Non-Hodgkin Lymphoma

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What you need to know about Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma (NHL) is a type of cancer that starts in the lymphatic system, which is part of the body’s immune system. It happens when lymphocytes, a type of white blood cell that fights infection, grow abnormally. Unlike Hodgkin lymphoma, which has a specific kind of cell called Reed-Sternberg cells, NHL includes many different types of lymphomas that can act and respond to treatment in very different ways.

Types

NHL includes a wide variety of subtypes, generally divided into B-cell lymphomas and T-cell lymphomas.

B-Cell Lymphomas:

Diffuse Large B-Cell Lymphoma (DLBCL): The most common type, aggressive but often treatable.
Follicular Lymphoma: Slow-growing, often indolent but can transform into a more aggressive form.
Mantle Cell Lymphoma: Rare and aggressive, often diagnosed at an advanced stage.
Burkitt Lymphoma: Highly aggressive, associated with EBV infection in endemic areas.
Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL): Slow-growing, often treated as chronic disease.

T-Cell Lymphomas:

Peripheral T-Cell Lymphoma (PTCL): A diverse group, generally aggressive.
Cutaneous T-Cell Lymphoma (CTCL): Includes mycosis fungoides and Sezary syndrome, often presenting with skin involvement.
Anaplastic Large Cell Lymphoma (ALCL): Can be cutaneous or systemic, with varying aggressiveness.

Causes

Weakened immune system: Conditions like HIV/AIDS, organ transplants, or immunosuppressive therapy.
Infections: Certain infections increase the risk, such as Epstein-Barr virus (EBV) and Helicobacter pylori.
Chemical exposure: Pesticides, herbicides, and certain industrial chemicals.
Age: More common in older adults.
Gender: Some types are more common in men.
Family history: Increased risk if there is a family history of NHL or other lymphomas.
Autoimmune diseases: Conditions like rheumatoid arthritis or lupus.

Symptoms

Swollen lymph nodes (painless, in neck, armpits, or groin)

Fever
Night sweats
Unexplained weight loss
Fatigue
Abdominal pain or swelling
Chest pain, coughing, or difficulty breathing (if lymph nodes in the chest are affected)
Itchy skin or skin rash (particularly in cutaneous T-cell lymphomas)

Diagnosis

Physical Examination: Checking for swollen lymph nodes or other physical signs.
Blood Tests: To check for abnormalities in blood cell counts and to assess overall health.
Imaging Tests: CT scans, PET scans, or MRI to identify the location and size of lymphomas.
Biopsy: Removing a sample of lymph node tissue or other affected tissue for examination under a microscope.
Bone Marrow Aspiration/Biopsy: To check if the lymphoma has spread to the bone marrow.
Lumbar Puncture: In some cases, to check for lymphoma cells in the cerebrospinal fluid.

Treatment

Treatment options depend on the type, stage, and aggressiveness of the lymphoma, as well as the patient’s overall health.

Chemotherapy: Often the first line of treatment, using drugs to kill cancer cells.
Radiation Therapy: Using high-energy rays to target and kill cancer cells.
Targeted Therapy: Drugs that specifically target cancer cells, such as monoclonal antibodies (e.g., rituximab).
Immunotherapy: Treatments that enhance the immune system’s ability to fight cancer, including checkpoint inhibitors and CAR T-cell therapy.
Stem Cell Transplant: Replacing diseased bone marrow with healthy stem cells, usually after high-dose chemotherapy.
Surgery: Rarely used, but may be an option for certain localized lymphomas.

Prognosis

The prognosis for NHL varies widely based on several factors:

Subtype: Some types, like follicular lymphoma, tend to be indolent with long survival times, while others like DLBCL are aggressive but potentially curable.
Stage at Diagnosis: Early-stage lymphomas generally have a better prognosis.
Patient’s Age and Health: Younger patients and those in good health generally fare better.
Response to Treatment: How well the cancer responds to initial treatment.

Prevention

There are no guaranteed ways to prevent NHL, but reducing known risk factors can help:

Avoiding Exposure to Certain Chemicals: Limiting contact with pesticides and industrial chemicals.
Healthy Lifestyle: Maintaining a healthy immune system through a balanced diet, regular exercise, and avoiding smoking.
Managing Infections: Prompt treatment of infections that could increase risk, such as Helicobacter pylori.
Monitoring for Symptoms: Early detection and monitoring for those at higher risk due to family history or other factors.

Survival rates

Survival rates for NHL vary by subtype and other factors. The 5-year survival rate for all types of NHL combined is approximately 73%. However, this can range widely:

Indolent Lymphomas (e.g., Follicular Lymphoma): Higher survival rates, often above 80%.
Aggressive Lymphomas (e.g., DLBCL): 5-year survival rate around 60-70%, but potentially curable in many cases.
Highly Aggressive Lymphomas (e.g., Burkitt Lymphoma): Rapid treatment can lead to high cure rates.

These rates are general estimates and can vary based on individual circumstances and advancements in treatment options.