Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma at a glance

• Non-Hodgkin lymphoma cancer occurs in cells that grow out of control in the lymphatic system, part of the body’s immune system.
• Because lymph tissue is found throughout most of the body, non-Hodgkin lymphoma can begin just about anywhere and spread to various parts of the body.
• Non-Hodgkin lymphoma symptoms include swollen lymph nodes, abdominal or chest pain, unexplained fever, weight loss and fatigue.
• No screening method can detect non-Hodgkin lymphoma, so if signs and symptoms present, the person must take early action.
• Scientists don’t know the exact cause of non-Hodgkin lymphoma, but they have identified risk factors that include age, gender, race, immune system-related medical conditions and obesity.
• Treatment varies according to the individual case but involves a combination of chemotherapy, radiation, immunotherapy or stem cell transplants in aggressive cases.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) cancer originates in the lymphatic system, a part of the body’s immune system. The disease occurs when lymphatic cells begin to grow and change uncontrollably, occasionally forming a tumor.

The two types of lymphoma, Hodgkin lymphoma and non-Hodgkin lymphoma (the more common of the two), are different regarding their development, spread and response to treatment. Oncologists identify the type of lymphoma through lab testing.

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Both these forms of lymphoma affect the lymphatic system, which consists of small, bean-shaped organs called lymph nodes found throughout the body. The largest groups of lymph nodes are located in the groin, pelvis, neck and underarms. These lymph nodes are composed of lymphoid tissue, lymph vessels and lymph.

Lymph, a colorless fluid, carries white blood cells – lymphocytes that protect the body against infection – through the lymph system. The three types of lymphocytes are as follows.

• B lymphocytes (B cells): white blood cells that form antibodies to fight bacteria.
• T lymphocytes (T cells): white blood cells that assist B cells in making antibodies and attack viruses and foreign cells.
• Natural killer cells (NK cells): white blood cells that kill cancer cells and viruses.

Non-Hodgkin lymphoma can develop in the B, T or NK cells, but begins most commonly in B cells. Since lymphatic tissue is found throughout the body, NHL can begin just about anywhere and spread to nearly every organ, including the lymph nodes, liver, spleen, stomach, bone marrow, intestines, skin, thyroid gland and brain. The cancer may travel via tissue, the lymph system vessels or the blood vessels.

NHL develops at different rates categorized as either indolent (slow growing) or aggressive. Indolent NHL tends to have few signs and symptoms (see below), whereas aggressive NHL frequently has serious symptoms.

According to the American Society of Clinical Oncology, the average 5-year survival rate for people with NHL is 70 percent. This number may depend on the stage and subtype of the cancer.

Certain other cancers, such as lung cancer, can spread to lymph tissue. However, cancers that start elsewhere and spread to lymph tissue are not considered lymphomas.

Non-Hodgkin lymphoma causes

Oncologists don’t know the exact cause of non-Hodgkin lymphoma but as with all cancers, it involves the growth of mutated cells.

Studies show that risk factors for developing NHL may include the following.

• Gender: NHL affects men more than women, though certain types of NHL are more common in women.
• Age: Most cases of NHL occur in people over 60 years old. Certain types of NHL occur in children.
• Race: Caucasians are the most likely to develop NHL in the United States.
• Certain medical conditions
• Inherited immune disorders
• Autoimmune diseases
• Immune system deficiency
• HIV/AIDS
• Human T-lymphotropic virus type I (HTLV-I)
• Epstein-Barr virus infection
• Helicobacter pylori infection
• Medications that suppress the immune system: Patients who have received an organ transplant are more susceptible to NHL because of immunosuppressive therapy.
• Weight and diet: Some studies suggest that obesity and diets high in fat and meats may increase risk.
• Breast implants: In rare cases, women have been diagnosed with anaplastic large cell lymphoma (an unusual type of NHL) in the scar tissue around their breast implants.

Non-Hodgkin lymphoma symptoms

Currently, oncologists recommend no screening tests for non-Hodgkin lymphoma that would seek to find the disease before symptoms appear. The best way to find NHL early is to react quickly to its signs and symptoms, which may include:

• Swollen lymph nodes in the neck, underarm, groin or stomach
• Abdominal pain and/or swelling leading to loss of appetite, nausea, vomiting or constipation
• Chest pain and difficulty breathing
• Coughing
• Unexplained fatigue, fever or weight loss
• Skin rash
• Sweating and chills.

The doctor confirms a diagnosis of NHL using a tissue biopsy, sometimes combined with blood tests and imaging tests such as CT or PET scans. If a patient has confirmed NHL, oncologists perform additional tests to determine the stage of the disease.

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Non-Hodgkin lymphoma treatments

Treatment of non-Hodgkin lymphoma depends on the specific type of NHL, the stage at time of diagnosis and the severity of symptoms. Oncologists also take into account age and overall health.

The main treatments, often in combination, for NHL are chemotherapy, radiation therapy and immunotherapy. Oncologists also consider stem cell transplants or surgery.

Chemotherapy

The most common treatment for NHL, chemotherapy, uses drugs to halt the growth of cancer cells in the lymph nodes, lymph organs and bone marrow. Chemotherapy may be delivered intravenously (directly into the bloodstream) or via a pill taken orally. Patients may receive more than one drug at a time. The stage of the cancer determines the regimen for this treatment.

Radiation therapy

Radiation therapy destroys cancer cells with high power X-rays or other radiation. A machine outside the body typically administers radiation therapy, which doctors often use in combination with chemotherapy, depending on the subtype of NHL.

Immunotherapy

Immunotherapy, a type of biologic treatment, uses materials to boost a body’s natural immune system function. Researchers are currently testing the biologic therapies Interferon, monoclonal antibodies and vaccines in clinical trials as alternative treatments for NHL.

Stem cell transplants

In a stem cell procedure, specialized cells that can develop into healthy bone marrow replace cancerous bone marrow. The goal is to kill all cancer cells in the blood, bone marrow and body by using intensive chemotherapy and/or radiation, then creating healthy bone marrow. Allogeneic (ALLO) stem cell transplants use donated stem cells and autologous (AUTO) stem cell transplants use the patient’s own stem cells.

Oncologists consider stem cell transplants an assertive treatment typically only used for cases of recurrent or aggressive NHL. For patients with certain NHL subtypes, a stem cell transplant may be recommended for initial treatment to prevent recurrence of the cancer.