Are you feeling sick?
Search 1000+ Symptoms
Credit by 

Introduction 

Non-Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body.

The lymphatic system is part of your immune system. Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells known as lymphocytes.

In non-Hodgkin lymphoma, the affected lymphocytes start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands). The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection.

The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin. 

.

Who is affected

About 80% of all lymphomas diagnosed are non-Hodgkin lymphoma. In the UK, more than 12,000 cases are diagnosed each year.

Non-Hodgkin lymphoma can occur at any age, but your chances of developing the condition increase as you get older, with most cases diagnosed in people over 65. Slightly more men than women are affected.

What causes non-Hodgkin lymphoma?

The exact cause of non-Hodgkin lymphoma is unknown.

However, your risk of developing the condition is increased if you have a medical condition that weakens your immune system, you take immunosuppressant medication or you have previously been exposed to a common virus called the Epstein-Barr virus (which causesglandular fever).

You may also have a slightly increased risk of developing non-Hodgkin lymphoma if a first-degree relative (such as a parent or sibling) has had the condition.

 

How non-Hodgkin lymphoma is diagnosed

The only way to confirm a diagnosis of non-Hodgkin lymphoma is by carrying out a biopsy.

This is a minor surgical procedure where a sample of affected lymph node tissue is removed and studied in a laboratory.

 

Treatment and outlook

There are many subtypes of non-Hodgkin lymphoma, but they can generally be put into one of two broad categories:

  • high-grade or aggressive non-Hodgkin lymphoma is where the cancer develops quickly and aggressively
  • low-grade or indolent non-Hodgkin lymphoma is where the cancer develops slowly, and you may not experience any symptoms for many years

The outlook for non-Hodgkin lymphoma varies greatly depending on the exact type, grade and extent of the lymphoma, and the person’s age.

Low-grade tumours do not necessarily require immediate medical treatment, but are harder to completely cure. High-grade lymphomas need to be treated straightaway but tend to respond much better to treatment and can often be cured. 

The main treatments used for non-Hodgkin lymphoma are chemotherapy, radiotherapy and a type of targeted treatment called monoclonal antibody therapy.

Overall, most cases of non-Hodgkin lymphoma are considered very treatable. More than half of those with high grade disease are cured and about half of those with low grade disease will live at least 10 years.

However, there is a risk of long-term problems after treatment, including infertility and an increased risk of developing another type of cancer in the future.

 



 

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma is the most common type of lymphoma in the UK, with more than 12,000 people diagnosed each year. An expert describes the symptoms, and Maureen talks about her experience of living with the condition.

Symptoms of non-Hodgkin lymphoma 

The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin.

The swelling is caused by an excess of affected lymphocytes (white blood cells) collecting in a lymph node (also called lymph glands). Lymph nodes are pea-sized lumps of tissue found throughout the body. They contain white blood cells that help to fight against infection.

 

Other symptoms

Some people with non-Hodgkin lymphoma also have other more general symptoms. These can include:

  • night sweats
  • unexplained weight loss
  • a high temperature (fever)
  • persistent tiredness or fatigue
  • difficulty recovering from infections or developing infections more often
  • persistent itching of the skin all over the body

Other symptoms will depend on where in the body the enlarged lymph glands are. For example, if the abdomen (tummy) is affected, you may have abdominal pain or indigestion.

When to seek medical advice

See your GP if you have any of the above symptoms, particularly if you have persistently swollen glands with no other signs of infection.

While the symptoms are unlikely to be caused by non-Hodgkin lymphoma, it is best to get them checked out

.

Causes of non-Hodgkin lymphoma 

Non-Hodgkin lymphoma is caused by a change (mutation) in the DNA of white blood cells called lymphocytes, although the exact reason why this happens is not known.

The DNA gives the cells a basic set of instructions, such as when to grow and reproduce. The mutation in the DNA changes these instructions so that the cells keep growing. This causes them to multiply uncontrollably.

