Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma (NHL) is a group of blood cancers that develop in your lymphatic system. It’s one of two types of lymphoma — cancers that start in white blood cells called lymphocytes. Lymphocytes are important immune system cells that help fight off infections.

With non-Hodgkin lymphoma, genes inside B lymphocytes (B cells) or T lymphocytes (T cells) mutate, or change, at some point in your lifetime. The abnormal lymphoma cells usually form in your lymph nodes and form tumors. But they can also be in other lymph system organs, like your thymus or spleen, or lymph tissue in other places. Without treatment, non-Hodgkin lymphoma can spread.

People with non-Hodgkin lymphoma are living longer than ever, thanks to new treatments. In some cases, treatments cure the condition. Other times, the goal of treatment is to put the disease into remission (no signs or symptoms of cancer) for as long as possible.

Types of non-Hodgkin lymphoma

There are more than 70 subtypes of non-Hodgkin lymphoma. Healthcare providers classify them based on the type of lymphocyte affected:

• B-cell lymphoma. These cancers arise from B cells. B cells make antibodies that fight infection-causing germs. B-cell lymphomas account for about 85% of all NHL diagnoses.
• T-cell lymphoma. These cancers arise from T cells. T cells target germs and other foreign cells and help B cells make antibodies.

Providers classify B-cell and T-cell lymphomas as either aggressive or indolent. Aggressive non-Hodgkin lymphomas spread faster than indolent non-Hodgkin lymphomas. Aggressive NHL often requires more intensive treatment.

How common are non-Hodgkin lymphomas?

They’re relatively common. Non-Hodgkin lymphoma is the 8th most common cancer diagnosis, with 80,620 new cases expected in 2024 in the U.S. It’s the 11th most common cancer worldwide.

Non-Hodgkin lymphoma is much more common than the other type of lymphoma — Hodgkin lymphoma.

What are the symptoms of non-Hodgkin lymphoma?

The most common symptom is painless swelling in your neck, armpits or groin. This is a sign of swollen lymph nodes in those areas. Other signs and symptoms depend on where the lymphoma cells are. Additional NHL symptoms include:

• Persistent fatigue
• Chest pain
• Cough
• Trouble breathing (dyspnea)
• Belly (abdominal) pain or swelling
• Feeling full even when you haven’t eaten much
• Unexplained fever (especially a fever that stays above 103 degrees Fahrenheit or 39.5 degrees Celsius for two or more hours after home treatment or that lasts longer than two days)
• Drenching night sweats (so intense that it soaks your sheets)
• Unexplained weight loss (losing 10% of your total body weight over six months)

It’s important to remember that many conditions share these symptoms. Having one or more doesn’t necessarily mean you have non-Hodgkin lymphoma. Still, it’s a good idea to contact a healthcare provider anytime you notice changes in your body that last for several weeks.

B symptoms

Healthcare providers consider whether you have B symptoms when they diagnose lymphomas. B symptoms include fever, night sweats and unexplained weight loss. These help your provider classify the type of non-Hodgkin lymphoma you have and determine the best treatments.

What causes non-Hodgkin lymphomas?

Non-Hodgkin lymphomas form when your body produces too many lymphocytes. These include B cells, T cells or (rarely) natural killer (NK) cells. Acquired genetic mutations that affect lymphocyte growth play a part in the process. “Acquired” means you develop them during your lifetime instead of being born with them.

When lymphocytes mutate, they multiply and eventually become tumors. Usually, the tumors start in your lymph nodes. As your lymphatic system touches nearly every part of your body, non-Hodgkin lymphoma often spreads to other lymph organs.

Risk factors

​​There are several risk factors linked to non-Hodgkin lymphoma. A risk factor is a trait, activity or condition that increases your risk of developing a disease. For example, people more likely to get diagnosed with NHL are:

• Over 60 (NHL risk increases with age)
• Male
• White

Other factors that may increase your risk of NHL include:

• Immune system deficiencies. Having HIV weakens your immune system and may increase your risk of HNL. Taking medications that suppress your immune system after an organ transplant is also a risk factor.
• Autoimmune diseases. People with inflammatory bowel disease (IBD), rheumatoid arthritis, psoriasis or other rheumatologic conditions may have an increased risk of developing NHL.
• Infections. Bacterial and viral infections that have been linked to NHL include H. pylori infection, human T-lymphotropic virus Type I, Hepatitis C and Epstein-Barr virus.
• Exposure to pesticides. Some research shows that people exposed to high levels of weed killers and insecticides may have a slightly increased risk of non-Hodgkin lymphoma.
• Family history. Your risk may be greater if you have a parent, sibling or child with lymphoma or other blood cancer.

How is non-Hodgkin lymphoma diagnosed?

A non-Hodgkin lymphoma diagnosis involves many steps. First, you’ll likely need tests to rule out more common conditions that may be causing your symptoms. For example, a swollen lymph node is more likely to mean an infection — not lymphoma. Once your healthcare provider determines you have non-Hodgkin lymphoma, they’ll do tests to determine the type and how advanced it is.

Tests or procedures you may need to diagnose non-Hodgkin lymphoma include:

• Physical exam. Your provider will ask about your symptoms and check for signs of non-Hodgkin lymphoma, like swollen lymph nodes.
• Blood tests. Blood tests, like a complete blood count (CBC), give your provider a view of your overall health. They may also test your blood for viruses linked to non-Hodgkin lymphoma or for substances that may be signs of tissue damage related to the disease.
• Imaging tests. Imaging tests can show cancer cells inside your body. Depending on where the lymphoma cells are, you may need a CT scan, MRI, ultrasound or PET scan.
• Biopsy. A biopsy is the only way to know for sure if abnormal cells are NHL. Your provider removes all or part of a lymph node or involved tissue. A pathologist will examine the tissue under a microscope to check for lymphoma cells.
• Immunophenotyping. This test helps diagnose specific NHL types. It identifies cancer cells based on the types of antigens (markers on cells’ surface).

