Non-Hodgkin’s Lymphoma

Non-Hodgkin’s lymphoma (NHL) represents a type of cancer that affects the lymphatic system, a complex network of organs, tissues and vessels, being part of the body’s immune system. Apart from distributing fluid and particulate matter throughout the bloodstream, the lymphatic system also fights infections and other diseases using white blood cells called lymphocytes. Although the cancer can start in any part of the body considering that it first targets lymph tissue, the main sites include bone marrow, spleen, lymph nodes, adenoids and tonsils, thymus and digestive track. Specialists make a clear distinction between non-Hodgkin’s lymphoma and Hodgkin’s lymphoma. Even though both of them share the same origin, namely in the lymphocytes, the main difference lies in the subset of lymphocytes affected, which have particular appearances. Identifying and analyzing them under the microscope is very important because it allows the ascertainment of an accurate diagnosis and a proper treatment. Furthermore, doctors categorize non-Hodgkin’s lymphoma on different types and grades, according to the severity and speed of cancer cell growth.

The most common types of Non-Hodgkin’s lymphoma are follicular lymphoma and large B-cell lymphoma.

  • Indolent lymphomas advance slowly and do not require immediate treatment. Nevertheless, doctors watch them closely in order to intervene when needed and keep them under control. Follicular lymphoma belongs to this category being the most common in the United States and generally affecting people around 60 years of age. Even though follicular lymphoma is very responsive to treatment most of the time, doctors find it difficult to cure. Gradually, in certain cases follicular lymphoma can transform into a diffuse large B-cell lymphoma, which spread very quickly.
  • Aggressive lymphomas advance fast and because of this, doctors provide treatment right away. Diffuse large B-cell lymphoma (DLBCL) enters this category as being the most common type of aggressive lymphoma. Once again, diffuse large B-cell lymphoma affects mostly elders and it usually begins as a tumor in the abdomen or chest as well as in the armpit or neck. Despite its aggressive nature, this type of lymphoma responds well to treatment.

Regardless of their type and speed of growth, non-Hodgkin’s lymphomas spread throughout the body in the lack of a proper treatment.


Causes of Non-Hodgkin’s Lymphoma

Specialists do not know the exact reason for the mutation of lymphocytes but they link multiple risk factors with the appearance of this condition by understanding that specific changes in DNA can lead to abnormal and uncontrollable multiplication of cells. These risk factors for non-Hodgkin’s lymphoma involve having immune deficiencies, chronic infections, where the body creates new lymphocytes with the purpose to fight infections, or autoimmune diseases, where the immune system keeps attacking the body.

People with HIV have a weakened immune system making them susceptible to non-Hodgkin’s lymphoma. Those with coeliac disease, which provokes small bowel inflammation as well as those who received radiotherapy or chemotherapy for treating another type of cancer in the past, face a higher risk of developing non-Hodgkin’s lymphoma. Previous exposure to certain viruses can also cause the appearance of this condition.

Fortunately, non-Hodgkin’s lymphoma does not run in the family and is not infectious. Apparently, this type of cancer affects more men than women, with the exception of primary mediastinal B-cell lymphoma, which represents a subtype of diffuse large B-cell lymphoma (DLBLC). It originates in the mediastinum, more specifically behind the breastbone thus pressing on the trachea and causing breathing difficulties.


Signs and Symptoms of Non-Hodgkin’s Lymphoma

People with non-Hodgkin’s lymphoma usually experience swollen lymph nodes in the armpit, groin or neck. Normally, these lymph nodes or lymph glands scattered throughout the body contain white blood cells that have the mission to protect it from infections. However, non-Hodgkin’s lymphoma development leads to the accumulation of lymphocytes in the lymph nodes, which explains the swelling. Because the glands tend to swell when the body experiences infections, it does not necessarily mean that the respective person suffers from this type of cancer.

Apart from the painless swelling in the lymph nodes, other symptoms of non-Hodgkin’s lymphoma include high temperature, itchy skin, persistent cough, weight loss and night sweats. The location of the enlarged lymph node causes specific symptoms.

