rays, CT scans or PET scans to look for signs of the disease and see if it has spread
• Perform a biopsy and remove a small sample of lymph node or other tissue to be examined in a laboratory
• Order a bone marrow biopsy to check for lymphoma cells
• Suggest a lumbar puncture (spinal tap) if lymphoma might have reached the fluid around the spinal cord
• Use molecular or genetic tests to determine the subtype of NHL and help guide treatment decisions

Stages of non-Hodgkin lymphoma

Non-Hodgkin lymphoma is staged based on how far it has spread:

• Stage 1: The lymphoma is in one lymph node or one area outside of the lymph nodes.
• Stage 2: The lymphoma is in two or more lymph node areas on the same side of your diaphragm (a large muscle below your lungs that helps you breathe).
• Stage 3: The lymphoma is in lymph node areas on both sides of your diaphragm.
• Stage 4: The lymphoma has spread to other organs, such as the liver, lungs or bone marrow.

Treatment options for non-Hodgkin’s lymphoma

Treatment depends on your subtype, stage and overall health. Options include:

• Active surveillance: Your provider may monitor you closely if you have a slow-growing type of NHL without symptoms. You may not need treatment right away.
• Chemotherapy: This common treatment for aggressive NHL uses drugs to kill cancer cells throughout the body.
• Radiation therapy: This treatment targets lymphoma in a certain area. It may also be used after chemotherapy.
• Immunotherapy: This treatment boosts your immune system to help fight lymphoma cells.
• Targeted therapy: These drugs attack certain cancer cells.
• Stem cell or bone marrow transplant: These treatments replace damaged bone marrow with healthy cells. They may be used after high-dose chemotherapy.
• CAR T-cell therapy: This newer treatment modifies your T-cells to better fight the lymphoma.
• Clinical Trials: You may be able to try new treatment options.

Treatments can have a range of side effects. Your health care provider can work with you to manage them.

Prognosis and survival rates

The prognosis for non-Hodgkin lymphoma depends on factors such as the subtype, the stage when you’re diagnosed and your overall health. Early diagnosis is key to improving the prognosis and odds of survival.

Aggressive forms of NHL tend to respond better to treatment and have a higher cure rate. Indolent types may be harder to cure but can be managed over time. 

Coping with non-Hodgkin lymphoma

Being diagnosed with cancer can be physically and emotionally overwhelming. Here are some of the ways you can cope with the challenges:

• Emotional support: Consider seeking counseling or therapy and joining in-person or online support groups. Support from others can help you manage the fear, stress, anxiety and other emotions you may feel.
• Physical rehabilitation: Cancer treatment can take a toll on your body and rehab can help you rebuild your strength and regain energy.
• Lifestyle adjustments: Eating a balanced diet, staying active and managing stress can help you recover and keep you feeling as good as you can.

Getting care

Non-Hodgkin lymphoma can be complicated, but early diagnosis and the right treatment can improve your odds of a good prognosis.

At Banner MD Anderson Cancer Center, we provide world-class care for patients with non-Hodgkin lymphoma. Our oncologists, hematologists and support staff work together to develop a treatment plan tailored to your needs. 

We offer cutting-edge treatments and access to clinical trials and we are committed to providing the most advanced care available. Our approach also includes emotional, nutritional and rehab support to help you through every step of your journey. 

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