Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma is a form of cancer. It develops in your body’s lymph tissue. This tissue is in your lymph nodes, spleen, and other organs that make up your immune system. Lymph nodes help your body fight infection. They eliminate fluid, waste, and bad cells from your body. Sometimes, non-Hodgkin lymphoma develops in the body’s bone marrow and blood. There are two subtypes of non-Hodgkin lymphoma: B-cell and T-cell. Your treatment and prognosis depend on the subtype.

Symptoms of non-Hodgkin lymphoma

Non-Hodgkin lymphoma symptoms include:

  • swelling of the lymph nodes in your neck, underarm, or groin
  • noticeable weight loss without trying
  • fever
  • drenching night sweats
  • chest pain, difficulty breathing, and coughing
  • fatigue
  • abdominal pain or bloating.

What causes non-Hodgkin lymphoma?

The exact cause of most lymphomas is unknown. Most lymphomas develop in a type of white blood cell called the B lymphocyte, or B cell. With non-Hodgkin lymphoma, your body produces too many white blood cells. Normally, your white blood cells die and new ones develop. When you have non-Hodgkin lymphoma, your white blood cells don’t die. They grow uncontrollably. This is what doctors believe contributes to cancer.

Doctors have identified certain risk factors. People with weakened immune systems (infection-fighting ability) are most at risk of developing non-Hodgkin lymphoma. Examples include people who have had their immune system damaged through an organ donation or HIV infection. People who have Down syndrome also are at a higher risk. People exposed to certain viruses and chemicals are at risk of the disease. Finally, non-Hodgkin lymphoma is more likely to occur in people over the age of 60.

How is non-Hodgkin lymphoma diagnosed?

Your doctor will do a physical exam. It will include looking (and feeling) for lumps in your neck, under your arm, and around your groin. He or she will also ask you questions about your medical history to assess your risk for certain conditions and diseases. Your doctor will likely order a blood test (inserting a small needle into the vein in your arm and withdrawing a small sample of blood). The blood will be sent to a lab for a complete blood count (CBC). The CBC will look at a number of factors, including your white blood cell count.

If your doctor finds a lump and wants to look at it more closely, he or she may order an imaging test (similar to an X-ray). This might include an MRI (magnetic resonance imaging), CT (computed tomography) scan, or PET (positron emission tomography) scan. An ultrasound might be used to see inside your body. This test uses a wand to move around the area in question to see inside. It creates pictures from sound waves as it moves across your body.

If your doctor needs more information to diagnose (or rule out) lymphoma, he or she may order a biopsy. This involves inserting a needle into the lump to sample a small amount of tissue. Your doctor may give you medicine to make you sleep during the procedure. If the biopsy is minor, you may be given medicine to relax you during the procedure. All of these tests give your doctor information about the type, stage, and severity of the disease.

Can non-Hodgkin lymphoma be prevented or avoided?

Preventive steps can be taken against certain risk factors. For example, reduce your exposure to HIV by practicing safe sex. If you are caring for a person who has Down syndrome, help them monitor their health and get an annual blood test. Reduce your risk of chemical exposure throughout your lifetime.

Non-Hodgkin lymphoma treatment

Your treatment plan will depend on your type and stage of non-Hodgkin lymphoma. Possible treatments include:

  • chemotherapy
  • immunotherapy (medicine designed to boost your immune system to fight cancer cells)
  • targeted therapy (medicine directed toward your genes and proteins)
  • radiation
  • stem cell transplant.

If left untreated, the disease will lead to death. If you decline treatment, you can choose to get support from palliative care (a medical team that manages your symptoms and pain). Later, hospice can support you in the final 6 months to help you manage your quality of life.

Living with non-Hodgkin lymphoma

Living with non-Hodgkin lymphoma depends on several factors.

  • Stage of your disease.
  • Type of treatment you receive.
  • Your prognosis.
  • Treatment or no treatment.

If you choose to undergo treatment, common approaches, such as chemotherapy and radiation, have significant side effects.

  • Chemotherapy can cause nausea and fatigue. It can cause infection, mouth sores, and hair loss.
  • Radiation can cause similar problems, as well as burns to the skin near the area being treated. It also can cause changes in blood counts.
  • Immunotherapy side effects include fever, chills, and nausea. More serious side effects include hepatitis and damage to the pancreas.
  • Targeted therapy side effects include high blood pressure, bleeding and blood clotting difficulties. That is dependent upon the type of medicine used. Also, it can include delayed wound healing, damage to the heart, swelling, and autoimmune problems (when your body is attacking its immune system). The most significant side effect of targeted therapy is skin problems. This can range from rash to itching and dry skin.
  • Stem cell transplant side effects include nausea, infection, mouth and throat pain, and bleeding. More serious problems include stem cell rejection, where your body attacks the new cells.

Questions to ask your doctor

  • Is the prognosis good if diagnosed early?
  • Is there a childhood version of non-Hodgkin lymphoma?
  • Is the disease hereditary?
  • Can the disease spread beyond the lymph nodes?