The abnormal lymphocytes usually begin to multiply in one or more lymph nodes in a particular area of the body, such as your neck or groin. Over time, it is possible for the abnormal lymphocytes to spread into other parts of your body, such as your bone marrow, spleen, liver, skin and lungs.

In some cases however, non-Hodgkin lymphoma first develops in an organ or elsewhere outside the lymphatic system (the network of lymph vessels and glands found throughout the body).

Who is most at risk?

While the cause of the initial mutation that triggers non-Hodgkin lymphoma is unknown, a number of factors can increase your risk of developing the condition:

  • having a medical condition that weakens your immune system, such as HIV
  • having medical treatment that weakens your immune system – for example, taking medication to suppress your immune system following an organ transplant
  • having an autoimmune condition (a condition caused by problems with the immune system), such as lupus or Sjogren's syndrome
  • being previously exposed to the Epstein-Barr virus (a common virus that causes glandular fever)
  • being previously exposed to the Human T-cell lymphotropic virus (HTLV)
  • having a Helicobacter pylori infection (a common bacterial infection that usually infects the lining of the stomach and small intestine)
  • having received  for an earlier cancer
  • having coeliac disease (an adverse reaction to gluten that causes inflammation of the small bowel)

Non-Hodgkin lymphoma isn't infectious and isn't thought to run in families, although your risk may be slightly increased if a first-degree relative (such as a parent or sibling) has had lymphoma.

Non-Hodgkin lymphoma can occur at any age, but most cases are diagnosed in people over 65. The condition is slightly more common in men than women.

Diagnosing non-Hodgkin lymphoma 

If you see your GP with symptoms of non-Hodgkin lymphoma, they will ask about your health and carry out a simple physical examination.

If necessary, your GP will refer you to hospital for further tests. In hospital, it is likely that a biopsy will be carried out, as this is the only way to confirm a diagnosis of non-Hodgkin lymphoma.

Biopsy

biopsy involves removing some or all of an affected lymph node, which is then studied in a laboratory.

Biopsies are small operations that can often be carried out under alocal anaesthetic, although there may be some cases where the affected lymph node is not easily accessible and a general anaestheticmay be required.

pathologist will then check the tissue sample for the presence of cancerous cells. If they find cancerous cells, they can also identify exactly which type of non-Hodgkin lymphoma you have, which is an important factor in planning your treatment.

Types of non-Hodgkin lymphoma

There are more than 30 types of non-Hodgkin lymphoma, including:

  • diffuse large B-cell lymphoma
  • follicular lymphoma
  • extranodal marginal zone B-cell (MALT)
  • mantle cell lymphoma
  • Burkitt lymphoma
  • mediastinal large B-cell lymphoma
  • nodal marginal zone B-cell lymphoma
  • small lymphocytic lymphoma
  • lymphoplasmacytic lymphoma 
  • peripheral T-cell lymphoma
  • skin (cutaneous) lymphomas
  • anaplastic large-cell lymphoma
  • lymphoblastic lymphoma

The Macmillan Cancer Support website has more detailed information on the different types of non-Hodgkin lymphoma.

Further testing

If a biopsy confirms a diagnosis of non-Hodgkin lymphoma, further testing will be required to check how far the lymphoma has spread. This allows a doctor to diagnose the stage of your lymphoma (see below).

Further tests may include:

  • Blood tests – samples of blood will be taken throughout your diagnosis and treatment to check your general health, the levels of red and white cells and platelets in your blood, and how well organs, such as your liver and kidney, are working.
  • Bone marrow sample – another biopsy may be carried out to see if the lymphoma has spread to your bone marrow. This involves using a long needle to remove a sample of bone marrow from your pelvis and can be done using a local anaesthetic.
  • Chest X-ray – can check whether your lymphoma has spread to your chest or lungs.
  • Computerised tomography (CT) scan – takes a series of X-rays that build up a three-dimensional picture of the inside of the body to check the spread of your lymphoma.
  • Magnetic resonance imaging (MRI) scan – uses strong magnetic fields to build up a detailed picture of areas of your body to check the spread of your lymphoma.
  • Positron emission tomography (PET) scan – a type of scan that measures the activity of cells in different parts of the body. It is usually taken at the same time as a CT scan to show precisely how the tissues of different sites of the body are working. It can check the spread of the cancer and the impact of treatment.
  • Lumbar puncture – using a thin needle, a sample of spinal fluid is taken and examined to see if it contains any lymphoma cells.

