15662 Non Hodgkin Lymphoma

Overview

Non-Hodgkin lymphoma is a type of cancer that starts in the lymphatic system. The lymphatic system is part of your body's immune system and helps fight infections. It includes lymph nodes (small bean-shaped glands), the spleen, bone marrow, and the fluid called lymph. In non-Hodgkin lymphoma, certain white blood cells called lymphocytes grow out of control and form tumors in lymph nodes or other organs. It is a serious condition, but many people are treated successfully and some are cured.

Non-Hodgkin lymphoma is the most common type of blood cancer overall, but it is still not common in everyday medical practice. Most people who have swollen lymph nodes do not have lymphoma.

It can affect people of any age, but it is most often diagnosed in adults over 60. Some types are more common in children and young adults, especially boys. It affects both men and women, and it appears to be slightly more common in men.

Symptoms

Common symptoms

• Painless swelling in one or more lymph nodes, usually in the neck, armpit, or groin
• Feeling very tired and lacking energy
• Night sweats that soak your clothes or sheets
• Fever that comes and goes, without another clear cause
• Losing weight without trying
• Itchy skin all over your body
• Feeling full or bloated, or pain in the belly, if the spleen or lymph nodes in the abdomen are affected
• Cough, chest pain, or trouble breathing, if lymphoma is in the chest

Symptoms in children

• Swollen lymph nodes in the neck, armpit, or groin that do not go away
• Fevers, night sweats, or weight loss
• Feeling very tired or weak
• Pale skin, easy bruising, or unusual bleeding
• Bone pain, especially in the chest, back, or legs

Symptoms in older adults

• Swollen lymph nodes that are often slow-growing and painless
• Unusual tiredness and loss of appetite
• Night sweats and fevers
• Repeated infections or slow-healing infections
• New confusion or memory trouble, sometimes due to infections or the lymphoma affecting the brain (rare)

Causes

Main causes

• The exact cause of most non-Hodgkin lymphomas is not known.
• It starts when a lymphocyte develops a change (mutation) in its DNA, causing the cell to divide and grow out of control.
• Some cases are linked to viral infections, such as the Epstein-Barr virus (the virus that causes glandular fever), but most people with these infections do not get lymphoma.

Risk factors

• Getting older, especially being over 60
• A weakened immune system, for example from organ transplantation, HIV, or certain medicines
• Autoimmune diseases, where the immune system attacks the body’s own tissues
• Infection with certain viruses, such as Epstein-Barr virus, human T-cell lymphotropic virus, or HIV
• A family history of lymphoma (rare)
• Previous treatment with chemotherapy or radiation for another cancer

When to see a doctor

See a doctor urgently if:

• If you feel a new lump anywhere on your body and it does not go away after two to three weeks
• If a lump is growing quickly, feels hard, or is painless
• If you have unexplained fevers, drenching night sweats, or unintentional weight loss
• If you have persistent coughing, chest pain, or trouble breathing

Book a routine appointment if:

• If you have swollen lymph nodes that keep coming back
• If you have lingering tiredness that interferes with daily life
• If you are worried about any symptom, you are always welcome to talk to a healthcare provider

Diagnosis

A doctor will ask about your symptoms, examine you, and feel your lymph nodes. No test alone can confirm lymphoma, so the only reliable way is to take a small sample of tissue from a swollen lymph node or other affected area. This is called a biopsy. The sample is looked at under a microscope to see if lymphoma cells are present and to determine the exact type.

Tests that may be done

• Physical examination of lymph nodes, spleen, and general health
• Blood tests to check blood counts, kidney and liver function, and signs of infection or inflammation
• A lymph node biopsy, which is the key test for diagnosis
• Imaging scans, such as CT, PET, or MRI, to see if lymphoma is in the chest, belly, or pelvis
• A bone marrow biopsy, if doctors need to check whether lymphoma is in the bone marrow

What to expect at your appointment

Diagnosis often takes a few weeks. You may need several appointments and tests. The biopsy is usually done under local or general anesthesia, so you should not feel pain. After that, your care team will explain the type of lymphoma and discuss what the next steps are. It is okay to ask questions and to bring someone with you to appointments.

