Non-Hodgkin's Lymphoma

Introduction

There are approximately 30 types of Non-Hodgkin’s Lymphoma. Lymphoma is a type of cancer that affects the lymphatic system. Your lymphatic system normally filters germs and infections from your body. Non-Hodgkin’s Lymphoma can occur in many places throughout the body and cause a variety of symptoms. With treatment, Non-Hodgkin’s Lymphoma is associated with good cure rates.

Anatomy

Your lymphatic system is part of your immune system. It is consists of your spleen, bone marrow, tonsils, and a system of lymph nodes located throughout your body. Your stomach, intestinal tract, and several other organs contain lymphatic tissue. The lymphatic system is responsible for filtering germs and infections from your body.

Causes

There are several different types of lymphomas. Lymphomas are cancers that originate in the lymphatic system. Non-Hodgkin’s Lymphoma results when certain types of cells in the lymphatic system grow abnormally and out of control, instead of dividing in an orderly manner.

In most cases, the cause of Non-Hodgkin’s Lymphoma is unknown. People with suppressed immune systems appear to have an increased risk of developing the disease. The condition develops more frequently in people that are older than 50.

There are about 30 different types of Non-Hodgkin’s Lymphomas. The different types vary in aggressiveness. Some forms of this cancer may grow slowly and others are very aggressive, spreading quickly to different parts of the body. Your doctor will specify the type of Non-Hodgkin’s Lymphoma that you have.

Symptoms

The symptoms of Non-Hodgkin’s Lymphoma vary, depending on where the cancer is located in the lymphatic system. Symptoms differ from person to person. Lymph nodes that are close to the surface of the body, such as in the neck, groin, or underarm areas, may enlarge. The abdomen and stomach area may become painful and swollen. The increased pressure can cause loss of appetite, constipation, nausea, vomiting, and blocked stools. Some people may lose weight without trying to.

If the lymph nodes in the chest area are affected, the increased pressure can cause shortness of breath, difficulty swallowing, coughing, wheezing, and chest pain. Lymphomas in the brain can cause headaches and change the way you think, behave, feel, and move your body. It can also cause seizures. Other common general symptoms of Non-Hodgkin’s Lymphoma include fever, flank pain, severe itching, and excessive sweating, especially at night.

A very serious condition called superior vena cava (SVC) syndrome can develop if a tumor located in the chest compresses the large vein, the SVC, that carries blood from the head and arms back to the heart. SVC syndrome causes swelling in the head and arms. It is dangerous for the brain. SVC syndrome needs emergent medical attention.

Diagnosis

Your doctor can begin to diagnose Non-Hodgkin’s Lymphoma by reviewing your medical history, conducting a physical examination, and running some tests. Your doctor will test your blood and examine your lymph nodes to see if they are enlarged. Enlarged lymph nodes can also be a symptom of less serious common illnesses. It is common for doctors to wait and see if the lymph nodes reduce in size or to prescribe antibiotics to fight infection.

If your doctor suspects that you have Non-Hodgkin’s Lymphoma, a biopsy will be performed. A biopsy is a procedure that involves obtaining a tissue or fluid sample and testing it for cancer or abnormal cells. There are several different biopsy methods, depending on the area that is being tested. To accurately diagnose Non-Hodgkin’s Lymphoma, it is necessary to biopsy the lymph nodes, spinal fluid, or bone marrow.

Imaging tests are helpful for determining the location and extent of cancer. They are important for prognosis and treatment planning. X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, positron emission tomography (PET) scans, gallium scans, bone scans, and ultrasound are common imaging tests used for diagnosing Non-Hodgkin’s Lymphoma.

X-rays are done to check for enlarged lymph nodes in the chest. A CT scan takes cross-sectional pictures of the body. It is used to see if lymphoma is in the abdomen, pelvis, chest, head, and neck. MRI scans provide more detailed images than CT scans. They are used to view the brain and spinal cord.

PET scans are used to look for lymphoma in all parts of the body. PET scans are unique in that they provide information about how body cell’s function. A PET scan takes images after the body absorbs a radioactive sugar substance. The PET scan determines how quickly body cells use the sugar. Cancer cells and normal cells metabolize sugar at distinct rates and appear differently on PET scans.

A gallium scan is useful for distinguishing lymphomas from other types of infections. A gallium scan uses an injected radioactive substance that is attracted to lymphatic tissues. It is especially helpful for identifying fast growing aggressive types of lymphoma.

A bone scan is used to locate lymphoma in a bone. A bone scan requires that you receive a small harmless injection of a radioactive substance several hours before your test. The substance collects in the bones in areas where the bone is breaking down or repairing itself.

An ultrasound uses sound waves to create pictures of the inside of the body. An ultrasound can show abnormal masses in the body. It can depict masses in the stomach or show if the kidneys are swollen as a result of lymphoma.

