Non-Hodgkin's Lymphoma

Non-Hodgkin's lymphoma or non-Hodgkin lymphoma is a cancer of your lymphatic system, the part of immune system which helps to fight disease and infection.

In Non-Hodgkin's lymphoma, cancer develops in lymphocytes, a type of white blood cell. Non-Hodgkin's lymphoma is more common than Hodgkin lymphoma.

Among the various types of Non-Hodgkin's lymphoma, the most common ones are diffuse large B-cell lymphoma and follicular lymphoma.

Symptoms of non-Hodgkin's lymphoma are:

• Inflamed lymph nodes in your neck, armpits or groin, usually painless
• Pain or swelling in abdomen
• Chest pain, coughing or breathlessness
• Extreme fatigue
• Fever
• Night sweats
• Loss of weight

When to see a doctor?

Visit your doctor if any signs and symptoms trouble you.

The cause of non-Hodgkin's lymphoma is unknown. DNA mutations in lymphocytes, a type of white blood cell causes “out-of-control” growth and multiplication of the lymphocytes.

These abnormal cells, unlike the normal ones, live longer and accumulate to form a mass of cancerous cells. The accumulated cells cause swelling of your lymph nodes.

Non-Hodgkin's lymphoma develops in your lymph node but these cancerous lymphocytes can invade other parts of your lymphatic systems, such as:

• the lymphatic vessels,
• tonsils,
• adenoids,
• spleen,
• thymus
• bone marrow.

Non-Hodgkin's lymphoma, sometimes, can spread to organs other than that of lymphatic system.

Non-Hodgkin's lymphoma can develop in:

B cells

B cells produce antibodies to destroy foreign particles and help fight infection. Most non-Hodgkin's lymphoma develops in B cells. Non-Hodgkin's lymphoma that involves B cells are classified as:

• Diffuse large B-cell lymphoma
• Follicular lymphoma
• Mantle cell lymphoma
• Burkitt lymphoma.

T cells

T cells, unlike B cells, do not produce antibodies rather they destroy foreign invaders directly. Non-Hodgkin's lymphoma in T-cells is not common. Non-Hodgkin's lymphoma of T cells is classified as

• Peripheral T-cell lymphoma
• Cutaneous T-cell lymphoma.

Categorizing Non-Hodgkin's lymphoma into B cell type or T cell type helps to select appropriate treatment option.

Making a diagnosis of non-Hodgkin's lymphoma is done by performing several tests.

After you visit your primary care doctor, s/he may refer you to a hematologist (a specialist in treating blood disorders).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms.

Write down your key medical information. Write down the names of all your medications, vitamins or supplements. Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor

Some typical questions can be:

• Do my symptoms indicate Non-Hodgkin's lymphoma? If yes, which type and stage?
• W is my non-Hodgkin's lymphoma growing, rapidly or slowly?
• What tests will I need?
• What are the treatment options available and side effects of each option?
• Can treatment affect my daily life?
• Is it possible for me to continue working during treatment?
• What is the duration of treatment?
• How would you suggest your friend if s/he were in my situation?
• Do you recommend visiting a specialist?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• When did the symptoms start appearing and how severe are they?
• Do your symptoms occur continuously or they come and go?
• Does anything improve or aggravate your symptoms?
• Do you have a family history of cancer, including Hodgkin's lymphoma or any other immune disorder?
• What infections did you have in the past, if any?

Following tests are performed for diagnosis of non-Hodgkin's lymphoma:

Physical examination

Your doctor examines if there are any swollen lymph nodes. S/he also checks for swollen spleen or liver.

Blood and urine tests

Blood and urine tests may be used to determine if your condition is due to infection or other disease.

Imaging tests

X-ray, computerized tomography (CT) scan, magnetic resonance imaging (MRI) or positron emission tomography (PET) are used to detect tumors in your body.

Biopsy of lymph node

A sample of lymph nodes is removed and analyzed in a lab to detect and if detected, categorize Non-Hodgkin's lymphoma.

Bone marrow biopsy

A sample of bone marrow may be removed from your pelvic bone with the help of a needle. This helps to detect whether the disease has affected your bone marrow.

Treatment approach for your Non-Hodgkin's lymphoma is guided by the type and stage of your cancer, your health condition, and your preferences.

Treatment may not be required for years if you have slow growing lymphoma.

However, you need to visit your doctor frequently to examine your condition and make sure that the cancer is not advancing.

Treatment for lymphoma that causes signs and symptoms

If you experience signs and symptoms or if your non-Hodgkin's lymphoma is aggressive treatment is necessary.

Treatment options are:

Chemotherapy

It uses oral or injectable chemicals to destroy cancer cells. Chemotherapy drugs can be given alone or in combination with other chemotherapy drugs or other treatments.

Radiation therapy

It uses ionizing radiations like X-rays to destroy the lymphomas. During radiation therapy, radiation coming out from a machine is targeted to specific areas of your body. It can be used alone or combined with other treatments.

Stem cell transplant

In stem cell transplant, your unhealthy bone marrow is replaced by healthy stem cells to generate new bone marrow.

Immune boosting medications

Biological therapy drugs boost your immune system and help fight cancer. For instance, rituximab, a type of monoclonal antibody, attaches to cancerous B cells and stimulates immune cells to kill those cells.

Rituximab reduces the number of cancerous B cells along with healthy B cells, but your body can produce new healthy B cells.

Radioimmunotherapy

It is a combination of radiation and biological therapy in which monoclonal antibodies are attached to radioactive isotopes.

The monoclonal antibodies bind to cancer cells and target the radiation directly to cancerous cells. Ibritumomab tiuxetan, a radioimmunotherapy drug, is used to treat lymphoma.

Lifestyle modifications are necessary in order to cope with the stress caused from non-Hodgkin's lymphoma.

Diagnosis of Hodgkin's lymphoma can cause a heap of stress and anxiety.

Following tips may be helpful to deal with the stress:

• Expand and update your knowledge on Hodgkin's lymphoma to be aware of your condition and possible treatment options.
• Join support group in your community or online.
• Find someone to talk to. You may talk to your friend or a family member about your anxiety, stress. Venting your emotions can make you feel lighter.
• Keep moving towards your treatment goal.
• Give yourself some time. Eat healthy food, exercise, relax and get enough rest to deal with the stress and fatigue of cancer.
• Stay active. If you feel well, continue doing things that you usually do or enjoy.

There are several risks associated with non-Hodgkin's lymphoma, which include:

• Immune suppressing medications: Drugs given to suppress your immune system after organ transplant increases your risk of non-Hodgkin's lymphoma.
• Infection with certain viruses and bacteria: HIV and Epstein-Barr virus can increase your risk of non-Hodgkin's lymphoma, so does ulcer-causing bacteria, Helicobacter pylori.
• Chemicals: There may be a possible link between exposure to insecticides and pesticides, and likelihood of developing non-Hodgkin's lymphoma.
• Age: Increasing age increases your risk of non-Hodgkin's lymphoma, though it can develop at any age. It mostly occurs in people who are older than 60 years.