Non-Hodgkin lymphoma (NHL) is cancer of the lymph tissue. Lymph tissue is found in the lymph nodes, spleen, and other organs of the immune system.A.D.A.M.

Causes, incidence, and risk factors

For most patients, the cause of NHL is unknown. But lymphomas may develop in people with weakened immune systems, including persons who have had an organ transplant or persons with HIV infection.

NHL most often affects adults. Men get NHL more often than women. Children can get some forms of lymphoma.

There are many types of NHL. Specific types are grouped according to how fast the cancer spreads. The cancer may be low grade (slow growing), intermediate grade, or high grade (fast growing).

The cancer is further grouped by how the cells look under the microscope, what type of white blood cell it originates from, and whether there are certain DNA changes.

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 if the cancer affects the thymus gland or lymph nodes in the chest, putting pressure on the windpipe (trachea) or other airways
• Abdominal pain or swelling, leading to loss of appetite, constipation, nausea, and vomiting
• Headache, concentration problems, personality changes, or seizures if the cancer affects the brain

Signs 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.

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 show you have NHL, more tests will be done to see how far it has spread. This is called staging. Staging helps guide future treatment and follow-up. It also gives you an idea of what to expect in the future.

Treatment

Treatment depends on:

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

You may receive chemotherapy, radiation therapy, or both. Or you may not need treatment. Your doctor can tell you more about your specific treatment.

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.

High-dose chemotherapy may be given when NHL returns after treatment or does not respond to the first treatment. This is followed by an autologous stem cell transplant (using your own stem cells).

Blood transfusions or platelet transfusions may be required if blood counts are low.

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Expectations (prognosis)

Low-grade NHL usually cannot be cured by chemotherapy alone. Low-grade NHL progresses slowly and it may take many years before the disease gets worse or even requires treatment.

Chemotherapy can often cure many types of high-grade lymphomas. If the cancer does not respond to chemotherapy, the disease can cause rapid death.

Complications

NHL itself and its treatments can lead to health problems. These include:

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

Keep following up with a doctor who knows about monitoring and preventing these complications.

Calling your health care provider

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

If you have NHL, call your health care provider if you experience persistent fever or other signs of infection.

References

1. National Cancer Institute: PDQ Adult Non-Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. Date last modified 09/28/2012. Available at http://www.cancer.gov/cancertopics/pdq/treatment/adult-non-hodgkins/HealthProfessional. Accessed 01/04/2013.
2. National Cancer Institute: PDQ Childhood Non-Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. Date last modified 11/26/2012. Available at http://cancer.gov/cancertopics/pdq/treatment/child-non-hodgkins/HealthProfessional. Accessed 01/04/2013.
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Non-Hodgkin’s Lymphomas. Version 1.2013. Available at http://www.nccn.org/professionals/physician_gls/pdf/nhl.pdf. Accessed 01/04/2013.
4. Wilson WH, Armitage JO. Non-Hodgkin’s lymphoma. In: Abeloff MD, Armitage JO, Niederhuber JE, et al., eds. Clinical Oncology. 4th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2008:chap 112.

Review Date: 2/8/2013.

Reviewed by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Blackman, Stephanie Slon, and Nissi Wang.