Non-Hodgkin’s Lymphoma: A Beginner’s Guide

Non Hodgkin Lymphoma (NHL) is a common type of cancer that starts in the blood, particularly in the lymphatic system. The lymphatic system is a network of tissues and organs that help flush out toxins and other waste materials from the body. 

The tumor starts in lymphocytes and spreads throughout the body. Many subtypes of NHL exist – Follicular Lymphoma and Diffuse Large B-cell Lymphoma being the most frequent ones. The cancer accounts for around 4% of the cancer cases in the United States of America.

Warning Signs: The Symptoms of Non Hodgkin Lymphoma

Following are the warning signs and symptoms of Non Hodgkin Lymphoma:

  • Fatigue
  • Fever
  • Chest Pain
  • Abdominal swelling or pain
  • Cough
  • Night sweats
  • Unintended weight loss
  • Swollen lymph nodes
  • Breathing trouble
  • Anaemia
  • Weakness
  • Loss of appetite
  • Itching of the skin

What is the main cause of lymphoma?

The exact cause of the NHL is not known. However, it develops due to a weakened part of the immune system in some people. NHL occurs when the body makes too many lymphocytes(a type of white blood cell).

In a routine, these cells develop and die. Then, new ones are created, which take place. But in NHL, these cells grow and divide very rapidly and don’t usually die. This oversupply of cells causes the lymph nodes to swell. 

The Main Types of NHL

NHL can begin in the following two cells:

B Cells

It produces antibodies to fight foreign intruders and prevent several infections. Most lymphomas start at B cells only. Below are the subtypes of NHL that are concerned with B cells:

  • Follicular Lymphoma
  • Mantle cell Lymphoma
  • Burkitt Lymphoma
  • Diffuse Large B cell Lymphoma

T cells

T-cells are concerned with the direct killing of foreign intruders. NHL occurring in T-cells is extremely rare as compared to B cells. Subtypes of NHL involving T-cells are as follows:

  • Peripheral T cell Lymphoma
  • Cutaneous T cell Lymphoma

Also Read: Deadly Types of Cancer

What Are the Risk Factors for NHL?

Following are the risk factors associated with Non-Hodgkin Lymphoma:

  1. Age: The risk for NHL increases with age, although it can happen to people of any age group. If you are above 60 years, you are at an elevated risk of developing the disease. 
  1. Family History: If you have someone in your family with Lymphoma, you can also have the disease. Therefore, you need to be extra cautious to keep the condition at bay. 
  1. Genetic Syndromes: Genetic syndrome like the following can develop NHL:
  • Down’s Syndrome (caused by the presence of complete or partial presence of a third copy of chromosome 21)
  • Klinefelter’s Syndrome (caused by the presence of an extra chromosome in men)
  1. Bacteria: The presence of the following bacteria in the body can lead to Non Hodgkin Lymphoma:
  • Helicobacter Pylori (related to gastric ulcers and gastritis)
  • Campylobacter jejuni (related to food-borne diseases)
  • Borrelia Burgdorferi (related to Lyme disease)
  • Chlamydia Psittaci (related to psittacosis)
  1. Viruses: Below is a list of viruses that can cause NHL:
  • HIV
  • HHV-8
  • SV-40
  • Hepatitis Virus
  • Epstein Barr Virus
  1. Certain Disorders:
  • Rheumatoid Arthritis
  • Systemic Lupus Erythematosus
  • Celiac disease
  • Inflammatory bowel disease
  • Psoriasis
  1. Exposure To Certain Chemicals: According to a recent survey, exposure to the following chemicals increases the risk of NHL:
  • Benzene
  • Insecticides
  • Pesticides
  1. Medications:

Certain medications weaken the immune system and make you susceptible to several diseases. If you have undergone organ implant surgery, your defensive mechanism could have been suppressed. It increases the risk of Non Hodgkin Lymphoma. 

How Is NHL Diagnosed?

