Non-Hodgkin Lymphoma: The Basics

Author: OncoLink Team
Content Contributor: Allyson Distel, MPH
Last Reviewed: December 25, 2023

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 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

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

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

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 healthcare provider thinks you have NHL, they will do a complete health history and physical exam. A biopsy of the enlarged lymph node removes some cells or the entire lymph node. This biopsy will help determine the type of NHL.

Other tests that may be done are:

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 (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) – 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:

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 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.

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 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.
  • Radiationuses 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:

All About Non-Hodgkin’s Lymphoma

Resources for More Information: Lymphoma

References

American Cancer Society. Non-Hodgkin Lymphoma Stages. https://www.cancer.org/cancer/types/non-hodgkin-lymphoma/detection-diagnosis-staging/staging.html

Ansell, SM & Armitage, J (2015) Non-Hodgkin's lymphoma: Diagnosis and treatment. Mayo Clinic Proceedings: 90(8): 1152-1163.

Armitage, J. O., Gascoyne, R. D., Lunning, M. A., & Cavalli, F. (2017). Non-Hodgkin lymphoma. The Lancet.

Brillant, C., Skoetz, N., Kluge, S., Schwarzer, G., Trelle, S., Greb, A., ... & Bohlius, J. (2016). High‐dose chemotherapy with autologous stem cell support for first‐line treatment of aggressive non‐Hodgkin lymphoma: a systematic review and meta‐analysis based on individual patient data. The Cochrane Library.

Cancer Support Community. Non-Hodgkin Lymphoma Staging.

Guss, Z. D., Madkhali, A., Chen, Q., Zhang, Y., Dah, S., Moore, J., & Terezakis, S. A. (2017). Intensity-modulated involved-site radiation therapy for non-Hodgkin lymphoma of the head and neck. Leukemia & Lymphoma, 1-3.

Leukemia and Lymphoma Society (2017), Non-Hodgkin Lymphoma. Retrieved from https://www.lls.org/sites/default/files/file_assets/nhl.pdf

National Comprehensive Cancer Network. B-Cell Lymphomas. Version 6.2023. https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf

National Comprehensive Cancer Network. T-Cell Lymphomas. Version 1.2023. https://www.nccn.org/professionals/physician_gls/pdf/t-cell.pdf

Mathen, P., Molnar, C., Trotter, T., Stewart, D., & Balogh, A. (2016). 253: Meeting the International Lymphoma Radiation Oncology Group Criteria to Deliver Radiotherapy for Lymphomas-A Quality Improvement Study at the Tom Baker Cancer Centre. Radiotherapy and Oncology, 120, S92

Morgner, A et al. Therapy of gastric mucosa associated lymphoid tissue lymphoma. World Journal of Gastroenterology. 13(26):3554-66, 2007 Jul 14.

Ruan, J., Martin, P., Shah, B., Schuster, S. J., Smith, S. M., Furman, R. R., ... & Katz, O. (2015). Lenalidomide plus rituximab as initial treatment for mantle-cell lymphoma. New England Journal of Medicine, 373(19), 1835-1844.

Rummel, M et al. Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatments for patients with indolent and mantle-cell lymphomas: an open-label, multicenter, randomized, phase 3 non-inferiority trial. The Lancet. 381(9873):1203-1210. 2013.

Shi, Y et al. Autologous peripheral blood stem cell mobilization following dose-adjusted cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy alone or in combination with rituximab in treating high-risk non-Hodgkin’s lymphoma. Chinese Journal of Cancer. 2015.

Swerdlow, S. H., Campo, E., Pileri, S. A., Harris, N. L., Stein, H., Siebert, R., … Jaffe, E. S. (2016). The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood, 127(20), 2375–2390. http://doi.org/10.1182/blood-2016-01-643569

Blogs

May 31, 2023

A Poet’s Autobiography of Cancer

by OncoLink Team


July 26, 2022

Fear

by Rodney Warner, JD


March 29, 2022

March is Multiple Myeloma Action Month

by Christina Bach, MSW, LCSW, OSW-C