Lymphomas are either Hodgkin lymphomas or non-Hodgkin lymphomas. Hodgkin lymphomas have a type of cell called Reed-Sternberg cells. Lymphomas without these cells are non-Hodgkin lymphomas. This topic is about non-Hodgkin lymphoma (NHL). To learn about Hodgkin lymphoma, see the topic Hodgkin Lymphoma.
Lymphoma is cancer that begins in the lymph system in white blood cells called lymphocytes. When these cells become abnormal, they don't protect the body from infection or disease. They also grow without control and may form lumps of tissue called tumors.
NHL can start almost anywhere in the body. It may start in a single lymph node, a group of lymph nodes, or an organ such as the spleen. Or it can spread to almost any part of the body, including the liver and bone marrow.
There are many types of NHL. Sometimes they are grouped as:
Treatment can cure some people and may allow others to live for years. How long you live depends on the type of NHL you have and the stage of your disease (how far it has progressed).
The cause of NHL is not known. The abnormal cell changes may be triggered by an infection or exposure to something in the environment. Or it may be linked to gene changes (mutations). NHL is not contagious.
Symptoms of NHL include:
Your doctor will do a physical exam and ask you questions about your health. The exam includes checking the size of your lymph nodes in your neck, underarm, and groin.
Your doctor will take a piece of body tissue (biopsy) to diagnose NHL. The tissue usually is taken from a lymph node. You may have other tests to find out what kind of NHL you have.
Your treatment depends on the type of lymphoma you have, the stage of the disease, your age, and your general health. You may not need treatment until you have symptoms. NHL is usually treated with chemotherapy. Sometimes radiation or radiation with chemotherapy may be used. Or you may have targeted therapy with monoclonal antibodies.
If treatment doesn't work, or if NHL comes back after initial treatment, you may have chemotherapy along with a stem cell transplant.
Experts don't know what causes non-Hodgkin lymphoma (NHL).
When a person has non-Hodgkin lymphoma, abnormal rapid cell growth occurs. This abnormal growth may need a "trigger" to start, such as an infection or exposure to something in your environment. There is also a link between NHL and problems with the immune system.
NHL is not contagious and is not caused by injury.
Symptoms of non-Hodgkin lymphoma (NHL) include:
In non-Hodgkin lymphoma (NHL), white blood cells called lymphocytes divide and grow without order or control. The abnormal lymphocytes usually are either B-cell or T-cell lymphocytes. But most cases of NHL involve B-cell lymphocytes.
Lymph tissue is present in many areas of the body, so NHL can start almost anywhere in the body. It may occur in a single lymph node, a group of lymph nodes, or an organ. And it can spread to almost any part of the body, including the liver, bone marrow, and spleen.
NHL may be classified as:
Over time, lymphoma cells may replace the normal cells in the bone marrow. Bone marrow failure results in the inability to produce red blood cells that carry oxygen, white blood cells that fight infection, and platelets that stop bleeding.
Long-term survival depends on the type of non-Hodgkin lymphoma and the stage of the disease when it is diagnosed. About 80 out of 100 people diagnosed with non-Hodgkin lymphoma are alive 1 year after the disease is diagnosed. That number drops to about 67 out of 100 at 5 years, and 57 out of 100 at 10 years.footnote 1
Some things can increase your chances of getting non-Hodgkin lymphoma (NHL). These things are called risk factors. But many people who get non-Hodgkin lymphoma don't have any of these risk factors. And some people who have risk factors don't get the disease.
Risk factors include:footnote 2
Call your doctor to schedule an appointment if you have any symptoms, such as:
If you have been diagnosed with cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.
If non-Hodgkin lymphoma (NHL) is suspected, your doctor will ask about your medical history and perform a physical exam. This exam includes checking for enlarged lymph nodes in your neck, underarm, and groin.
A tissue sample (biopsy) is needed to make a diagnosis. A biopsy for non-Hodgkin lymphoma is usually taken from a lymph node, but other tissues may be sampled as well.
A bone marrow aspiration and biopsy is usually done to find out if lymphoma cells are present in the bone marrow.
Your doctor may also order other tests, including:
Treatment for non-Hodgkin lymphoma (NHL) depends on:
Your doctor will work with you and your medical team (which may include an oncologist, a hematologist, and an oncology nurse) to come up with your treatment plan.
