Non-Hodgkin's lymphoma is a disease in which cancer cells form in a person's lymphatic system and start to grow uncontrollably. There are several different types of lymphomas. Some lymphomas involve a particular type of cell; these are grouped under the heading Hodgkin's disease. All other forms of lymphoma fall into the non-Hodgkin's grouping. The different forms of non-Hodgkin's lymphoma depend on such things as what the cells look like under a microscope.
Alternative names: Lymphoma - non-Hodgkin's; Lymphocytic lymphoma; Histiocytic lymphoma; Lymphoblastic lymphoma; Cancer - non-Hodgkin's lymphoma
The signs and symptoms of non-Hodgkin's lymphoma vary from person to person depending on the type of lymphoma and where a tumor is located. Some people may feel stomach pain, constipation, and decreased appetite. Others may have trouble breathing, difficulty swallowing, and notice coughing, wheezing, or chest pain. Other symptoms may include:
- painless swollen lymph nodes
- fever, chills, or night sweats
- itchy skin
- weight loss despite eating normally
- bone or joint pain
- recurring infections
The symptom that some people notice first is swollen lymph nodes — usually in the neck, armpits, and groin. Of course, swollen lymph nodes do not usually mean cancer — they're most often a sign of a common illness, like an infection. In fact, all of the symptoms of non-Hodgkin's lymphoma can also be caused by other conditions, which is why only a doctor can determine what's really wrong.
White blood cells called lymphocytes are found in lymph tissues. 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. It is classified according to how fast the cancer spreads.
* The cancer may be low grade (slow growing), intermediate grade, or high grade (fast growing). Burkitt's tumor is an example of a high-grade lymphoma.
* The cancer is further sub-classified 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. Most of the time, this cancer affects adults. However, children can get some forms of lymphoma. High-risk groups include those who have received an organ transplant or who have a weakened immune system.
This type of cancer is slightly more common in men than in women.
The doctor will perform a physical exam and check body areas with lymph nodes to feel if they are swollen. Tests to diagnose and stage non-Hodgkin's lymphoma include:
- Blood chemistry tests, includes protein levels, liver function tests, kidney function tests, and uric acid levels
- Bone marrow aspiration and biopsy
- CBC to check for anemia and low white blood cell count
- CT scans of the chest, abdomen and pelvis
- Gallium scan
- Lymph node biopsy
- PET (positron emission tomography) scan
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.
Treatment primarily 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
Radiation therapy may be used for disease that is confined to one body area.
Chemotherapy is commonly used as the main form 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 an autologous 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, to fight low platelet counts and anemia
- Antibiotics to fight infection, especially if a fever occurs