lymphoma (NHL) is cancer of the
lymphatic system, which is part of the
immune system. The lymphatic system is found
throughout the body. When you have this disease, cells in the lymphatic system
either grow without control or do not die as cells normally do.
There are many types of NHL. Sometimes they are grouped as:
Non-Hodgkin's lymphoma is different from
NHL can start almost
anywhere in the body. It may start in a single
lymph node, a group of lymph nodes, or an organ such
spleen. NHL can spread to almost any part of the body,
including the liver and
Treatment can cure some
people and may allow others to live for years. How long you live depends on the
type of NHL you have and how early it’s diagnosed.
The cause of
NHL is not known. The abnormal cell changes may be triggered by an infection or
exposure to something in the environment. It is not contagious.
Symptoms of NHL
doctor will do a physical exam and ask you questions about your health. The
exam includes checking the size of your lymph nodes in your neck, underarm, and
Your doctor will take a piece of body tissue (biopsy) to diagnose NHL. The tissue usually is taken
from a lymph node. Your doctor also may do other test, including tests to see
what kind of NHL you have.
Your treatment depends on the
type of lymphoma you have, the stage of the disease, your age, and your general
health. You may not need treatment until you have symptoms. The treatment
When you have
cancer, you may feel confused, alone, and scared. Your loved ones may feel this
way too. You are not alone. Others are facing the same struggles, and they know
what you are going through. Many of them are feeling the same way.
To help yourself:
If your emotions are too much to handle, be sure to tell
your doctor. You may be able to get counseling or other types of help.
Learning about non-Hodgkin's lymphoma:
Living with non-Hodgkin's lymphoma:
Health Tools help you make wise health decisions or take action to improve your health.
The cause of
non-Hodgkin's lymphoma (NHL) is unknown. The incidence
of NHL has continued to increase over the years. When a person has
non-Hodgkin's lymphoma, abnormal rapid cell growth occurs. This abnormal growth
may need a "trigger" to start, such as an infection or exposure to something in
your environment. There is also a link between NHL and problems with the immune system. NHL is not contagious and is not caused by injury.1
non-Hodgkin's lymphoma (NHL) depend on the area of the
body affected by the disease. The most common symptom is a painless swelling of
lymph nodes in the neck, underarm, or groin. Other
symptoms may include:
non-Hodgkin's lymphoma (NHL), either abnormal cells in
lymphatic system divide and grow without order or
control or old cells do not die normally. Lymphatic tissue is present in many
areas of the body, so non-Hodgkin's lymphoma can start almost anywhere in the
Non-Hodgkin's lymphoma may occur in a single
lymph node, a group of lymph nodes, or an organ. And
it can spread to almost any part of the body, including the
bone marrow, and
spleen. Doctors classify NHL into
stages based on where the lymphoma is growing in the
Over time, lymphoma cells may replace the normal cells in
the bone marrow. Bone marrow failure results in the inability to produce red
blood cells that carry oxygen, white blood cells that fight infection, and
platelets that stop bleeding.
Long-term survival depends on the
type of non-Hodgkin's lymphoma and the stage of the disease when it is
diagnosed. Approximately 80 out of 100 people diagnosed with non-Hodgkin's
lymphoma are alive 1 year after the disease is diagnosed. That number drops to
about 65 out of 100 at 5 years and 54 out of 100 at 10 years.2
No one knows exactly what
increases your risk of getting
non-Hodgkin's lymphoma (NHL). Experts do agree that
the disease is not caused by injury and is not contagious. The following risk
factors may increase your chances of having the disease. But most people with
these risk factors do not ever have non-Hodgkin's lymphoma. And many people who
have non-Hodgkin's lymphoma do not have any of these risk factors.1
Call your doctor to schedule an
appointment if you have had any symptoms for longer than 2 weeks, such
Watchful waiting (surveillance) is a period
after the diagnosis of some types of non-Hodgkin's lymphoma (NHL) when you are not receiving treatment but are still being watched closely by your doctor. Watchful waiting is not appropriate for aggressive or
high-grade lymphoma. Watchful waiting does not mean that your doctor is giving
up or refusing to give you treatment. During this time you will:
Watchful waiting may be as effective as immediate
aggressive treatment for some types of NHL. But watchful waiting ends
when one of the following occurs:
Doctors who can help diagnose
non-Hodgkin's lymphoma (NHL) include:
When NHL is suspected, a tissue sample (biopsy) is needed to make a diagnosis. A biopsy for
non-Hodgkin's lymphoma is usually taken from a lymph node. But other tissues
may be sampled as well. A
surgeon will remove a sample of tissue so that a
pathologist can examine it under a microscope to check
for cancer cells.
Non-Hodgkin's lymphoma is usually treated by a
medical oncologist or a
hematologist. If you require radiation therapy, you
will also see a
To prepare for your appointment, see the topic Making the Most of Your Appointment.
non-Hodgkin's lymphoma (NHL) is suspected, your doctor
will ask about your medical history and perform a physical exam. This
exam includes checking for enlarged
lymph nodes in your neck, underarm, and groin.
