Non-Hodgkin Lymphoma (NHL): Types, Symptoms, Causes, Risks, Diagnosis, Stages, Treatment and Outlook

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Medicines to a patient with Non-Hodgkin Lymphoma(NHL)

1Overview

Lymphoma is cancer that originates in the lymph system particularly in the white blood cells called lymphocytes which protect the body from infection. When these cells become aberrant and grow uncontrollably and form tumors, they would not safeguard the body against disease and infection. There are two types of lymphoma: the Hodgkin’s lymphoma and the non-Hodgkin’s lymphoma.

Non- Hodgkin’s lymphoma or NHL is cancer that starts in the body’s defense system particularly in the lymphocytes (WBC). The two types of lymphocytes are the B lymphocytes and the T lymphocytes. The B lymphocytes help protect the body from bacteria and viruses by producing antibodies. The T lymphocytes destroy abnormal cells and germs in the body and can help also slow down or increase the activity of other cells in the immune system.

B-cell lymphomas progress from abnormal B-lymphocytes and are the most common lymphomas in the United States accounting 85 percent of all Non-Hodgkin’s disease.
The T-cell lymphomas account 15 percent of all NHL cases.

Non- Hodgkin’s disease may grow in a lymph node or group of lymph nodes, tissue or an organ and may spread to any part of the body like the liver and bone marrow. Non-Hodgkin’s lymphoma can be grouped as slow-growing (indolent) or fast-growing lymphomas (aggressive).

Indolent NHL has lymphomas that grow slowly thus there’s no need to start the treatment upon diagnosis. Only then when symptoms develop, the management begins. Aggressive NHL develops rapidly and the treatment starts at once.

Early detection of cancer is important for the success of the various treatments.

2Types of Non-Hodgkin’s Disease

The World Health Organization (WHO) classified lymphomas based on the type of lymphocyte the lymphoma starts in, the characteristics of the lymphoma cells, how the lymphoma looks under a microscope, and the existence of certain proteins on the surface of the cells.

  • AIDS-Related Lymphomas, a disease where cancer cells are formed in the lymph system of patients who have AIDS
  • Anaplastic Large-Cell Lymphoma (ALCL)
  • Angioimmunoblastic Lymphoma
  • Burkitt’s Lymphoma
  • Chronic Lymphocytic Leukemia/ Small Lymphocytic Lymphoma
  • Cutaneous T- cell Lymphoma
  • Diffuse Large B-Cell Lymphoma (DLBCL)
  •  Enteropathy-TypeT- Cell Lymphoma
  • Follicular Lymphoma
  • Hepatosplenic Gamma-Delta T-Cell Lymphoma
  • Lymphoblastic Lymphoma
  • Mantle Cell Lymphoma
  • Marginal Zone Lymphoma
  • Nasal T- Cell Lymphoma
  • Pediatric Lymphoma
  • Peripheral T- Cell Lymphomas (PTCLs)
  • Primary Central Nervous System Lymphoma (PCNSL) also known as microglioma
  • T-Cell Leukemia
  • Transformed Follicular Lymphomas
  • Treatment-Related T-Cell Lymphomas appear after transplant
  • Waldenstrom Macroglobulinemia

3Symptoms

The common signs and symptoms of NHL are as follows:

  • Painless swelling of lymph nodes located in the neck, groin, and underarm; these may be felt as lumps under the skin.
  • Fever without an infection
  • drenching night sweats
  • Having severe and frequent infections
  • Easy bruising or bleeding
  • unexplained weight loss (at least 10 percent of body weight over six months)
  • itching skin
  • Pain in the back or belly
  • Over-fatigue
  • Symptoms of lymphoma affecting the brain and spinal cord include: a headache, trouble thinking, personality changes, seizures, double vision, facial numbness and trouble speaking

4Causes

The cause of non-Hodgkin’s lymphoma is still unknown the fact that lymphomas are diverse. The changes in the abnormal cells may be caused by an infection, mutations in the genes, or exposure to something in the environment. This disease is not infectious.

5Risk Factors

Several factors can affect an individual’s chance of acquiring non-Hodgkin lymphoma (NHL). Here are some of the factors that have been associated with certain types of NHL lymphoma.

Age and Gender

Most of the NHL cases have clients who are in the age bracket 60 years old and above.
Men have the higher risk of developing NHL and the reason for this is still unknown.

Ethnicity, race, and geography

The whites are more prone to develop NHL than Asian Americans and African Americans. Non-Hodgkin lymphoma is more common in the United States and Europe.