A common concern of cancer patients are the side effects of treatments like chemotherapy and radiation. Your medical team will let you know ahead of time what side effects you can expect and help you manage them. And there are things you can do at home. To learn more, see Home Treatment.
Sometimes NHL comes back after treatment. This is called recurrence or relapse. Treatments for recurrent NHL include chemotherapy, radiation, or a combination of the two. This treatment may be followed by a stem cell transplant.
You will need regular exams after you have been treated for NHL.
Let your doctor know if you have any problems as soon as they appear.
Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.
Your doctor may use the term "remission" instead of "cure" when talking about the effectiveness of your treatment. Although many people with non-Hodgkin lymphoma are successfully treated, the term remission is used because cancer can return. It is important to discuss with your doctor the possibility of recurrence.
Even after effective treatment for NHL, you may be at slightly higher risk for other types of cancer, especially melanoma, lung, brain, kidney, and bladder cancers. Be watchful for any symptoms of cancer.
Additional information about NHL is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/non-hodgkin.
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit. You can have this care along with treatment to cure your illness.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
For more information, see the topic Palliative Care.
For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.
For more information, see the topics:
You can do things at home to help manage your side effects. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.
Other problems that can be treated at home include:
Having cancer can be very stressful, and it may feel overwhelming to face the challenges in front of you. Finding new ways of coping with the symptoms of stress may improve your overall quality of life.
These ideas may help:
Your doctor may prescribe medicines that will affect the growth of non-Hodgkin lymphoma and relieve your symptoms.
Chemotherapy may be used alone or with radiation therapy. Sometimes a combination of chemotherapy medicines is more effective than a single drug.
The most commonly used combination is called CHOP. It combines four medicines: cyclophosphamide, doxorubicin, vincristine, and prednisone.
Your doctor will work with you to find the best medicine for the type of lymphoma you have.
Chemotherapy causes many side effects. For help with how to deal with these, see Home Treatment. Your doctor may prescribe medicines to control nausea and vomiting from chemotherapy.
Targeted therapy uses monoclonal antibodies in medicine that is injected into the body so these antibodies can attach to cancer cells and destroy them. The monoclonal antibodies used to treat NHL include:
You may not be able to become pregnant or father a child after chemotherapy treatment. Discuss fertility issues with your doctor before starting treatment. Chemotherapy medicines can also cause birth defects. If you are pregnant or wish to father a child, discuss the risk of birth defects with your doctor before using any chemotherapy medicine.
Radiation therapy for non-Hodgkin lymphoma (NHL) may be given in different ways.
A stem cell transplant may be used to treat NHL that is in remission or that has come back. Stem cells may be obtained from blood, through a peripheral blood stem cell transplant (PBSCT). Or stem cells can be obtained from bone, in a bone marrow transplant (SBMT). PBSCT is the most common method for treating NHL.
A stem cell transplant may be done right after you have very high-dose chemotherapy. (You may also have radiation to your entire body.) The stem cell transplant is done to replace your damaged bone marrow cells with healthy stem cells. A stem cell transplant may be offered as part of standard treatment or in a clinical trial.
Clinical trials are research studies that try to find better NHL treatments. Your doctor may suggest that you join a clinical trial. Some treatments being used in clinical trials include lymphoma vaccines and stem cell transplants with high-dose chemotherapy. If you are interested in taking part in a clinical trial, check with your doctor to see if any are available in your area.
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.
- American Cancer Society (2011). Cancer Facts and Figures 2011. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-029771.pdf.
- Freedman AS, et al. (2015). Non-Hodgkin's lymphoma. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer Principles and Practices of Oncology, 10th ed., pp. 1552–1583. Philadelphia: Walters Kluwer.
Other Works Consulted
- Bierman PJ, et al. (2016). Non-Hodgkin lymphomas. In L Goldman, A Shafer, eds., Goldman-Cecil Medicine, 24th ed., vol. 1, pp. 1257–1268. Philadelphia: Saunders.
- Hillman R, et al. (2011). Non-Hodgkin lymphomas. In Hematology in Clinical Practice, 5th ed., pp. 279–300. New York: McGraw-Hill.
- Kyle F, Hill M (2010). NHL (diffuse large B-cell lymphoma), search date January 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- National Comprehensive Cancer Network (2011). Non-Hodgkin's lymphomas. Clinical Practice Guidelines in Oncology, Version 4. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
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