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What is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma (NHL) is a type of cancer that begins in the lymph system, in white blood cells called lymphocytes. It occurs when the lymphocytes grow abnormally and out of control. When these cells form a mass, it is called a lymphoma. 

Non-Hodgkin's lymphoma can start almost anywhere in the body. It may start in a single lymph node, a group of lymph nodes or an organ such as the spleen. It can spread to almost any part of the body, including the liver and bone marrow.

There are many types of NHL. Sometimes they are grouped as:

  • Slow-growing lymphomas, which spread slowly and cause few symptoms. These may also be called indolent or low-grade lymphomas.
  • Fast-growing lymphomas, which spread quickly and cause severe symptoms. These may also be called aggressive lymphomas and may be classified as intermediate-grade or high-grade.

Treatment can cure some people and may allow others to live for years. How long you live depends on the type of NHL you have and the stage of your disease.

Our approach

At Northwell Health Cancer Institute, we take a very collaborative approach to treating non-Hodgkin lymphoma. Our Hematologic Oncology Center is home to the Adult Bone Marrow and Stem Cell Transplant Program, one of the largest in the New York metro area and the only Foundation for the Accreditation of Cellular Therapy (FACT)-accredited program in Long Island, Queens and Brooklyn. 

As a patient, you gain the advantage of an integrated, multidisciplinary team specialized in non-Hodgkin lymphoma, as well as access to leading-edge therapies and world-class facilities. Your dedicated care team works to achieve the best possible outcome, collaborating with specialists to carefully coordinate your cancer treatment along with any other existing conditions. Every non-Hodgkin lymphoma diagnosis is unique, so your team of physicians will meet once a week to share ideas, review every step of your care and ensure milestones are reached. We are here to answer questions and coordinate integrative care and support services.

Research at Northwell

As part of your non-Hodgkin’s lymphoma treatment plan, you may have opportunities to participate in clinical trials. These trials study new chemotherapy drugs, radiation technologies and surgical approaches. While not every patient is a candidate for clinical trials, your care team will work with you to determine eligibility. Learn more about clinical trials at Northwell Health.

Symptoms

These signs and symptoms may be caused by adult non-Hodgkin lymphoma or by other conditions. Check with your doctor if you have any of the following:

  • Swelling in the lymph nodes in the neck, underarm, groin or stomach
  • Fever for no known reason
  • Recurring night sweats
  • Feeling very tired
  • Weight loss for no known reason
  • Skin rash or itchy skin
  • Pain in the chest, abdomen or bones for no known reason

When fever, night sweats and weight loss occur together, this group of symptoms is called B symptoms.

Other signs and symptoms of adult non-Hodgkin lymphoma may occur and depend on the following:

  • Where the cancer forms in the body
  • The size of the tumor
  • How fast the tumor grows

Causes

There is no known cause of non-Hodgkin's lymphoma.

Risk factors

Some risk factors can increase your chances of getting non-Hodgkin lymphoma (NHL). However, there are many people who have none of these risk factors and still get non-Hodgkin lymphoma, just as some people with these risk factors don't get the disease.

Risk factors include:

  • Gender. NHL is more common in men than in women.
  • Age. The likelihood of getting NHL increases as you get older.
  • Impaired immune system. NHL is most common among those who have an impaired immune system, an autoimmune disease, or HIV or AIDS. It also occurs among those who take immunosuppressant medicines, such as medicines following an organ transplant.
  • Viral infection. A viral infection, such as Epstein-Barr virus, increases the risk of developing NHL.
  • Bacterial infection. Infection with Helicobacter pylori increases the risk of lymphoma involving the stomach.
  • Environmental exposure. Exposure to agricultural pesticides or fertilizers, solvents and other chemicals may increase the risk of developing NHL.

Diagnosis

The first step to making a non-Hodgkin lymphoma diagnosis is usually a physical exam, during which a doctor will look for swollen lymph glands and other signs. A doctor will also consider personal and family medical history. If non-Hodgkin lymphoma is suspected, you will be referred to a specialist for diagnosis.

Specialists use a variety of procedures and tests to deliver an accurate non-Hodgkin lymphoma diagnosis and determine the stage of the cancer. 

  • Blood and urine tests—These tests measure the levels of certain antibodies, known as immunoglobulins, to determine presence of the cancer.
  • Flow cytometry—This lab test measures the number of cells in a sample, the percentage of live cells, their size and shape, and the presence of tumor markers on the cell surface.
  • Bone marrow aspiration and biopsy—A needle is inserted into the hipbone of sternum to get a small piece of bone and bone marrow to determine if the cancer has spread there.
  • Lumbar puncture—A needle is inserted into the spinal column to collect cerebrospinal fluid and look for signs of the cancer.
  • Lymph node biopsy—A lymph node is removed and examined under a microscope to look for cancer.
  • Chest x-rays—Looks for tumors in the chest and lungs.
  • CT or CAT scan (computerized axial tomography)—More detailed than an X-ray, this procedure uses a combination of X-rays and computer technology to produce detailed images.
  • MRI (magnetic resonance imaging)—A powerful magnet, radio waves and computer imaging combine to create highly detailed pictures of areas inside the body.

Treatment types

Treatment can cure some people and may allow others to live for years. Treatment options depend on a variety of factors:

  • Type and stage of lymphoma
  • Possible side effects
  • Results of scans during treatment
  • Patient preferences and overall health

The following treatments are often used to treat non-Hodgkin lymphoma:

  • Chemotherapy—Some individuals with newly-diagnosed non-Hodgkin lymphoma receive chemotherapy, followed by radiation therapy. A combination of chemotherapy drugs is usually given one at a time. If the disease does not go into complete remission following the first treatment, or if it relapses, second-line chemotherapy treatments are available.
  • Stem cell transplantation—Stem cell transplantation may be recommended if the lymphoma recurs or if chemotherapy and radiation are not effective in treating it. The goal of transplantation is to destroy the cancer cells in the bone marrow, blood and other parts of the body with high doses of chemotherapy and/or radiation therapy and then enable blood stem cells to create healthy bone marrow.
  • Targeted therapy and immunotherapy—Recent advancements in targeted therapies and immunotherapies are offering new treatment options for patients with non-Hodgkin lymphoma that has recurred or progressed after other treatments.
  • Radiation therapy—Radiation therapy is directed at the affected lymph node areas to reduce the risk of damaging healthy tissues. Radiation therapy is typically given after or in addition to chemotherapy depending on the type of lymphoma you have.

You may not require immediate treatment for non-Hodgkin lymphoma if you are otherwise healthy and without symptoms. During this time, you will be closely watched. This is called "watchful waiting." Treatment only begins if you start to develop symptoms or if tests indicate that the cancer is progressing.

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