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