About Non-Hodgkin Lymphoma

Overview

Non-Hodgkin lymphoma (NHL) is a type of cancer that affects the lymphocytes, which are a type of white blood cell. These lymphocytes are an important part of the immune system and help defend the body against infections and diseases. In non-Hodgkin lymphoma, these cells start to grow abnormally, weakening the immune system and potentially forming tumors throughout the body.

These cancers can develop from B cells, T cells, or natural killer cells. There are more than 85 different types of non-Hodgkin lymphoma. Some NHL types are indolent (slow growing) and some are aggressive (faster growing). Types include:

• Burkitt lymphoma
• Diffuse large B-cell lymphoma
• Lymphoblastic lymphoma
• Follicular lymphoma
• Chronic lymphocytic leukemia/small lymphocytic lymphoma
• Waldenstrom macroglobulinemia (lymphoplasmacytic lymphoma)
• Peripheral T-cell lymphoma
• Cutaneous T-cell lymphoma (including Mycosis fungoides and Sezary syndrome)

Non-Hodgkin lymphoma can affect people of all ages but is most commonly seen in individuals over 60 years old. Common symptoms include painless swollen lymph nodes in the neck, armpits, or groin, fatigue, unexplained weight loss, and night sweats.

Causes and Risk Factors

Non-Hodgkin lymphoma develops when lymphocytes continuously multiply abnormally, forming tumors. Genetic mutations (changes in DNA) in lymphocytes cause the lymphocytes to multiply out of control. While the exact cause of the mutations leading to non-Hodgkin lymphoma is unknown, there are several factors that can increase a person's risk of developing this condition.

Non-modifiable risk factors for NHL (factors that a person cannot change or control):

• Age: Most people diagnosed with non-Hodgkin lymphoma are 65 years or older.
• Sex assigned at birth: Being male is associated with a higher risk of developing non-Hodgkin lymphoma
• Autoimmune conditions: Some autoimmune conditions, like rheumatoid arthritis and lupus, are associated with a higher risk of non-Hodgkin lymphoma.

Modifiable risk factors for NHL (factors that a person potentially can change or control):

• Exposure to radiation: Exposure to radiation, such as during cancer treatment or from X-rays or other sources, can increase the risk.
• Weakened immune system: Having a weakened immune system, which can occur due to certain medical conditions or medications, can increase the risk.
• Viral and bacterial infections: Certain viral infections, such as Epstein-Barr virus (EBV), human T-cell lymphotropic virus type 1 (HTLV-1), and human herpesvirus 8, can increase the risk. Bacterial infections like Helicobacter pylori have also been linked to non-Hodgkin lymphoma.
• Obesity or excessive weight: While the link between obesity and non-Hodgkin lymphoma is still being researched, maintaining a moderate weight is recommended by the American Cancer Society to reduce the risk of multiple types of cancer.

It's important to note that having one or more of these risk factors does not necessarily mean that someone will develop non-Hodgkin lymphoma. Conversely, some individuals without any known risk factors may still develop this condition. If you have concerns about your risk for non-Hodgkin lymphoma, it's best to speak with your healthcare provider who can provide personalized guidance and support.

Symptoms

Non-Hodgkin lymphoma (NHL) can cause a variety of symptoms, which may vary depending on the specific type and stage of the cancer. Here are common symptoms of NHL:

• Swollen lymph nodes: Painless swelling in the groin, neck, and armpit
• Abdominal pain or abdominal bloating
• Chest pain or pressure
• Fatigue
• Chills
• Cough
• Shortness of breath/trouble breathing
• Unexplained weight loss
• Feeling full quickly
• Frequent or severe infections
• Bruising or bleeding easily
• Itchy skin
• Unexplained fever
• Drenching night sweats
• Loss of appetite
• Enlargement of the liver or spleen
• Skin rashes or lumps

It's important to note that a person may not experience any symptoms until the cancer has grown large. Therefore, it's crucial to speak with a doctor if you notice any symptoms of NHL.

By reporting these symptoms early and seeking medical attention, individuals with NHL can improve their outlook. Remember to consult with your doctor if you develop new or worsening symptoms, as they can help determine the underlying cause and provide appropriate care.

Diagnosis

To diagnose non-Hodgkin lymphoma, doctors commonly perform the following examinations, tests, and procedures:

• Medical history: The healthcare professional will ask about symptoms, medical history, medications, and family medical history.
• Physical exam: During a physical exam, the doctor looks for swollen lymph nodes in the neck, groin, and underarms, and checks for swelling in the spleen and liver. This helps provide a baseline for your diagnosis.
• Blood tests: A complete blood count (CBC) is performed to check the number of red blood cells, white blood cells, and platelets in your blood. It also measures the amount of hemoglobin (the protein that carries oxygen) in the red blood cells. Other blood tests may check for general health of the kidneys and liver or for signs of inflammation or infection.
• Biopsy: This involves taking a sample of cells from a lymph node or tumor using a small needle. A pathologist then examines this sample under a microscope to check for signs of the lymphoma. Additional tests may be performed on the tissue sample to look for signs of cancer cells.
• Imaging tests: X-rays, ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), or PET scans may be used to examine areas inside the body, such as the liver, spleen, brain and spinal cord. These tests help determine if there are any abnormalities or tumors.

