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American Academy of Family Physicians.

Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma is a form of cancer. If you have non-Hodgkin lymphoma, your white blood cells become abnormal. The cancer starts in your body’s lymph system. This includes your lymph nodes, spleen, and other organs. These are the things that make up your immune system. Lymph nodes help your body fight infection. They eliminate fluid, waste, and bad cells from your body. Non-Hodgkin lymphoma also can develop in your  bone marrow and blood. There are two types of non-Hodgkin lymphoma: B-cell and T-cell. Treatment and prognosis depend on the type.

Symptoms of non-Hodgkin lymphoma

Possible symptoms include:

  • Swelling of the lymph nodes in your neck, underarm, or groin
  • Noticeable and unexplained weight loss
  • Fever
  • Drenching night sweats
  • Chest pain, difficulty breathing, and coughing
  • Fatigue
  • Stomach 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. It is called the B lymphocyte, or B cell. With non-Hodgkin lymphoma, your body produces too many white blood cells. Normally, white blood cells die and new ones develop. When you have non-Hodgkin lymphoma, white blood cells don’t die. They grow uncontrollably. This is what doctors believe contributes to cancer.

Doctors have identified certain risk factors for non-Hodgkin lymphoma. People with weakened immune systems are most at risk. This means they don’t have infection-fighting ability. This includes people who have had an organ donation or HIV infection. People who have Down syndrome are at a higher risk. Certain viruses and chemicals can cause the disease. Non-Hodgkin lymphoma often occurs in people over the age of 60.

How is non-Hodgkin lymphoma diagnosed?

Your doctor will do a physical exam. He or she will look and feel for lumps in your neck, under your arm, and around your groin. He or she will ask you about your medical history and assess your risk. Your doctor will likely order a blood test. This involves inserting a small needle into the vein in your arm and withdrawing a small sample of blood. He or she will send the blood to a lab. The lab will look at your white blood cell count.

If your doctor finds a lump, your doctor 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. It creates pictures from sound waves as it moves across your body.

To diagnose (or rule out) lymphoma, your doctor 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?

Prevention is helpful for certain risk factors. For example, reduce your exposure to HIV by practicing safe sex. 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)
  • 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 life-saving 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. This includes 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 newer 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?
  • What viruses lead to non-Hodgkin lymphoma?
  • Which chemicals cause non-Hodgkin lymphoma?
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