Staging non-Hodgkin lymphoma

When the testing is complete, it should be possible to determine the stage of your lymphoma. Staging means scoring the cancer by how far it has spread.

The main stages of non-Hodgkin lymphoma are.

  • stage 1 – the lymphoma is limited to one group of lymph nodes, such as your neck or groin nodes either above or below your diaphragm (the sheet of muscle underneath the lungs)
  • stage 2 – two or more lymph node groups are affected on the same side of the diaphragm
  • stage 3 – the lymphoma has now spread to lymph node groups above and below the diaphragm
  • stage 4 – the lymphoma has spread through the lymphatic system and is now present in organs or bone marrow outside of the lymphatic system

Health professionals also add the letter 'A' or 'B' to your stage to indicate whether or not you have certain symptoms.

'A' is put after your stage if you have no additional symptoms other than swollen lymph nodes. 'B' is put after your stage if you have additional symptoms of weight loss, fever or night sweats.

In some cases, health professionals also use additional letters to indicate where the cancer first developed. For example, 'E' (extranodal) means the cancer developed outside the lymphatic system.

Grading non-Hodgkin lymphoma

Testing can also help health professionals decide the 'grade' of the cancer. There are two main grades of non-Hodgkin lymphoma:

  • low-grade or indolent non-Hodgkin lymphoma is where the cancer develops slowly, and you may not experience any symptoms for many years
  • high-grade or aggressive non-Hodgkin lymphoma is where the cancer develops quickly and aggressively

Low-grade tumours do not necessarily require immediate medical treatment, but are harder to completely cure. High-grade lymphomas need to be treated immediately but tend to respond much better to treatment and can often be cured.

In some cases, low-grade lymphomas can develop into high-grade lymphomas over time.

 

Treating non-Hodgkin lymphoma 

Non-Hodgkin lymphoma is usually treated with cancer-killing medication or radiotherapy, although some people may not need treatment straight away.

 

Your treatment plan

The recommended treatment plan will depend on your general health and age, because some of the treatments can cause serious side effects and complications, which can put a significant strain on the body.

Other important factors taken into consideration when deciding the best treatment in your circumstances include:

  • your symptoms
  • the specific subtype of your lymphoma
  • how far the lymphoma has spread (the 'stage')
  • how fast it is likely to spread (the 'grade') and where it is likely to spread to

Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma. This is known as a multidisciplinary team (MDT). Your personal wishes for treatment will always be taken into consideration in this discussion.

Your MDT will recommend the best treatment options for you. However, you should not be rushed into making a decision about your treatment plan. Before deciding, you may wish to talk to friends, family and your partner.

You will be invited back to see your care team for a full review and discussion about the risks and benefits of any treatments planned before treatment begins.

Your care team may also offer you the opportunity to participate in aclinical trial. Find clinical trials for non-Hodgkin lymphoma.

The main treatment options for non-Hodgkin lymphoma are described below.

Wait-and-see approach

If the disease is low-grade (slow developing) and you are well, a period of 'watchful waiting' is often recommended as some people take many years to develop troublesome symptoms in these circumstances and starting treatment immediately is therefore often felt to be unnecessary.

If watchful waiting is recommended, you will be seen regularly for reviews and invited to come back at any stage if you feel your symptoms are getting worse.

Chemotherapy

Chemotherapy is a widely used treatment for non-Hodgkin lymphoma, which involves using medicine to kill cancer cells. It may be used on its own, combined with biological therapy and/or combined with radiotherapy (see below).