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The following tests help diagnose NHL:

Medical History & Physical Examination

The doctor will ask about your complete medical history. Tell him the symptoms you’re experiencing and if you are on certain medications. It will reduce the risk of future drug interactions. 

Then, you shall undergo a physical examination. The doctor will examine lymph nodes and other possible affected areas. The liver and spleen can become swollen by some bacterial infection. The doctor examines these areas of the body to detect the cause of symptoms. 

Blood Test

Doctors sometimes order blood tests to determine the complete blood count of white blood cells. In most cases, the blood tests are not sufficient to diagnose the disease. But then it can be excellent assistance in ruling out other causes of your symptoms. 

Imaging Tests

The doctor will take a chest x-ray or CT scan to detect the presence of a tumor or swollen lymph nodes. 

A new test, Positron Emission Tomography(PET), can also help diagnose Non Hodgkin Lymphoma.

Bone Marrow Biopsies

The doctor may take a biopsy of your lymph nodes to detect the cause of the swelling. First, a small tissue sample is taken and examined under the microscope. Biopsies are of many types, including:

  • Excision Biopsy: removes the entire lymph node.
  • Incisional Biopsy: removes a small portion of the lymph node.
  • Core Needle Biopsy: removes a small sample of the lymph node with the help of a needle. 
  • Laparoscopic Biopsy: removes all or part of the lymph node. 

What are the four stages of lymphoma?

Stage 1: Cancer remains at one lymph node region or in some nearby lymph nodes.

Stage 2: Cancer spreads to more than one lymph node region or a surrounding organ. The tumor is limited to either above or below the diaphragm.

Stage 3: Cancer spreads to both above and below the diaphragm. It can also apply to the section above the diaphragm or spleen.

Stage 4: This is the final stage of Non Hodgkin Lymphoma. The cancer spreads to several parts of the body in this stage, including several lymph nodes, lungs, liver, and bones. 

NHL Treatment Alternatives

The best treatment alternative for NHL depends on the type and stage of the Lymphoma. Also, treatment for the disease is not always essential. In some cases, cancer does not spread for years. However, frequent health checkups can be helpful in this case to determine the extent of the spread of cancerous cells. 

Treatment options available for the treatment of dangerous lymphomas are as follows:

Chemotherapy

Chemotherapy is given to kill cancerous cells in the body. Both oral and injected forms of the therapy are allowed. Your health condition and personal preference decide the mode of treatment. The doctor can give you chemotherapy in combination with other treatment alternatives.

Radiation Therapy

High-intensity radiation is used to kill cancer cells and eradicate the tumor. 

Stem Cell Transplant

The doctor gives a massive dose of chemotherapy, killing cancer cells and stem cells. Then, it utilizes a transplant to ensure healthy cells in the body. Again, he can use your cells or donor cells.

Medications

The doctor can give you certain drugs to strengthen your immune system. Some of the medicines approved for NHL are as follows:

  • Axicabtagene(Yescarta)
  • Bortezomib(Veltip 2 Mg)
  • Bendamustine(Xnta 100 Mg)
  • Belinostat(Beleodaq®)
  • Brentuximab vedotin(Adcetris)
  • Leukeran (Chlorambucil)
  • Rituximab(Rituxan 500 Mg)
  • Romidepsin(Istodax®)
  • Vorinostat( Zolinza)

Drug combinations utilized in the treatment of NHL are as follows:

  • CVP
  • COPP
  • CHOP
  • EPOCH
  • ICE
  • R-ICE
  • R-CVP
  • R-CHOP
  • R-EPOCH

Non Hodgkin Lymphoma that is aggressive can typically be treated, but cancer that has progressed to a later stage can be challenging to cure. Cancer may have gone so far that the treatment objective is to keep it from spreading further in many circumstances.

See a doctor if you have both NHL symptoms and recognized risk factors for the disease. Early detection and treatment might help you have a better overall perspective.