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Lymphomas are either Hodgkin's lymphomas or non-Hodgkin's lymphomas. Hodgkin's lymphomas have a type of cell called Reed-Sternberg cells. Lymphomas without these cells are non-Hodgkin's lymphomas. This topic is about non-Hodgkin's lymphoma (NHL). To learn about Hodgkin's lymphoma, see the topic Hodgkin's Lymphoma.
Lymphoma is cancer that begins
in the lymph system in white blood cells called lymphocytes. When these cells become abnormal, they
don't protect the body from infection or disease. They also grow without control and may form lumps
of tissue called tumors.
NHL can start almost
anywhere in the body. It may start in a single
lymph node, a group of lymph nodes, or an organ such
spleen. Or it can spread to almost any part of the body,
including the liver and
There are many types of NHL. Sometimes they are grouped as:
Treatment can cure some
people and may allow others to live for years. How long you live depends on the
type of NHL you have and the stage of your disease (how far it has progressed).
The cause of
NHL is not known. The abnormal cell changes may be triggered by an infection or
exposure to something in the environment. Or it may be linked to gene changes (mutations). NHL is not contagious.
Symptoms of NHL
doctor will do a physical exam and ask you questions about your health. The
exam includes checking the size of your lymph nodes in your neck, underarm, and
Your doctor will take a piece of body tissue (biopsy) to diagnose NHL. The tissue usually is taken
from a lymph node. You may have other tests to find out what kind of NHL you have.
Your treatment depends on the
type of lymphoma you have, the stage of the disease, your age, and your general
health. You may not need treatment until you have symptoms. NHL is usually treated with chemotherapy. Sometimes radiation or radiation with chemotherapy may be used. Or you may have targeted therapy with monoclonal antibodies.
If treatment doesn't work, or if NHL comes back after initial treatment, you may have chemotherapy along with a stem cell transplant.
Learning about non-Hodgkin's lymphoma:
Living with non-Hodgkin's lymphoma:
Experts don't know what causes non-Hodgkin's lymphoma (NHL).
When a person has
non-Hodgkin's lymphoma, abnormal rapid cell growth occurs. This abnormal growth
may need a "trigger" to start, such as an infection or exposure to something in
your environment. There is also a link between NHL and problems with the immune system.
NHL is not contagious and is not caused by injury.
non-Hodgkin's lymphoma (NHL) include:
non-Hodgkin's lymphoma (NHL), white blood cells called lymphocytes divide and grow without order or
control. The abnormal lymphocytes usually are either B-cell or T-cell lymphocytes. But most cases of NHL involve B-cell lymphocytes.
Lymph tissue is present in many
areas of the body, so NHL can start almost anywhere in the
body. It may occur in a single
lymph node, a group of lymph nodes, or an organ. And
it can spread to almost any part of the body, including the
bone marrow, and
NHL may be classified as:
Over time, lymphoma cells may replace the normal cells in
the bone marrow. Bone marrow failure results in the inability to produce red
blood cells that carry oxygen, white blood cells that fight infection, and
platelets that stop bleeding.
Long-term survival depends on the
type of non-Hodgkin's lymphoma and the stage of the disease when it is
diagnosed. About 80 out of 100 people diagnosed with non-Hodgkin's
lymphoma are alive 1 year after the disease is diagnosed. That number drops to
about 67 out of 100 at 5 years, and 57 out of 100 at 10 years.1
Some things can increase your chances of getting non-Hodgkin's lymphoma (NHL). These things are called risk factors. But many people who get non-Hodgkin's lymphoma don't have any of these risk factors. And some people who have risk factors don't get the disease.
Risk factors include:2
Call your doctor to schedule an
appointment if you have had any symptoms for longer than 2 weeks, such
Health professionals who can evaluate your symptoms of
non-Hodgkin's lymphoma (NHL) include:
When NHL is suspected, a tissue sample (biopsy) is needed to make a diagnosis. A biopsy for
non-Hodgkin's lymphoma is usually taken from a lymph node. But other tissues
may be sampled as well. A
surgeon will remove a sample of tissue so that a
pathologist can examine it under a microscope to check
for cancer cells.