  • For instance, if the condition affects the abdomen, the person may experience pain in the stomach and indigestion. In some cases, doctors find abnormal cells in the patient’s bone marrow leading to excessive bleeding, high risk of infections and persistent tiredness.
  • If the condition affects the brain, it manifests with headaches, personality changes, trouble thinking and even seizures. Certain types of lymphoma surround the brain and spread to the spinal cord provoking facial numbness, double vision and speaking difficulties.
  • People with skin lymphoma can see and feel it due to the appearance of red or purple bumps or lumps under the skin, which distinguishes it from other types of lymphoma.

If a person has the symptoms mentioned above without any sign of infection, seeking medical advice becomes imperative. Even if the doctor does not establish a diagnosis for non-Hodgkin’s lymphoma, it can still discover other alarming conditions that could lead to complications and threaten the patient’s life.


Non-Hodgkin's lymphoma


Diagnosis for Non-Hodgkin’s Lymphoma

When interacting with a person that presents non-Hodgkin’s lymphoma signs and symptoms, the doctor will first make inquiries concerning her medical history followed by a detailed physical examination, during which he will pay close attention to the affected areas of the body. Furthermore, he will investigate the swollen lymph nodes to determine if they represent the consequence of an infection or if he should consider the presence of non-Hodgkin’s lymphoma. The doctor can order blood tests, which can reveal unquestionable signs of infection or a biopsy if he suspects that the enlarged lymph nodes are the result of non-Hodgkin’s lymphoma. In the first case, the patient must take antibiotics for several weeks and wait for the nodes to shrink. However, in the second case, the doctor will remove a small part or the entire node with the goal to view it under the microscope and perform other tests in the laboratory.

Biopsy represents the only solution that helps doctors clear their doubts when it comes to establishing a diagnosis for non-Hodgkin’s lymphoma and depending on each patient’s situation, they have the possibility to choose between several types of biopsy.

  • Incisional or excisional biopsy is the most common procedure used by doctors when dealing with non-Hodgkin’s lymphoma. Incisional biopsy refers to the removal of a small piece of the node or tumor while excisional biopsy consists in removing the entire lymph node. The location of the node influences the intervention difficulty. For instance, if the swollen node is located under the skin, doctors will not encounter difficulties in performing the operation and they will use a local anesthesia for numbing the patient. On the other hand, if the tumor developed inside the abdomen or chest, doctors will resort to general anesthesia for the patient because the intervention will take longer and be more complicated.
  • Needle biopsy is less invasive than incisional or excisional biopsy but this comes with a drawback: doctors may not be able to remove the needed sample size for giving an accurate diagnosis or determine the specific type of lymphoma. Once again, doctors can choose to perform a fine-needle aspiration biopsy, also known as FNA or core needle biopsy. In the first situation, they aspirate or withdraw a certain amount of tissue from the tumor mass by using a syringe with a hollow needle. In the second situation, they remove a bigger part of tissue by using a larger needle.
  • Other types of biopsies include lumbar puncture, bone marrow biopsy as well as pleural or peritoneal fluid sampling. Usually, doctors do not use these procedures for diagnosing non-Hodgkin’s lymphoma, but for assessing the severity or the stage of the condition.

Imaging tests provide clear and detailed pictures of the patient’s body using magnetic fields, radioactive particles, sound waves or X-rays. Doctors resort to them for various reasons including to discover the causes of unexplainable symptoms, to assess the stage of the condition, to determine the efficiency of the treatment and look for signs of lymphoma recurrence after the treatment.

