Non-Hodgkin Lymphoma: The Basics

Non-Hodgkin lymphoma (NHL) is cancer that affects the immune system. It is sometimes called “blood cancer”. NHL begins in the lymph nodes and is made of up cancerous lymphocytes (white blood cells). There are over 60 different types of NHL.

Risks

The actual cause of NHL is not known. There are some known risk factors:

• Long-term changes in how your immune system works (increased or decreased function).
• Certain viruses and bacteria.
• Use of some pesticides and herbicides.
• Immune system depression from organ/bone marrow transplant, rheumatoid arthritis, inherited immune deficiencies, and infections, including HIV.

Screening

There are no screening tests for NHL.

Signs of NHL

The first sign of NHL is often swelling of the lymph nodes. Other symptoms include:

• Fever.
• Night sweats.
• Weight loss.
• Fatigue.
• Itchy Skin.
• Alcohol intolerance.

Because there are many types of NHL, signs, and symptoms depend on the type and the area of the body that is affected.

Diagnosis of NHL

When your healthcare provider suspects NHL, they will perform a complete health history and physical exam. A biopsy will be done of the enlarged lymph node, removing some cells or the entire lymph node. This biopsy will help determine the type of NHL.

Other tests that may be done to see the extent of cancer include:

• Blood tests.
• Chest x-ray.
• CT scan or MRI of the chest, abdomen, and pelvis.
• PET scan.
• Bone marrow biopsy.

Types of NHL

There are more than 60 different types of NHL. The major types of NHL are B-cell, T-cell, and NK-cell lymphomas. Your provider will also describe your NHL as aggressive (faster-growing) or indolent (slow-growing). Each type has both aggressive and indolent subtypes.

• B-cell NHL makes up more than 85% of all NHL cases.
  • Most common aggressive types:
    • Diffuse large B-cell lymphoma (DLBCL) – 31% of cases.
    • Mantle cell (can be aggressive or indolent) – 6% of cases.
    • Lymphoblastic lymphoma – 2% of cases.
    • Burkitt lymphoma – 2% of cases.
  • Most common indolent types:
    • Follicular lymphoma – 22% of cases.
    • Marginal zone lymphoma – 8% of cases.
    • Chronic lymphocytic lymphoma / small cell (CLL/SLL) – 6% of cases.
    • Gastric mucosa-associated lymphoid tissue lymphoma (MALT) – 5% of cases.
• T-cell / NK cell NHL makes up 10-15% of NHL cases.
  • Most common aggressive types:
    • Peripheral T-cell lymphoma (PTCL) – 6% of cases.
    • Systemic anaplastic large-cell lymphoma (ALCL) – 2% of cases.
    • Lymphoblastic lymphoma – 2% of cases.
  • Most common indolent types:
    • Cutaneous T-cell lymphoma (CTCL) – 4% of cases.
    • Mycosis fungoides.

Staging NHL

Staging for NHL is done based on the Ann Arbor Staging Classification, which ranges from stages I through IV:

• Stage I: cancer is located in a single region.
• Stage II: cancer is located in two separate lymph node regions on the same side of the diaphragm.
• Stage III: cancer involves lymph nodes or organs on both sides of the diaphragm.
• Stage IV: cancer has spread to multiple spots of an organ outside the lymph system OR cancer has spread to only one organ outside the lymph system, but lymph nodes far from that organ are involved OR bone marrow is involved.

Letters A, B, E, and X can be added to each stage to represent the symptoms related to the diagnosis.

Treatment

Treatment depends on the type of NHL and the stage of cancer.

• Chemotherapy is the most commonly used treatment. 
• Immunotherapy/Targeted Therapy uses the body’s own immune system to attack cancer cells, in combination with medications, to kill cancer cells.
• Radioimmunotherapy uses monoclonal antibodies and radiation to seek out tumor cells, attach to them, expose them to radiation, and destroy them.
• Radiation uses high-energy rays (similar to x-rays) to kill cancer cells in a targeted, small area of the body.
• Bone marrow and stem cell transplants use a patient’s own, or another person’s bone marrow or stem cells to help the patient recover after being given high doses of chemotherapy.

This article is a basic guide to NHL. You can learn more about NHL diagnosis and treatment by using the link below.

All About Non-Hodgkin’s Lymphoma