Non-Hodgkin's Lymphoma

Types of NHL

The specific types of NHL are associated with different symptoms.

Low-Grade NHL

Low-grade, or indolent, NHL progresses slowly and is associated with painless swelling of lymph nodes (usually in the neck or over the collarbone), but patients are otherwise healthy. The swelling may go away for a while, but then return.

If low-grade NHL has spread outside of the lymph nodes, there may be discomfort in the affected area. Types of low grade NHLs include:

• Marginal zone lymphoma
• MALT lymphoma
• Follicular lymphoma
• Mantle cell lymphoma

Intermediate Grade NHL

Intermediate grade NHL grows more rapidly and is associated with more symptoms than low-grade NHL. There may be pain or swelling in the legs, neck, arms or abdomen. Fever, night sweats and unexplained weight loss may also occur. Examples of Intermediate grade NHLs include:

• Diffuse large cell lymphoma
• Primary mediastinal large cell lymphoma
• Anaplastic large cell lymphoma

High-Grade NHL

High-grade NHL grows very rapidly and has many different symptoms, depending on the location of the cancer. Symptoms may include fatigue, shortness of breath, pain, weakness in the arms and/or legs and confusion. High-grade NHLs include:

• Burkitt’s lymphoma
• Lymphoblastic lymphoma

Symptoms

Symptoms of NHL may include:

• Painless swelling of lymph nodes in the neck, groin or underarm
• Fevers
• Heavy night sweats
• Tiredness
• Weight loss without a known reason
• Severe itchiness
• Reddened patches on the skin
• Nausea, vomiting or abdominal pain

NHL has no known cause, and most people diagnosed with NHL don’t have any risk factors.

Since there are no screening tests to find NHL in its earliest stages, the best approach is to take notice of any unusual symptoms and seek medical attention promptly.

Some common tests used to identify NHL include:

Biopsy: The removal of a piece of tissue from an area of suspected cancer for examination under a microscope. Non-Hodgkin’s Lymphoma is diagnosed by looking at cancer cells and determining how they are growing in the lymph nodes or other tissues. The information provided by this tissue sample is crucial to the diagnosis and treatment of NHL.

X-Ray: This procedure uses radiation to take pictures of an area inside the body.

Computerized Axial Tomography (CT) scan: A CT scan takes X-rays from different angles around the body. The images are then combined using a computer to give a detailed image. CT scans are most commonly performed on the neck, chest, abdomen and/or pelvis. 

Positron Emission Tomography (PET) scan: PET is a technology that combines the fields of medicine, computer science, chemistry, physics and physiology to study the function of organs such as the heart, brain and bone. Rather than providing an image of the tissue such as X-rays, CTs, ultrasounds or MRIs, PET scans provide information about how tissue functions.

Magnetic Resonance Imaging (MRI): MRI is similar to a CT scan but uses magnets and radio frequency waves instead of X-rays. MRI can provide important information about tissues and organs that is not available from other imaging techniques. It is less used in NHL than are CT scans, but it can be useful in evaluation of the bones and brain.

Lymphangiogram: A special X-ray of the lymphatic system. A dye (contrast medium) is injected into the lymphatic vessels in both feet. When the body is X-rayed, lymph nodes and lymphatic vessels containing the dye are more clearly seen on the film.

Gallium (radioisotope) Scan: Radioactive gallium is a chemical that collects in some tumors. A small amount of gallium is injected into a blood vessel, and it circulates throughout the body. The body is then scanned from several angles to see if the gallium has collected in a tumor. This test can be very useful in managing NHL.

Blood Tests: These are performed to determine if the different types of blood cells are normal in numbers and appearance and if blood chemistry is normal.

Bone Marrow Aspiration and Biopsy: Bone marrow contains immature cells called stem cells, which go on to develop into three types of cells: red blood cells, which deliver oxygen and take away carbon dioxide; white blood cells, which protect the body from infection; and platelets, which help blood to clot. Bone marrow is obtained by numbing the skin, tissue and surface of the bone with a local anesthetic. A thin needle is inserted into the hip or another large bone to collect a small sample.

Echocardiogram: This diagnostic test evaluates the size and function of the heart.

Pulmonary Function Test: This test will determine how well the lungs function. It is an important test since some drugs used to treat NHL may affect lung function.

Staging

Staging is a standardized method to determine if the cancer has spread, and to determine the best possible treatment. Accurate staging also helps to predict patient’s prognosis and how the disease might progress.

Stage I (early stage): One lymph node region is involved. If the cancer is found in one organ outside the lymph node such as the skin, lung, brain, etc., this is called "extension," or "E" disease.