A tissue sample (biopsy) is needed to make a diagnosis.
A biopsy for non-Hodgkin's lymphoma is usually taken from a
lymph node, but other tissues may be sampled as
bone marrow aspiration and biopsy is usually done to find
out if lymphoma cells are present in the bone marrow.
may also order other tests, including:
At this time, there are no special tests
recommended for early detection of non-Hodgkin's lymphoma. The best strategy
for early diagnosis is to see your doctor if you develop signs or symptoms of
Different types of treatment are
used for different types of
non-Hodgkin's lymphoma (NHL). Treatment of NHL depends
Treatment recommendations that
may be appropriate when you are first diagnosed with
non-Hodgkin's lymphoma include:
If you have recently been diagnosed with non-Hodgkin's
lymphoma, you may experience a lot of emotions. Most people experience
some denial, anger, and grief. Other people may have fewer emotions. There is
no "normal" or "right" way to react to a diagnosis of lymphoma. There are many
steps you can take to help with your emotional reactions. You may find that
talking with family and friends helps you with your emotions. Some people may
find that spending time alone is what they need.
If your reaction
is interfering with your ability to make decisions about your health, it is
important to talk with your doctor. Your cancer treatment center may offer
psychological or financial services. You may also contact your local chapter of
the American Cancer Society to help you find a support group. Talking with
other people who may have had similar feelings can be very helpful.
You may use
home treatment to help you manage the side effects that may happen with NHL
or its treatment.
Schedule regular follow-up
examinations with your doctor after you have been treated for
non-Hodgkin's lymphoma. Follow-up care is an important
part of the overall treatment plan. During regular follow-up care:
Report to your doctor any problems you have, as soon as
they appear. If you are having a problem, you may need to make some new
You may be
offered the following treatment options if your disease progresses:
Survival rates have improved
as a result of
clinical trials. Clinical trials provide evidence
about new medicines and treatments that may help people who have non-Hodgkin's
lymphoma live longer and have a better quality of life. If you are interested
in taking part in a clinical trial, check with your doctor to see if there are
any clinical trials available in your area.
Your doctor may use
the term "remission" instead of "cure" when talking about the effectiveness of
your treatment. Although many people with non-Hodgkin's lymphoma are
successfully treated, the term remission is used because cancer can return. It
is important to discuss with your doctor the possibility of recurrence.
Even after effective treatment for NHL, you may be at slightly higher
risk for other types of cancer, especially melanoma, lung, brain, kidney, and
bladder cancers. Be watchful for any symptoms of cancer.
information about specific treatments, see the following topics:
Non-Hodgkin's lymphoma can also occur in children and adolescents, but it is not very common. When children get NHL, it is not the same kind that is common in adults. Also, treatments for children and adolescents are different from treatments for adults.
For more information about treatments for children and adolescents, see the following topics:
There is no known way to prevent
non-Hodgkin's lymphoma (NHL). Most people with NHL do
not have known risk factors.
During treatment for any stage of
non-Hodgkin's lymphoma (NHL), you can use home
treatment to help manage the side effects that may accompany NHL or its
treatment. Home treatment may be all that is needed to manage the following
common problems. If your doctor has given you instructions or medicines to
treat these symptoms, be sure to follow them. In general, healthy habits such
as eating a balanced diet and getting enough sleep and exercise may help
control your symptoms.
Other issues that may arise include:
Many people with lymphoma face emotional issues because of
their disease or its treatment.
Not all forms of cancer or cancer treatment cause pain. If
pain occurs, many treatments are available to relieve it. If your doctor has
given you instructions or medicines to treat pain, be sure to follow them. You
home treatment for pain to improve your physical and mental well-being. Be
sure to discuss with your doctor any home treatment you use for pain.
Your doctor may prescribe medicines that
will affect the growth of
non-Hodgkin's lymphoma and relieve your symptoms.
Treatment depends on:
may be used alone or with radiation therapy. Sometimes a
combination of chemotherapy medicines is more effective than a single
drug. The most commonly used combination is called CHOP, which combines
Your doctor will work with you to find the best medicine for your kind of lymphoma.
For more information about medicine treatments for adults, see the
For more information about medicine treatments for children and adolescents, see the
Chemotherapy causes many side effects. These side effects
are usually temporary and go away when treatment is stopped. Your doctor may
medicines to control nausea and vomiting from
Older adults may find side effects harder to tolerate.
Side effects may also cause more problems if you have other diseases, such as
chronic lung disease, or
coronary artery disease.
You may not be able to become
pregnant or father a child after chemotherapy treatment. Discuss fertility
issues with your doctor before starting treatment. Chemotherapy medicines can
also cause birth defects. If you are pregnant or wish to father a child,
discuss the risk of birth defects with your doctor before using any
Surgery is often used to obtain a biopsy sample when NHL is being diagnosed or classified. But surgery is used only rarely in the treatment of non-Hodgkin's lymphoma.
