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 85% of lymphomas, and T-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 2016, 5315 people were diagnosed with non-Hodgkin lymphoma in Australia.
In 2018 there were 1585 deaths caused by non-Hodgkin lymphoma in Australia.
Non-Hodgkin lymphoma symptoms
painless swelling of a lymph node
excessive sweating, especially at night
loss of appetite
unexplained weight loss
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 anyone else, and does not run in families.
Diagnosis of 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.
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 may 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.
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 to check you liver and kidney function (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, your age and overall health.
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.
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 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.
Radiation therapy (radiotherapy)
Radiation therapy 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 radiation therapy 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.
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.
Treatment TeamDepending on your treatment, your treatment team may consist of a number of different health professionals, such as:
- GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
- Haematologist- specialises in diagnosing and treating diseases of the blood and lymphatic system.
- Radiation oncologist- prescribes and coordinates radiation therapy treatment.
- Medical oncologist- prescribes and coordinates the course of chemotherapy.
- Cancer nurses- assist with treatment and provide information and support throughout your treatment.
- Other allied health professionals- such as social workers, pharmacists and counsellors.
Screening for non-Hodgkin lymphoma
There is currently no national screening program for non-Hodgkin lymphoma.
Preventing 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.
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.
Understanding Non-Hodgkin Lymphoma, Cancer Council NSW, © 2019. Last medical review of source booklet: November 2019.
Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW.
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