Non-Hodgkin's lymphoma (also called NHL) is cancer that begins in the lymphatic system.
It starts when a lymphocyte (a B
cell or T cell) becomes abnormal.
Usually, non-Hodgkin's lymphoma starts in a B cell in a lymph
node. The abnormal cell divides to make copies of itself. The new cells
divide again and again, making more and more abnormal cells. The abnormal
cells are cancer cells. They do not die when they should. They do not protect
the body from infections or other diseases. Also, the cancer cells can spread
to nearly any other part of the body.
Doctors can seldom explain why one person develops non-Hodgkin's lymphoma
and another does not. But research shows that certain risk factors increase
the chance that a person will develop this disease. In general, the risk
factors for non-Hodgkin's lymphoma include the following:
Researchers are studying obesity and other possible risk factors for non-Hodgkin's
lymphoma. People who work with herbicides or certain other chemicals may
be at increased risk of this disease. Researchers are also looking at a
possible link between using hair dyes before 1980 and non-Hodgkin's lymphoma.
- Weak immune system: Having a
weak immune system (from an inherited condition, HIV infection, or certain
drugs) increases the risk of developing non-Hodgkin's lymphoma.
- Certain infections: Having certain types of infections increases the
risk of developing lymphoma. However, lymphoma is not contagious. You
cannot "catch" lymphoma from another person. The following are the main
types of infection that can increase the risk of lymphoma:
- Human immunodeficiency virus (HIV): HIV is the virus that
People who have HIV infection are at much greater risk of some types
of non-Hodgkin's lymphoma.
- Epstein-Barr virus (EBV): Infection with EBV has been linked to an increased risk of
lymphoma. In Africa, EBV infection is linked to Burkitt's lymphoma.
- Helicobacter pylori: H. pylori are bacteria that can cause
stomach ulcers. They also increase a person's risk of lymphoma in
the stomach lining.
- Human T-cell leukemia/lymphoma virus (HTLV-1): Infection
with HTLV-1 increases a person's risk of lymphoma and leukemia.
- Hepatitis C virus: Some studies have found an increased
risk of lymphoma in people with hepatitis C virus. More research
is needed to understand the role of hepatitis C virus.
- Age: Although non-Hodgkin's lymphoma can occur in young people, the
chance of developing this disease goes up with age. Most people with
non-Hodgkin's lymphoma are older than 60.
Most people who have known risk factors do not get non-Hodgkin's lymphoma.
On the other hand, people who do get the disease often have no known risk
factors. If you think you may be at risk, you should discuss this concern
with your doctor.
Non-Hodgkin's lymphoma can cause many symptoms:
Most often, these symptoms are not due to cancer. Infections or other health
problems may also cause these symptoms. Anyone with symptoms that do not
go away within 2 weeks should see a doctor so that problems can be diagnosed
- Swollen, painless lymph nodes in the neck, armpits, or groin
- Unexplained weight loss
- Soaking night sweats
- Coughing, trouble breathing, or chest pain
- Weakness and tiredness that don't go away
- Pain, swelling, or a feeling of fullness in the abdomen
If you have swollen lymph nodes or other symptoms that suggest non-Hodgkin's
lymphoma, your doctor will help you find out whether they are from cancer
or some other cause. Your doctor may ask about your personal and family
You may have some of the following exams and tests:
The doctor does not remove the tissue sample with a needle (needle biopsy).
A needle cannot remove a large enough sample for the pathologist to diagnose
- Physical exam: Your doctor checks for swollen lymph nodes in your
neck, underarms, and groin. Your doctor also checks your spleen and
liver to see if they are swollen.
- Blood tests: The lab does a complete
blood count to check the number of blood cells. The lab also checks
for other substances, such as lactate dehydrogenase (LDH). Lymphoma
may cause a high level of LDH.
- Chest X-rays: You may have X-rays
to check for swollen lymph nodes or other signs of disease in your chest.
