Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma (NHL) is a cancer in the lymphatic system. The American Cancer Society estimates that there will be about 70,000 new cases of non-Hodgkin lymphoma in 2013. Although NHL is among the most common cancers in childhood, more than 95 percent of cases occur in adults.

Non-Hodgkin lymphoma causes the cells in the lymphatic system to abnormally reproduce, eventually causing tumors to grow. Non-Hodgkin lymphoma cells can also spread to other organs.

There are several types of non-Hodgkin lymphoma, which are classified by what types of cells they start in and how quickly they spread.

What are the symptoms of non-Hodgkin lymphoma?

The following are the most common symptoms of non-Hodgkin lymphoma. However, symptoms can vary depending on where the lymphoma starts and what type it is, so each individual may experience symptoms differently. Symptoms may include:

  • Painless swelling of lymph nodes in neck, underarm, and/or groin

  • Fever

  • Night sweats

  • Fatigue

  • Weight loss

  • Itching of the skin

  • Recurring infections

  • Swelling in the abdomen

  • Swelling in the face and arms

  • Cough or shortness of breath 

The symptoms of non-Hodgkin lymphoma may resemble other blood disorders or medical problems, such as influenza or other infections. In fact, many of these symptoms are more likely to be caused by something other than lymphoma. Always consult your doctor for a diagnosis.

What are the risk factors for non-Hodgkin lymphomas?

Suggested risk factors for non-Hodgkin lymphomas include the following:

  • Older age

  • Male gender

  • Immune system deficiency

  • Autoimmune diseases

  • Exposure to radiation

  • Exposure to chemicals such as benzene and herbicides

  • Organ transplantation

  • Infections with human immunodeficiency virus (HIV), hepatitis C virus, or human T-cell leukemia/lymphoma virus (HTLV-1)

  • History of infectious mononucleosis (caused by an infection with the Epstein-Barr virus)

  • Infection with Helicobacter pylori (H. pylori) bacterium, which has been identified as a cause of stomach ulcers

How is non-Hodgkin lymphoma diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for non-Hodgkin lymphoma may include the following:

  • Blood tests and other evaluation procedures

  • Lymph node biopsy. A procedure performed to remove tissue or cells from lymph nodes in the body for examination under a microscope. This test is needed to confirm a diagnosis of non-Hodgkin lymphoma. 

  • Bone marrow aspiration and/or biopsy. A procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells. This test may be done to see if the lymphoma has reached the bone marrow. 

  • X-ray of the chest. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. This test is sometimes done to see if the lymphoma has spread to lymph nodes in the chest. 

  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • Magnetic resonance imaging (also called MRI). MRIs use radio waves and magnets. The energy from the radio waves creates patterns formed by different types of tissue and diseases. This produces detailed cross-sectional pictures that look like slices of the body. This test is helpful in examining your brain and spinal cord. Or, it may be used if the results of an X-ray or CT scan aren't entirely clear.

  • Ultrasound (also called sonography). A diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

  • Positron emission tomography (PET). A type of nuclear medicine procedure. For this test, you get injected with a small amount of radioactive glucose. Then you lie still on a table that is pushed into the PET scanner, which rotates around you, taking pictures. Glucose use is a sign of active, quickly dividing cells, such as lymphoma. The images from a PET scan are not finely detailed like a CT or a MRI scan, but they can show areas of increased cellular activity anywhere in the body, even if they don't show up on other tests. Many medical centers now have machines that combine PET and CT scans (PET/CT scanners), which are able to compare the information from the PET scan with the detailed image of the CT scan.

Treatment for non-Hodgkin lymphoma

Specific treatment for non-Hodgkin lymphoma will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • The type, location, and extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include:

  • Radiation therapy

  • Chemotherapy

  • Biologic (immune) therapy

  • Careful monitoring without active treatment until the lymphoma causes symptoms (for some slow-growing lymphomas) 

  • Surgery

  • High-dose chemotherapy with stem cell transplantation