Non-Hodgkin Lymphoma , lymphoma, cancer, white blood cells, lymphatic system, spleen, lymph, tonsils, adenoids, thymus
About Non-Hodgkin Lymphoma : Alberta Cancer Board
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Non-Hodgkin Lymphoma
About the disease
Non-Hodgkin lymphoma actually involves more than thirty types of cancers with different symptoms, treatments and outcomes. They affect the lymphocytes, a type of white blood cell and can occur in any organ associated with the lymphatic system including: spleen, lymph nodes, tonsils, adenoids, thymus. It can also spread to organs outside the lymphatic system and into the bone marrow. Because lymphatic tissue is found throughout the body, non-Hodgkin lymphoma can occur anywhere. About five per cent of cases affect children. Almost 500 Albertans are diagnosed with non-Hodgkin lymphoma every year.
Risk Factors
Risk factors are determined by analyzing the numbers of patients with cancer in a larger population and trying to find differences in the characteristics or behaviors between those individuals who develop cancer and those who do not. The Alberta Cancer Board’s Tomorrow Project, for instance, is tracking more than 50,000 Albertans over a fifty-year period to learn more about who develops cancer and why.
The causes of most lymphomas are unknown. Bacteria, viruses and country of origin may play a role in determining who gets the diseases.
Other factors that may increase the risk of developing non-Hodgkin lymphoma include:
- Age – the risk increases after 60 years
- Gender – men are diagnosed more often than women
- Race – more common among Caucasians
- Immune system deficiencies – associated with HIV/AIDS, organ transplants/immune suppressant drugs, inherited immune deficiencies
- Immune Diseases – SLE, Rheumatoid Arthritis, Sjogren’s Syndrome, Hashimoto’s Thyroiditis
- Viruses – including Epstein-Barr, Hepatitis C, HTLV-1 (Human T-lymphotropic virus type 1)
- Bacteria – Helicobacter pylori
- Environment – pesticides, solvents, hair dye
Factors that may decrease the risk of developing non-Hodgkin lymphoma include:
- Diet – one that’s low in fat and includes vegetables and fruit
Genetic Link
The cause of non-Hodgkin lymphoma is not known, but some researchers believer there is a genetic factor that may be triggered by environmental causes.
Detection and Diagnosis:
The most common symptoms of non-Hodgkin lymphoma are swelling of the lymph nodes in the neck, under the arms or in the groin. Some people also get unexplained low-grade fevers, night sweats, unexplained weight loss, fatigue, itchiness and rashes. Other people develop organ-related symptoms such as chest pain, shortness of breath, abdominal pain, cramps, back pain, or neurological symptoms.
It takes a biopsy to confirm the presence of cancer. For non-Hodgkin lymphoma a sample of tissue is usually taken from the enlarged palpable peripheral lymph nodes and in rare cases a biopsy via a laparotomy or mediastinoscopy (surgery on the abdomen or chest) is required. Surgical biopsies are much preferred over core needle biopsies. Fine needle aspirates are not adequate for lymphoma diagnosis.
Typically, lymphoma staging involves a physical examination, blood tests, chest x-ray, and a chest/abdomen/pelvis CT scan. Other test that may be ordered include a PET or MRI scan, lumbar puncture, or gastroscopy/colonoscopy.
Non-Hodgkin lymphoma is classified by how the cancer cells look under a microscope, as well as special stains for surface antigen expression. B-Cell lymphomas (caused by cancerous B cell lymphocytes) are much more common than T-Cell lymphomas. Aggressive lymphomas grow and spread quickly whereas indolent types grow slowly and cause fewer symptoms.
Treatment
Treatment for non-Hodgkin’s lymphoma usually involves chemotherapy, radiation therapy or a combination of the two. In some cases bone marrow transplants may be options.
Radiation therapy involves using concentrated beams of high energy x-rays to target cancer cells in a specific area of the body.
Chemotherapy involves drugs that can be taken by pills or administered by needle into a vein.
Bone marrow transplant is most commonly used for those who have suffered a relapse of non-Hodgkin lymphoma. It involves collecting healthy blood stem cells that are capable of regrowing a damaged bone marrow. The patient is then treated with administering high dose chemotherapy and possibly total body irradiation aimed at curing the lymphoma, followed by infusing the healthy blood stem cells to repair the bone marrow that would have been damaged by the high dose chemoradiotherapy. The stem cell donor is usually the patient (autologous) but a healthy sibling or unrelated person (allogeneic) may also be the donor.
Immunotherapy uses the body’s immune system to fight cancer. Monoclonal antibodies seek out cancer cells and alert the body’s immune system to destroy them.
Doctors treating indolent lymphomas may adopt a “Watch and Wait” tactic. This does not mean they have given up; they consider the lymphoma to be almost dormant and are waiting for it to flare up before recommending chemotherapy.
Links:
 National Comprehensive Cancer Network (U.S.) guide to treatment decisions with links to other sites
Canadian education and support group for lymphoma sufferers, including cancers
Factors Affecting Prognosis
The biggest single factor affecting duration of response to treatment is the aggressiveness of the lymphoma. Ironically, indolent types are less curable with standard dose chemotherapy than the aggressive types, but indolent lymphomas progress slowly and therapy can often put the disease into remission for prolonged periods of time. Aggressive and highly aggressive non-Hodgkin lymphoma are often cured through the use of combination chemotherapy.
Other factors include:
- Age
- Performance status (activity level)
- Blood counts and chemistry (LDH)
- Clinical stage
- Extent of the disease (bulky masses >10cm, number of nodal and extranodal sites)
For non-Hodgkin lymphoma cancer patients:
- Clinical trial information
- Guide to radiation therapy
- Guide to chemotherapy
Learn more
Support for non-Hodgkin lymphoma patients
How you can help
Other Resources
Canadian Cancer Society
American Society of Clinical Oncology
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