The medication can be given in a number of different ways, depending on the stage of your cancer.

If doctors think that your cancer is curable, you will normally receive chemotherapy through a drip directly into a vein (intravenous chemotherapy). If a cure is unlikely, you may only need to take chemotherapy tablets to help relieve your symptoms.

If there is a risk of the cancer spreading to your brain, you may have chemotherapy injections directly into the cerebrospinal fluid around your spine.

Chemotherapy is usually given over a period of a few months on an outpatient basis, meaning you should not have to stay in hospital overnight. However, there may be times when your symptoms or the side effects of treatment become particularly troublesome, and a longer hospital stay may be needed.

Chemotherapy can have several side effects, the most significant of which is potential damage to your bone marrow. This can interfere with the production of healthy blood cells and cause the following problems:

  • fatigue
  • breathlessness
  • increased vulnerability to infection
  • bleeding and bruising more easily

If you experience these problems, treatment may need to be delayed so that you can produce more healthy blood cells. Growth factor medicines can also stimulate the production of blood cells.

Other possible side effects of chemotherapy include:

  • nausea and vomiting
  • diarrhoea
  • loss of appetite
  • mouth ulcers
  • tiredness
  • skin rashes
  • hair loss
  • infertility, which may be temporary or permanent (seecomplications of non-Hodgkin lymphoma for more information)

Most side effects should pass once your treatment has finished. You must tell your care team if side effects become particularly troublesome, as there are medicines that can help you cope better with some side effects

When you start treatment, you will be given a '24-hour hotline' number to call so that any problems relating to your treatment can be addressed as soon as possible.

 

High-dose chemotherapy

If non-Hodgkin lymphoma does not get better with initial treatment (known as 'refractory' lymphoma), you may have a course of chemotherapy at a stronger dose.

Following this, you may be considered for something known as high-dose chemotherapy which involves having stem cell or bone marrow transplants after high doses of chemotherapy.

Radiotherapy

Radiotherapy is most often used to treat early-stage non-Hodgkin lymphoma, where the cancer is only in one part of the body.

Treatment is normally given in short daily sessions, Monday to Friday, over the space of several weeks. You should not have to stay in hospital between appointments.

Before radiotherapy begins, the radiographer (radiotherapy specialist) will need to first carefully plan your treatment over one or more appointments. The radiographer uses a machine to 'map' out the lymphoma and decide what parts of your body the radiotherapy should be directed at. This planning may involve making small tattoo marks on your skin or making a special cast to ensure that you are kept in exactly the same position for each treatment session.

Radiotherapy itself is painless, but it can have some significant side effects. These can vary depending on which part of your body is being treated. For example, treatment to your throat can lead to a sore throat, while treatment to the head can lead to hair loss.

Other common side effects include:

  • sore and red skin in the treatment area
  • tiredness
  • nausea and vomiting
  • dry mouth
  • loss of appetite

Most side effects are temporary, but there is a risk of long-term problems including permanently darkened skin in the treatment area.

 

Monoclonal antibody therapy

For some types of non-Hodgkin lymphoma, you may have a type of medication called a monoclonal antibody.

These medications attach themselves to the surface of cancerous cells and stimulate the immune system to attack and kill the cells. They are often given in combination with chemotherapy to make the treatment more effective.

For some types of non-Hodgkin lymphoma, you may continue having monoclonal antibody treatment regularly for up to two years after initial treatment with a combination of these medications and chemotherapy achieves remission (when the cancer can no longer be detected) because this can reduce the chances of the cancer coming back in the future.

One of the main monoclonal antibody medications used to treat non-Hodgkin lymphoma is called rituximab. This medication is administered directly into your vein over the course of a few hours.

Side effects of rituximab can include:

  • flu-like symptoms, such as a headaches, fever and chills
  • tiredness
  • nausea
  • an itchy rash

You may be given additional medication to prevent or lessen these side effects. Side effects should improve over time as your body gets used to rituximab.

