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They may start in the bone marrow, spleen, thymus or lymph nodes and spread to other parts of the body.
Non-Hodgkin’s lymphoma is the seventh most common cancer in men and women in the nation. According to the American Cancer Society, about 66,000 new cases of non-Hodgkin’s lymphoma are diagnosed each year in the United States. Non-Hodgkin’s lymphoma is slightly more common in white men.
What are the parts of the lymphatic system?
The lymphatic system carries disease-fighting white blood cells throughout the body. It includes:
Lymph: Fluid that carries lymphocytes, a type of white blood cells, through the body in a network of lymph vessels, which are like tiny veins. Lymph helps fight against infection and cancer.
Lymph nodes: Tiny, bean-shaped masses in the underarm, pelvis, neck, abdomen and groin. They filter lymph and store white blood cells to help the body fight disease.
Spleen: An organ on the left side of the abdomen that makes lymphocytes, stores blood cells and gets rid of old blood cells.
Thymus: Located in the chest, this tiny organ stores lymphocytes.
Tonsils: The are nodes in back of throat that produce lymphocytes.
Bone marrow: This is material in bones that produces blood cells.
Non-Hodgkin's Lymphoma Types
Non-Hodgkin’s lymphoma is divided into three types depending on the type of cells in the cancer. These types are:
- B-cell, which makes up 85% of Non-Hodgkin’s lymphoma cases
Non-Hodgkin’s lymphoma is classified also by how quickly it spreads.
Low-grade non-Hodgkin’s lymphoma includes:
- Marginal zone lymphoma
- Mucosa-associated lymphoid tissue (MALT) lymphoma
- Follicular lymphoma
- Mantle cell lymphoma
Intermediate grade non-Hodgkin’s lymphoma includes:
- Diffuse large cell lymphoma
- Primary mediastinal large cell lymphoma
- Anaplastic large cell lymphoma
High-grade non-Hodgkin’s lymphoma includes:
- Burkitt’s lymphoma
- Lymphoblastic lymphoma
Relapsed non-Hodgkin’s lymphoma is disease that comes back after you have received treatment for Non-Hodgkin’s lymphoma.
Refractory non-Hodgkin’s lymphoma is new or relapsed disease that does not respond to treatment.
Non-Hodgkin’s Lymphoma Risk Factors
Anything that increases your chance of getting non-Hodgkin’s lymphoma is a risk factor. Although scientists don’t know yet what causes non-Hodgkin’s lymphoma, some factors seem to make you more likely to develop non-Hodgkin’s lymphoma. These include:
- Gender: Non-Hodgkin’s lymphoma is slightly more common in men
- Race: Non-Hodgkin’s lymphoma is slightly more common in Caucasians
- Living in a farming community. Some studies suggest that certain herbicides and pesticides may play a part in lymphoma, but this has not been proven
- Bacteria or viruses, including human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), human T-lymphotropic virus (HTLV) and the bacterium Helicobacter pylori
- Inherited syndromes
Not everyone with risk factors gets non-Hodgkin’s lymphoma. However, if you have risk factors, you should discuss them with your doctor.
In rare cases, non-Hodgkin's lymphoma can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
Non-Hodgkin’s lymphoma symptoms vary from person to person. They may include:
- Painless swelling of lymph nodes in the neck, groin or underarm
- Heavy night sweats
- Weight loss without a known reason
- Severe itchiness
- Reddened patches on the skin
- Nausea, vomiting or abdominal pain
- Coughing or shortness of breath
- Headaches, concentration problems, personality changes
Symptoms of non-Hodgkin’s lymphoma also often differ by the type of disease. Low-grade (indolent) non-Hodgkin’s lymphoma develops slowly. Patients may have painless swelling of lymph nodes (usually in the neck or over the collarbone) but appear healthy otherwise. The swelling may go away for a while and then return. If low-grade non-Hodgkin’s lymphoma spreads outside the lymph nodes, there may be discomfort in the affected area.
Aggressive non-Hodgkin’s lymphoma grows quicker and tends to have more symptoms than low-grade non-Hodgkin’s lymphoma. Symptoms may include:
- Pain in neck, arms or abdomen
- Fever and/or night sweats
- Unexplained weight loss
- Shortness of breath
- Weakness in arms and/or legs
These symptoms do not always mean you have non-Hodgkin’s lymphoma. However, it is important to discuss any symptoms with your doctor, since they may also signal other health problems.
Accurate and precise diagnosis of non-Hodgkin's lymphoma helps doctors choose the best course of action specifically for you. It plays a big part in your chances for successful treatment.