- Biopsy: Your doctor removes tissue
to look for lymphoma cells. A biopsy is the only sure way to diagnose
lymphoma. Your doctor may remove an entire lymph node (excisional biopsy)
or only part of a lymph node (incisional biopsy). A pathologist checks
the tissue for lymphoma cells with a microscope.
You may want to ask the doctor these questions before having a biopsy:
- How will the biopsy be done?
- Where will I have my biopsy?
- How long will it take?
- Will I be awake?
- Will the biopsy hurt?
- Are there any risks? What are the chances of infection or bleeding
after the biopsy?
- How long will it take me to recover?
- How soon will I know the results? Who will explain them to me?
- If I do have cancer, who will talk to me about the next steps? When?
Types of lymphoma
When lymphoma is found, the pathologist will report the type. The most common
types are diffuse large B-cell lymphoma and follicular lymphoma.
Lymphomas may be grouped by how quickly they are likely to grow:
- Indolent (also called low-grade) lymphomas grow slowly. They tend
to cause few symptoms.
- Aggressive (also called intermediate-grade and high-grade) lymphomas
grow and spread more quickly. They tend to cause severe symptoms. Over
time, many indolent lymphomas become aggressive lymphomas.
Your doctor needs to know the extent (stage) of non-Hodgkin's lymphoma to
plan the best treatment. Staging may involve some of these tests:
The stage is based on where lymphoma cells are found (in the lymph nodes
or in other organs or tissues). The stage also depends on how many areas
are affected. The stages of non-Hodgkin's lymphoma are as follows:
- Bone marrow biopsy:
The doctor uses a thick needle to remove a small sample of bone and
bone marrow from your hipbone or another large bone. Local anesthesia can help control pain. A pathologist then looks for lymphoma cells in
- CT scan:
An X-ray machine linked to a computer takes a series of detailed pictures
of your chest, abdomen, or pelvis.
You may receive an injection of contrast material. Also, you may be
asked to drink another type of contrast material. The contrast material
makes it easier for the doctor to see swollen lymph nodes and other
abnormal areas on the X-ray.
- MRI: A powerful
magnet linked to a computer is used to make detailed pictures of your
spinal cord, bone marrow, or brain. Your doctor can view these pictures
on a monitor and can print them on film.
- Ultrasound: An
ultrasound device sends out sound waves that people cannot hear. The
small hand-held device is held against your body. The waves bounce off
nearby tissues, and a computer uses the echoes to create a picture.
Tumors may produce echoes that are different from the echoes made by
healthy tissues. The picture can show possible tumors.
- Lumbar puncture: The
doctor uses a long, thin needle to remove fluid from the spinal column.
Local anesthesia can help control pain. You must lie flat for a few
hours afterward so that you will not get a headache.
The lab checks the fluid for lymphoma cells or other problems.
- PET scan:
You receive an injection of a small amount of radioactive sugar. A machine
makes computerized pictures of the sugar being used by cells in the
body. Cancer cells sometimes show up in the pictures as areas of high
- Stage I: The lymphoma cells are in a single lymph node group
(such as in the neck or underarm). Or, if the abnormal cells are not
in the lymph nodes, they are in only one part of a tissue or organ (such
as the lung, but not the liver or bone marrow).
- Stage II: The lymphoma cells are in at least two lymph node
groups on the same side of (either above or below) the diaphragm. Or,
the lymphoma cells are in an organ and the lymph nodes near that organ
(on the same side of the diaphragm). There may be lymphoma cells in
other lymph node groups on the same side of the diaphragm.
- Stage III: The lymphoma is in groups of lymph nodes above and
below the diaphragm. It also may be found in an organ or tissue near
these lymph node groups.
- Stage IV: The lymphoma is throughout at least one organ or
tissue (in addition to the lymph nodes). Or, it is in the liver, blood,
or bone marrow.
For treatment options, go to the article on non-Hodgkin's
Source: National Cancer Institute