Non-Hodgkin lymphoma (NHL) of the blood and lymph system is a type of cancer that affects the lymphocytes, a type of white blood cell, and can affect the lymph nodes, bone marrow, spleen, and other organs. NHL can be classified into various subtypes based on the type of lymphocyte affected, the rate of cell growth, and other factors.
Causes and Risk Factors
The actual cause of Non-Hodgkin lymphoma (NHL) of the blood and lymph system is unknown, but certain risk factors may increase the likelihood of developing the disease. These risk factors include –
- Age – NHL is more common in older adults.
- Weakened immune system – People with a weakened immune system, such as those who have undergone an organ transplant or have HIV/AIDS, are at an increased risk.
- Infections – Certain infections, such as the Epstein-Barr virus, hepatitis C virus, and human T-cell leukemia/lymphoma virus type 1 (HTLV-1), can increase the risk of NHL.
- Family history – Having a first-degree relative with NHL or another lymphoma increases the risk.
Exposure to certain chemicals or radiation – Exposure to certain chemicals, such as pesticides and solvents, and radiation, such as radiation therapy, can increase the risk of NHL.
Autoimmune diseases – Certain autoimmune diseases, such as rheumatoid arthritis and Sjögren’s syndrome, are associated with an increased risk of NHL.
Having one or more risk factors doesn’t mean that a person will develop NHL, and also many people with NHL may notice no identifiable risk factors.
The symptoms of Non-Hodgkin lymphoma (NHL) of the blood and lymph system can vary depending on the type and stage of the disease. Some people may experience no symptoms at all, while others may have one or more of the following –
- Enlarged lymph nodes -The most common symptom of NHL is painless swelling of one or more lymph nodes, usually in the neck, armpit, or groin.
- Fever – Persistent, unexplained fever may be a symptom of NHL.
- Night sweats – Profuse sweating, especially at night, may be a symptom of NHL.
- Weight loss – Unexplained weight loss of 10% or more of body weight over a six-month period may be a symptom of NHL.
- Fatigue – Excessive fatigue or weakness that does not improve with rest may be a symptom of NHL.
- Abdominal pain or swelling – Swelling of the abdomen or pain in the abdomen may be a symptom of NHL affecting the lymph nodes in the abdomen.
- Chest pain or coughing – NHL that affects the lymph nodes in the chest may cause chest pain, coughing, or difficulty breathing.
These symptoms can also be caused by other conditions, so it’s important to see a doctor for proper individualized diagnosis and treatment.
Diagnosis and Tests
Diagnosis of Non-Hodgkin lymphoma (NHL) of the blood and lymph system typically involves a combination of tests and procedures. These may include –
- Physical exam – A doctor will perform a physical exam to check for enlarged lymph nodes, liver, and spleen.
- Blood tests – Blood tests can help detect abnormal levels of white blood cells and identify other abnormalities in the blood.
- Imaging tests – Imaging tests, such as CT scans, PET scans, and MRI scans, can help detect enlarged lymph nodes and identify the extent and location of NHL.
- Biopsy – A biopsy is the definitive way to diagnose NHL. In this procedure, a small piece of tissue or an entire lymph node is removed for examination under a microscope.
- Bone marrow biopsy – If NHL is suspected, a bone marrow biopsy may be done to determine if the cancer has spread to the bone marrow.
- Lymph node biopsy – A biopsy of an affected lymph node can help identify the type of NHL.
- Flow cytometry – Flow cytometry is a laboratory test that analyzes cells in a sample of blood or bone marrow to determine the type of lymphoma.
Once the diagnosis of NHL has been confirmed, further tests may be done to determine the stage of the cancer and whether it has spread to other parts of the body. This information is used to help determine the best treatment plan.
The staging system commonly used for NHL is the Ann Arbor staging system, which is as follows –
- Stage I – The cancer is localized to one lymph node region or one extranodal site.
- Stage II – The cancer involves more than one lymph node region on the same side of the diaphragm or one lymph node region and one extranodal site on the same side of the diaphragm.
- Stage III – The cancer involves lymph node regions on both sides of the diaphragm.
- Stage IV – The cancer has spread beyond the lymph nodes to other organs or tissues, such as the bone marrow, liver, or lungs.
In addition to the stage, NHL is also classified based on its histology, which refers to the specific type of cancer cells involved. Histology can help guide treatment decisions and predict the outlook for the patient. The most common types of NHL include diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, and marginal zone lymphoma, among others.
The treatment of Non-Hodgkin lymphoma (NHL) of the blood and lymph system depends on several factors, including the type and stage of cancer, the age and overall health of the patient, and the patient’s preferences. The main treatments for NHL include –
- Chemotherapy – Chemotherapy is the most common treatment for NHL. It involves using drugs to kill cancer cells.
- Radiation therapy – Radiation therapy uses high-energy radiation to kill cancer cells. It may be used alone or in combination with chemotherapy.
- Immunotherapy – Immunotherapy uses drugs to help the immune system recognize and attack cancer cells.
- Targeted therapy – Targeted therapy uses drugs that specifically target cancer cells.
- Stem cell transplant – A stem cell transplant involves replacing the patient’s diseased bone marrow with healthy stem cells.
The choice of treatment depends on the type and stage of the NHL, as well as the patient’s overall health and preferences. In some cases, a combination of treatments may be used. Treatment is often very effective, and many people with NHL are able to achieve remission or even a cure.
The outlook for Non-Hodgkin lymphoma (NHL) of the blood and lymph system depends on several factors, including the type and stage of the cancer, the age and overall health of the patient, and how well the cancer responds to treatment. Generally, NHL is a treatable cancer, and the prognosis has improved significantly in recent years due to advances in treatment.
Some forms of NHL, such as indolent lymphomas, may grow slowly and not require immediate treatment, allowing patients to live for many years with a good quality of life. Other forms of NHL, such as aggressive lymphomas, may require intensive treatment and may have a poorer prognosis. Overall, the five-year survival rate for NHL is about 72%, but this varies widely depending on the specific type and stage of cancer.
It’s important for patients with NHL to work closely with their medical team to develop a personalized treatment plan and to stay on top of follow-up care and monitoring to ensure the best possible outcome.