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Non-Hodgkin's lymphoma

In the UK, NHL accounts for about four in every 100 cancers diagnosed. It's more common in people who are over 50. Around 10,000 people are diagnosed with NHL every year.

It can be confused with Hodgkin's lymphoma, which is a separate condition. For information on Hodgkin's lymphoma, see here.

  • About non-Hodgkin's lymphoma
  • Symptoms
  • Causes
  • Diagnosis
  • Treatment
  • Living with non-Hodgkin's lymphoma
  • Further information
  • Sources
  • Related topics

About non-Hodgkin's lymphoma (NHL)

The lymphatic system

Your lymphatic system consists of a network of organs which includes the liver, spleen, thymus and lymph glands (nodes) connected by lymph vessels. These vessels transport lymph fluid which contains body fluid, fat and white blood cells called lymphocytes, which fight infection. There are two main types of lymphocyte cell - B cells (which produce antibodies) and T cells (which kill virus-infected cells). These cells develop from stem cells.

What is NHL?

NHL occurs when you have an abnormal and uncontrolled growth of certain cells in the lymph organs.

The tumour can grow through your lymph organs and cells can spread in the lymph system where they may grow and form secondary tumours. The cells may also spread to other parts of your body through your bloodstream and may grow and form secondary tumours in other organs of your body. This spread of cancer is called metastasis.

Types of NHL

There are many different types of NHL. There are two main types:

  • low grade - grows slowly
  • high grade - grows faster

Lymphomas which are low grade need little or no treatment for months or years because they are slow growing. High grade lymphomas may need immediate treatment because they are growing quickly but are more likely to be cured.

NHL is also defined by which type of lymphocyte is affected - the B cell or T cell. The cells also look different under a microscope and may be large or small, and occur clumped together or spread out. B cell lymphomas are more common than T cell lymphomas. Follicular B cell lymphoma is the most common type. Your doctor will be able to explain which type you have and how it will be treated, as this can vary considerably.

Symptoms

The initial symptom of NHL is swelling, often found in the neck, armpit or groin.

Other symptoms can include:

  • excessive sweating - particularly at night
  • a high temperature which comes and goes
  • unexplained weight loss
  • tiredness
  • coughing or finding it hard to breathe
  • pain and a lump in your abdomen (tummy)
  • feeling itchy - this occurs all over the body
  • getting more infections than usual
  • excessive bleeding, such as during a period if you are a woman or when you have a nosebleed
  • headaches
  • change in personality or difficulty thinking

Although not usually a sign of NHL, if you experience these symptoms you should seek medical advice.

Causes

The cause of non-Hodgkin's lymphoma isn't understood at present and most people who get it don't have any obvious risk factors. However, there are certain factors that make non-Hodgkin's lymphoma more likely, including the following.

  • Lowered immunity - such as if you have HIV, are taking medicines after a transplant operation or you have a medical condition which affects your immunity.
  • Viruses such as the Epstein-Barr virus or the human T cell lymphoma virus 1 (HTLV1) slightly increase your risk of developing non-Hodgkin's lymphoma.
  • Helicobacter pylori bacteria can cause a type of non-Hodgkin's lymphoma in the stomach called MALT lymphoma.
  • If you have had previous cancer treatment you might have a slightly increased risk.
  • If you have coeliac disease there is a slightly increased risk of developing B cell or enteropathy type T cell non-Hodgkin's lymphoma.

Diagnosis

Your doctor will ask you about your symptoms and will examine you. He or she may take a blood test. Your doctor may refer you to a specialist for more tests, including more blood tests, and the following.

A biopsy is when a small sample of the tissue, which may be enlarged lymph node tissue or the lymph node itself, is taken. An ultrasound or CT scan may be used to guide a needle to a specific area or lymph node to take a biopsy. This will be sent to a laboratory for testing.

A sample of bone marrow may be taken to see if it contains lymphoma cells. The sample of bone marrow is often taken from the hip bone (pelvis). You will be given a local anaesthetic and may have a sedative.

You may need a chest X-ray. This creates an image so your doctor can see if any of the lymph nodes in the chest are enlarged.

