What Is Non-Hodgkin Lymphoma?
Non-Hodgkin lymphoma is cancer that begins in cells of the immune system. The immune system fights infections and other diseases.
This picture shows lymph nodes above and below the diaphragm.
It also shows the lymph vessels, tonsils, thymus, and spleen.
Because lymphatic tissue is in many parts of the body, Hodgkin lymphoma can start almost anywhere. Usually, it's first found in a lymph node.
Non-Hodgkin Lymphoma Cells
Non-Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. 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 don't die when they should. They don't protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Doctors seldom know why one person develops non-Hodgkin 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 lymphoma include the following:
The following are the main types of infection that can increase the risk of lymphoma:
Researchers are studying obesity and other possible risk factors for non-Hodgkin 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 lymphoma.
Having one or more risk factors does not mean that a person will develop non-Hodgkin lymphoma. Most people who have risk factors never develop cancer.
Non-Hodgkin 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 and treated.
If you have swollen lymph nodes or another symptom that suggests non-Hodgkin lymphoma, your doctor will try to find out what's causing the problem. Your doctor may ask about your personal and family medical history.
You may have some of the following exams and tests:
You may want to ask your doctor these questions before having a biopsy:
Types of Non-Hodgkin Lymphoma
When lymphoma is found, the pathologist reports the type. There are many types of lymphoma. 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:
It's a good idea to get a second opinion about the type of lymphoma that you have. The treatment plan varies by the type of lymphoma. A pathologist at a major referral center can review your biopsy. See the Second Opinion section for more information.
Your doctor needs to know the extent (stage) of non-Hodgkin lymphoma to plan the best treatment. Staging is a careful attempt to find out what parts of the body are affected by the disease.
Lymphoma usually starts in a lymph node. It can spread to nearly any other part of the body. For example, it can spread to the liver, lungs, bone, and bone marrow.
Staging may involve one or more of the following 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 lymphoma are as follows:
In addition to these stage numbers, your doctor may also describe the stage as A or B:
Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat non-Hodgkin lymphoma include hematologists, medical oncologists, and radiation oncologists. Your doctor may suggest that you choose an oncologist who specializes in the treatment of lymphoma. Often, such doctors are associated with major academic centers. Your health care team may also include an oncology nurse and a registered dietitian.
The choice of treatment depends mainly on the following:
If you have indolent non-Hodgkin lymphoma without symptoms, you may not need treatment for the cancer right away. The doctor watches your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting.
If you have indolent lymphoma with symptoms, you will probably receive chemotherapy and biological therapy. Radiation therapy may be used for people with Stage I or Stage II lymphoma.
If you have aggressive lymphoma, the treatment is usually chemotherapy and biological therapy. Radiation therapy also may be used.
If non-Hodgkin lymphoma comes back after treatment, doctors call this a relapse or recurrence. People with lymphoma that comes back after treatment may receive high doses of chemotherapy, radiation therapy, or both, followed by stem cell transplantation.
You may want to know about side effects and how treatment may change your normal activities. Because chemotherapy and radiation therapy often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.
At any stage of the disease, you can have supportive care. Supportive care is treatment to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring. See the Supportive Care section.
You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. See the Taking Part in Cancer Research section.
You may want to ask your doctor these questions before you begin treatment:
People who choose watchful waiting put off having cancer treatment until they have symptoms. Doctors sometimes suggest watchful waiting for people with indolent lymphoma. People with indolent lymphoma may not have problems that require cancer treatment for a long time. Sometimes the tumor may even shrink for a while without therapy. By putting off treatment, they can avoid the side effects of chemotherapy or radiation therapy.
If you and your doctor agree that watchful waiting is a good idea, the doctor will check you regularly (every 3 months). You will receive treatment if symptoms occur or get worse.
Some people do not choose watchful waiting because they don't want to worry about having cancer that is not treated. Those who choose watchful waiting but later become worried should discuss their feelings with the doctor.
You may want to ask your doctor these questions before choosing watchful waiting:
Chemotherapy for lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body.
You may receive chemotherapy by mouth, through a vein, or in the space around the spinal cord. Treatment is usually in an outpatient part of the hospital, at the doctor's office, or at home. Some people need to stay in the hospital during treatment.
Chemotherapy is given in cycles. You have a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and on the anticancer drugs used.
If you have lymphoma in the stomach caused by H. pylori infection, your doctor may treat this lymphoma with antibiotics. After the drug cures the infection, the lymphoma also may go away.
The side effects depend mainly on which drugs are given and how much. The drugs can harm normal cells that divide rapidly:
The drugs used for non-Hodgkin lymphoma also may cause skin rashes or blisters, and headaches or other aches. Your skin may become darker. Your nails may develop ridges or dark bands.
Your doctor can suggest ways to control many of these side effects. You may find it helpful to read NCI's booklet Chemotherapy and You.
You may want to ask your doctor these questions before having chemotherapy:
People with certain types of non-Hodgkin lymphoma may have biological therapy. This type of treatment helps the immune system fight cancer.
