Lymphoma: Non-Hodgkin's Lymphoma

Cancer (Oncology)

Lymphoma is a cancer that affects the lymphatic system. There are two main types of lymphoma: Non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma. Both Non-Hodgkin's and Hodgkin's lymphoma start in white blood cells called lymphocytes – which are part of the body's immune system – but they have different behaviors and responses to treatment. Non-Hodgkin's lymphoma is really a group of more than 20 different types of related cancers; each cancer having unique characteristics that range in severity.

Almost all cases of NHL start in so-called B lymphocytes (B cells). B lymphocytes mature into antibody-producing plasma cells that protect against germs. A small percentage of cases begin in T lymphocytes (T cells), which destroy certain bacteria or viruses. Non-Hodgkin's lymphoma can start in the lymph nodes, in a lymphatic organ such as the spleen, or in the lymph tissue found in the stomach or intestines. Abnormal lymphocytes can spread to any part of the body. While some NHLs are localized, most have spread to other parts of the body by the time of diagnosis.

Lymphoma expert Dr. John P. Leonard discusses how treatment for the disease is advancing rapidly.

Non-Hodgkin's lymphoma is one of the most common cancers in the United States, accounting for about 4 percent of all cancers. More than 95 percent of cases occur in adults. The number of cases has been steadily growing, particularly among women, for the last 40 years. This growth is expected to continue as the American population ages.

Risk Factors

Age is a strong risk factor for this disease, with most cases occurring in people in their 60s or older. Overall, the risk of non-Hodgkin's lymphoma is higher for men. However, certain types of non-Hodgkin's lymphoma are more common in women. In the United States, Caucasians are at higher risk than other ethnic groups. Worldwide, Non-Hodgkin's lymphoma is more common in developed countries, with the highest rates in the United States and Europe.

Obesity is likely a risk for non-Hodgkin's lymphoma. People exposed to significant radiation and those with weakened immune systems (due to organ transplants or genetic syndromes) have an increased risk to the disease. Infection with the human T-cell leukemia/lymphoma virus (HTLV-1), the Epstein-Barr virus, HIV, Hepatitis C and other, rarer infections may raise the risk as well. Exposure to chemicals such as pesticides, fertilizers or solvents may increase risk, although the link isn't certain. Some autoimmune diseases such as rheumatoid arthritis, lupus, and celiac sprue have been linked to an increased rate of Non-Hodgkin's lymphoma.

Symptoms and Diagnosis

There are no recommended screening tests for Non-Hodgkin's lymphoma. The disease may cause many general symptoms, including: enlarged lymph nodes in the neck, groin or underarm; swelling in the abdomen; feeling full after a small amount of food; chest pain; shortness of breath; coughing; fever; weight loss; night sweats; and fatigue. These symptoms are more often a sign of some other condition. However, any chronic instances should be checked by a physician.

Treatment

For Non-Hodgkin's lymphoma that is localized, radiation therapy is usually preferred over surgery. Depending on the cancer's type and stage, chemotherapy or a combination of radiation and chemotherapy may be appropriate. The use of stem cell transplants is growing as a treatment for this disease.