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Non-Hodgkin lymphoma

Definition

Non-Hodgkin lymphoma (NHL) is cancer of the lymph tissue. Lymph tissue is found in the lymph nodes, spleen, and other organs of the immune system.

White blood cells called lymphocytes are found in lymph tissue. They help prevent infections. Most lymphomas start in a type of white blood cell called the B lymphocyte, or B cell.

Alternative Names

Lymphoma - non-Hodgkin; Lymphocytic lymphoma; Histiocytic lymphoma; Lymphoblastic lymphoma; Cancer - non-Hodgkin lymphoma

Causes

For most people, the cause of NHL is unknown. But lymphomas may develop in people with weakened immune systems, including people who have had an organ transplant or people with HIV infection.

NHL most often affects adults. Men develop NHL more often than women. Children can also develop some forms of NHL.

There are many types of NHL. One classification (grouping) is by how fast the cancer spreads. The cancer may be low grade (slow growing), intermediate grade, or high grade (fast growing).

NHL is further grouped by how the cells look under the microscope, what type of white blood cell it originates from, and whether there are certain DNA changes in the tumor cells themselves.

Symptoms

Symptoms depend on what area of the body is affected by the cancer and how fast the cancer is growing.

Symptoms may include:

  • Drenching night sweats
  • Fever and chills that come and go
  • Itching
  • Swollen lymph nodes in the neck, underarms, groin, or other areas
  • Weight loss
  • Coughing or shortness of breath if the cancer affects the thymus gland or lymph nodes in the chest, putting pressure on the windpipe (trachea) or its branches
  • Abdominal pain or swelling, leading to loss of appetite, constipation, nausea, and vomiting
  • Headache, concentration problems, personality changes, or seizures if the cancer affects the brain

Exams and Tests

The doctor will perform a physical exam and check body areas with lymph nodes to feel if they are swollen.

The disease may be diagnosed after biopsy of suspected tissue, usually a lymph node biopsy.

Other tests that may be done include:

  • Blood test to check protein levels, liver function, kidney function, and uric acid level
  • Complete blood count (CBC)
  • CT scans of the chest, abdomen and pelvis
  • Gallium scan
  • PET (positron emission tomography) scan

If tests show you have NHL, more tests will be done to see how far it has spread. This is called staging. Staging helps guide future treatment and follow-up.

Treatment

Treatment depends on:

  • The specific type of lymphoma
  • The stage when you are first diagnosed
  • Your age and overall health
  • Symptoms, including weight loss, fever, and night sweats

You may receive chemotherapy, radiation therapy, or both. Or you may not need immediate treatment. Your doctor can tell you more about your specific treatment.

Radioimmunotherapy may be used in some cases. This involves linking a radioactive substance to an antibody that targets the cancerous cells and injecting the substance into the body.

High-dose chemotherapy may be given when NHL recurs or fails to respond to the first treatment administered. This is followed by an autologous stem cell transplant (using your own stem cells) to rescue the bone marrow after the high-dose chemotherapy. With certain types of NHL, these treatment steps are used at first remission to try and achieve a cure.

Blood transfusions or platelet transfusions may be required if blood counts are low.

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

Low-grade NHL usually cannot be cured by chemotherapy alone. Low-grade NHL progresses slowly and may take many years before the disease gets worse or even requires treatment. The need for treatment is usually determined by symptoms, how fast the disease is progressing, and if blood counts are low.

Chemotherapy may cure many types of high-grade lymphomas. If the cancer does not respond to chemotherapy, the disease can cause rapid death.

Possible Complications

NHL itself and its treatments can lead to health problems. These include:

  • Autoimmune hemolytic anemia
  • Infection
  • Side effects of chemotherapy drugs

Keep following up with a doctor who knows about monitoring and preventing these complications.

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of this disorder.

If you have NHL, call your provider if you experience persistent fever or other signs of infection.

References

National Cancer Institute: PDQ Adult Non-Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. Date last modified February 13, 2015. Available at: www.cancer.gov/cancertopics/pdq/treatment/adult-non-hodgkins/HealthProfessional. Accessed March 2, 2015.

National Cancer Institute: PDQ Childhood Non-Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. Date last modified June 6, 2014. Available at: cancer.gov/cancertopics/pdq/treatment/child-non-hodgkins/HealthProfessional. Accessed February 2, 2015.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Non-Hodgkin Lymphomas. Version 2.2015. Available at: www.nccn.org/professionals/physician_gls/pdf/nhl.pdf. Accessed March 2, 2015.

Roschewiski MJ, Wilson WH. Non-Hodgkin lymphoma. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 106.



Review Date: 2/13/2015
Reviewed By: Rita Nanda, MD, Assistant Professor of Medicine, Section of Hematology/Oncology, University of Chicago Medicine, Chicago, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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