At MD Anderson, our group of experts is among the most experienced and skilled in the nation in diagnosing non-Hodgkin's lymphoma. In fact, we are one of the few cancer centers that include hemopathologists, specialized doctors who focus on lymphoma and myeloma, on your care team. With a high level of expertise, they use the most modern equipment to find out the precise extent of disease. This can make a huge difference in accurate diagnosis and successful treatment.
Non-Hodgkin's Lymphoma Diagnostic Tests
If you have symptoms that may signal non-Hodgkin's lymphoma, your doctor will examine you and ask you questions about your health and your medical history. One or more of the following tests may be used to find out if you have cancer and if it has spread. These tests also may be used to find out if treatment is working.
- Lymph node biopsy: A small piece of tissue is removed from a lymph node and looked at under a microscope. Sometimes the entire node is removed.
- Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- Blood tests: To determine if blood cells are normal in number and appearance and if blood chemistry is normal. If you have been diagnosed with non-Hodgkin's lymphoma, certain blood tests may help doctors determine your outlook.
- Bone marrow aspiration and biopsy
- Liver and kidney function tests
- Echocardiogram: To evaluate the size and function of the heart.
- Immunophenotyping: Cells from a lymph node, blood or bone marrow are examined with a microscope to determine what type of non-Hodgkin's lymphoma cells are present.
- Pulmonary function test: Finds out how well the lungs function.
Non-Hodgkin's Lymphoma Staging
If you are diagnosed with non-Hodgkin’s lymphoma, your doctor will determine the stage (or extent) of the disease. Staging is a way of classifying how much disease is in the body and where it has spread when it is diagnosed. This information helps your doctor decide on the best type of treatment. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.
Non-Hodgkin's Lymphoma Stages
(source: National Cancer Institute)
Stage 1 (early stage): One lymph node region is involved. If the cancer is in one organ outside the lymph node such as the skin, lung, brain, etc., this is called extension, or E non-Hodgkin’s lymphoma.
Stage 2 (locally advanced disease): The cancer is in two or more lymph regions on one side of the diaphragm. If the cancer is in one lymph node region plus a nearby area or organ, it is considered E disease.
Stage 3 (advanced disease): Non-Hodgkin’s lymphoma involves lymph nodes above and below the diaphragm or one node area and one organ on opposite sides of the diaphragm.
Stage 4 (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. A means the patient does not have symptoms including fever, drenching sweats or unexplained weight loss. When patients have any of these symptoms, the non-Hodgkin’s lymphoma is classified as B.
MD Anderson is committed to helping people with non-Hodgkin’s lymphoma live longer, healthier lives – and we’re making great strides toward advanced therapies with less impact on your body.
For instance, we were instrumental in the pivotal clinical trial for Rituxan® (rituximab), one of the biggest developments in lymphoma treatment over the past decade. And we helped discover a way to vaccinate follicular lymphoma patients with proteins from their tumors, causing their immune systems to attack the cancer cells.
We have found the most successful way to treat indolent (slow-growing) Non-Hodgkin’s lymphoma often is with highly focused chemotherapy that has less impact on your body. Instead of using intense chemotherapy in an attempt to cure non-Hodgkin’s lymphoma totally, the most successful approach often is to treat non-Hodgkin’s lymphoma so it goes into remission for extended periods.
Treatment for Non-Hodgkin’s Lymphoma
If you are diagnosed with non-Hodgkin’s lymphoma, your doctor will discuss the best options to treat it. This depends on several factors, including:
- Type of lymphoma
- Stage and category of disease
- Your age and general health
Your treatment for non-Hodgkin’s lymphoma cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
This is the treatment most often used for non-Hodgkin’s lymphoma. And since chemotherapy may lower certain types of blood cells, a transfusion of a type of drug called blood cell growth factors may be needed. Liposomal drug delivery is an advanced way of giving chemotherapy that may help it be more effective.
Radiation therapy may be used in early-stage lymphoma or to help symptoms such as pain. It is seldom the only treatment given.
The Proton Therapy Center at MD Anderson is one of the largest and most advanced centers in the world. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.
Proton therapy delivers high radiation doses directly to the tumor site, with no damage to nearby healthy tissue. For some patients, this therapy results in better cancer control with fewer side effects.
Immunotherapy for Non-Hodgkin’s lymphoma may include:
- Monoclonal antibodies, including Rituxan®
- Biological therapies that develop antibodies to help the body fight the cancer
- Proteasome inhibitors, such as Velcade®
- Immune modulators, such as thalidomide and lenalidomide, that modify the environment of the tumor cell and allow it to die
- Targeted therapies that attack cancer cells by using small molecules to block pathways cells used to survive and multiply
- Small molecule treatments such as panobinostat
- Cytokine therapies
- Interferon is made by the body to help fight infection. Sometimes interferon that has been made in the laboratory is given to patients with non-Hodgkin’s lymphoma.
