Non-Hodgkin Lymphoma
A diverse group of lymphatic system cancers
Quick Facts
- Type: Cancer of the lymphatic system
- Includes: Many subtypes, fast- and slow-growing
- Common sign: Painless swollen lymph nodes
- Common in: Adults over 60
Overview
Non-Hodgkin lymphoma (NHL) is a broad group of cancers that begin in the lymphatic system, the network of vessels, lymph nodes, and organs that is part of the body's immune defense. It develops when white blood cells called lymphocytes grow abnormally and accumulate, usually in the lymph nodes but sometimes in other organs such as the spleen, stomach, or skin.
Unlike Hodgkin lymphoma, non-Hodgkin lymphoma does not contain the characteristic Reed-Sternberg cell and includes many different subtypes. Some grow slowly over years (indolent), while others grow quickly (aggressive) and need prompt treatment. Because there are so many types, symptoms, treatment, and outlook vary widely. Non-Hodgkin lymphoma is among the more common cancers and occurs most often in older adults.
Symptoms
Symptoms depend on the type and where the lymphoma is, but common ones include:
- Painless swelling of lymph nodes in the neck, armpit, or groin
- Fever without a clear infection
- Drenching night sweats
- Unexplained weight loss
- Persistent fatigue
- Itchy skin
- A feeling of fullness or swelling in the abdomen if internal nodes or the spleen are involved
- Cough or shortness of breath if lymphoma is in the chest
Fever, night sweats, and weight loss together are sometimes called B symptoms. Many of these signs have harmless causes, but a swollen node that lasts or symptoms that persist should be checked.
Causes
In most cases the exact cause of non-Hodgkin lymphoma is unknown. It begins when a lymphocyte develops genetic changes that make it grow uncontrollably and live longer than it should, building up into tumors.
Several factors are linked to a higher risk. These include a weakened immune system, certain chronic infections, and some autoimmune diseases. However, most people with these factors never develop lymphoma, and the disease is not contagious.
Risk Factors
- Older age, with most cases in people over 60
- A weakened immune system, such as from HIV or immune-suppressing medication after an organ transplant
- Certain infections, such as Epstein-Barr virus, certain stomach bacteria linked to one type of lymphoma, and some others
- Autoimmune diseases such as rheumatoid arthritis or Sjogren syndrome
- Past exposure to certain chemicals or previous chemotherapy or radiation
- A family history of lymphoma
Diagnosis
Diagnosis involves examining affected tissue and finding out the type and extent of the lymphoma:
- Lymph node biopsy: Removing a node or tissue sample to examine under the microscope and identify the specific subtype.
- Blood tests: To check blood counts and overall health.
- Imaging: CT and PET scans to locate involved areas and assess spread.
- Bone marrow test: To see whether the marrow is affected.
- Specialized tests: Laboratory analysis of the cancer cells to classify the subtype, which strongly influences treatment.
Treatment
Treatment depends heavily on the subtype, how fast it is growing, and the stage. A team of cancer specialists creates an individual plan.
- Watchful waiting: Some slow-growing lymphomas causing no symptoms may simply be monitored before treatment is needed.
- Chemotherapy: Often combined with other drugs, a common treatment for many subtypes.
- Immunotherapy and targeted therapy: Medicines such as monoclonal antibodies that target lymphoma cells or harness the immune system.
- Radiation therapy: Targeted radiation, sometimes used alone for limited disease or with other treatments.
- Stem cell transplant: For some aggressive or recurrent lymphomas.
Many people respond well, and some types are highly curable, while slow-growing types can often be controlled for a long time.
Prevention
There is no certain way to prevent non-Hodgkin lymphoma, but some steps may lower risk or aid early detection:
- Manage HIV and avoid behaviors that increase infection risk
- Treat chronic infections linked to certain lymphomas when appropriate
- Follow medical advice if you take immune-suppressing medication
- See a doctor about any persistent swollen lymph node or unexplained symptoms
When to See a Doctor
See a doctor if you have a painless swollen lymph node that lasts more than a couple of weeks, or if you have unexplained fever, drenching night sweats, weight loss, persistent fatigue, or itching. Also seek care for new abdominal fullness, cough, or shortness of breath that does not resolve.
Although these symptoms often have harmless causes, persistent or unexplained ones should be evaluated so that lymphoma or another condition can be diagnosed and treated early.
Frequently Asked Questions
What is non-Hodgkin lymphoma?
It is a broad group of cancers that start in the lymphatic system, when white blood cells called lymphocytes grow abnormally. It includes many subtypes, some slow-growing and some aggressive, so symptoms, treatment, and outlook vary widely between people.
How is it different from Hodgkin lymphoma?
Both are cancers of the lymphatic system, but Hodgkin lymphoma is defined by a specific abnormal cell called the Reed-Sternberg cell. Non-Hodgkin lymphoma lacks these cells and is a larger, more varied group of diseases, which affects treatment and prognosis.
What are the symptoms of non-Hodgkin lymphoma?
Common symptoms include painless swollen lymph nodes, fever without infection, drenching night sweats, unexplained weight loss, fatigue, and itchy skin. Lymphoma in the chest or abdomen can also cause cough, shortness of breath, or a feeling of fullness.
Is non-Hodgkin lymphoma treatable?
Yes. Treatment depends on the subtype and stage and may include chemotherapy, immunotherapy, targeted therapy, radiation, or a stem cell transplant. Some types are highly curable, while slow-growing types can often be controlled over a long time, sometimes after a period of monitoring.
What raises the risk of non-Hodgkin lymphoma?
Risk factors include older age, a weakened immune system such as from HIV or immune-suppressing medication, certain infections, and some autoimmune diseases. Most people with these factors never develop lymphoma, and the disease is not contagious.
References
- National Cancer Institute (NCI). Non-Hodgkin Lymphoma Treatment.
- American Cancer Society. Non-Hodgkin Lymphoma.
- Mayo Clinic. Non-Hodgkin's lymphoma — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Non-Hodgkin lymphoma.