Non-Hodgkin’s Lymphoma

Non-Hodgkin’s lymphoma is a group of cancers that develop in the lymphatic system, a network of vessels and glands that helps protect your body from infection and disease. When cells in this system grow out of control, they form tumors that can affect lymph nodes and spread to other parts of the body.

What is Non-Hodgkin’s lymphoma?
Types of Non-Hodgkin’s lymphoma
How common is Non-Hodgkin’s lymphoma?
Signs and symptoms
What causes Non-Hodgkin’s lymphoma?
How is it diagnosed?
Treatment options
Outlook and survival
Living with Non-Hodgkin’s lymphoma

What is Non-Hodgkin’s lymphoma?

Non-Hodgkin’s lymphoma is a type of cancer that forms in the lymphatic system, which is part of your body’s immune system. The lymphatic system includes organs, glands, tubelike vessels, and clusters of cells called lymph nodes that help fight infection and disease^[1].

The lymphatic system contains a clear fluid called lymph that carries infection-fighting white blood cells known as lymphocytes. In Non-Hodgkin’s lymphoma, these lymphocytes start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes^[3]. The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection^[3].

The lymphatic system is made up of several components^[7]:

Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells. They are found in the neck, underarm, abdomen, pelvis, and groin
Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream
Spleen: An organ that makes lymphocytes, stores blood cells, and filters the blood
Thymus: An organ where certain lymphocytes mature and multiply
Tonsils: Two small masses of lymph tissue at the back of the throat
Bone marrow: The soft, spongy tissue in the center of certain bones where blood cells are made

Lymph nodes
Lymph vessels
Spleen
Thymus
Tonsils
Bone marrow
Liver

With Non-Hodgkin’s lymphoma, genes inside B lymphocytes or T lymphocytes mutate, or change, at some point in your lifetime. The abnormal lymphoma cells usually form in your lymph nodes and create tumors. However, they can also develop in other lymph system organs, like your thymus or spleen, or lymph tissue in other places. Without treatment, Non-Hodgkin’s lymphoma can spread^[2].

Types of Non-Hodgkin’s lymphoma

There are more than 70 subtypes of Non-Hodgkin’s lymphoma^[2]. Healthcare providers classify them based on the type of lymphocyte affected:

B-cell lymphoma: These cancers arise from B cells, which are lymphocytes that make antibodies to help fight infection. B-cell lymphomas account for about 85% of all Non-Hodgkin’s lymphoma diagnoses^[2]. Common types include diffuse large B-cell lymphoma, follicular lymphoma, Burkitt lymphoma, and mantle cell lymphoma^[1]^[4].

T-cell lymphoma: These cancers arise from T cells, which are lymphocytes that help B cells make antibodies and target germs and other foreign cells^[2]. Examples include adult T-cell lymphoma and mycosis fungoides^[4].

Providers also classify both B-cell and T-cell lymphomas as either aggressive or indolent^[2]:

Indolent lymphoma: Also called low-grade lymphoma, this type grows slowly. You may not experience any symptoms for many years. Indolent lymphomas are easier to treat and you can live with them for many years, but they are usually harder to completely cure^[3]^[5].

Aggressive lymphoma: Also called high-grade lymphoma, this type grows quickly. The cancer grows and spreads rapidly and has noticeable signs and symptoms. Aggressive lymphomas need to be treated straight away but tend to respond much better to treatment and can often be cured^[3]^[5].

How common is Non-Hodgkin’s lymphoma?

Non-Hodgkin’s lymphoma is relatively common. It is the 8th most common cancer diagnosis, with 80,620 new cases expected in 2024 in the United States^[2]. It is the 11th most common cancer worldwide^[2].

In the United Kingdom, more than 13,000 people are diagnosed with Non-Hodgkin’s lymphoma each year^[3]. Non-Hodgkin’s lymphoma is much more common than the other type of lymphoma, called Hodgkin lymphoma^[2].

Non-Hodgkin’s lymphoma can occur at any age, but your chances of developing the condition increase as you get older, with just over a third of cases diagnosed in people over 75^[3]. Slightly more men than women are affected^[3].

Signs and symptoms

The most common symptom of Non-Hodgkin’s lymphoma is a painless swelling in a lymph node, usually in the neck, armpit, or groin^[1]^[3]. This swelling is caused by abnormal lymphocytes collecting in the lymph nodes.