Stem cell transplantation: If non-Hodgkin’s lymphoma does not respond to chemotherapy or if it returns, your doctor may recommend a stem cell transplant. Also, since chemotherapy often destroys healthy cells in the blood and bone marrow, patients who have certain types of chemotherapy may need stem cell transplants.
Radioimmunotherapy pairs a monoclonal antibody to a radioactive substance to target cancer cells.
Watchful waiting: This approach involves closely monitoring non-Hodgkin’s lymphoma without active treatment.
Why choose MD Anderson for non-Hodgkin's lymphoma care?
At MD Anderson's Lymphoma and Myeloma Center, our goal is to treat non-Hodgkin's lymphoma with methods that are strong on the disease, but as gentle as possible on your body.
Drawing upon a wide range of treatments for every stage of disease, as well as clinical trials of new and novel agents, our physicians design a treatment plan that is uniquely yours. We're constantly working to bring new treatments to patients, including targeted biological agents that help your body fight the cancer.
While some patients with non-Hodgkin's lymphoma can be successfully treated, for many the most effective course is to keep knocking back the disease over a period of many years. In these cases, personalized long-term care is especially important. Our teams of specialized physicians, as well as support staff including nurses, physician assistants, dietitians, social workers and many others, work closely together – and with you – to give you higher chance for successful treatment.
MD Anderson has helped advance the treatment of non-Hodgkin's lymphoma in many areas, including development of new, leading-edge treatments. Our doctors recently pioneered Rituxan®, a vaccine that helps the body fight lymphoma. And we continue to research ways to improve your health and quality of life.
At MD Anderson's Lymphoma and Myeloma Center, you benefit from one of the most active research programs in the United States, which includes a prestigious federally funded SPORE (Specialized Program of Research Excellence) program. This means we are able to offer a wide range of clinical trials (research studies) for every type and stage of non-Hodgkin's lymphoma.
Life is beautiful. I am drinking it all in and savoring every little sip.
B-Cell Lymphoma Moon Shot
MD Anderson’s B-Cell Lymphoma Moon Shot™ aims to rapidly and dramatically improve treatment outcomes for Non-Hodgkin’s lymphoma patients through powerful new treatment approaches and research.Learn more about the B-Cell Lymphoma Moon Shot
If it hadn’t been for my mom, I might not be here today.
I thought I was in remission in the spring of 2008. I’d already completed six rounds of chemotherapy for T-cell lymphoma — a type of non-Hodgkin’s lymphoma — near my home in central Louisiana.
But my mother, a registered nurse, insisted I go to MD Anderson. She knew I might still need a stem cell transplant, and my local oncologist didn’t do those. She made an appointment for me at MD Anderson on March 24, 2008. I’m really glad now that I went.
Second opinion leads to non-Hodgkin’s lymphoma re-diagnosis
I met with Issa Khouri, M.D., that day. Thanks to the advanced technology MD Anderson uses, we discovered that I wasn't in remission after all. I still had tumors in my chest and kidneys.
Dr. Khouri recommended I start chemotherapy immediately, in preparation for an allogeneic stem cell transplant. I followed his advice and had my transplant on Aug. 7, 2008. My immune system is still recovering, but I’ve been cancer-free ever since.
What makes MD Anderson superior
I really liked my local oncologist, and I’m grateful to him for keeping me alive. But if I had to do it all over again, I’d go to MD Anderson first.
From the moment I arrived here, I was amazed. Every single employee I encountered was professional and polite. And the sheer number of cancer patients that they treat on a daily basis gives them an advantage over smaller facilities.
But the quality of care I received at MD Anderson is what really separates it from other hospitals. The technology and treatment plans are advanced, extensive and impressive. And there’s a specialist for nearly every complication a patient could run into.
Amenities make the difference
MD Anderson provides so many things that made my visits comfortable, too.
Just the services offered (in-house pharmacies, physical therapy, religious facilities, eateries, coffee shops, libraries, care training, etc.) show that MD Anderson has thought of every possible aspect of dealing with cancer. I used The Learning Center a few times myself to do research.
The hospital rooms are spacious and comfortable. Meal quality far exceeds any hospital I’ve ever been in. And having the Rotary House right next door is such a plus. It’s so nice to be able to wake up and just take a shuttle to your appointments, instead of having to fight Houston traffic.
If any of my loved ones had cancer today, I would encourage them to go straight to Houston. MD Anderson is the “big guns.” They know what they are doing, and I’m so glad my mother sent me their way.
That old saying about mothers always being right is true. I’m so glad that I listened to mine.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.