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Non-Hodgkin lymphoma



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What is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma is a type of lymphoma, a cancer that begins in the lymphatic system. The lymphatic system is an important part of the immune system and includes the various lymph glands around the body. Non-Hodgkin lymphoma most commonly occurs in a lymph node but it can also occur in the liver, spleen, stomach or bones. There are more than 60 sub-types of non-Hodgkin lymphoma and they vary in how fast they grow and spread, and how sick people feel

There are two classifications of non-Hodgkin lymphoma: B-cell lymphomas which account for around 80% of lymphomas, and T-cell lymphomas: 

B-cell lymphomas

Follicular lymphoma - cancer cells grow slowly in lymph nodes in circular groups at the microscopic level, called follicles

Diffuse large B-cell lymphoma - a fast-growing cancer and one of the commonest subtypes in adults

Small lymphocytic lymphoma - a slow-growing cancer = similar to chronic lymphocytic leukaemia

Mantle cell lymphoma - develops in the outer edge (mantle zones) of affected growth centres in lymph glands. Uncommon and not curable at present but with modern treatment, most people have very long periods not requiring treatment

T-cell lymphomas (generally, these are harder to cure)

Peripheral T-cell lymphoma - a rare type of lymphoma that often occurs as widespread enlarged, painless lymph nodes in the neck, armpit or groin

Precursor T-lymphoblastic lymphoma - starts in immature (precursor) T-cells in the lymph nodes

Cutaneous T lymphoma - cell primarily affects the skin and starts as red, scaly patches or raised bumps that can be itchy; this includes a type called "mycosis Fungoides".

In 2013, 4978 people were diagnosed with non-Hodgkin lymphoma in Australia.

In 2014, 1504 people in Australia died from non-Hodgkin lymphoma. 


Non-Hodgkin lymphoma symptoms

  • painless swelling of a lymph node
  • unexplained fevers
  • excessive sweating, especially at night
  • loss of appetite
  • unexplained weight loss
  • fatigue
  • itchy skin.

Causes of non-Hodgkin lymphoma

Most lymphomas are not associated with any known risk factors. Some factors that can increase your risk of non-Hodgkin lymphoma include:

  • certain infections such as Human T-lymphoma virus 1, Epstein-Barr virus infection and human herpesvirus 8
  • immune system deficiency where the immune system is weakened in people with HIV or taking immunosuppressants or autoimmune diseases
  • age – most cases occur in adults over the age of 60.

In the vast majority of individual cases, however, no specific cause can be identified. Lymphoma is not infectious to partners or any one else, and does not run in families.

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Diagnosis for non-Hodgkin lymphoma

There are a number of tests to diagnose non-Hodgkin lymphoma. Your GP may initially give you a physical examination to check for swelling in your lymph nodes.

Biopsy

The swollen lymph node, or part of it, will be removed and examined under a microscope to check for any cell abnormalities. A needle biopsy is easier but less accurate and miss a diagnosis; therefore an "open biopsy" to remove a bit of the affected lymph gland is much more likely to provide an accurate diagnosis.

Further tests

If the results of your biopsy indicate that you have non-Hodgkin lymphoma, you may have further tests to see how far the cancer has spread. Additional tests can include:

  • blood tests (there is no direct blood test for lymphoma)
  • bone marrow biopsy
  • imaging tests such as CT, PET and MRI scans and ultrasound
  • lumbar puncture also known as spinal tap.

The two important questions when a diagnosis of lymphoma is made are:

  • what exact subtype is it (as treatment varies)?
  • how far has it spread in the body (stage)?  

Treatment for non-Hodgkin lymphoma

Treatment will usually depend on the type of non-Hodgkin lymphoma you have, how far it has spread and your age and overall health. 

Staging

The results of further tests after a biopsy will indicate the stage of the lymphoma. Staging describes the size and extent of spread of the cancer. This will help your doctors and you to decide on the best treatment options for you.

Watchful waiting

If you are diagnosed with a slow growing lymphoma (low-grade), your doctor may recommend regular check-ups to monitor the cancer rather immediate treatment.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or slow their growth. It can be combined with other treatments such as monoclonal antibody therapy or steroid therapy. Chemotherapy is the main treatment for more aggressive non-Hodgkin lymphomas (high-grade) and is usually given in cycles over about 3-4 months. Most people can't keep working, especially in physical jobs, during this time.

Radiotherapy

Radiotherapy uses X-rays to kill or injure cancer cells and is generally used in early stage (I or II) of non-Hodgkin lymphoma. In more advanced lymphomas, a combination of radiotherapy and chemotherapy is usually used.

Blood stem cell transplant

Your doctor may recommend a stem cell transplant if there is a risk of the cancer returning, if the cancer has returned or if you have not responded to other forms of treatment.

Treatment team

Depending on the treatment you receive, you may see a number of different health professionals including:

  • a GP
  • a haematologist who diagnoses and treats diseases of the lymphatic system, blood and bone marrow
  • a radiation oncologist who coordinates the course of radiotherapy
  • a medical oncologist who prescribes the course of chemotherapy
  • nurses
  • other allied health professionals such as a pharmacist, social worker, occupational therapist and dietitian.

Palliative care

In some cases of non-Hodgkin lymphoma, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer without aiming to cure the disease.

As well as slowing the spread of non-Hodgkin lymphoma, palliative treatment can relive pain and help to manage other symptoms. Treatment may include chemotherapy, radiotherapy or other drug therapies.

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Screening for non-Hodgkin lymphoma

There is currently no screening test for non-Hodgkin lymphoma. 


Prognosis for non-Hodgkin lymphoma

Prognosis refers to the expected outcome of a disease. It is not possible for your doctors to predict the exact course of the disease but you may want to discuss its progress and treatment options. In general the B-cell non-Hodgkin lymphomas have a higher chance of cure, but for just about every type of non-Hodgkin lymphoma, even if it can't be cured it can generally be controlled for many years, with bursts of treatment when required. Your doctor will be able to advise you on issues that people affected by the same type of non-Hodgkin lymphoma experience. 


Preventing for non-Hodgkin lymphoma

There are no proven measures to prevent non-Hodgkin lymphoma although people with a weakened immune system, an HIV infection or Epstein-Barr virus have an increased risk of developing the disease. 


Source

Understanding Non-Hodgkin Lymphoma, Cancer Council NSW, ©2015. Last medical review of this booklet: December 2015.

Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW.

Australian Institute of Health and Welfare (AIHW) 2017. Cancer in Australia 2017. Cancer series no. 101. Cat. no. CAN 100. Canberra: AIHW. 

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For more information

For support and information on cancer and cancer-related issues, call Cancer Council 13 11 20 (cost of a local call). This is a confidential service.

Booklets

Includes additional information on treatment, making decisions around treatment and managing side effects of non-Hodgkin lymphoma treatment.

Also included, detailed information on looking after yourself during and after treatment, and links to both professional and community support. 

How you can help

You can support Cancer Council by:

  • volunteering your time
  • participating in an event or
  • making a donation to help fund our cancer research, education and support services.

This page was last updated on: Tuesday, July 11, 2017