Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma?

Lymphomas are cancers that usually begin in the lymph nodes. Lymph nodes are part of the circulation and infection-fighting systems of the body. They carry away waste products that are removed from the body through the liver and kidneys. Lymph nodes are connected with each other by lymph channels that are next to arteries and veins. The lymphatic system also makes antibodies and white blood cells to fight things that are foreign to the body, such as viruses and bacteria.

There are many types of lymphoma. Hodgkin lymphoma is one type. Other types of lymphomas are called non-Hodgkin lymphoma (NHL). The type of lymphoma is determined by how the cancer cells look under a microscope. Non-Hodgkin lymphoma is far more common than Hodgkin lymphoma.

How does it occur?

Lymphomas develop when white blood cells called lymphocytes become abnormal and start dividing without control. What causes this to happen is not known. Because lymph nodes are present in many parts of the body, lymphoma can start almost anywhere. It can occur in one lymph node, in a group of nodes, or in an organ, such as the spleen, lung, bone marrow, brain, stomach, or small intestine. It can then spread to almost any part of the body. The risk of developing non-Hodgkin lymphoma increases as you get older.

What are the symptoms?

Symptoms may include:

• swelling of lymph nodes in the neck, armpits, or groin (often the swelling is painless)
• fever
• night sweats
• tiredness
• itching
• weight loss for no known reason.

If you notice lumps in your neck, armpit, or groin, tell your healthcare provider.

How is it diagnosed?

A sample of tissue (biopsy) taken from an enlarged lymph node is examined under a microscope to confirm the diagnosis of non-Hodgkin lymphoma. Other tests may be done to see how far the disease has spread and to help decide the best treatment. Examples of such tests are:

• blood tests
• chest X-ray
• scans, such as a CT, MRI, or PET scan
• biopsy of your bone marrow
• biopsies of the liver or lymph nodes in the abdomen

How is it treated?

Treatment depends on the type of lymphoma you have, your symptoms, and how far the disease has spread. Some types grow very slowly and cause few problems. These lymphomas may be treated just with what is called watchful waiting. This means your condition is closely watched, but you do not receive any treatment until you have symptoms or the disease gets worse.

If you have a slow-growing type of lymphoma that is causing symptoms or you have a lymphoma that grows and spreads quickly, you will probably receive chemotherapy or biological therapy. You may also have radiation therapy.

• Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from making new cells.
• Biological therapy is a treatment that uses your immune system to fight cancer.
• Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells.

If lymphoma comes back after treatment, you may be given a different treatment called a stem cell transplant. This means you are given young blood cells from your own blood or a donor's blood after you have been given high-dose chemotherapy. The chemotherapy destroys your old blood-forming cells, and the new transplanted stem cells become new, healthier blood cells.

How can I take care of myself?

• Follow the full course of treatment your healthcare provider prescribes.
• Ask your healthcare provider what you should do to protect yourself when people around you have a viral or bacterial infection.
• If you have a fever above 100°F (37.8°C), call your provider and stay in bed. After your temperature has fallen below 100°F (37.8°C), become as active as you comfortably can. Ask your provider if you can take aspirin or acetaminophen to control your fever.
• Because cancer treatments often harm healthy cells and tissues, side effects are common. Learn about side effects you may have from radiation or different types of chemotherapy. It helps to be prepared for severe or distressing side effects such as nausea or vomiting. Besides the short-term side effects, some effects last for weeks or months, like losing your hair during treatment. Find where you can get hats or wigs and remember that your hair will grow back when therapy stops.
• Consider joining a cancer support group during your illness and recovery.
• Do not try unproven cancer treatments.
• For more information, contact national and local self-help organizations such as:

  American Cancer Society, Inc.
  Phone: 1-800-ACS-2345 (1-800-227-2345)
  Web site: http://www.cancer.org

  AMC Cancer Research Center and Foundation
  Phone: 1-800-321-1557
  Web site: http://www.amc.org

  Cancer Information Service
  Phone: 1-800-4-CANCER (1-800-422-6237)
  Web site: http://cis.nci.nih.gov