If you have Non-Hodgkin’s Lymphoma, your doctor will assign your cancer a classification stage based on the results of all of your tests. Staging describes the cancer and if it has metastasized. Cancer that has spread from its site of origin to other parts of the body is termed metastasized. Staging is helpful for treatment planning and recovery prediction.

There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one. Generally, lower numbers in a classification system indicate a less serious cancer, and higher numbers indicate a more serious cancer. The stages may be subdivided into grades or classifications that use letters and numbers.

Treatment

Treatment for Non-Hodgkin’s Lymphoma depends on many factors, including the stage of the cancer, the cancer cell type, and the location of the cancer. Chemotherapy and radiation are the most common treatments for Non-Hodgkin’s Lymphoma. Chemotherapy uses cancer-fighting drugs to destroy cancer cells. There are different types of chemotherapy, and the drugs are usually received in cycles over a period of time. Radiation therapy uses high-energy rays to kill cancer cells. Surgery is not a common treatment for Non-Hodgkin’s Lymphoma.

People with aggressive or resistant cancers may require more intense treatment. Immunotherapy may be used to help the body’s immune system fight the cancer. Stem cell transplants and bone marrow transplants may be used in select people after other treatment methods have failed. Aggressive treatment methods may also be used in cases where Non-Hodgkin’s Lymphoma comes back after treatment. Such cases are termed “recurrent Non-Hodgkin’s Lymphoma.”

The experience of Non-Hodgkin’s Lymphoma and cancer treatments can be an emotional process for people with cancer and their loved ones. It is important that you receive support from a positive source. Some people find comfort in their family, friends, co-workers, counselors, and faith. Cancer support groups are another good option. They can be a source of information and support from people who understand what you are experiencing. Ask your doctor for cancer support groups in your area.

Prevention

You may prevent Non-Hodgkin’s Lymphoma by reducing the risk factors that you can control, such as your weight. You can avoid Hepatitis C and HIV by avoiding the possibility of blood-borne or sexually transmitted infections. You should tell your doctor about your family’s history of cancer and receive prompt evaluation of your symptoms.

Am I at Risk

Risk factors may increase your likelihood of developing Non-Hodgkin’s Lymphoma, although some people that experience this cancer may not have any risk factors. People with all of the risk factors may never develop Non-Hodgkin’s Lymphoma; however, the likelihood increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for Non-Hodgkin’s Lymphoma:

_____ Increasing age is a risk factor for Non-Hodgkin’s Lymphoma. The majority of Non-Hodgkin’s Lymphoma cases occur in people that are older than 50.
_____ People with suppressed immune systems are at risk for developing Non-Hodgkin’s Lymphoma. Some organ transplant recipients, people with HIV or AIDS, people with cancer, or people being treated for another cancer may have suppressed immune systems.
_____ Children that are born with suppressed immune system have a higher risk of developing Non-Hodgkin’s Lymphoma in childhood or as young adults.
_____ Survivors of atomic bombs or nuclear reactor accidents have a higher risk of Non-Hodgkin’s Lymphoma because of radiation exposure.
_____ People treated with radiation therapy are at slightly higher risk for developing Non-Hodgkin’s Lymphoma later in life. The risk is greater for people that received both radiation and chemotherapy.
_____ The bacteria that cause some stomach ulcers, Helicobacter pylori, can cause lymphomas in the stomach.
_____ Research suggests a link between Hepatitis C and Non-Hodgkin’s Lymphoma.
_____ Obesity may be a risk factor for Non-Hodgkin’s Lymphoma.
_____ Infection with AIDS, HIV, HTLV-1, or the Epstein-Barr virus (EBV) has been linked to the development of lymphomas.
_____ People with a family history of Non-Hodgkin’s Lymphoma may have an increased risk for developing this cancer.
_____ Certain medications used to treat autoimmune diseases such as rheumatoid arthritis or inflammatory bowel disease have rarely been described to be associated with Non-Hodgkin’s Lymphoma.

Complications

In some cases, Non-Hodgkin’s Lymphoma can come back following treatment. Advanced Non-Hodgkin’s Lymphoma can spread to other lymph nodes and distant sites or organs throughout the body. Although a good cure rate is associated with treatment, some cases of Non-Hodgkin’s Lymphoma can cause death.

Advancements

Researchers are learning more about the genetic changes in cells that cause lymphoma. They hope to use this information to develop drugs to block the process. Researchers hope to be able to predict the course of each type of lymphoma and identify new medications to treat those that are resistant to chemotherapy. Additionally, researchers continue to focus on a vaccine to prevent the cellular changes that cause lymphoma. Further, researchers strive to improve the stem cell transplantation process.

This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Author Dr. Mary Car-Blanchard, OTD/OTR/L and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. The library commenced development on September 1, 2005 with the latest update/addition on April 5, 2010.