Non-Hodgkin's Lymphoma (Adult)
Lymphomas are cancers of the lymphatic system. The lymphatic system drains excess fluid from the tissues and helps protect against infections.
Non-Hodgkin’s lymphoma is a general name that applies to many types of cancer found in the lymphatic system. These cancers are different from Hodgkin’s lymphoma, a related type of lymphoma cancer. The two types of lymphoma—non-Hodgkin’s and Hodgkin's lymphoma—can be distinguished from one another by examining the cancerous tissue under a microscope.
In addition, there are several different types of non-Hodgkin’s lymphoma, based on the cell type that is involved and the patterns of growth. In general, these different types can be divided into two main groups: indolent (or slow growing) lymphomas and aggressive lymphomas. Treatment will vary according to type.
Cancer occurs when cells in the body (in this case lymph cells, or lymphocytes) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably, a mass of tissue called a growth or tumor forms. The term cancer refers to malignant tumors, which can invade nearby tissues and can spread to other parts of the body. A benign tumor does not invade or spread.
The cause of non-Hodgkin’s lymphoma is unknown. Scientists do believe, however, that mutations in DNA (the genetic material that instructs cells what to do) that occur after birth are related to non-Hodgkin’s lymphoma. These mutations can occur as a result of exposure to radiation or cancer-causing chemicals, but may also occur with age or for no apparent reason.
A risk factor is something that increases your chance of getting a disease or condition.
Most people who develop non-Hodgkin’s lymphoma have no known risk factors, but the following factors may increase your chance of developing non-Hodgkin’s lymphoma:
- Sex: male
- Age: 60-70
- Frequent and accumulating exposure to certain types of chemicals (herbicides, pesticides, benzene)
- Infections involving the immune system, such as HIV/AIDS and Epstein-Barr virus
- History of chemotherapy or radiation therapy
- Chromosomal translocations (DNA breaks off one chromosome and becomes attached to another)
- Celiac disease (gluten enteropathy or gluten intolerance)
- Painless swelling of the neck, underarm, groin, or any other lymph node bearing regions of the body
- Unexplained fever
- Profuse sweating
- Constant fatigue
- Unexplained weight loss
- Itchy skin, especially on the legs and feet
- Reddened patches on the skin
- Chest pain or shortness of breath
Your doctor will ask about your symptoms and medical history, and perform a physical exam, which will include examination of your lymph nodes. Most enlarged or swollen lymph nodes result from infection, not lymphomas. If infection is suspected, you may be given medication and told to return for re-examination.
If swelling persists, your doctor may order more tests to determine whether there is cancer and, if so, the type of cancer that is present.
Tests may include the following:
- Excisional or Incisional Biopsy–a surgeon removes all of a lymph node (excisional) or part of the tumor (incisional) so it can be examined in the laboratory to determine if cancer is present
- Fine Needle Aspiration (FNA) Biopsy–a physician uses a thin needle and syringe to withdraw a sample of tissue from the tumor so it can be examined in the laboratory to determine if cancer is present
- Bone Marrow Aspiration and Biopsy–a needle and syringe are used to remove a small amount of bone marrow (aspiration) and a larger needle is used to remove a sample of bone and bone marrow (biopsy) from the back of the pelvic bone so it can be examined; this test is often used to determine the extent of lymphoma after it has been diagnosed
- Spinal Tap–removal of a small amount of cerebrospinal fluid so it can be examined; this test is often used to determine the extent of lymphoma after it has been diagnosed
- Immunohistochemistry–biopsy samples are treated with antibodies that are able to distinguish between different types of non-Hodgkin’s lymphomas
- Flow Cytometry–biopsy samples are treated with fluorescent antibodies and exposed to a laser beam to determine the cause of lymph node swelling and/or determine the exact type of non-Hodgkin’s lymphoma
- Cytogenetics and/or Molecular Genetic Studies–the DNA that is packaged in chromosomes within a lymphoma cell is examined for abnormalities
- Blood Tests–to help determine the advancement of the lymphoma
- Chest X-ray–a test that uses radiation to take a picture of structures inside the chest to look for enlarged lymph nodes
- Computed Tomography (CT) Scan–a type of x-ray that uses a computer to make pictures of structures inside the body to look for lymphomas in the abdomen, head, pelvic, chest, and neck
- Magnetic Resonance Imaging (MRI) Scan–a test that uses magnetic waves to make pictures of structures inside the brain and spinal cord
- Positron Emission Tomography (PET) Scan–a radioactive solution is injected into a vein so a special camera can look for lymphoma throughout your body and/or determine if an enlarge lymph node contains lymphoma
- Gallium Scan–a radioactive solution is injected into a vein so a special camera can look for non-Hodgkin’s lymphoma in bones and other organs; this test is useful in finding tumors that may be missed by a PET scan
- Bone Scan–a radioactive solution is injected and travels to damaged parts of the bone
- Ultrasound–a test that uses sound waves to examine internal organs and find masses
Treatments for non-Hodgkin’s lymphoma depend on the stage of the cancer and its type (determined in part by microscopic examination and other studies, to determine its aggressiveness). Talk with your doctor about the best treatment plan for you. Treatment options include:
For some indolent lymphomas, no treatment may be needed for some time, unless the tumor begins to cause symptoms such as weight loss, fever, night sweats, impairs function of an organ because of involvement with lymphoma, becomes too large for the patient to tolerate, or otherwise shows signs of becoming aggressive.
Chemotherapy involves the use of drugs to kill cancer cells. It may be given in many forms, including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body, killing mostly cancer cells, but also some healthy cells.
External Radiation Therapy
Radiation is directed at the tumor from a source outside the body to kill the cancer cells.
Bone Marrow Transplantation
In a bone marrow transplantation, bone marrow is removed, treated, and frozen. Large doses of chemotherapy and/or radiation therapy are then applied to kill the cancer cells. After treatment, the bone marrow is replaced via a vein. Transplanted bone marrow may be marrow of the patient’s that was treated to remove cancer cells, or marrow from a healthy donor.
Peripheral Stem Cell Transplantation (PSCT)
Stem cells (very immature cells that produce blood cells) are removed from circulating blood before chemotherapy or radiation treatment, and then replaced after treatment.
Biological Therapy, Immunotherapy, or Biological Response Modifier (BRM) and Radioimmunotherapy Therapy
These medications or substances are made by the body to increase or restore the body’s natural defenses against cancer. One type of biological therapy, interferons, interferes with the division of cancer cells and can slow tumor growth. Interferons are produced by the body and can also be made in the laboratory to treat cancer and other diseases. Sometimes a drug or antibody that is directed at the lymphoma is linked to a radioactive substance to deliver a focused dose of radiation to the tumor.
There are no guidelines for preventing non-Hodgkin’s lymphoma. To reduce your risk, avoid exposure to chemicals such as herbicides, pesticides, and benzene. If you have celiac disease (gluten intolerance) maintain your gluten-free diet to minimize the stimulation of your immune system by exposure to gluten.