Non-Hodgkin's lymphoma is usually treated by a
medical oncologist or a
hematologist. If you need radiation therapy, you
will also see a
To prepare for your appointment, see the topic Making the Most of Your Appointment.
non-Hodgkin's lymphoma (NHL) is suspected, your doctor
will ask about your medical history and perform a physical exam. This
exam includes checking for enlarged
lymph nodes in your neck, underarm, and groin.
A tissue sample (biopsy) is needed to make a diagnosis.
A biopsy for non-Hodgkin's lymphoma is usually taken from a
lymph node, but other tissues may be sampled as
bone marrow aspiration and biopsy is usually done to find
out if lymphoma cells are present in the bone marrow.
may also order other tests, including:
Treatment for non-Hodgkin's lymphoma (NHL) depends
Your doctor will work with you and your medical team (which may include an oncologist, a hematologist, and an oncology nurse) to come up with your treatment plan.
A common concern of cancer patients are the side effects of treatments like chemotherapy and radiation. Your medical team will let you know ahead of time what side effects you can expect and help you manage them. And there are things you can do at home. To learn more, see Home Treatment.
Sometimes NHL comes back after treatment. This is called recurrence or relapse. Treatments for recurrent NHL include chemotherapy, radiation, or a combination of the two. This treatment may be followed by a stem cell transplant.
You will need regular exams after you have been treated for NHL.
Let your doctor know if you have any problems as soon as
Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.
For support in managing the many changes that having cancer can bring, see the topic
Getting Support When You Have Cancer.
Your doctor may use
the term "remission" instead of "cure" when talking about the effectiveness of
your treatment. Although many people with non-Hodgkin's lymphoma are
successfully treated, the term remission is used because cancer can return. It
is important to discuss with your doctor the possibility of recurrence.
Even after effective treatment for NHL, you may be at slightly higher
risk for other types of cancer, especially melanoma, lung, brain, kidney, and
bladder cancers. Be watchful for any symptoms of cancer.
Additional information about NHL is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/non-hodgkin.
Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It can also help you with other concerns that you may have when you are living with a serious illness.
For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.
It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care.
To learn about the different types of supportive care, see:
There is no known way to prevent
non-Hodgkin's lymphoma (NHL).
You can do things at home to help manage your side effects. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.
Other problems that can be treated at home include:
Having cancer can be very stressful, and it may feel overwhelming to face the challenges in front of you. Finding new ways of coping with the symptoms of stress may improve your overall quality of life.
These ideas may help:
Your doctor may prescribe medicines that
will affect the growth of
non-Hodgkin's lymphoma and relieve your symptoms.
Chemotherapy may be used alone or with radiation therapy. Sometimes a
combination of chemotherapy medicines is more effective than a single
The most commonly used combination is called CHOP. It combines four medicines: cyclophosphamide, doxorubicin, vincristine, and prednisone.
Your doctor will work with you to find the best medicine for the type of lymphoma you have.
Chemotherapy causes many side effects. For help with how to deal with these, see Home Treatment. Your doctor may
medicines to control nausea and vomiting from
Targeted therapy uses monoclonal antibodies in medicine that is injected into the body so these antibodies can attach to cancer cells and destroy them. The monoclonal antibodies used to treat NHL include:
Some treatments use interferon or antibiotic medicines. Your doctor will suggest the treatment that works best for your kind of lymphoma.
You may not be able to become
pregnant or father a child after chemotherapy treatment. Discuss fertility
issues with your doctor before starting treatment. Chemotherapy medicines can
also cause birth defects. If you are pregnant or wish to father a child,
discuss the risk of birth defects with your doctor before using any
Surgery is often used to obtain a biopsy sample when non-Hodgkin's lymphoma is being diagnosed or classified. But surgery is rarely used for treatment.
for non-Hodgkin's lymphoma (NHL) may be given in different ways.
