CONDITIONS

What Is Non-Hodgkin Lymphoma

Non-Hodgkin Lymphoma, also called Non-Hodgkin’s lymphoma or NHL, is defined as any of a large group of cancers of lymphocytes (white blood cells), which are a crucial part of your immune system. It generally involves the presence of cancerous lymphocytes in your lymph nodes, but it can also spread to other parts of your lymphatic system, such as the tonsils, adenoids, spleen, thymus, and bone marrow. NHL can even involve organs outside of the lymphatic system.

In contrast to NHL, Hodgkin’s lymphoma was the first lymphoma described and was important to diagnose for patients and doctors alike as it was extremely sensitive to radiation treatment.

It is estimated that there are 70,800 new cases of NHL and over 18,000 deaths secondary to NHL in the United States in 2014.

There are many different types of Non-Hodgkin Lymphoma, which can be divided into aggressive (fast-growing types) or indolent (slower growing types). In addition, they may be formed from either B-cells or T-cells. B- and T-cells—also known as B- and T-lymphocytes—are highly specialized defender cells. Among these cells, there are different groups that are tailored to combat diverse types of germs.  This is how they work: if your body is infected with a particular germ, only be B- and T-cells that recognize this invader will respond. These select cells are quickly able to multiply, thus creating an army of identical cells that can fight the infection.  Special types of B- and T-cells are “memory” cells—meaning that they ‘remember’ each particular invader they have fought, making you immune to a second attack.

  • B cell NHL include: Burkitt lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B-cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma
  • T cell NHL include: mycosis fungoides, anaplastic large cell lymphoma, and precursor T-lymphoblastic lymphoma

What Causes Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma is caused by the uncontrolled growth and replication of  white blood cells or lymphocytes. Normally, lymphocytes have a predictable life cycle with cells aging, dying, and new cells being produced. With NHL, there is dysfunction in this life cycle whereby the cancerous lymphocytes replicate.

Risk Factors For Non-Hodgkin Lymphoma

Some factors that may increase the risk of non-Hodgkin’s lymphoma include:

  • Medications that suppress your immune system
  • Infection with certain viruses and bacteria: HIV, Epstein-Barr virus, and Helicobacter pylori
  • Chemicals, such as pesticides, herbicides, and petrochemicals
  • Age: the risk of NHL increases with age and is most common in people in their 60s and older
  • Radiation exposure
  • Genetic factors: if a close relative in your family has NHL, your risk of developing the disease is increased
  • Gender: males are more commonly affected than females

Diagnosing Non-Hodgkin Lymphoma

If you have symptoms that may signal non-Hodgkin’s lymphoma, your doctor will examine you and ask you questions about your health and medical history. In addition, the visit will likely include the following:

  • Lymph node biopsy, where a small piece of tissue is removed from a lymph node and looked at under a microscope.
  • Imaging tests, which may include x-rays, CT or CAT (computed axial tomography) scans, PET (positron emission tomography) scans, and MRI (magnetic resonance imaging) scans
  • Blood tests to determine if blood cells are normal in number and appearance
  • Bone marrow aspiration and biopsy
  • Liver and kidney function tests
  • Echocardiogram to evaluate the size and function of the heart
  • Immunophenotyping, which involves taking cells from a lymph node, blood, or bone marrow that are then examined with a microscope to determine what type of non-Hodgkin’s lymphoma cells are present
  • Pulmonary function test that finds out how well the lungs function

Symptoms of Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma can go without symptoms for a very long time, while other types may show symptoms much sooner.  Common symptoms of NHL include:

  • Swollen lymph nodes in your neck, armpits or groin
  • Abdominal pain or swelling
  • Chest pain, coughing or trouble breathing
  • Fatigue
  • Fever
  • Night sweats
  • Weight loss

Prognosis

According to the University of Maryland, the survival rates for NHL vary widely, depending on the lymphoma type, stage, age of the patient, and other variables. The overall 5-year relative survival rate for patients with non-Hodgkin’s lymphoma is 67%, and the 10-year relative survival rate if 55%.

Because the outlook varies so widely, a definite prognosis is difficult to offer many patients. For instance, those patients with slow growing lymphomas may live many years. However, if this same patient was diagnosed at a late stage with widespread cancer, the survival rate may be severely diminished. Aggressive lymphomas are more likely to cause early death, but can be cured with an early diagnosis and proper treatment.

The most common indolent, or slowly growing, NHL is the follicular lymphoma. If these are diagnosed early, they are potentially curable in early stages I and II. If a patient with follicular lymphoma is not diagnosed until it has spread to other sites, which may include the spleen and bone marrow, successful treatment and cure is much more difficult. In addition, follicular lymphomas very often recur even after treatment. Nonetheless, treatment may achieve a response even after it recurs. The survival rate for follicular lymphoma is 7-10 years after diagnosis. New drug treatments, which include monoclonal antibodies, have improved survival rates.

