Non-Hodgkin’s Lymphoma

What is Non-Hodgkin’s Lymphoma?
Non-Hodgkin’s Lymphoma (NHL) is cancer that starts in lymphoid tissue (also called lymphatic tissue), part of the lymphatic system. The lymphatic system is important for filtering bacteria and cancer cells and carrying fluid from the limbs and internal organs back into the blood.

What are risk factors for Non-Hodgkin’s Lymphoma?
The exact cause of Non-Hodgkin’s Lymphoma is not known, however there are risk factors.
a. Age – the rate of NHL increases exponentially with age between 20 and 70 years.
b. Infections – the chance of developing NHL is increased among people who have been exposed to:
> Human T-lymphotrophic virus type I (HTLV-1);
> Epstein-Barr (EBV) virus;
Helicobacter pylori, a bacteria that may infect the gastrointestinal tract and can cause lymphomas of the stomach;
> Human immunodeficiency virus (HIV), the “AIDS” virus.
It is important to note that there is no evidence of infection in many NHL patients, so its role in cancer development remains uncertain.
c. Medical conditions – specific medical conditions may make a person more likely to develop NHL. In particular, NHL is more common among people with a weakened immune system, such as those with
> Autoimmune disease (e.g. HIV/AIDS), diseases caused by the body’s immunologic attacks against its own tissues;
> Inherited immune deficiency syndromes (e.g. ataxia telangiectasia)
> Organ transplants that require the use of immunosuppressant drugs.

Is screening available?
Routine screening for NHL is not recommended. There is no single blood test that can confirm the diagnosis of NHL. Routine physical examination, a careful assessment of any new symptoms, and routine blood-work can alert the physician to the possibility of lymphoma.

What are the symptoms of Non-Hodgkin’s Lymphoma?
Signs and symptoms of NHL may be different depending on its location in the body. Generalized symptoms can include:
> Unexplained weight loss
> Fever
> Profuse sweating, particularly at night time
> Severe itchiness
> Swollen lymph nodes in the neck, armpit, or groin area that does not go away.

How is Non-Hodgkin’s Lymphoma diagnosed?
A biopsy is the best way to diagnose NHL. There are several biopsy procedures, and the doctor’s choice is based on the unique aspects of each person’s situation.

What is staging?
Staging describes the extent of the cancer. It determines if the cancer has spread and if so, what parts of the body are affected. Staging a cancer is important to assist the doctor with determining the appropriate course of treatment and assessing an accurate prognosis.

The most common staging system is the TNM.
> T – size of the tumor
> N – degree to which regional lymph nodes are involved
> M – the absence or presence of distant metasteses
Once the TNM has been determined, then a stage of I, II, III or IV is assigned.
> Stage I – cancers are small and local and usually curable
> Stage II x III – typically these are locally advanced and could involve the lymph nodes
> Stage IV – cancer has metastasized and can be inoperable.

What are treatment options?
Treatment depends on a number of factors, including the type of lymphoma, the patient’s age, the stage of the lymphoma and whether the lymphoma has been treated before. It also may depend upon certain features of the lymphoma cells. The doctor also takes into consideration the patient’s symptoms and general health.

What clinical trials are available?
Clinical trials are studies that seek to find better ways to prevent, screen, diagnose and treat a disease such as cancer. Clinical trials test new approaches to treatment, such as, new drugs, new approaches to surgery or radiation therapy, or a combination of treatments. Learn more about clinical trials.

What questions should I ask my doctor?
It is often helpful to make a list of questions before an appointment. This will help to remember what the doctor says. Patients and care givers can write notes or ask if they may use a tape recorder. Sometimes it is helpful to have a family member or friend at the appointment to take notes, ask questions or just listen. Below are a few suggested questions a patient may ask their doctor.

Will you please write down the type of cancer that I have?
What stage is my cancer and what does that mean?
What are my treatment options?
What treatment do you recommend and why?
What are the risks and benefits of each treatment?
What are possible side effects of treatment?
How will you help manage my side effects?
How will treatment affect my normal activities?
Are there specific things I must do to get ready for treatment?
Are there other things I can be doing to help with my treatment, such as diet and exercise?
What are resources that I can turn to learn more about my cancer and help me deal with it?

Make an appointment

Resources
American Cancer Society – 1-800-ACS-2345
National Cancer Institute – 1-800-4CANCER
The Leukemia and Lymphoma Society – 1-800-955-4572
The Lymphoma Research Foundation of American, Inc.