Stages of non-Hodgkin lymphoma

Test results help providers with cancer staging. Providers stage cancer to develop treatment plans and estimate prognosis, or expected outcome. The stages of non-Hodgkin lymphoma are:

• Stage I. One lymph node area or lymphoid organ contains cancer cells. Or there’s lymphoma in one area of a single organ outside of your lymph system.
• Stage II. There’s lymphoma in two or more groups of lymph nodes on the same side of (or near) your diaphragm.
• Stage III. There are cancer cells in lymph node areas both above and below your diaphragm or in the lymph nodes above your diaphragm and in your spleen.
• Stage IV. At least one organ outside your lymph system, like your liver or lung, contains widespread lymphoma.

How is non-Hodgkin lymphoma treated?

There are several types of treatment for non-Hodgkin lymphoma. The treatment you’ll need depends on factors like the type of NHL, the cancer stage and your overall health. Treatments include:

• Active surveillance. If you have an indolent (slow-growing) non-Hodgkin lymphoma and aren’t experiencing symptoms, your provider may hold off on treatment. This is called active surveillance, or watchful waiting. Providers monitor your health, so they’re ready to start treatment as soon as you have symptoms.
• Chemotherapy. Chemotherapy uses drugs to attack cancer cells throughout your body. It’s the most common NHL treatment. You may get chemo alone or alongside other treatments.
• Targeted therapy. These treatments home in on weaknesses in cancer cells to destroy them. Monoclonal antibody therapy is a common targeted therapy treatment for NHL.
• Immunotherapy. This treatment boosts your body’s immune system, so it’s better at destroying cancer cells. CAR-T cell therapy is a common immunotherapy treatment for NHL. Bispecific antibodies are a new class of drug treatments that direct your own T cells to eliminate the cancerous lymphoma cells.
• Radiation therapy. This treatment uses energy beams from a machine to destroy cancer cells. It may be the only treatment needed for early-stage NHL. Providers also use it to destroy lymphoma cells that remain after chemotherapy.
• Chemotherapy with stem cell transplantation. For this treatment, providers give high doses of chemotherapy to treat your cancer. Then, they replace stem cells (immature blood cells) damaged during chemotherapy with healthy ones from your own body or a donor. You may need a transplant if other NHL treatments haven’t worked.

Side effects of treatment

Common cancer treatments for non-Hodgkin lymphoma — including chemotherapy, radiation therapy and immunotherapy — can cause side effects. Most are short term and go away once treatment ends, while other side effects may be long term.

Ask your healthcare provider about potential side effects before starting treatment. They’ll help you weigh the benefits of treatment against the risks of possible side effects.

What is the outlook for non-Hodgkin lymphoma?

In some cases, treatment can cure non-Hodgkin lymphoma. This means that treatment has eliminated all cancer cells for good. This is more common after treatment for aggressive B-cell lymphomas. Most aggressive non-Hodgkin lymphomas that come back usually do so within the first two years after treatment, or they never come back. Still, you’ll need regular check-ups so your healthcare provider can check for relapse.

With other non-Hodgkin lymphomas, especially indolent ones, you may have this condition in the long term. This means you may need continuous or occasional treatment for the rest of your life.

It’s important to remember, though, that even when non-Hodgkin lymphoma isn’t curable, current treatments are helping people live longer, fuller lives with this disease. Most people with indolent lymphoma die from other causes, even if the lymphoma can’t be cured.

What is the survival rate for non-Hodgkin lymphoma?

According to the U.S. National Cancer Institute, 74% percent of people with non-Hodgkin lymphoma are alive five years after their diagnosis.

Generally, people diagnosed before the condition spreads live longer than people who are diagnosed after cancer spreads. The five-year survival rate for early-stage non-Hodgkin lymphomas (stages I and II) ranges from 79% to 87%. The survival rate for advanced-stage disease (stages III and IV) ranges from 64% to 73%.

How do I take care of myself?

You can manage living with non-Hodgkin lymphoma in several ways. These activities won’t make your condition go away, but they may help you feel more confident about living with it:

• Eat healthy meals. Food is energy. Eating well is one way to maintain strength. Ask a dietitian for more information or ideas for meals and snacks.
• Rest as much as you can. Chemotherapy and other treatments may make you feel worn out. Rest helps your body recover and regain strength.
• Manage stress. Living with a non-Hodgkin lymphoma isn’t easy. You may wonder how the condition and treatment will affect your daily life. Talk to your provider if you’re worried about your prognosis. They’ll answer your questions and recommend programs, like support groups, that may help.
• Exercise. Regular exercise is one of the best ways to keep your mind and body in shape. Talk to your provider about the types of activities and intensity levels that are good for you.
• Seek additional resources. If you’re living with non-Hodgkin lymphoma, you may want to explore palliative care. Palliative care provides symptom relief and support for people with cancer, no matter their stage or prognosis.

When should I see my healthcare provider?

If you’re receiving treatment for non-Hodgkin lymphoma, you should contact your provider if your symptoms return or get worse. If your treatment has ended, make sure to attend all regular follow-up visits.

When should I go to the emergency room?

Visit the emergency room if you have severe or significantly worsening symptoms that don’t get better despite measures to improve how you feel.

What questions should I ask my healthcare provider?

Questions you may want to ask your healthcare provider include:

• What kind of non-Hodgkin lymphoma do I have?
• What stage is the disease?
• What treatments do you recommend?
• What are the side effects of those treatments?
• Can you cure my non-Hodgkin lymphoma?
• What are the chances the cancer will come back?