A CT (computerised tomography) scan uses X-rays to build up a three-dimensional picture of the body which can help your doctor see if the cancer has spread. Before the scan, you may be given a drink and/or an injection which contains a dye to help see any areas of cancer.

An MRI (magnetic resonance imaging) scan uses magnets and radiowaves to produce two- and three-dimensional pictures of the inside of the body to help your doctor see if the cancer has spread. You may be given an injection before the scan which will help show any areas of cancer.

A new type of scan called a PET scan may be used but this is not widely available. For this you will be given an injection of a weak radioactive sugar a few hours before the scan. This is usually into your arm. The radioactive substance will show any areas where there may be cancer.

Other tests may be needed such as an endoscopy which is when a camera is used to check your airways or digestive system, or urogram which looks at your urinary system (including your bladder) to see if it has been affected. Sometimes a lumbar puncture is performed to take a fluid sample from around your spinal cord.

Ask your doctor to explain the tests you will have.

For more information please see Related topics.

Treatment

The treatment for non-Hodgkin's lymphoma depends on the type of cancer you have and the stage (how far it has spread) and grade (low or high) of the cancer. The main types of treatment are chemotherapy and radiotherapy, and a newer type known as biological therapy.

Radiotherapy

This uses radiation like strong X-rays to destroy cancer cells. This will only be used if the cancer is in one or two lymph node areas. It may be given at the same time as chemotherapy.

Chemotherapy medicines

Medicines to attack cancer cells (chemotherapy) are usually given as an injection into your arm but may be taken as tablets or capsules. A combination of medicines may be given over a number of days, this is often followed by a break in the treatment for a few weeks. The treatment cycle is then restarted. The breaks between the treatments allow your body to recover from the side-effects of the medicines.

Medicines such as chlorambucil and fludarabine are often given for low grade lymphomas. For high grade lymphomas the CHOP combination (which includes cyclophosphamide, doxorubicin, vincristine and prednisolone medicines) is usually given.

Steroids

Some chemotherapy treatments include steroid medicines (eg prednisolone) to treat the cancer and to help reduce side-effects of the chemotherapy. It's best to take steroids early in the day so they do not interfere with sleep.

High dose treatment

Very high doses of chemotherapy can be given to some people if standard chemotherapy has not treated non-Hodgkin's lymphoma or if it has come back. With this treatment you will have a stem cell transplant (also known as a peripheral blood stem cell transplant). A stem cell transplant is needed so healthy cells can be replaced after the treatment because high dose chemotherapy can destroy the bone marrow where the stem cells are produced. All the cells in the body can develop from stem cells.

Biological therapy

Rituximab is a monoclonal antibody used to treat non-Hodgkin's lymphoma. These medicines are being used more often when treating lymphoma. They can recognise certain cancer cells and destroy them, either by stimulating the immune system or by passing a radioactive molecule to the cancer cells which is attached to the monoclonal antibody to kill it.

A well-known example of a monoclonal antibody is Herceptin, which is used to treat breast cancer.

For more information please see Related topics.

Living with non-Hodgkin's lymphoma

After treatment for the cancer you will have regular check ups with your doctor to detect any evidence of the lymphoma growing again. Low grade lymphoma can be slow growing over several years, even without treatment.

Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There may be support groups so you can meet people who may have similar experiences to you. Ask your doctor for advice.

Further information

Cancerbackup

Sources

  • UK Non-Hodgkin's Lymphoma Incidence Statistics. Cancer Research UK. http://info.cancerresearchuk.org, accessed 24 September 2007
  • Hodgkin's Lymphoma. Cancer Research UK. www.cancerhelp.org.uk, accessed 25 September 2007
  • Non-Hodgkin's Lymphoma. Cancer Research UK. www.cancerhelp.org.uk, accessed 28 September 2007
  • Improving Outcomes in Haemological Cancers. National Institute for Health and Clinical Excellence (NICE), 2003. www.nice.org.uk
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005: 534-535
  • British National Formulary (BNF) March 2007, Vol. 53: BMJ Publishing Group, 2007

Related topics

  • Chemotherapy
  • CT scan
  • Gastroscopy
  • Hodgkin's lymphoma
  • MRI scan
  • Radiotherapy