Non-Hodgkin's lymphoma

Causes

White blood cells called lymphocytes are found in lymph tissues. They help prevent infections. Most lymphomas start in a type of white blood cells called B lymphocytes, or B cells.

For most patients, the cause of this cancer is unknown. However, lymphomas may develop in people with weakened immune systems. For example, the risk of lymphoma increases after an organ transplant or in people with HIV infection.

There are many different types of non-Hodgkin's lymphoma (NHL). It is grouped according to how fast the cancer spreads.

• The cancer may be low grade (slow growing), intermediate grade, or high grade (fast growing). Burkitt's lymphoma is an example of a high-grade lymphoma. Follicular lymphoma is a low-grade lymphoma
• The cancer is further grouped by how the cells look under the microscope, for example, if there are certain proteins or genetic markers present.

According to the American Cancer Society, a person has a 1 in 50 chance of developing non-Hodgkin's lymphoma. NHL most often affects adults. However, children can get some forms of lymphoma. You are more likely to get lymphoma if you have a weakened immune system or have had an organ transplant.

This type of cancer is slightly more common in men than in women.

Symptoms

Symptoms depend on what area of the body is affected by the cancer and how fast the cancer is growing.

Symptoms may include:

• Night sweats (soaking the bedsheets and pajamas even though the room temperature is not too hot)
• Fever and chills that come and go
• Itching
• Swollen lymph nodes in the neck, underarms, groin, or other areas
• Weight loss

Coughing or shortness of breath may occur if the cancer affects the thymus gland or lymph nodes in the chest, which may put pressure on the windpipe (trachea) or other airways.

Some patients may have abdominal pain or swelling, which may lead to a loss of appetite, constipation, nausea, and vomiting.

If the cancer affects cells in the brain, the person may have a headache, concentration problems, personality changes, or seizures.

Exams and Tests

The doctor will perform a physical exam and check body areas with lymph nodes to feel if they are swollen.

The disease may be diagnosed after:

• Biopsy of suspected tissue, usually a lymph node biopsy
• Bone marrow biopsy

Other tests that may be done include:

• Blood test to check protein levels, liver function, kidney function, and uric acid level
• Complete blood count (CBC)
• CT scans of the chest, abdomen and pelvis
• Gallium scan
• PET (positron emission tomography) scan

If tests reveal you do have cancer, additional tests will be done to see if it has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.

Treatment

Treatment depends on:

• The type of lymphoma
• The stage of the cancer when you are first diagnosed
• Your age and overall health
• Symptoms, including weight loss, fever, and night sweats

Common treatments:

• Radiation therapy may be used for disease that is confined to one body area.
• Chemotherapy is the main type of treatment. Most often,multiple different drugs are used in combination together.
• Another drug, called rituximab (Rituxan), is often used to treat B-cell non-Hodgkin's lymphoma.

Radioimmunotherapy may be used in some cases. This involves linking a radioactive substance to an antibody that targets the cancerous cells and injecting the substance into the body.

People with lymphoma that returns after treatment or does not respond to treatment may receive high-dose chemotherapy followed by a bone marrow transplant (using stem cells from yourself).

Additional treatments depend on other symptoms. They may include:

• Transfusion of blood products, such as platelets or red blood cells
• Antibiotics to fight infection, especially if a fever occurs

During treatment, you and your health care team may need to manage other concerns. See also:

• Being at home during chemotherapy

Support Groups

The stress of illness may be eased by joining a support group whose members share common experiences and problems.

See: Cancer - support group

Outlook (Prognosis)

Low-grade non-Hodgkin's lymphoma usually cannot be cured by chemotherapy alone. However, the low-grade form of this cancer progresses slowly, and it may take many years before the disease gets worse or even requires any treatment.

Chemotherapy can often cure many types of high-grade lymphoma. However, if the cancer does not respond to chemotherapy drugs, the disease can cause rapid death.

Possible Complications

• Autoimmune hemolytic anemia
• Infection
• Side effects of chemotherapy drugs

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of this disorder.

If you have non-Hodgkin's lymphoma, call your health care provider if you experience persistent fever or other signs of infection.

Alternative Names

Lymphoma - non-Hodgkin's; Lymphocytic lymphoma; Histiocytic lymphoma; Lymphoblastic lymphoma; Cancer - non-Hodgkin's lymphoma

References

Bierman PJ, Harris N, Armitage JO. Non-Hodgkin’s lymphoma. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 191.

National Comprehensive Cancer Network. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Non-Hodgkin’s Lymphomas. 2012. Version 1.2012.

Update Date: 3/4/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.