As rituximab has been so successful in treating non-Hodgkin lymphoma, scientists are working hard to make more monoclonal antibody treatments for lymphoma and some of these are already at an advanced stage in clinical trials. You may be asked if you want to participate in one of these trials during your treatment.

Steroid medication

Steroid medication is commonly used in combination with chemotherapy to treat non-Hodgkin lymphoma. This is because research has shown that using steroids makes the chemotherapy more effective.

The steroid medication is normally given as tablets, usually at the same time as your chemotherapy. A short course of steroids, lasting no more than a few months, is usually recommended as this limits the number of side effects you could have.

Common side effects of short-term steroid use include:

  • increased appetite, which can lead to weight gain
  • indigestion
  • problems sleeping
  • feeling agitated

On rare occasions, you may have to take steroids on a long-term basis. Side effects of long-term steroid use include weight gain and swelling in your hands, feet and eyelids.

The side effects of steroid medication will usually start to improve once treatment finishes. 

Follow-up

After your course of treatment ends, you may have a repeat scan to see how well the treatment has worked. Following this, you will need to have regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning (known as a 'relapse').

These appointments will start off being every few weeks or months, but will become less frequent over time.

Want to know more?

  • Cancer Research UK: treating non-Hodgkin lymphoma
  • Cancer Research UK: living with non-Hodgkin lymphoma
  • Macmillan: treating non-Hodgkin lymphoma
  • Macmillan: living with non-Hodgkin lymphoma\

 

Complications of non-Hodgkin lymphoma 

Some people treated for non-Hodgkin lymphoma experience long-term problems, even if they have been cured.

Some of the main complications of non-Hodgkin lymphoma are described below.

Weakened immune system

Having a weakened immune system is a common complication of non-Hodgkin lymphoma and it can become more severe while you are being treated.

However, your immune system will usually recover in the months and years after treatment.

If you have a weak immune system, you are more vulnerable to infections, and there is an increased risk of developing serious complications from infections. In some cases, you may be advised to take regular doses of antibiotics to prevent infections occurring.

It is also important to report any symptoms of an infection to your GP or care team immediately because prompt treatment may be needed to prevent serious complications. This is particularly important in the first few months after treatment.

Symptoms of infection include:

  • a high temperature (fever)
  • headache
  • aching muscles
  • diarrhoea
  • tiredness
  • a painful blistering rash

You should also make sure all of your vaccinations are up to date. However, it’s important to speak to your GP or care team about this because it may not be safe for you to have ‘live’ vaccines (vaccines containing a weakened form of the virus or organism being vaccinated against) until several months after your treatment finishes.

Examples of ‘live’ vaccines include the shingles vaccine, the BCG vaccine (against tuberculosis) and the MMR vaccine (against measles, mumps and rubella).

Infertility

Chemotherapy and radiotherapy for non-Hodgkin lymphoma can causeinfertility. This is sometimes temporary, but it can be a permanent.

Your care team will estimate the risk of infertility in your specific circumstances and let you know what your options are.

In some cases, it may be possible for men to store samples of their sperm and women to store their eggs before treatment, so these can be used to try for a baby afterwards.

Other health issues

Treatment for non-Hodgkin lymphoma can increase your risk of getting conditions such as heart disease, lung disease, kidney disease, thyroid disease, diabetes and cataracts at a younger age than normal. Having a diagnosis of cancer can also increase your risk of suffering fromdepression.

You should report unexpected symptoms, such as increasing shortness of breath, to your GP for further advice.

Second cancers

Having treatment for non-Hodgkin lymphoma can increase your risk of developing another type of cancer in the future. This is known as a 'second cancer'.

The risk of getting cancer is particularly increased after cancer treatment because chemotherapy and radiotherapy damage healthy cells as well as cancer cells. This damage can then cause the affected cells to become cancerous many years after treatment.

Lymphoma

Lymphoma