Additional signs and symptoms depend on where the lymphoma cells are in your body and may include^[1]^[2]:

Feeling very tired (persistent fatigue)
Belly pain or swelling
Chest pain, coughing, or trouble breathing
Feeling full even when you haven’t eaten much
Fever that lasts for several days
Night sweats that are so intense they soak your sheets
Weight loss without trying (losing 10% of your total body weight over six months)

Healthcare providers call fever, night sweats, and unexplained weight loss “B symptoms.” These symptoms help providers classify the type of Non-Hodgkin’s lymphoma you have^[2].

In children, first symptoms may be different and can include anemia (a low number of red blood cells), rash, weakness, and unusual sensations^[5].

It’s important to remember that many conditions share these symptoms. Having one or more doesn’t necessarily mean you have Non-Hodgkin’s lymphoma. However, if you notice swollen lymph nodes that don’t go away after a few weeks or other symptoms that last for several weeks, it’s a good idea to contact a healthcare provider^[2]^[3].

What causes Non-Hodgkin’s lymphoma?

Doctors don’t know exactly what causes Non-Hodgkin’s lymphoma^[5]. It happens when genes inside lymphocytes mutate or change at some point in your lifetime^[2]. The tumors may result from chromosomal changes, various toxins, infections, and chronic inflammation^[4].

However, your risk of developing Non-Hodgkin’s lymphoma is increased if^[3]:

You have a medical condition that weakens your immune system
You take immunosuppressant medicine
You have previously been exposed to a common virus called the Epstein-Barr virus, which causes glandular fever

You also have a slightly increased risk of developing Non-Hodgkin’s lymphoma if a close relative, such as a parent or sibling, has had the condition^[3]. Being older and being male can also increase the risk^[7].

How is it diagnosed?

Non-Hodgkin’s lymphoma diagnosis often begins with a physical exam that checks for swollen lymph nodes in the neck, underarms, and groin. The healthcare professional also checks for a swollen spleen or liver^[9].

The only way to confirm a diagnosis of Non-Hodgkin’s lymphoma is by carrying out a biopsy^[3]. This is a minor surgical procedure where a sample of affected lymph node tissue is removed and studied in a laboratory. A lymph node biopsy involves removing all or part of a lymph node. In the lab, tests may show whether you have Non-Hodgkin’s lymphoma and, if so, which type^[9].

Other tests used to detect and understand Non-Hodgkin’s lymphoma include^[9]:

Blood and urine tests: These may help rule out an infection or other disease
Imaging tests: Tests to look for lymphoma cells in other parts of the body may include CT (computed tomography) scans, MRI (magnetic resonance imaging), and PET (positron emission tomography) scans
Bone marrow tests: Bone marrow aspiration and biopsy are procedures that involve collecting cells from the bone marrow to check for lymphoma cells

Before doctors start treatment, they need to see how far the lymphoma has spread. Doctors use several tests to check the spread of Non-Hodgkin’s lymphoma, such as bone marrow biopsy, chest x-rays, CT scans of your chest, belly area, and pelvis, and PET scans^[5].

Treatment options

The recommended treatment plan depends on the type of Non-Hodgkin’s lymphoma you have, how far it has spread, your general health, and your age^[3]^[11]. Many of the treatments can put a strain on the body.

Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialize in different aspects of treating lymphoma. This is known as a multidisciplinary team^[11].

Watch and Wait

If Non-Hodgkin’s lymphoma is low grade (slow developing) and you’re feeling well, a period of “watch and wait” is often recommended^[11]. This is because some people take many years to develop troublesome symptoms, and starting treatment immediately is often felt to be unnecessary. If you have indolent lymphoma that hasn’t spread, you may not need treatment for years^[5].

Main Treatment Approaches

The main treatments used for Non-Hodgkin’s lymphoma are^[3]^[10]:

Chemotherapy: This is a widely used treatment that involves using medicine to kill cancer cells. It may be used on its own, combined with biological therapy, or combined with radiotherapy. The medicine can be given through a drip directly into a vein, as tablets taken by mouth, or a combination of both^[11]. Chemotherapy is usually given over a period of a few months on an outpatient basis, which means you get treatment during the day and shouldn’t have to stay in hospital overnight^[11].

Radiotherapy: This treatment is most often used to treat early-stage Non-Hodgkin’s lymphoma, where the cancer is only in one part of the body^[11]. It’s normally given in short daily sessions, Monday to Friday, usually for no more than 3 weeks^[11].

Targeted treatment called monoclonal antibody therapy: These treatments use your immune system to fight your cancer^[3]^[5]. Monoclonal antibodies are given into your vein.

If your lymphoma comes back later after successful treatment (relapses), doctors may try chemotherapy or stem cell transplantation^[5]. High-dose chemotherapy destroys your bone marrow, so you’ll need a stem cell or bone marrow transplant to replace the damaged bone marrow^[11].