Aggressive lymphomas usually cause symptoms early during the disease process and are potentially curable with rapid treatment. The most common aggressive NHL is the diffuse large B-cell lymphoma. Although it is fatal if not treated quickly, it is often cured with chemotherapy treatment.

Living With Non-Hodgkin Lymphoma

A diagnosis of cancer can be overwhelming. With time you’ll find ways to cope with the distress and uncertainty of cancer. It is also helpful to:

  • Learn about the condition so you can make informed decisions, advocate for yourself or your child, and know what to expect.
  • Keep friend and family close.
  • Find someone to talk with. Find a good listener with whom you can talk about your hopes and fears. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

Screening

There is no standard screening test for NHL but sometimes a routine doctor’s visit with a medical history, physical exam, and routine blood tests may uncover the disease.

Prevention

For most people, there is no way to reduce the risk of NHL. If you smoke, quitting can improve your odds. It’s also a good idea to avoid working with radiation or with chemicals such as pesticides, herbicides, and petrochemicals. If exposure is unavoidable, follow proper handling procedures to maximize safety.

Medication And Treatment

According to the university of Maryland, the treatment for non-Hodgkin’s lymphoma is highly specific for each patient and is determined by the tumor classification, which incorporates the stage (the extent of the tumor), grade (the growth pattern of the tumor), histologic type (cellular structure), location of tumor, and a variety of other factors, such as the patient’s age and overall health status.

Staging of NHL

Stage I:  disease found only in one lymph node area or in only one area or organ outside the lymph nodes

Stage II: disease is found in two or more lymph nodes on the same side of the diaphragm or the lymphoma extends from a singly lymph node or single group of lymph nodes into a nearby organ

Stage III: lymphoma is found in lymph node areas above and below the diaphragm. Lymphoma may have also spread into areas or organs adjacent to lymph nodes, such as the spleen.

Stage IV: lymphoma has spread (metastasized) via the bloodstream to organs outside the lymph system, such as the bone marrow, brain, skin, or liver.

Treatment of NHL is usually multi-modal, meaning utilizing many different methods. Of note, this generally does not include surgery. Treatment options include all of the following:

  • Chemotherapy plays a role in the treatment of nearly all patients with lymphoma and has achieved remarkable results, even in late stages. This treatment option involves the use of drugs to kill cancerous cells. Chemotherapy is typically administered in cycles of 21-28 days, which involves taking the drugs for a few days, followed by rest, and repeat. The current standard chemotherapy for NHL is CHOP, which stands for cyclophosphamide, doxorubicin, vincristine, and prednisone. Common side effects from chemotherapy include nausea, vomiting, diarrhea, and hair loss. Chemotherapy may also be used along with radiation.
  • Biologic therapy (Immunotherapy). These drugs are aimed at improving the body’s own immune system to fight the cancer. The mainstay of this therapy is the use of monoclonal antibodies, which are laboratory-derived antibodies, which mimic the body’s own antibodies, to help the immune system against the cancer. Ritubximab is a monoclonal antibody that is particularly effective against B-cell lymphomas. Side effects include confusion, dizziness, and visual problems. Even newer therapies include the use of radioactive antibodies, which target cancer cells and selectively use radioisotopes to kill the cancerous cells. This type of treatment is called radioimmunotherapies.
  • Radiation uses high-energy x-rays to kill cancer cells and shrink tumors. It is particularly effective against slow-growing tumors and may be used for symptom control during palliative cases of lymphoma. Side effects may include fatigue, nausea, diarrhea, dry mouth, skin irritation, and damage to nearby healthy tissue.
  • Transplantation is typically utilized after an intensive regimen of high-dose chemotherapy, which kills the cancerous cells, but also destroys many health tissues and cells in the bone marrow. As a result, the stem cell transplantation replaces these healthy, blood-forming cells in the bone marrow.

Complementary and Alternative Treatment

According to the American Cancer Society, complementary methods used to make a person feel better are not considered cures or treatment methods. Some complementary methods that ma prove useful for patient’s suffering from NHL include:

  • Meditation to reduce stress
  • Acupuncture to help relieve pain
  • Peppermint tea to relieve nausea

Also according to the American Cancer Society, alternative treatments may be offered as cures. However, “These treatments have not been proven safe and effective in clinical trials. Some of these methods may pose danger, or have life-threatening side effects. But the biggest danger in most cases is that you may lose the chance to be helped by standard medical treatment. Delays or interruptions in your medical treatments may give the cancer more time to grow and make it less likely that treatment will help.”

When To Contact A Doctor

Non-Hodgkin lymphoma symptoms can include: swollen lymph nodes in the neck, armpit, or groin; abdominal pain and swelling; chest pain, coughing or difficulty breathing; fever; fatigue; night sweats, among others—and may often seem like the flu or other common diseases. Talk to your doctor if you have persistent symptoms that worry you and don’t go away.

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • What type of NHL do I have?
  • Do I need more tests?
  • What treatment do you recommend?
  • What are the side effects?
  • What are my other treatment options?
  • What is the outlook for me?
  • Is there anything else I should know about NHL?