Stage II (locally advanced disease): The cancer is found in two or more lymph regions on one side of the diaphragm. If the cancer is found in one lymph node region plus a nearby area or organ, the situation is considered "E" disease.

Stage III (advanced disease): The disease involves lymph nodes both above and below the diaphragm or one node area and one organ on opposite sides of the diaphragm.

Stage IV (widespread disease): The Lymphoma is outside the lymph nodes and spleen and has spread to one or more organs such as bone, bone marrow, skin and other organs.

In addition, each stage is classified as "A" or "B". An "A" means asymptomatic, which is used for patients who do not complain of fever, drenching sweat or unexplained weight loss. When patients have any of these symptoms, "B" is assigned to their stage.

Treatment for NHL depends on disease stage, the patient’s general health and other factors. Treatment may consist of chemotherapy, radiation therapy, bone marrow or stem cell transplantation or a combination of these treatments.

Chemotherapy

Chemotherapy uses drugs to treat cancer. There are many different types of drugs available to treat NHL. Doctors may prescribe a single drug, but combinations of drugs are most often used. Chemotherapy drugs work in various ways and have different side effects. Giving several drugs at once may increase their effectiveness but also may increase side effects.

Radiation Therapy

Radiation is a special kind of energy carried by waves or a stream of energy particles. It may be delivered by a radiation machine or by radioactive substances injected into the bloodstream. External beam radiation equipment aims radiation at tumors or certain areas of the body, killing cancer cells in the target area

Bone Marrow & Stem Cell Transplantation

Autologous or allogeneic bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT) restore the supply of normal cells that have been destroyed by high-dose chemotherapy and/or radiation therapy. In autologous transplantation, the bone marrow or blood stem cells are collected from the patient. Allogeneic transplantation involves collection of bone marrow or stem cells from a carefully matched donor, who may be a family member or unrelated individual

Peripheral blood stem cell transplantation is the most common procedure, in which stem cells are collected from the blood by pheresis, a procedure similar to donating blood. Before the transplant, patients receive high doses of chemotherapy, alone or in combination with radiation, to destroy as many cancer cells as possible. They then receive the bone marrow or stem cell transplant. In bone marrow transplantation, which is seldom done, stem cells are taken from the donor or patient's hip bone.

Clinical Trials

Enrollment in a clinical trial (research study) may also be an option for some NHL patients. All patients who participate in clinical trials are volunteers. They can choose to stop their participation in a clinical trial at any time. To learn more about clinical trials and the current clinical trials for NHL patients at M. D. Anderson, search our online clinical trials database.

Cancer is a journey that no one needs to take alone. There are many forms of support to help you through every stage: diagnosis, treatment and survivorship. Whether you meet with other cancer survivors like yourself, use complementary therapies or individual coping mechanisms, help is available in many forms. Listed below are just some of the ways to find help...and hope.

Learn more about patient and family support programs

Support Groups

Getting together with other cancer patients in a support group is a valuable coping tool. Support groups are usually focused on a single disease or topic, such as breast cancer survivors or people coping with life-changing side effects from their cancer or cancer therapy. These groups allow participants to meet others like themselves and seek strength from each other. Most major cities and cancer hospitals offer support groups that meet weekly or monthly. There are also dozens of online support web sites or message boards for those who may not have access to a traditional meeting. 

Find a support group

Complementary Therapies

Complementary therapies are used in conjunction with cancer treatment, in an effort to reduce treatment side effects, ease depression and anxiety and help cancer patients take their mind off the negative aspects of their situation. Complementary therapies may include mind-body exercises like yoga, tai chi and Qi gong; visualization or guided imagery; using art or music as therapy and self-expression and traditional Eastern medicine such as acupuncture. 

Find complementary therapies at M. D. Anderson

Physical Activity

Staying physically active as much as possible during cancer treatment has many positive benefits. Physical activity stimulates the release of endorphins, a hormone that helps elevate mood, as well as decreasing feelings of fatigue.

Exercises for cancer patients can range from simple stretches done in the bed or chair, to more active pursuits such as walking or light gardening work. However, it’s important not to push yourself too hard. Check with your doctor before attempting any physical activity to make sure you are up to it.

Journaling/Blogging

Many people find it helpful to keep a journal of their cancer treatment experience. It may be as simple as recording symptoms and side effects into a notebook, or may include personal emotions and opinions about what they may be going through. Journals can be private, like a diary, or shared with loved ones and even strangers. 

Increasingly, people are turning to the Internet to share their cancer journey with the world at large and to seek out others with similar experiences. Many cancer patients have begun their own web log, or “blog” to publicize their battle with cancer. Twitter, a mini-blogging technology that limits posts to 140 characters, has also proven to be a helpful tool for cancer patients to keep friends updated and reach out to others.