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Non Hodgkin’s Lymphoma

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Any cancer that affects the lymphatic system is called as non-Hodgkin’s lymphoma (NHL). Non-Hodgkin’s lymphoma can occur at any age and there are many types of this cancer. The following paragraphs will discuss more facts about this large group of cancers affecting the lymphocytes.

Definition of Non-Hodgkin’s Lymphoma

Non-Hodgkin’s lymphoma, also called as NHL, or lymphoma is a cancer of the lymphocytes. These lymphocytes are a part of the immune system. Lymphocytes are present in the lymph nodes and lymphoid tissues such as the spleen and bone marrow. NHL is the fifth most common cancer. There are different types of non-Hodgkin’s lymphoma. Some are fast growing cancers (aggressive) and few are slow growing (indolent) cancers.

What is the Lymphatic System?

The lymphatic system is the body’s defense system against infectious agents and diseases. It comprises of the lymph vessels that help in the transportation of a fluid called the lymph. There are tiny lymph nodes along the lymph vessels that help filter the lymph as it passes through. These lymph nodes are present in the neck, armpit, abdomen and groin region.

Lymphocytes or white blood cells are present within the lymph nodes that fight any infection within the body. There are two types of lymph nodes in the body: B-cell lymphocytes and T-cell lymphocytes. The lymphatic tissue takes care of any infection. It is present in the spleen, bone marrow, tonsils and the thymus. Some of it is also found around the eye, stomach lining, thyroid gland as well as the testicles. Lastly, the bone marrow is present within the bones where all blood cells as well as lymphocytes are produced.

How Does Non-Hodgkin’s Lymphoma Develop?

Non-Hodgkin’s lymphoma develops like any other cancer. Cells that are lymphocytes develop some kind of mutation and start dividing out of control. When the number of abnormal cells is more than the normal cells, it forms a lump called tumor. Lymphoma usually develops in the lymphatic system, but can occur in any part of the body like small bowel, skin, thyroid, tonsils, testicles, etc. As lymphocytes travel within the lymph vessels, they can spread cancer in any other lymph node far away from the site of origin. They can also enter the blood and spread the cancer to bone marrow, liver, lungs, spleen, etc.

Types of Non-Hodgkin’s Lymphoma

There are several types of non-Hodgkin’s lymphoma of which some of the common types are mentioned below:

B-cell Lymphomas

The most commonly occuring B-cell lymphomas include:

Diffuse large B-cell lymphoma

  • Primary mediastinal B-cell lymphoma
  • Intravascular large B-cell lymphoma

Follicular lymphoma

The less common or rarely occurring B-cell lymphomas include:

  • Extranodal marginal zone lymphoma of mucosa-associated tissue (MALT lymphoma)
  • Small lymphocytic lymphoma (SLL)
  • Lymphoplasmacytic lymphoma
  • Mediastinal large B-cell lymphoma
  • Burkitt lymphoma
  • Mantle cell lymphoma
  • Nodal marginal zone lymphoma

T-Cell Lymphoma

T-cell lymphomas are less common than B-cell lymphoma. Some of the T-cell lymphoma type include:

  • Peripheral T-cell lymphoma
  • Cutaneous lymphoma
  • Lymphoblastic lymphoma
  • Anaplastic large cell lymphoma

What Are the Causes and Risk Factors of Non-Hodgkin’s Lymphoma?

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In most cases, the exact cause for NHL remains unknown. However, experts have outlined certain risk factors that make some people vulnerable to non-Hodgkin’s lymphoma. These factors include:

  • Genetic conditions such as Klinefelter’s syndrome, Chediak-Higashi syndrome, etc.
  • A weak immune system that makes the person vulnerable to lymphoma
  • Getting infected with infectious agents such as Epstein-Barr virus, Human T-cell leukemia virus, Helicobactery pylori, Hepatitis C virus, HHV-8, HIV infection
  • Exposure to certain chemicals like polychlorinated biphenyls, dioxin, phenoxy herbicides
  • Autoimmune diseases such as Rheumatoid arthritis, SLE, etc.
  • A previous cancer treatment that includes chemotherapy and radiation therapy, increases one’s chances of developing NHL many years later

Symptoms of Non-Hodgkin’s Lymphoma

Signs and symptoms of non-Hodgkin’s lymphoma are related to the site of origin in some people. These symptoms include:

  • A painless swelling of a lymph node in one area of the body like neck, armpit or groin
  • Lymphoma in the chest causes chronic cough, difficulty swallowing or breathlessness
  • Lymphoma of the stomach or bowel can lead to indigestion, abdominal pain, unexplained weight loss
  • Lymphoma of the bone marrow leads to tiredness, recurrent infections and unexplained and easy bruising and bleeding

Other general symptoms of non-Hodgkin’s lymphoma includes:

  • Excessive sweating at night
  • Fever that comes and goes
  • Itchy skin
  • Lethargy
  • Unexplained weight loss

Diagnosis of Non-Hodgkin’s Lymphoma

The doctor will conduct a physical examination and take the medical history as well as ask about the symptoms one is experiencing. The doctor will conduct certain tests and procedures to diagnose non-Hodgkin’s lymphoma.

  • Blood and urine tests
  • CT scan, MRI and PET scan
  • Lymph node biopsy
  • Bone marrow biopsy

Treatment for Non-Hodgkin’s Lymphoma

Treatment for non-Hodgkin’s lymphoma is based on the site, stage and type of lymphoma. In case of the indolent/slow growing cancer, the doctor may schedule checkups every few months. Only if the cancer continues to advance, a treatment plan will be chalked out.

In other cases, the management of NHL is carried out as follows:

  • Use of biological drugs that like Rituximab that helps the immune system target B-cells and reduce the number of cancerous B-cells. As the body can reproduce B-cells, it will soon be free of cancerous B-cells to some extent
  • Use of radioimmunotherapy drugs that pass radiation directly to the cells
  • Chemotherapy
  • Radiation therapy
  • Stem cell transplantation where healthy donor stem cells are injected into the patient’s body

Cancer changes the life of the affected person as well as their loved ones. One should develop a strong support system around them to remain positive and overcome cancer. After the treatment, live a healthy lifestyle. Eat healthy, exercise and follow any instructions given by your doctor.

Written by: Saptakee sengupta
Date last updated: April 05, 2015