- What Is Non-Hodgkin's
- Risk Factors
- Recognizing Symptoms
- Classification & Staging
- Orthodox Treatment
- Side Effects of Orthodox Treatment
What Is Non-Hodgkin's Lymphoma?
Non-Hodgkin's lymphoma is a type of cancer. Lymphoma is a
general term for cancers that develop in the lymphatic system.
Hodgkin's disease is one type of lymphoma. All other lymphomas
are grouped together and are called non-Hodgkin's lymphoma.
The lymphatic system is part of the body's immune system.
It helps the body fight disease and infection. The lymphatic
system includes a network of thin tubes that branch, like
blood vessels, into tissues throughout the body. Lymphatic
vessels carry lymph, a colorless, watery fluid that contains
infection-fighting cells called lymphocytes. Along this network
of vessels are small organs called lymph nodes. Clusters of
lymph nodes are found in the underarms, groin, neck, chest,
and abdomen. Other parts of the lymphatic system are the spleen,
thymus, tonsils, and bone marrow. Lymphatic tissue is also
found in other parts of the body, including the stomach, intestines,
The incidence of non-Hodgkin's lymphoma has increased dramatically
over the last couple of decades. This disease has gone from
being relatively rare to being the fifth most common cancer
in the United States. At this time, little is known about
the reasons for this increase or about exactly what causes
Doctors can seldom explain why one person gets non-Hodgkin's
lymphoma and another does not. It is clear, however, that
cancer is not caused by an injury, and is not contagious;
no one can "catch" non-Hodgkin's lymphoma from another
By studying patterns of cancer in the population, researchers
have found certain risk factors that are more common in people
who get non-Hodgkin's lymphoma than in those who do not. However,
most people with these risk factors do not get non-Hodgkin's
lymphoma, and many who do get this disease have none of the
known risk factors.
The following are some of the risk factors associated with
- Age/Sex -- The likelihood of getting non-Hodgkin's lymphoma
increases with age and is more common in men than in women.
- Weakened Immune System -- Non-Hodgkin's lymphoma is more
common among people with inherited immune deficiencies,
autoimmune diseases, or HIV/AIDS, and among people taking
immunosuppressant drugs following organ transplants.
- Viruses -- Human T-lymphotropic virus type I (HTLV-1)
and Epstein-Barr virus are two infectious agents that increase
the chance of developing non-Hodgkin's lymphoma.
- Environment -- People who work extensively with or are
otherwise exposed to certain chemicals, such as pesticides,
solvents, or fertilizers, have a greater chance of developing
The most common symptom of non-Hodgkin's lymphoma is a painless
swelling of the lymph nodes in the neck, underarm, or groin.
Other symptoms may include unexplained fever, night sweats,
constant fatigue, unexplained weight loss, itchy skin and
reddened patches on the skin
When symptoms like these occur, they are not sure signs of
non-Hodgkin's lymphoma. They may also be caused by other,
less serious conditions, such as the flu or other infections.
Only a doctor can make a diagnosis. When symptoms are present,
it is important to see a doctor so that any illness can be
diagnosed and treated as early as possible. Do not wait to
feel pain; early non-Hodgkin's lymphoma may not cause pain.
If non-Hodgkin's lymphoma is suspected, the doctor asks about
the person's medical history and performs a physical exam.
The exam includes feeling to see if the lymph nodes in the
neck, underarm, or groin are enlarged. In addition to checking
general signs of health, the doctor may perform blood tests.
The doctor may also order tests that produce pictures of
the inside of the body. These may include:
X-rays: Pictures of areas inside the body created
by high-energy radiation.
CT (or CAT) scan: A series of detailed pictures of
areas inside the body. The pictures are created by a computer
linked to an x-ray machine.
MRI (magnetic resonance imaging): Detailed pictures
of areas inside the body produced with a powerful magnet linked
to a computer.
Lymphangiogram: Pictures of the lymphatic system taken
with x-rays after a special dye is injected to outline the
lymph nodes and vessels.
A biopsy is needed to make a diagnosis. A surgeon
removes a sample of tissue so that a pathologist can examine
it under a microscope to check for cancer cells. A biopsy
for non-Hodgkin's lymphoma is usually taken from a lymph node,
but other tissues may be sampled as well. Sometimes, an operation
called a laparotomy may be performed. During this operation,
a surgeon cuts into the abdomen and removes samples of tissue
to be checked under a microscope.
