Non-Hodgkin lymphoma

Overview

Non-Hodgkin lymphoma is a malignancy of immune system cells and occurs when the lymphatic system produces abnormal, malignant lymphocytes. Lymphocytes are made up of B and T cells that produce antibodies and directly kill tumor cells and microbes. They are the main component of the immune system. 

Our approach

The Hematologic Oncology Center, part of Northwell Health Cancer Institute, offers the most advanced technology to ensure an accurate non-Hodgkin lymphoma diagnosis. 

There are more than 30 distinct types of non-Hodgkin lymphoma, so treatment varies widely for each individual. The regionally and nationally recognized team of specialists has extensive experience diagnosing and treating all types and stages of non-Hodgkin lymphoma.

Northwell Health takes an advanced approach to treating non-Hodgkin lymphoma. The highly regarded experts in the Hematologic Oncology Center use the latest technology and research-backed therapies to treat all types and stages of non-Hodgkin lymphoma. 

Multidisciplinary Non-Hodgkin Lymphoma Treatment

Within the first several days of a visit, the multidisciplinary team at the Hematologic Oncology Center will conduct comprehensive tests and develop a personalized cancer treatment program. 

Highlights of Non-Hodgkin lymphoma treatments and services at the center include:

  • The most effective therapies aimed at curing or containing lymphoma.
  • Leading-edge chemotherapy and immunotherapy regimens.
  • Precision radiation therapy techniques that protect healthy tissue while targeting diseased areas
  • Targeted therapies that identify and attack cancer cells
  • Biologic therapy that enhances the immune system to fight the cancer 
  • FACT-accredited bone marrow/stem cell transplantation program

Each diagnosis is unique, so the team meets regularly to discuss patient treatment during weekly teleconferences where the physicians who are experts in the diagnosis and treatment of Hodgkin and non-Hodgkin lymphoma share ideas and best practices for delivering the most up to date and effective  patient care. The specialists review each treatment phase to ensure that treatment milestones are reached. 

From diagnosis through treatment including nutritional, social work and pain management support, patients are the capable hands of experts every step of the way. 

Symptoms

Symptoms may include:

  • Swollen, painless lymph nodes in neck, armpits or groin
  • Abdominal pain or distention
  • Back or other bone pain
  • Unexplained weight loss
  • Fever
  • Drenching night sweats
  • Coughing, trouble breathing or chest pain
  • Feeling weak and very tired constantly
  • Itching of the skin

Be aware that these symptoms could be due to conditions other than Non-Hodgkin lymphoma, so it’s best to see a doctor right away.

Types

There are several types of non-Hodgkin lymphoma. Some of these are:

Cutaneous T-cell lymphoma is a subset of non-Hodgkin lymphoma. It is a disease caused when T-lymphocytes become malignant and affect the skin. T-lymphocytes are the infection-fighting white blood cells in the lymph system that kill harmful bacteria in the body, among other things. Cutaneous T-cell lymphoma usually is a slow-growing cancer that often develops over many years. The two most common types of cutaneous T-cell lymphoma are mycosis fungoides and the Sezary syndrome.

Since the emergence of AIDS, there has been recognition of an association between HIV infection and the development of certain cancers. One of these is high-grade B-cell non-Hodgkin lymphoma, also known as a HIV-related lymphoma. Immune system suppression is implicated as the cause of this condition.

Orbital lymphoma is a form of B-cell non-Hodgkin lymphoma that appears in the eyelid or around the eye.

Diagnosis

The first step to making a non-Hodgkin lymphoma diagnosis is usually a physical, during which a doctor will look for swollen lymph glands and other signs. The doctor will also consider personal and family medical history. If non-Hodgkin lymphoma is suspected, the patient will be sent for additional tests, usually administered on an outpatient basis. 