Additional tests or procedures may be performed based on initial findings or to determine the stage or severity of non-Hodgkin lymphoma. These may include:

• Lumbar puncture: This procedure involves collecting cerebrospinal fluid (CSF) from the spinal column by placing a needle between two bones in the spine. The CSF sample is then checked under a microscope for signs that the cancer has spread to the brain and spinal cord.
• Bone marrow biopsy: A small sample of bone marrow is taken from your hipbone or another large bone to check for cancer cells. This test helps determine if the cancer has spread to the bone marrow.
• Heart and lung function tests: These tests assess how well your heart and lungs are functioning. They provide important information about your overall health and help determine if you can tolerate certain treatments.

After diagnosis of NHL, the doctor will determine the stage of NHL. The stage is based on where the lymphoma is located, if it has spread, and where it has spread. The stage helps the healthcare provider to determine a recommended treatment plan.

It's important to remember that these examinations, tests, and procedures are performed by healthcare professionals to accurately diagnose non-Hodgkin lymphoma and determine its stage or severity.

Treatment Options

The goals of treatment for non-Hodgkin lymphoma (NHL) are to destroy cancer cells, alleviate symptoms, and restore overall health. The specific treatment options for NHL may vary depending on factors such as the type and stage of the lymphoma, as well as the person's overall health and fitness levels.

The doctor may recommend watchful waiting for some early stage, indolent (slow growing) NHLs that are not causing symptoms. This means you will not start treatment immediately. You and the doctor will closely monitor for symptoms and start treatment if they occur.

For treatment, options may include:

• Chemotherapy: Chemotherapy is a primary treatment for NHL. It involves the use of drugs to kill cancer cells or stop them from growing. Combinations of different types of chemotherapy medications may be used, and the specific drugs and dosage depend on the individual's condition and cancer stage. Chemotherapy can be given orally or through intravenous infusion.
• Immunotherapy: Immunotherapy is a type of treatment that boosts the body's immune system to fight cancer cells. It uses substances that stimulate the immune system or antibodies that specifically target cancer cells. Immunotherapy can help enhance the body's natural defenses against NHL.
• Targeted cell therapies: Targeted cell therapies are a newer form of treatment for NHL that specifically target cancer cells while sparing healthy cells. Targeted therapies disrupt a cancer cell’s function or processes needed to divide, multiply, grow, or spread.
• Radiation therapy: Radiation therapy uses high-energy beams to target and destroy cancer cells. It is often used in combination with chemotherapy for NHL treatment. The radiation is directed at specific areas where the lymphoma is located or has spread.
• Stem cell transplantation: This procedure may be recommended for some people with NHL. It involves replacing damaged or diseased stem cells (the immature cells that normally become red blood cells, white blood cells, and platelets) with healthy stem cells.
• Surgery: Surgery may be considered for certain types of extranodal NHL, such as testicular lymphoma. In these cases, the affected testicle may be surgically removed.
• Antibiotic treatment: In some cases of a type of NHL called mucosa-associated lymphoid tissue (MALT) lymphoma, which is associated with H. pylori infection, treatment with antibiotics may be recommended as a first-line therapy.
• Supportive treatments: Additional medications or therapies may be used as part of the treatment plan. Examples include medications to help reduce nausea or vomiting or to help reduce the risk of infections.

It's important to note that treatment plans are individualized based on each person's specific condition and needs. Often, a combination of treatments is recommended to achieve the best outcomes in terms of destroying cancer cells and improving overall health.

These treatments work together to destroy cancer cells, alleviate symptoms, and improve quality of life for individuals with NHL. Ongoing research continues to contribute to better treatment strategies and improved survival rates for this condition.

Progression or Complications

Over time, the natural progression of NHL can vary depending on factors such as age at diagnosis and the specific type of NHL. Complications may result from the NHL itself, or from its treatment.

Complications of NHL include:

• Weakened immune system, which makes a person more vulnerable to infections
• Depression
• Dental and oral complications from chemotherapy treatment, such as mucositis or sores in the mouth
• Fertility problems from chemotherapy or radiation therapy
• Secondary cancers from exposure to chemotherapy or radiation therapy
• Organ damage to heart and lungs
• Cytopenia: Low red blood cells (anemia), low white blood cells (leukopenia), or low platelets (thrombocytopenia). This increases chances of bleeding or infection.
• Hair loss
• Loss of appetite

Specialists on the healthcare team can advise on ways to help minimize complications of NHL. For example, a dietitian may be able to advise on foods that are easy to eat and provide key nutrients.

It's important to consult with your doctor or healthcare provider for personalized advice regarding natural progression, complications, and treatment options for Non-Hodgkin Lymphoma. They will be able to provide you with specific information based on your individual situation.