Treatment

Treatment for non-Hodgkin lymphoma depends on the exact type, how fast it appears to be growing, the stage (where it is in your body), and your general health. Some slow-growing types may not need treatment right away, and doctors may take a 'watch and wait' approach. Fast-growing types are usually treated quickly. The care team will create a plan that is right for you.

Self-care at home

• Keep all your appointments and tell your care team about any new symptoms or side effects
• Ask a friend or family member to come with you to appointments for support and to help remember what was said
• Write down your questions before visits so you don't forget
• Plan rest breaks during the day and do not push yourself too hard
• Try to keep your hands clean and avoid crowded places if your immune system is weaker

Medical treatments

The main treatment options are chemotherapy, which uses medicines to destroy cancer cells; targeted therapies, which attack specific changes in lymphoma cells; immunotherapy, which helps your own immune system fight the lymphoma; and sometimes radiotherapy, which uses high-energy rays to kill cancer cells. In some cases, a stem cell or bone marrow transplant may be offered after intensive chemotherapy. The exact combinations vary, and your healthcare team will explain your options in detail.

When is surgery considered?

Surgery is rarely used as a main treatment for non-Hodgkin lymphoma. The only common surgical procedure is a biopsy, where a small piece of lymph node is removed for testing. In very rare cases, surgery may be used to remove a single tumor if it is only in one place.

Living with this condition

Living with non-Hodgkin lymphoma can feel uncertain, but many people manage daily life well. It helps to pace yourself, rest when you need to, and focus on one day at a time. Your care team can give you advice about work, travel, and activities. You may have good days and bad days, and that is normal.

Lifestyle tips

• Stay active as much as you can, even if it is just a short daily walk
• Avoid alcohol or keep it very limited, especially during treatment
• Do not smoke, and ask for help if you need it to quit
• Protect your skin from strong sunlight, especially after radiation treatment
• Ask your healthcare team before taking any vitamins, herbal remedies, or over-the-counter medicine, because they can interact with treatment

Diet and exercise

Eating a balanced diet with enough protein, fruits, vegetables, and whole grains can help you stay stronger. If you have trouble eating or lose weight, ask to speak with a dietitian. Gentle exercise, such as walking or stretching, can improve energy and mood. Always check with your care team before starting a new exercise program, especially during chemotherapy or after surgery.

Mental health and emotional wellbeing

A cancer diagnosis can bring fear, anxiety, sadness, and stress. These feelings are common and are not a sign of weakness. Talk to your healthcare team about emotional support, counselling, or medicines for anxiety or depression if you need them. If you ever feel overwhelmed or have thoughts of harming yourself, reach out to a crisis support line immediately.

Prevention

There is no proven way to completely prevent non-Hodgkin lymphoma. Because the causes are not fully understood, most cases occur without a clear reason. However, keeping a healthy immune system by eating well, exercising, avoiding smoking, and managing chronic infections may lower your general risk.

Vaccines

There is no vaccine that specifically prevents non-Hodgkin lymphoma. Some vaccines can help prevent infections that may weaken the immune system, but they do not prevent lymphoma itself. Always ask your healthcare team whether vaccines are safe for you, especially during treatment.

Screening programmes

There is no routine screening test for non-Hodgkin lymphoma in people without symptoms. If you have an increased risk, your doctor may recommend regular check-ups and blood tests, but this is not the same as population screening.

Complications

If left untreated

• Lymphoma can spread to other lymph nodes, bone marrow, liver, lungs, or other organs
• Tumors can press on the spinal cord, causing pain, weakness, or difficulty with bladder or bowel control
• Large lymph nodes in the chest may make it hard to breathe
• The lymphatic system can become less able to fight infections, leading to serious repeated infections
• Heavy night sweats, fevers, and weight loss can cause severe tiredness and weakness

Long-term outlook

It is very understandable to be worried, but keep in mind that non-Hodgkin lymphoma is one of the most treatable blood cancers. Some slow-growing types can be managed for many years, and fast-growing types often respond well to treatment. Many people are cured, especially if the disease is found early and the right treatment is given. Your healthcare team will be honest about your situation and will support you at every stage.

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