Because of recent
improvements in body scans (such as the
PET scan), exploratory surgery is rarely used to stage
is often the treatment of choice for early-stage or nonaggressive (indolent)
non-Hodgkin's lymphoma (NHL). Radiation therapy may be
used alone or combined with other treatment options, such as chemotherapy, for
later or more advanced NHL.
Stem cell transplant may be used to treat NHL that is in remission or has relapsed. Stem cells may be obtained from blood, through a peripheral blood stem cell transplant (PBSCT). Or stem cells can be obtained from bone, in a bone marrow transplant (BMT). PBSCT is the most common method for treating NHL.
There are many other treatments for non-Hodgkin's lymphoma, because there are many kinds of lymphomas. Treatments sometimes include the use of interferon or antibiotic medicines. Your doctor will suggest the treatment that works best for your kind of lymphoma. Or your doctor may suggest that you join a clinical trial. Some treatments being used in clinical trials include lymphoma vaccines and stem cell transplants with high-dose chemotherapy.
non-Hodgkin's lymphoma gets worse, you may want to
palliative care. Palliative care is a kind of care for
people who have illnesses that do not go away and often get worse over time. It
is different from care to cure your illness, called curative treatment.
Palliative care focuses on improving your quality of life—not just in your body
but also in your mind and spirit. Some people combine palliative care with
Palliative care may help you manage symptoms or
side effects from treatment. It could also help you cope with your feelings
about living with a long-term illness, make future plans around your medical
care, or help your family better understand your illness and how to support
If you are interested in palliative care, talk to your
doctor. He or she may be able to manage your care or refer you to a doctor who
specializes in this type of care.
For more information, see the
Non-Hodgkin's lymphoma is often
a progressive condition. If you have been diagnosed with NHL, you may wish to
discuss with your family and your doctor the health care and other legal issues
that arise near the end of life.
A time may come when your goals
or the goals of your loved ones may change from treating or curing an illness
to maintaining comfort and dignity. You may find it helpful and comforting to
state your health care choices in writing (with an
advance directive or living will) while you are still
able to make and communicate these decisions. Think about your treatment
options and which kind of treatment will be best for you. You may wish to
health care agent to make and carry out decisions
about your care if you become unable to speak for yourself. For more
information, see the topic
Care at the End of Life.
The Leukemia and Lymphoma Society is the world's largest voluntary
health organization dedicated to funding blood cancer research, education, and
patient services. The Society's mission is to cure leukemia, lymphoma,
Hodgkin's lymphoma, and myeloma and to improve the quality of life for patients
and their families.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free numbers have information about services and activities
in local areas and can provide referrals to local ACS divisions.
Cancer.Net is the information Web site of the American
Society of Clinical Oncology (ASCO) for people living with cancer and for those
who care for them. ASCO is the world's leading professional organization
representing physicians of all oncology subspecialties. Cancer.Net provides
current oncologist-approved information on living with cancer.
The Lymphoma Research Foundation (LRF) is devoted to funding lymphoma research and providing patients and healthcare professionals with information about lymphoma. Some states have local chapters of the Lymphoma Research Foundation. Services for patients and their loved ones include in-person programs, a patient aid grant program, and publications and newsletters. There are also teleconferences, webcasts, and podcasts.
The National Cancer Institute (NCI) is a U.S. government agency
that provides up-to-date information about the prevention, detection, and
treatment of cancer. NCI also offers supportive care to people with cancer and
to their families. NCI information is also available to doctors, nurses, and
other health professionals. NCI provides the latest information about clinical
trials. The Cancer Information Service, a service of NCI, has trained staff
members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
Friedberg JW, et al. (2008). Non-Hodgkin's lymphomas. In
VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 2098–2143. Philadelphia: Lippincott Williams and
American Cancer Society (2009). Cancer Facts and Figures 2009. Available online: http://www.cancer.org/downloads/STT/500809web.pdf.
Other Works Consulted
American Joint Committee on Cancer (2010). Hodgkin and non-Hodgkin lymphomas section in Lymphoid
neoplasms. AJCC Cancer Staging Manual, 7th ed., pp.
607–611. New York: Springer.
Bierman PJ, et al. (2008). Non-Hodgkin’s lymphomas. In
L Goldman, D Ausiello, eds., Cecil Medicine,
23rd ed., pp. 1408–1419. Philadelphia: Saunders Elsevier.
Foon KA, Fisher RI (2006). The non-Hodgkin lymphomas.
In MA Lichtman et al., eds., Williams Hematology, 7th
ed., pp. 1407–1459. New York: McGraw-Hill.
Kyle F, Hill M (2008). Non-Hodgkin’s lymphoma
(diffuse large B cell lymphoma), search date April 2007. Online version of
BMJ Clinical Evidence. Also available online:
National Cancer Institute (2009). Adult Non-Hodgkin Lymphoma Treatment (PDQ): Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/adult-non-hodgkins/healthprofessional.
National Cancer Institute (2009). Childhood Non-Hodgkin Lymphoma Treatment (PDQ): Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/child-non-hodgkins/healthprofessional.
May 28, 2010
Anne C. Poinier, MD - Internal Medicine
& Douglas A. Stewart, MD - Medical Oncology
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