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Non-Hodgkin's lymphoma

Definition

Non-Hodgkin's lymphoma is cancer of the lymphoid tissue, which includes the lymph nodes, spleen, and other organs of the immune system.

Alternative Names

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

Causes, incidence, and risk factors

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.

Symptoms

Non-Hodgkin's lymphoma can cause a variety of 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
  • Severe itchiness that cannot be explained
  • Swollen lymph nodes in the neck, underarms, groin, or other areas
  • Unintentional weight loss and loss of appetite

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.

Signs and tests

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
  • X-rays

Treatment

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

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

Expectations (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.

Complications

Calling your health care provider

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.

References

Wilson WH, Armitage JO. Non-Hodgkin’s Lymphoma. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff’s Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 112.

National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Non-Hodgkin's Lymphomas. National Comprehensive Cancer Network; 2010. Version 1.2010.


Review Date: 3/2/2010
Reviewed 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., Inc.
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