Low-grade tumors do not necessarily require immediate medical treatment but are harder to completely cure. High-grade lymphomas need to be treated straight away but tend to respond much better to treatment and can often be cured^[3].

Treatment Side Effects

Treatments can have several side effects. The most significant side effect of chemotherapy is potential damage to your bone marrow. This can interfere with the production of healthy blood cells and cause problems like feeling very tired, breathlessness, increased vulnerability to infection, and bleeding and bruising more easily^[11].

Other possible side effects of chemotherapy include nausea and vomiting, diarrhea, loss of appetite, mouth ulcers, tiredness, skin rashes, hair loss, and infertility^[11]. Most side effects should pass once your treatment has finished. Your care team can suggest ways to treat side effects if they become troublesome.

Radiotherapy can have side effects that vary depending on which part of your body is being treated. Common side effects include sore and red skin in the treatment area and feeling very tired^[11].

Outlook and survival

People with Non-Hodgkin’s lymphoma are living longer than ever, thanks to new treatments. In some cases, treatments cure the condition. Other times, the goal of treatment is to put the disease into remission (no signs or symptoms of cancer) for as long as possible^[2].

The outlook and treatment for Non-Hodgkin’s lymphoma varies greatly, depending on the exact type, grade, and extent of the lymphoma, and the person’s age^[3]. In general, with modern treatment, the 5-year overall survival rate is over 60%. More than 70% of patients with aggressive Non-Hodgkin’s lymphoma can be cured^[12].

Indolent lymphoma has a relatively good prognosis, with a median survival as long as 20 years, but it is usually not curable in advanced stages^[12]. Aggressive Non-Hodgkin’s lymphoma has a worse prognosis in the short term, but a significant number of these patients can be cured with intensive combination chemotherapy^[12].

Most relapses occur in the first 2 years after therapy^[12]. Overall, most cases of Non-Hodgkin’s lymphoma are considered very treatable^[3].

Living with Non-Hodgkin’s lymphoma

Coping and adjusting to life with Non-Hodgkin’s lymphoma can be difficult. Patients may experience different feelings when diagnosed, and those being treated may experience various side effects caused by the treatment^[19].

Emotional Impact

You might have a number of different feelings when you’re told you have Non-Hodgkin’s lymphoma. You may feel shocked, upset, numb, frightened, confused, angry, guilty, or sad^[17]. All sorts of feelings are likely to come and go. Experiencing different feelings is a natural part of coming to terms with cancer^[17].

Sometimes it’s hard to take in the fact that you have cancer at all. Not everyone wants to know about their outlook right away, and that’s okay. You can always ask for more information when you feel ready^[17].

Getting Support

Building a strong support system is important^[19]. Talking to your friends and relatives about your cancer can help, although some people find this difficult. You might also find it helpful to talk to other people affected by lymphoma or to seek counseling^[17].

You may be more able to cope and make decisions if you have information about your type of cancer and its treatment. Make a list of questions before you see your doctor. Take someone with you to remind you what you want to ask and to help you remember the information given^[17].

Managing Physical Changes and Symptoms

There are supportive care services available to help meet your needs and improve your quality of life^[22]. People treated for Non-Hodgkin’s lymphoma may have concerns about:

Self-esteem and body image: Cancer treatments may result in body changes such as hair loss, skin changes, or changes in body weight. Some of these changes can be temporary, others will last for a long time, and some will be permanent^[22].

Fatigue: This is a symptom of having a low red blood cell count (anemia). Once the cause of fatigue is known, your healthcare team can suggest ways to treat it, which may include iron pills, blood transfusion, nutritional supplements, or medicines^[22].

Infection: Infection can develop if you have a low white blood cell count. Preventing infection is important. Having good hygiene, protecting your skin, and maintaining good general health are some ways to help prevent infection^[22].

Fertility problems: Some treatments for Non-Hodgkin’s lymphoma can cause fertility problems for both men and women. Whether or not this occurs depends on the type of treatment and the area of the body treated^[22].

Practical Strategies for Coping

There are several strategies that can help you cope with living with Non-Hodgkin’s lymphoma^[19]:

Communicate your fears and concerns by talking to your family, friends, doctors, and counselors
Maintain a journal to write down your concerns
Find a support group or peer support program
Eat a healthy diet that includes fruits, vegetables, proteins, and whole grains
Follow a physical exercise routine to help control weight, improve mood, and reduce anxiety and fatigue
Get ample rest to help fight stress and fatigue
Set reasonable goals

Recovery from Non-Hodgkin’s lymphoma and getting used to life after treatment is different for each person. Recovery depends on the stage and grade of the disease, the type of treatment, and many other factors^[22].