Exposure to drugs and certain chemicals

Those who have been exposed to fertilizers, pesticides, or solvents for a long period are at risk of getting NHL. Those who used some chemotherapy drugs to manage other cancer are also at risk of developing the disease.

Exposure to radiation

Those who survived nuclear reactor accidents and atomic bombs are at risk of the NHL disease and so with those who are being treated with radiation therapy.

Those with weak immune system

Those who have HIV/AIDS, Epstein Barr, Human T-lymphotropic virus type 1 (HTLV-1), hepatitis C, and H-pylori are at risk since their immune system is weakened.
Those recipients of organ transplants are also at risk since they used drugs as part of their treatment. These drugs repress their immune system

Autoimmune diseases

This has been associated with an increased risk of Non-Hodgkin Lymphoma. Here, the immune system wrongly sees the body’s tissues as an invader and destroys them.
The immune system in autoimmune diseases could make lymphocytes mutate and divide more often. Thus, there is a risk of them becoming into lymphoma cells.

Have a genetic history of NHL (familial history)

People with relatives who have lymphomas also are at risk of developing NHL.

6Diagnosis

These tests and procedures used to diagnose non-Hodgkin’s lymphoma include:

Physical examination

The doctor does a physical examination to check the size of the lymph nodes located in the neck, underarm (armpit), and groin. This is also done to assess whether the liver and spleen are enlarged.

Blood and urine tests

This helps rule out an infection or other diseases.

Imaging tests

The doctor recommends imaging tests to find tumors in the body. It includes x-ray, computerized tomography (CT or CAT) scan, Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET).

Biopsy

The doctor removes a sample of lymph node tissue and sends to the laboratory for testing. The sample taken is analyzed whether the client has non-Hodgkin’s lymphoma or none. If confirmed that the client has NHL, the result will also reveal which type of NHL does the client has.

Find cells that are cancerous in the bone marrow

The doctor may request a bone marrow biopsy to see if the disease affects already the bone marrow. A needle into the pelvic bone to get a sample of bone marrow.

7Stages

Non-Hodgkin lymphoma (NHL) has four (4) stages based on the extent of metastasis

Stage 1: the cancer is located in a single lymph node or one (1) organ outside the lymph node; this is called the early disease.

Stage II: the cancer is seen in two (2) or more lymph node regions and only located on one side of the diaphragm; this is a locally advanced disease.

Stage III: cancer has spread to lymph nodes in the diaphragm both below and above it; is called the advanced disease.

Stage IV: cancer has already metastasized to several parts of the body affecting one or more tissue or organs like the liver, blood or bone marrow; also called widespread disease.

8Treatment

The treatment depends on the type and extent of how far the lymphoma has spread. Consider also some factors like the health and treatment options for people with Non-Hodgkin’s lymphoma.

Chemotherapy

This method uses anti-cancer drugs that are introduced into the vein (intravenous) or taken orally thus reaching almost all areas of the body. Chemotherapy may be used solely or together with immunotherapy drugs or radiation therapy.

Immunotherapy

This treatment boosts or enhances the client’s natural defenses to fight cancer.

Use of targeted agents or drugs

These drugs work in another way from standard chemotherapy drugs. They have different side effects. Targeted agents or drugs used are the proteasome inhibitors, histone deacetylase (HDAC) inhibitors, and the kinase inhibitors.

Radiation therapy

This can be used as a treatment for some types of NHL that are still at the early stage (I and II) since the tumors respond well to radiation. Otherwise, use radiation therapy along with chemotherapy for aggressive lymphomas and advanced cases.

This can also be used as palliative treatment to ease symptoms like a pain since the tumor is pressing on the nerves causing pain.

Stem cell treatment (bone marrow transplant)

Doctors give high doses of chemo drugs since the patient has received blood-forming stem cells as a transplant to renew the bone marrow. Sometimes, stem cell transplant is used to manage lymphoma patients who are in remission or have a relapse.

Surgery

This is often used for biopsy but it is rarely used as a management or a form of treatment. Surgery is seldom used to treat lymphomas that begin in the spleen, or outside the lymph system, like the thyroid and stomach, and that have not metastasized further these organs.

9Outlook

The prognosis for people with lymphoma differs by the stage of cancer. Statistics often gives five years (estimate) survival rates after the diagnosis of a particular type and stage of cancer. But this does not tell how long a patient lives but rather helps in understanding how likely the treatment will be favorable.

The survival rates are higher for clients with an early stage of cancer. Remember the outlook can vary based on the number of factors specific to a patient.