A stem cell transplant may be used to treat NHL that is in remission or that has come back. Stem cells may be obtained from blood, through a peripheral blood stem cell transplant (PBSCT). Or stem cells can be obtained from bone, in a bone marrow transplant (SBMT). PBSCT is the most common method for treating NHL.
A stem cell transplant may be done right after you have very high-dose chemotherapy. (You may also have radiation to your entire body.) The stem cell transplant is done to replace your damaged bone marrow cells with healthy stem cells. A stem cell transplant may be offered as part of standard treatment or in a clinical trial.
Clinical trials are research studies that try to find better NHL treatments. Your doctor may suggest that you join a clinical trial. Some treatments being used in clinical trials include lymphoma vaccines and stem cell transplants with high-dose chemotherapy. If you are interested in taking part in a clinical trial, check with your doctor to see if any are available in your area.
People sometimes use complementary therapies
along with medical treatment to help relieve symptoms and side effects of
cancer treatments. Some of the complementary therapies that may be helpful
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.
The Leukemia and Lymphoma Society is the world's largest voluntary
health organization dedicated to funding blood cancer research, education, and
patient services. The Society's mission is to cure leukemia, lymphoma,
Hodgkin's lymphoma, and myeloma and to improve the quality of life for patients
and their families.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
Cancer.Net is the information website of the American
Society of Clinical Oncology (ASCO) for people living with cancer and for those
who care for them. ASCO is the world's leading professional organization
representing physicians of all oncology subspecialties. Cancer.Net provides
current oncologist-approved information on living with cancer.
The Lymphoma Research Foundation (LRF) is devoted to funding lymphoma research and providing patients and health professionals with information about lymphoma. Some states have local chapters of the Lymphoma Research Foundation. Services for patients and their loved ones include in-person programs, a patient aid grant program, and publications and newsletters. There are also teleconferences, webcasts, and podcasts.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
American Cancer Society (2011). Cancer Facts and Figures 2011. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-029771.pdf.
Friedberg JW, et al. (2011). Non-Hodgkin lymphoma. In VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg’s Cancer: Principles and Practice of Oncology, 9th ed., pp. 1855–1893. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
American Joint Committee on Cancer (2010). Hodgkin and non-Hodgkin lymphomas section in Lymphoid
neoplasms. AJCC Cancer Staging Manual, 7th ed., pp.
607–611. New York: Springer.
Bierman PJ, Armitage JO (2012). Non-Hodgkin's lymphomas. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 1218–1228. Philadelphia: Saunders.
Hillman R, et al. (2011). Non-Hodgkin lymphomas. In Hematology in Clinical Practice, 5th ed., pp. 279–300. New York: McGraw-Hill.
Kyle F, Hill M (2010). NHL (diffuse large B-cell lymphoma), search date January 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
National Cancer Institute (2011). Adult Non-Hodgkin Lymphoma Treatment (PDQ): Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/adult-non-hodgkins/HealthProfessional.
National Cancer Institute (2011). Adult Non-Hodgkin Lymphoma Treatment (PDQ): Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/adult-non-hodgkins/Patient.
National Cancer Institute (2011). Childhood Non-Hodgkin Lymphoma Treatment (PDQ): Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/child-non-hodgkins/HealthProfessional.
National Cancer Institute (2011). Childhood Non-Hodgkin Lymphoma Treatment (PDQ): Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/child-non-hodgkins/Patient.
National Comprehensive Cancer Network (2011). Non-Hodgkin's lymphomas. Clinical Practice Guidelines in Oncology, Version 4. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
October 22, 2012
Anne C. Poinier, MD - Internal Medicine & Douglas A. Stewart, MD - Medical Oncology
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