Classification & Staging
Over the years, doctors have used a variety of terms to classify
the many different types of non-Hodgkin's lymphoma. Most often,
they are grouped by how the cancer cells look under a microscope
and how quickly they are likely to grow and spread. Aggressive
lymphomas, also known as intermediate and high-grade lymphomas,
tend to grow and spread quickly and cause severe symptoms.
Indolent lymphomas, also referred to as low-grade lymphomas,
tend to grow quite slowly and cause fewer symptoms.
If non-Hodgkin's lymphoma is diagnosed, the doctor needs to
learn the stage, or extent, of the disease. Staging is a careful
attempt to find out whether the cancer has spread and, if
so, what parts of the body are affected. Treatment decisions
depend on these findings.
The doctor considers the following to determine the stage
of non-Hodgkin's lymphoma:
The number and location of affected lymph nodes;
Whether the affected lymph nodes are above, below, or on
both sides of the diaphragm (the thin muscle under the lungs
and heart that separates the chest from the abdomen); and
Whether the disease has spread to the bone marrow, spleen,
or to organs outside the lymphatic system, such as the liver.
In staging, the doctor may use some of the same tests used
for the diagnosis of non-Hodgkin's lymphoma. Other staging
procedures may include additional biopsies of lymph nodes,
the liver, bone marrow, or other tissue. A bone marrow biopsy
involves removing a sample of bone marrow through a needle
inserted into the hip or another large bone. A pathologist
examines the sample under a microscope to check for cancer
Chemotherapy and radiation therapy are the most common treatments
for non-Hodgkin's lymphoma, although bone marrow transplantation,
biological therapies, or surgery are sometimes used.
Chemotherapy is the use of drugs to kill cancer cells.
Chemotherapy for non-Hodgkin's lymphoma usually consists of
a combination of several drugs. Patients may receive chemotherapy
alone or in combination with radiation therapy.
Chemotherapy is usually given in cycles: a treatment period
followed by a recovery period, then another treatment period,
and so on. Most anticancer drugs are given by injection into
a blood vessel (IV); some are given by mouth. Chemotherapy
is a systemic treatment because the drugs enter the bloodstream
and travel throughout the body.
Usually a patient has chemotherapy as an outpatient (at the
hospital, at the doctor's office, or at home). However, depending
on which drugs are given and the patient's general health,
a short hospital stay may be needed.
Radiation therapy (also called radiotherapy) is the
use of high-energy rays to kill cancer cells. Treatment with
radiation may be given alone or with chemotherapy. Radiation
therapy is local treatment; it affects cancer cells only in
the treated area. Radiation therapy for non-Hodgkin's lymphoma
comes from a machine that aims the high-energy rays at a specific
area of the body. There is no radioactivity in the body when
the treatment is over.
Sometimes patients are given chemotherapy and/or radiation
therapy to kill undetected cancer cells that may be present
in the central nervous system (CNS). In this treatment, called
central nervous system prophylaxis, the doctor injects anticancer
drugs directly into the cerebrospinal fluid.
Bone marrow transplantation (BMT) may also be a treatment
option, especially for patients whose non-Hodgkin's lymphoma
has recurred (come back). BMT provides the patient with healthy
stem cells (very immature cells that produce blood cells)
to replace cells damaged or destroyed by treatment with very
high doses of chemotherapy and/or radiation therapy. The healthy
bone marrow may come from a donor, or it may be marrow that
was removed from the patient, treated to destroy cancer cells,
stored, and then given back to the person following the high-dose
treatment. Until the transplanted bone marrow begins to produce
enough white blood cells, patients have to be carefully protected
from infection. They usually stay in the hospital for several
Biological therapy (also called immunotherapy) is
a form of treatment that uses the body's immune system, either
directly or indirectly, to fight cancer or to lessen the side
effects that can be caused by some cancer treatments. It uses
materials made by the body or made in a laboratory to boost,
direct, or restore the body's natural defenses against disease.
Biological therapy is sometimes also called biological response
Surgery may be performed to remove a tumor. Tissue
around the tumor and nearby lymph nodes may also be removed
during the operation.
