Non-Hodgkin Lymphoma: The Basics

Non-Hodgkin lymphoma (NHL) is a cancer that affects the immune system. It is sometimes called “blood cancer." NHL begins in the lymph nodes and is made of up of cancerous lymphocytes (white blood cells). There are over 70 different types of NHL.

Risks

The 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

Often, the first sign of NHL is swelling of the lymph nodes. Other symptoms are:

• Fever.
• Night sweats.
• Weight loss.
• Fatigue.
• Itchy Skin.
• Rash
• Alcohol intolerance.
• Swelling in one or more of the lymph nodes.
• Belly pain.

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

Diagnosis of NHL

When your provider thinks you have NHL, they will do a complete health history and physical exam. A biopsy of the enlarged lymph node will be done. This biopsy will help determine the type of NHL.

Other tests that may be done are:

• 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 70 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 (fast-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) – 30% of cases.
    • Mantle cell (can be aggressive or indolent) – 3% 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) – 7% of cases.
    • Gastric mucosa-associated lymphoid tissue lymphoma (MALT) – 8% 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 Lugano classification, a modified version of the Ann Arbor Staging Classification, which ranges from stages I (one) through IV (four):

• Stage I: Cancer is in one region.
• Stage II: Cancer is in two separate lymph node regions on the same side of the diaphragm or in a group of lymph node(s) and in one area of a nearby organ.
• Stage III: Cancer is in the 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.

The letter E (Extranodal) isused if the cancer has spread from a lymph node into a nearby organ. A mass is considered Bulky if it is over 6–10 cm.  

Treatment

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

• Chemotherapy is the most used treatment.
• Immunotherapy uses medication to rev up your immune system to attack cancer cells.
• Targeted Therapyuses medications that target something specific on the 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 (like 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 by using the links below:

Non-Hodgkin’s Lymphoma Staging and Treatment

Resources for More Information: Lymphoma