  • Ultrasound tests show images of the patient’s internal organs. Doctors lubricate the skin with a gel then place a small instrument similar to a microphone called transducer, which emits sound waves and receives the echoes reverberated by the organs. A computer converts these echoes into a picture so doctors can analyze closely the situation, in this case, the lymph nodes situated inside the abdomen or under the skin. Although this device also detects swollen kidneys, doctors cannot use it for the chest area because the ribs do not allow sound waves to pass.
  • Computed tomography (CT) scan uses X-rays to provide cross-sectional pictures of the patient’s body and enables doctors to search for lymphoma in various areas including head, neck, chest and pelvis. The CT scan is also useful for guiding doctors when performing a biopsy in a delicate area. The patient must lie on a scanning table while the doctor inserts the needle into the correct area for obtaining a sample that he will next examine under the microscope.
  • MRI scan is similar to CT scan because it displays detailed images of the body’s soft tissues but the main difference is that instead of X-rays, it uses strong magnets and radio waves. This test is not very common when diagnosing non-Hodgkin’s lymphoma but doctors choose it when having concerns regarding the spreading degree of the condition, especially in those cases when it affects the brain or spinal cord.
  • Positron emission tomography (PET) scan consists in injecting the patient with radioactive sugar that usually collects in cancerous cells then creating images of body areas that present radioactivity with a special camera. Although the pictures are not as detailed as an MRI or CT scan, they do provide the necessary information for doctors, which use this method for several reasons. For instance, it helps them determine if a swollen lymph node or gland contains lymphoma, if the condition responds to the treatment or if the lymphoma still affects the patient’s body after the treatment.


Treatment for non-Hodgkin’s lymphoma

Doctors provide medical treatment for non-Hodgkin’s lymphoma after assessing the cancer’s type and stage as well as the patient’s age and overall health. In certain cases, doctors successfully accomplish cancer removal during a biopsy, which allows them to exclude further treatment. However, if the lymphoma is growing fast, medication and radiotherapy represent the main options available. Doctors and healthcare professionals specialized in treating lymphoma, such as hematologists, cancer and transplant specialists, psychologists and counselors communicate and work together concerning the most adequate, painless and effective treatment plan.

  • Chemotherapy consists in taking cancer-killing medicines. Doctors can opt for a combination between chemotherapy and biological therapy or radiotherapy. According to the severity of the cancer, the patient can receive the medication directly into the vein through a drip if the doctor believes that he has chances of recovery. On the other hand, if the cure is not possible, the patient will take tablets to ease his symptoms. If the doctor suspects the slightest risk for the cancer to affect the brain, he will inject medications into the patient’s cerebrospinal fluid. This method of treatment does not require the patient to remain in the hospital, unless the side effects become alarming. These side effects refer to bone marrow damage, breathlessness, fatigue, bruising and bleeding easily. Other potential side effects involve loss of appetite, skin rashes, hair loss, vomiting and infertility.
  • Radiotherapy is mostly effective for non-Hodgkin’s lymphoma in early stages, more exactly when the cancer affects just one part of the body. The patient must follow a treatment for several weeks without having to stay in the hospital throughout the entire period. Even though radiotherapy does not cause pain, it does have side effects that vary, depending on the body area treated. For instance, when receiving treatment for the throat, the patient will experience soreness in that area or treatment to the head inevitably leads to hair loss. Other side effects involve dry mouth, nausea, red and sore skin as well as tiredness. Generally, they disappear at the end of the treatment but certain side effects that are more serious like darkened skin and infertility may remain with the patient for a long time, even permanently.
  • Steroid medication usually comes in combination with chemotherapy when treating non-Hodgkin’s lymphoma because it increases its efficiency, according to researchers. Patents take the medicines in the form of tablets for several months. They do present side effects including sleeping difficulties, a state of agitation, increased appetite and indigestion. Once the treatment is complete, these unpleasant side effects will improve without any intervention from the doctors.
  • Monoclonal antibody therapy is beneficial for treating certain types of non-Hodgkin’s lymphoma and consists in taking some medications that stimulate the patient’s immune system to kill the cancerous cells. For more effectiveness, doctors recommend them in combination with chemotherapy, especially because it impedes the cancer from returning. They inject the medications directly into the patient’s veins during a few hours. Side effects refer to itchy rashes, tiredness, nausea, headaches and fever. The patient may receive other medicines with the purpose to lessen or prevent the side effects caused by monoclonal antibody therapy.

Last updated on March 2nd, 2018

Chris Riley

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