Side Effects of Orthodox Treatment
Treatments for non-Hodgkin's lymphoma are very powerful.
It is hard to limit the effects of therapy so that only cancer
cells are removed or destroyed. Because treatment also damages
healthy cells and tissues, it often causes side effects.
The side effects of cancer treatment depend mainly on the
type and extent of the therapy. Side effects may not be the
same for everyone, and they may even change from one treatment
to the next.
The side effects of chemotherapy depend mainly on the drugs
and the doses the patient receives. As with other types of
treatment, side effects may vary from person to person.
Anticancer drugs generally affect cells that divide rapidly.
In addition to cancer cells, these include blood cells, which
fight infection, help the blood to clot, or carry oxygen to
all parts of the body. When blood cells are affected, the
patient is more likely to get infections, may bruise or bleed
easily, and may feel unusually weak and tired. The patient's
blood count is monitored during chemotherapy and, if necessary,
the doctor may decide to postpone treatment to allow blood
counts to recover.
Cells in hair roots also divide rapidly; therefore, chemotherapy
may lead to hair loss. Patients may have other side effects
such as poor appetite, nausea and vomiting, or mouth and lip
sores. They may also experience dizziness and darkening of
skin and fingernails.
Most side effects go away gradually during the recovery periods
between treatments or after treatment is over. However, certain
anticancer drugs can increase the risk of developing a second
cancer later in life.
In some men and women, chemotherapy causes a loss of fertility
(the ability to produce children). Loss of fertility may be
temporary or permanent, depending on the drugs used and the
patient's age. For men, sperm banking before treatment may
be an option. Women's menstrual periods may stop, and they
may have hot flashes and vaginal dryness. Menstrual periods
are more likely to return in young women.
The side effects of radiation depend on the treatment dose
and the part of the body that is treated. During radiation
therapy, people are likely to become extremely tired, especially
in the later weeks of treatment. Rest is important, but doctors
usually advise patients to try to stay as active as they can.
It is common to lose hair in the treated area and for the
skin to become red, dry, tender, or itchy. There may also
be permanent darkening or "bronzing" of the skin
in the treated area.
When the chest and neck are treated, patients may have a
dry, sore throat and trouble swallowing. Some patients may
have tingling or numbness in their arms, legs, and lower back.
Radiation therapy to the abdomen may cause nausea, vomiting,
diarrhea, or urinary discomfort. Often, changes in diet or
medicine can ease these problems.
Radiation therapy also may cause a decrease in the number
of white blood cells, cells that help protect the body against
infection. If that happens, patients need to be careful to
avoid possible sources of infection. The doctor monitors a
patient's blood count during radiation therapy. In some cases,
treatment may have to be postponed to allow blood counts to
Although the side effects of radiation therapy can be difficult,
they can usually be treated or controlled. It may also help
to know that, in most cases, side effects are not permanent.
However, patients may want to discuss with their doctor the
possible long-term effects of radiation treatment on fertility
and the increased chance of second cancers after treatment
Bone Marrow Transplantation
Patients who have a bone marrow transplant face an increased
risk of infection, bleeding, and other side effects from the
large doses of chemotherapy and radiation they receive. In
addition, graft-versus-host disease (GVHD) may occur in patients
who receive bone marrow from a donor. In GVHD, the donated
marrow attacks the patient's tissues (most often the liver,
the skin, and the digestive tract). GVHD can range from mild
to very severe. It can occur any time after the transplant
(even years later). Drugs may be given to reduce the risk
of GVHD and to treat the problem if it occurs.
The side effects caused by biological therapy vary with the
specific type of treatment. These treatments may cause flu-like
symptoms such as chills, fever, muscle aches, weakness, loss
of appetite, nausea, vomiting, and diarrhea. Patients also
may bleed or bruise easily, get a skin rash, or retain fluid.
These problems can be severe, but they usually go away after
The side effects of surgery depend on the location of the
tumor, the type of operation, the patient's general health,
and other factors. Although patients are often uncomfortable
during the first few days after surgery, the pain can usually
be controlled with medicine. People can talk with their doctor
or nurse about pain relief. It is also common for patients
to feel tired or weak for a while. The length of time it takes
to recover from an operation varies for each patient.