Diseases & Conditions

Adult Non-Hodgkin’s Lymphoma

What is adult non-Hodgkin’s lymphoma?

Adult non-Hodgkin’s lymphoma (NHL) is a malignant cancer that begins in the lymph system. The lymph system is part of the body’s immune system. “Malignant” means a disease spreads from where it starts and invades other areas of the body. Adult non-Hodgkin’s lymphoma differs from lymphoma in children and has a different course of treatment. “Non-Hodgkin’s” means the absence of a certain type of cell, called Reed-Sternberg cells, in the cancerous tissue.

The lymph includes the following:

  • Bone marrow – The spongy interior of large bones where white blood cells, red blood cells (which carry oxygen), and platelets (which help blood clot) are made.
  • Lymph – Colorless, watery fluid that carries white blood cells (lymphocytes) through the vessels of the lymph system all through the body. Lymphocytes can be either B-cells or T-cells. Their job is to fight disease and the growth of tumors.
  • Lymph vessels – Tubes that collect lymph from different parts of the body and send it back to the bloodstream.
  • Lymph nodes – Small oval or round structures that filter lymph and store white blood cells. Lymph nodes are located throughout the body but are concentrated in the underarms, pelvis, neck, abdomen and groin.
  • Thymus – An organ behind the breastbone in which lymphocytes grow and reproduce.
  • Spleen – An organ on the left side of the body near the stomach. The spleen filters blood, stores blood cells, and removes old blood cells. It also makes lymphocytes.
  • Tonsils – Lymph tissue in the back of the throat that makes lymphocytes.

Because the lymph system is present throughout the body, lymphoma can begin in almost any area and spread to other tissues and organs such as the liver.

What are the risk factors for non-Hodgkin’s lymphoma?

  • Being older, male, or Caucasian
  • Having any of the following conditions:
    • An inherited immune system disorder
    • An autoimmune disease, such as rheumatoid arthritis or psoriasis
    • HIV/AIDS
    • Human T-lymphotrophic virus Type I or Epstein-Barr virus
    • Repeated bouts of Helicobacter pylori infection, which causes stomach ulcers
  • Use of immunosuppressant drugs following an organ transplant
  • Exposure to certain pesticides
  • Exposure to radiation
  • A diet containing high amounts of meat and fat
  • Previous treatment for Hodgkin’s lymphoma

What are the symptoms of adult non-Hodgkin’s lymphoma?

  • Painless swelling in the lymph nodes of the neck, underarm, groin, or stomach
  • Unexplained fever
  • Heavy night sweats
  • Feeling much more tired than usual for at least several weeks for no apparent reason
  • Unexplained weight loss
  • Skin rash or itchy skin
  • Unexplained pain in the chest, abdomen, or bones

How common is adult non-Hodgkin’s lymphoma?

An estimated 70,800 people (38,270 men and 32,530 women) in the US were diagnosed with NHL in 2013, making it the sixth most common cancer in women and the seventh most common cancer in men.

How is adult non-Hodgkin’s lymphoma diagnosed?

  • Physical examination and medical history, focusing especially on lumps or anything that seems unusual.
  • Blood tests to measure levels of red blood cells, white blood cells, and platelets
  • Blood and urine tests that measure the amounts of certain immunoglobulins (proteins produced by the immune system to help fight infections).
  • Bone marrow aspiration or biopsy – Using a needle to take a sample of bone marrow, from the back of the pelvic bones. The sample is then viewed under a microscope for signs of cancer.
  • Lymph node biopsy – Removal of all or part of a lymph node in order to examine it under a microscope for signs of cancer.

If cancer is detected, more laboratory tests will be needed to pinpoint what specific form of the disease is present.

Can adult non-Hodgkin’s lymphoma be treated?

Yes, NHL is a very treatable disease. Before treatment begins, it is necessary to know how far the cancer has advanced. This is called the stage of the disease. The stages begin with I (least severe) and go through IV (most severe). Stages of adult non-Hodgkin lymphoma may include “E” (meaning extranodal, or that cancer has spread beyond the lymph nodes) and “S” (meaning that cancer has been found in the spleen).

Because NHL is a blood and lymph system disease, most patients are at an advanced stage at diagnosis.

NHL comes in many types, but is often divided into indolent (slow-moving, usually with few symptoms) or aggressive (growing quickly, often causing symptoms) These two forms of NHL behave quite differently and are treated differently

How is adult non-Hodgkin’s lymphoma treated?

There are several types of treatments used to kill cancer cells or keep them from dividing:

  • Radiation therapy – X-rays or other types of radiation.
  • Chemotherapy – Drugs taken either by mouth or injected into a vein, or less commonly into the cerebrospinal fluid.
  • Targeted therapy – Treatments such as monoclonal antibodies that bind to targets on the surface of lymphocytes or small molecules designed to block pathways that make lymphoma cells grow but are not critical to normal cells.
  • Biologic therapy (also called biotherapy or immunotherapy) – Using substances or cells made by the patient’s own immune system or in a laboratory to help boost the body’s natural defenses.

Some patients with indolent lymphoma that is not causing problems do not need treatment. This is called watchful waiting. It is the close monitoring of the patient without giving any treatment until symptoms appear or change.

There are also a number of new treatments being developed in clinical trials. A clinical trial might be preferred if standard treatments do not work or are too toxic. Ask the doctor about clinical trials.

What can be expected after treatment for adult non-Hodgkin’s lymphoma?

Regular appointments with the patient’s doctor are necessary following any treatment for cancer. It is important to monitor how the patient feels and to do physical exams. Also, providers need to perform laboratory tests or imaging tests to look for signs of cancer or side effects from treatment.

For many people with NHL, treatment successfully removes the cancer. For others, the lymphoma may never completely disappear. Ongoing treatments will be needed as long as possible to keep the disease under control.

What is the outlook for people with adult non-Hodgkin’s lymphoma?

The outlook for people with this disease depends upon the stage of the cancer. Another factor is the type of lymphoma present. The age and general health of the patient also are taken into account. In general, the survival rate of patients with NHL at the five-year mark is more than 60%.

Other facts:

  • Indolent NHLs have a median survival rate of as long as 20 years, and Stage I and Stage II varieties can often be treated with radiation alone.
  • When treated early, over half of patients with aggressive NHLs can be cured with combination chemotherapies.
  • Most relapses of aggressive NHL occur within two years of treatment.
  • Relapses of indolent lymphoma can occur later.

How can adult non-Hodgkin’s lymphoma be prevented?

Many of the risk factors for NHL are outside a person’s direct control. The following factors, however, can be controlled:

  • Avoiding behaviors that increase the chance of getting AIDS and hepatitis C infections, both of which weaken the immune system.
  • Avoiding unnecessary exposure to radiation.
  • Avoiding exposure to chemicals such as benzene and certain herbicides and insecticides.
  • Maintaining normal weight and eating a healthy diet.
  • Rarely, some women develop lymphoma in the scar tissue around breast implants. The decision to get breast implants should be well thought-out.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/20/2015…#15662