  • Biopsy - Biopsies may be used to take tissue from bone, bone marrow, cerebrospinal fluid and lymph nodes to look for signs of cancer. Biopsy procedures that may be performed include:
    • Lymph node biopsy — a lymph node or a tissue sample is removed for examination:
      • Excisional biopsy — An entire lymph node is removed by cutting through the skin.
      • Incisional biopsy — Similar to an excisional biopsy, but only part of a lymph node is removed.
      • Fine-needle aspiration (FNA) — A thin needle inserted into a lymph node removes a small sample of cells. An incision doesn’t need to be made, but sometimes the needle can’t remove enough tissue.
      • Core needle biopsy — A needle with a special tip removes sample of tissue that’s larger than what can be removed with FNA.
      • Laparoscopy — A thin tool called a laparascope is inserted through a small cut in the abdomen and views the inside.
      • Laparotomy — When less-invasive procedures are unable to examine a tissue sample, a longer cut in the abdomen is required to access a larger part of the abdominal cavity.
    • Bone marrow aspirate and biopsy — A needle is used to obtain a small amount of marrow from the back of a hip bone, and a small sliver of bone is obtained for pathology review. This test is usually done once a diagnosis of lymphoma has been established. Less commonly, a bone marrow examination can help in making the diagnosis of non-Hodgkin lymphoma.
    • Lumbar puncture (spinal tap) — A thin needle called a spinal needle is inserted into the lower part of the spinal column to collect cerebrospinal fluid or to deliver drugs.
  • Blood and Urine Tests — These measure kidney and liver function as well as lymphoma-related blood markers like LDH and beta 2 microglobulin. A complete blood count is obtained and the blood smear is reviewed under a microscope. Tests measure the levels of antibodies, also known as immunoglobulins, excluding the presence of viral infection, including hepatitis B and C and HIV.
  • Flow Cytometry — A lab test that 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
  • Cytogenetics and Fluorescence in situ Hybridization (FISH) — Looks for specific chromosome abnormalities that can provide genetic information affecting diagnosis, therapy and prognosis.
  • Imaging Tests
    • Chest X-rays — X-rays help doctors look 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.
    • PET scan (positron emission tomography) — Small amounts of radioactive sugar are injected to highlight cancers and areas of infection and inflammation.
    • Additionally, ultrasound, Galllium and bone scans may also be used for non-Hodgkin lymphoma diagnosis.

If cancer is found, the following tests are used to study cancer cells:

  • Flow cytometry — Measures presence of structures on surface of cancer cell that can help in diagnosis and classification. Complements what is measured by immunohistochemistry.
  • Immunohistochemistry — Determining the specific type of cancer can be made in a laboratory when a substance such as a dye or antibody is added to a tissue sample.
  • Cytogenetic analysis — Changes in chromosomes, which signify cancer, within the tissue sample are examined.

Staging

According to the National Cancer Institute, the extent that non-Hodgkin lymphoma has spread is measured in many stages and sub-stages from Stage I to Stage IV:

  • Stage I — Cancer is found in one lymphatic area (lymph node group, tonsils and nearby tissue, thymus, or spleen) (Stage I), or in one organ or area outside the lymph nodes (Stage IE). 
  • Stage II — Cancer is found in two or more lymph node groups either above or below the diaphragm (Stage II), or cancer is found in one or more of those areas as well as outside the lymph nodes in one organ or area on the same side of the diaphragm as the affected lymph nodes (Stage IIE).
  • Stage III — Cancer is found in lymph node groups above and below the diaphragm.
    • Stage IIIE — Cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area.
    • Stage IIIS — Cancer is found in lymph node groups above and below the diaphragm, and in the spleen.
    • Stage IIIE+S — Cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area, and in the spleen.
  • Stage IV — Cancer is found in one of the following scenarios:
    • Involvement of one or more organs that are not part of a lymphatic area (lymph node group, tonsils and nearby tissue, thymus or spleen), and may be in lymph nodes near those organs.
    • In one organ that is not part of a lymphatic area and has spread to organs or lymph nodes far away from that organ.
    • In vital organs such as liver, bone, bone marrow, lungs, testis, ovaries, kidneys, bladder, stomach, bowel, brain or cerebrospinal fluid (CSF).

With the data from these state-of-the-art tests for non-Hodgkin lymphoma diagnosis, a doctor will develop a customized treatment plan with the best possible outcomes.

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