Adult Non-Hodgkin's Lymphoma
Lymphomas are cancers of the lymphatic system. The lymphatic system drains excess fluid from the tissues. It also helps protect against infections.
Non-Hodgkin’s lymphoma is a general name. It applies to many types of lymphomas. There are several different types of non-Hodgkin’s lymphoma. They are based on the cell type that is involved and the patterns of growth. Treatment will vary according to type.
In general, these different types can be divided into two main groups:
- Indolent (or slow growing) lymphomas
- Aggressive lymphomas
These cancers are different from Hodgkin’s lymphoma]]> .
The Lymphatic System
Cancer occurs when cells in the body divide out of control or order. If cells keep dividing, a mass of tissue forms. These are called growths or tumors. If the tumor is malignant, it is cancer. They can invade nearby tissue and spread to other parts of the body.
The cause of non-Hodgkin’s lymphoma is unknown. Mutations in DNA that occur after birth may be related to this cancer. These mutations can occur as a result of exposure to radiation or cancer causing chemicals. It may also occur with age or for no apparent reason.
Most people who develop non-Hodgkin’s lymphoma have no known risk factors, but the following factors may increase your chance of developing this condition:
- Sex: male
- Age: 60 to 70 years old
- Frequent and accumulating exposure to certain types of chemicals (herbicides, pesticides, benzene)
- Infections involving the immune system, such as HIV/AIDS]]> and Epstein-Barr virus
- History of ]]>chemotherapy]]> or ]]>radiation therapy]]>
- Chromosomal translocations (DNA breaks off one chromosome and becomes attached to another)
- ]]>Celiac disease]]> (gluten enteropathy or gluten intolerance)
- Painless swelling of the neck, underarm, groin, or any other lymph node bearing regions of the body
- Unexplained fever
- Profuse sweating
- Constant fatigue
- Unexplained weight loss
- Itchy skin, especially on the legs and feet
- Reddened patches on the skin
- Chest pain or shortness of breath
Your doctor will ask about your symptoms and medical history. A physical exam will be done. It will include an exam of your lymph nodes. Most enlarged or swollen lymph nodes result from an infection. If infection is suspected, you may be given medication and told to return.
Lymph Nodes in the Head and Neck
If swelling persists, your doctor may order more tests. They will help to determine whether there is cancer and what type of cancer is present.
Tests may include the following:
- Excisional or incisional biopsy]]> —all of a lymph node (excisional) or part of the tumor (incisional) is removed to be examined in the lab to look for cancer
- ]]>Fine needle aspiration (FNA) biopsy]]> —a sample of tissue is removed from the tumor with a needle so it can be examined in the lab to look for cancer
- ]]>Bone marrow aspiration and biopsy]]> —a small amount of bone marrow (aspiration) and bone are removed so it can be examined; often used to determine the extent of lymphoma
- ]]>Spinal tap]]> —A small amount of cerebrospinal fluid is removed and examined; this test is often used to determine the extent of lymphoma
- Immunohistochemistry—antibodies are used to distinguish between different types of non-Hodgkin’s lymphomas
- Flow cytometry—Biopsy samples are treated with fluorescent antibodies and exposed to a laser beam to determine the cause of lymph node swelling and/or determine the exact type of non-Hodgkin’s lymphoma
- Cytogenetics and/or molecular genetic studies—DNA in a lymphoma cell is examined for abnormalities
- Blood tests—to help determine the advancement of the lymphoma
- ]]>Chest x-ray]]> —takes a picture of structures inside the chest to look for enlarged lymph nodes
- ]]>Computed tomography (CT) scan]]> —makes pictures of structures inside the body to look for lymphomas in the abdomen, head, pelvic, chest, and neck
- ]]>Magnetic resonance imaging (MRI) scan]]> —uses magnetic waves to make pictures of structures inside the brain and spinal cord
- ]]>Positron emission tomography (PET) scan]]> —radioactive solution is injected into a vein so a special camera can look for lymphoma throughout your body and/or determine if an enlarge lymph node contains lymphoma
- Gallium scan—a radioactive solution is injected into a vein so a special camera can look for non-Hodgkin’s lymphoma in bones and other organs; this test is useful in finding tumors that may be missed by a PET scan
- ]]>Bone scan]]> —a radioactive solution is injected and travels to damaged parts of the bone
- ]]>Ultrasound]]> —uses sound waves to examine internal organs and find masses
Treatments depend on the stage of the cancer and its type. The type is determined in part by microscopic exam and other studies. Talk with your doctor about the best plan for you. Treatment options include:
For some indolent lymphomas, no treatment may be needed for some time. Treatment is needed if the tumor begins to cause symptoms such as:
- Weight loss
- Night sweats
- Impaired organ function because of involvement with lymphoma
Chemotherapy]]> involves the use of drugs to kill cancer cells. It may be given in many forms. This may include pills, injection, and via a catheter. The drugs enter the bloodstream. It travels through the body. It will kill mostly cancer cells. Some healthy cells may also be killed.
External Radiation Therapy
]]>Radiation]]> is directed at the tumor from a source outside the body to kill the cancer cells.
Bone Marrow Transplantation
A patient may use their own bone marrow. In this case, ]]>bone marrow]]> is removed, treated, and frozen. Large doses of chemotherapy and/or radiation therapy are then applied to kill the cancer cells. After treatment, the bone marrow is replaced via a vein.
Marrow may also be donated from a healthy donor.
Peripheral Stem Cell Transplantation
Stem cells are very immature cells that produce blood cells. They are removed from circulating blood before chemotherapy or radiation treatment. These cells are then replaced after treatment. The cells can then develop new healthy cells.
These medications or substances are made by the body. They increase or restore the body’s natural defenses against cancer.
One type of biological therapy, interferons, interferes with the division of cancer cells and can slow tumor growth. Interferons are produced by the body. They can also be made in the lab to treat cancer and other diseases.
Sometimes a drug or antibody that is directed at the lymphoma is linked to a radioactive substance. It will deliver a focused dose of radiation to the tumor.
There are no guidelines for preventing non-Hodgkin’s lymphoma. To reduce your risk, avoid exposure to chemicals such as herbicides, pesticides, and benzene. If you have celiac disease]]> (gluten intolerance), maintain your gluten-free diet. This diet will minimize the stimulation of your immune system by exposure to gluten.
American Cancer Society
Leukemia and Lymphoma Society
National Cancer Institute
Canadian Cancer Society
Lymphoma Foundation Canada
Detailed guide: lymphoma, non-Hodgkin’s type. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=32 . Accessed November 10, 2005.
Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005.
Non-Hodgkin's lymphoma. National Cancer Institute website. Available at: http://www.cancer.gov/ . Updated 2009. Accessed July 20, 2009.
Last reviewed October 2009 by ]]>Igor Puzanov, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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