Non-Hodgkin’s Lymphoma in Pictures

NHL is a cancer of the lymphatic system

NHL starts in your lymphatic system — a network of vessels, nodes, organs, and tissues that are part of your immune system.

NHL first develops in specific types of white blood cells known as lymphocytes. These include B cells, T cells, and natural killer cells, which typically protect the body against infection and disease. But in NHL, these cells grow and divide uncontrollably.

Where NHL occurs

Lymphocytes originate in the bone marrow, but you can find them circulating throughout your body, concentrated in lymph tissues like the:

• lymph nodes
• thymus
• tonsils
• adenoids
• spleen

NHL is most likely to start in the lymph nodes.

NHL can also begin in mucosal-associated lymphoid tissue (MALT), which is found in the lining of several organs, including the digestive tract and lungs.

Early symptoms of NHL

NHL often doesn’t cause symptoms until it has grown large. The most noticeable symptom is usually swollen lymph nodes in your neck, armpit, or groin. But this can often be a sign of another illness, so many people often miss or disregard it.

NHL may cause other symptoms throughout your body. Some of the most noticeable include:

• abdominal pain and swelling
• chest pain
• skin rash
• easy bleeding and bruising

B symptoms of NHL

Some people with NHL experience B symptoms. Doctors added the letter “B” to the cancer stage when these symptoms were present, which is where the term comes from. B symptoms often suggest more advanced disease.

B symptoms of NHL include:

• fever above 38ºC (100.4ºF)
• drenching night sweats
• loss of 10% of body weight over 6 months

Diagnosing and identifying the type of NHL

If a doctor notices symptoms like enlarged lymph nodes during a physical exam, they may request further testing. They may order urine or blood tests to help rule out infections. A complete blood count may also reveal signs of NHL.

Imaging, like CT and PET scans, can help doctors identify which organs may be affected. They may also request an MRI or ultrasound.

A doctor will likely perform a biopsy on any suspicious tissue or lymph node. This involves taking a small sample of the tissue and sending it to a lab for analysis under a microscope. A detailed analysis can confirm the presence of cancer cells and help diagnose the specific NHL subtype.

Determining the NHL stage

It will be important for doctors to determine the stage of your NHL. That’s a measure of how advanced the cancer is. Staging helps doctors determine the best treatment plan and provides some insight into your outlook.

To determine the stage, doctors will consider your symptoms as well as how widespread cancer cells are in your body. In stage 1 NHL, cancer cells are typically restrained to one area. But in stage 4 NHL (the most advanced), cancer cells have spread to an organ outside the lymphatic system.

CT and PET scans are instrumental in staging.

Treating NHL

You may not always need immediate treatment for NHL. If it isn’t causing symptoms, a doctor may recommend monitoring your condition (“watchful waiting”).

If a doctor does recommend treatment, the first line is often chemotherapy. This involves taking medications, either by mouth or intravenously, to kill cancer cells. The specific chemotherapy drugs you take will depend on the type of NHL you have, but a common option is R-CHOP, which includes:

• rituximab (Rituxan)
• cyclophosphamide
• doxorubicin hydrochloride
• vincristine (Oncovin)
• prednisolone

Other common treatments for NHL include:

• radiation therapy
• immunotherapy
• targeted therapy
• stem cell transplant

After NHL treatment

NHL treatments often have significant side effects. Even with successful treatment, you will still need to have regular follow-ups with a doctor to manage side effects and check for relapse. Some types of NHL, such as follicular lymphoma, are more prone to relapse than others.

Follow-up appointments typically include a physical exam and blood tests and may include imaging.

According to the ACS, the overall 5-year relative survival rate for NHL is 74%. But rates vary considerably depending on the type of NHL, the stage at diagnosis, and other factors like age and overall health. For example, people who receive a diagnosis before age 60 are more likely to have a favorable outcome.

Takeaway

NHL is a common cancer but is usually treatable and has a generally favorable outlook. It may not cause noticeable symptoms in the early stages, yet early detection is key to improving your outlook. Contact a doctor if you notice symptoms like swollen lymph nodes so they can confirm the cause.