Monoclonal antibodies are the type of biological therapy used for lymphoma. They are proteins made in the lab that can bind to cancer cells. They help the immune system kill lymphoma cells. People receive this treatment through a vein at the doctor's office, clinic, or hospital.
Flu-like symptoms such as fever, chills, headache, weakness, and nausea may occur. Most side effects are easy to treat. Rarely, a person may have more serious side effects, such as breathing problems, low blood pressure, or severe skin rashes. Your doctor or nurse can tell you about the side effects that you can expect and how to manage them.
You may find it helpful to read NCI's booklet Biological Therapy.
You may want to ask the doctor these questions before having biological therapy:
Radiation therapy (also called radiotherapy) uses high-energy rays to kill lymphoma cells. It can shrink tumors and help control pain.
Two types of radiation therapy are used for people with lymphoma:
The side effects of radiation therapy depend mainly on the type of radiation therapy, the dose of radiation, and the part of the body that is treated. For example, external radiation to your abdomen can cause nausea, vomiting, and diarrhea. When your chest and neck are treated, you may have a dry, sore throat and some trouble swallowing. In addition, your skin in the treated area may become red, dry, and tender. You also may lose your hair in the treated area.
You are likely to become very tired during external radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise people to try to stay as active as they can.
People who get systemic radiation also may feel very tired. They may be more likely to get infections.
If you have radiation therapy and chemotherapy at the same time, your side effects may be worse. The side effects can be distressing. You can talk with your doctor about ways to relieve them.
You may find it helpful to read NCI's booklet Radiation Therapy and You.
You may want to ask your doctor these questions before having radiation therapy:
Stem Cell Transplantation
If lymphoma returns after treatment, you may receive stem cell transplantation. A transplant of your own blood-forming stem cells allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in the bone marrow.
Stem cell transplants take place in the hospital. After you receive high-dose treatment, healthy blood-forming stem cells are given to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells.
The stem cells may come from your own body or from a donor: :
You may find it helpful to read NCI's fact sheet Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation: Questions and Answers.
You may want to ask the doctor these questions before having a stem cell transplant:
Before starting treatment, you might want a second opinion about your diagnosis and your treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it.
It may take some time and effort to gather your medical records and see another doctor. In most cases, a brief delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Sometimes people with non-Hodgkin lymphoma need treatment right away.
There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists. Other sources can be found in the NCI fact sheet How To Find a Doctor or Treatment Facility If You Have Cancer.
Nonprofit groups with an interest in lymphoma may be of help. Many such groups are listed in the NCI fact sheet National Organizations That Offer Cancer-Related Services.
Non-Hodgkin lymphoma and its treatment can lead to other health problems. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life during treatment.
You may receive antibiotics and other drugs to help protect you from infections. Your health care team may advise you to stay away from crowds and from people with colds and other contagious diseases. If an infection develops, it can be serious, and you will need treatment right away.
Non-Hodgkin lymphoma and its treatment also can lead to anemia, which may make you feel very tired. Drugs or blood transfusions can help with this problem.
You can get information about supportive care on NCI's Web site and from NCI's Cancer Information Service at 1-800-4-CANCER.
Nutrition and Physical Activity
It's important for you to take care of yourself by eating well and staying as active as you can.
You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to deal with these problems. Also, the NCI booklet Eating Hints has many useful ideas and recipes.
Many people find they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it.
You'll need regular checkups after treatment for non-Hodgkin lymphoma. Your doctor will watch your recovery closely and check for recurrence of the lymphoma. Checkups help make sure that any changes in your health are noted and treated as needed. Checkups may include a physical exam, lab tests, chest x-rays, and other procedures. Between scheduled visits, you should contact the doctor right away if you have any health problems.
You may want to read the NCI booklet Facing Forward: Life After Cancer Treatment. It answers questions about follow-up care and other concerns.
You may want to ask your doctor these questions after you have finished treatment:
Sources of Support
Learning you have non-Hodgkin lymphoma can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to have many different and sometimes confusing feelings.
Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.
Here's where you can go for support:
Taking Part in Cancer Research
Doctors all over the country are studying new ways to treat lymphoma. Clinical trials (research studies in which people volunteer to take part) find out whether promising approaches to treatment are safe and effective. Research already has led to advances.
Researchers are studying many types of treatments for lymphoma:
People who join clinical trials may be among the first to benefit if a new approach is effective. And even if participants do not benefit directly, they still help doctors learn more about lymphoma and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.
If you are interested in being part of a clinical trial, you should talk with your doctor. You may want to read the NCI booklet Taking-Part-in-Cancer-Treatment-Research-Studies. It describes how treatment studies are carried out and explains their possible benefits and risks.
NCI's Web site includes a section on clinical trials. It has general information about clinical trials as well as detailed information about specific ongoing studies of non-Hodgkin lymphoma. Information specialists at 1-800-4-CANCER or at LiveHelp can answer questions and provide information about clinical trials.