Non-Hodgkin's lymphoma is a type of cancer that begins in your lymphatic system, which is part of the body's germ-fighting immune system. In non-Hodgkin's lymphoma, white blood cells called lymphocytes grow abnormally and can form growths (tumors) throughout the body.
Non-Hodgkin's lymphoma is a general category of lymphoma. There are many subtypes that fall in this category. Diffuse large B-cell lymphoma and follicular lymphoma are among the most common subtypes. The other general category of lymphoma is Hodgkin's lymphoma.
Advances in diagnosis and treatment of non-Hodgkin's lymphoma have helped improve the prognosis for people with this disease.
Signs and symptoms of non-Hodgkin's lymphoma may include:
Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.
In most instances, doctors don't know what causes non-Hodgkin's lymphoma. It begins when your body produces too many abnormal lymphocytes, which are a type of white blood cell.
Normally, lymphocytes go through a predictable life cycle. Old lymphocytes die, and your body creates new ones to replace them. In non-Hodgkin's lymphoma, your lymphocytes don't die, and your body keeps creating new ones. This oversupply of lymphocytes crowds into your lymph nodes, causing them to swell.
Non-Hodgkin's lymphoma most often begins in the:
Whether your non-Hodgkin's lymphoma arises from your B cells or T cells helps to determine your treatment options.
Non-Hodgkin's lymphoma generally involves the presence of cancerous lymphocytes in your lymph nodes. But the disease can also spread to other parts of your lymphatic system. These include the lymphatic vessels, tonsils, adenoids, spleen, thymus and bone marrow. Occasionally, non-Hodgkin's lymphoma involves organs outside of your lymphatic system.
Most people diagnosed with non-Hodgkin's lymphoma don't have any obvious risk factors. And many people who have risk factors for the disease never develop it.
Some factors that may increase the risk of non-Hodgkin's lymphoma include:
Your doctor will likely ask you about your personal and family medical history. He or she may then have you undergo tests and procedures used to diagnose non-Hodgkin's lymphoma, including:
Other tests and procedures may be used depending on your situation.
Your doctor uses information from these tests and procedures to determine the subtype of your non-Hodgkin's lymphoma and which treatments may be most effective. Many types of non-Hodgkin's lymphoma exist, including rare forms that some doctors may have never seen. Research shows that having your tissue samples reviewed by an experienced doctor may result in a more accurate diagnosis. If you have any concerns about your diagnosis, consider seeking a second opinion.
Several non-Hodgkin's lymphoma treatments are available. Which treatment or combination of treatments is best for you will depend on the particulars of your lymphoma, such as the types of cells involved and whether your lymphoma is aggressive. Your doctor also considers your overall health and your preferences.
If your lymphoma appears to be slow growing (indolent) and doesn't cause signs and symptoms, you might not need treatment right away. Instead, your doctor may recommend regular checkups every few months to monitor your condition and whether your cancer is advancing.
If your non-Hodgkin's lymphoma is aggressive or causes signs and symptoms, your doctor may recommend treatment. Options may include:
Chemotherapy is a drug treatment that kills cancer cells. It can be given orally or by injection. Chemotherapy drugs can be used alone, in combination with other chemotherapy drugs or combined with other treatments.
Chemotherapy is a common initial treatment for non-Hodgkin's lymphoma. It might also be an option if your lymphoma comes back after your initial treatments.
For people with non-Hodgkin's lymphoma, chemotherapy is also used as part of a bone marrow transplant, also known as a stem cell transplant. Very high doses of chemotherapy drugs can help prepare your body for the transplant.
Radiation therapy uses high-powered energy beams, such as X-rays and protons, to kill cancer cells. During radiation therapy, you lie on a table and a large machine moves around you, directing the energy beams to specific points on your body.
For certain types of non-Hodgkin's lymphoma, radiation therapy may be the only treatment you need, particularly if your lymphoma is slow growing and located in just one or two spots. More commonly, radiation is used after chemotherapy to kill any lymphoma cells that might remain. Radiation can be aimed at affected lymph nodes and the nearby area of nodes where the disease might progress.
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
For non-Hodgkin's lymphoma, targeted drugs can be used alone, but are often combined with chemotherapy. This combination can be used as your initial treatment and as a second treatment if your lymphoma comes back.
A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body's germ-fighting T cells, engineers them to fight cancer and infuses them back into your body.
CAR-T cell therapy might be an option for certain types of B-cell non-Hodgkin's lymphoma that haven't responded to other treatments.
Bone marrow transplant, also known as a stem cell transplant, involves using high doses of chemotherapy and radiation to suppress your bone marrow and immune system. Then healthy bone marrow stem cells from your body or from a donor are infused into your blood where they travel to your bones and rebuild your bone marrow.
For people with non-Hodgkin's lymphoma, a bone marrow transplant might be an option if other treatments haven't helped.
Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.
Immunotherapy drugs may be an option for certain types of non-Hodgkin's lymphoma if other treatments haven't helped.
No alternative medicines have been found to cure non-Hodgkin's lymphoma. But alternative medicine may help you cope with the stress of a cancer diagnosis and the side effects of cancer treatment. Talk with your doctor about your options, such as:
A non-Hodgkin's lymphoma diagnosis can be overwhelming. The following strategies and resources may help you deal with cancer:
Maintain a strong support system. Keeping your close relationships strong will help you deal with your non-Hodgkin's lymphoma. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.
Although friends and family can be your best allies, they sometimes may have trouble dealing with your illness. If so, the concern and understanding of a formal support group or others coping with cancer can be especially helpful.
Make an appointment with your family doctor if you have any signs or symptoms that worry you. If your doctor suspects you have a type of lymphoma, he or she may refer you to a doctor who specializes in diseases that affect blood cells (hematologist).
Because appointments can be brief, and because there's often a lot of information to discuss, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect from your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For non-Hodgkin's lymphoma, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions.
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:
