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There are many different types of non-Hodgkin lymphoma depending on which type of lymphocyte is affected (B cell or T cell) and whether the grade is low (slow growing) or high (fast growing). It is only possible to tell the type by looking at the lymphoma cells under a microscope.
Non-Hodgkin lymphoma can develop in any part of the body. However, it is usually found first in lymph nodes, in the neck, armpit or groin. Cancer cells can spread through the lymphatic system to other lymph nodes, or to other organs through travelling in the bloodstream.
The lymphatic system
The lymphatic system is part of the body’s defences against infection and disease. It runs throughout the body and is made up of lymph vessels, lymph nodes (glands) and organs such as the spleen. Lymph nodes are found in clusters in different parts of the body, but there are groups of nodes in the neck, armpits and groin.
The vessels of the lymphatic system carry lymph, a white liquid made up of white blood cells called lymphocytes. Lymphocytes play an important role in helping to fight infections.
Causes of non-Hodgkin lymphoma
The cause of most types of non-Hodgkin lymphoma is not known. People with a poor immune system have a higher risk of developing the disease.
The most common symptom of non-Hodgkin lymphoma is a painless swelling in the lymph nodes in your neck, groin or armpit. Other signs and symptoms may include:
- high temperatures
- night sweats
- unexplained loss of appetite or weight loss
- widespread itching
The symptoms of non-Hodgkin lymphoma can be caused by other less serious complaints. Your doctor will carry out a full physical examination, ask you how you are feeling and ask you to have several tests to confirm a diagnosis.
A biopsy is the removal of a small sample of tissue for examination under the microscope. This is usually done under a general anaesthetic. A biopsy of an enlarged lymph node is the only way to confirm a diagnosis. The results will tell your specialist whether or not it is a lymphoma and if so, what kind of lymphoma.
If the biopsy shows you have non-Hodgkin lymphoma, your doctor will want to carry out further tests to find out which parts of your body are affected. This process is called staging and may include the following tests.
Blood samples will be taken to check your general health and how well certain organs in your body are working, for example your liver and kidneys. If you want more details about these, please ask your doctor or nurse.
Blood tests will be taken throughout your treatment to monitor how you are responding and how effective your treatment is.
Bone marrow test
You may have a bone marrow biopsy to find out if you have any lymphoma cells in your bone marrow. This is normally taken from the hip bone.
The process is conducted under local anaesthetic and takes five to ten minutes. It can be uncomfortable and may even be painful. The procedure will be explained to you before it is carried out and you will be able to ask any questions or raised any concerns you might have.
Your doctor may recommend you undergo other investigations. These may include:
- X-rays of the chest
- CT scan
- MRI scan
- ultrasound scan.
The main types of treatment for non-Hodgkin lymphoma are chemotherapy and radiotherapy. Your treatment will be planned by a team of specialists and will be based on the results of the tests you have had.
Factors taken into account when planning your treatment will include:
- your age
- your general health
- the size of affected lymph nodes
- whether the lymphoma has spread to other organs.
Your doctor will explain the planned treatment and take the time to answer any questions you may have.
Low-grade non-Hodgkin lymphoma
Low-grade non-Hodgkin lymphoma often grows very slowly and your doctors may decide that regular checkups are sufficient in the early stages. Treatment depends on how advanced the disease is. Many people will have more than one course of treatment, sometimes with long periods in between.
Where treatment is needed, it may take the form of radiotherapy (if the disease only affects one area) or chemotherapy or a combination of both. With advanced low-grade non-Hodgkin lymphoma, the aim of treatment is to keep the disease under control rather than cure.
High-grade non-Hodgkin lymphoma
Treatment for high-grade non-Hodgkin lymphoma aims to cure. Chemotherapy is the main treatment, using a combination of different drugs. Sometimes a drug called Rituximab, a kind of antibody, is given with the chemotherapy. You may be offered high-dose chemotherapy with bone marrow or stem cell transplant. Sometimes lymph nodes are treated with radiotherapy if they are just in one area of the body.
Steroids are generally given with chemotherapy to lessen their side effects. If you have to take steroids for more then a few months you may experience a range of side effects. Your doctor will be able to give you information on how to cope with them. All side effects are temporary and you will notice them disappearing once you finish the treatment.
The doctor will ask you to attend hospital at regular intervals during and after your treatment for non-Hodgkin lymphoma. You will be given a clinic appointment, and these will probably become less frequent as time passes.
At each checkup your doctor will examine you. Blood tests, X-rays or scans may be repeated to check your recovery and make sure the cancer hasn't returned.
If you are worried about anything between your appointments, for example any unexplained aches or pains, please contact your hospital doctor. Your family doctor will also have been sent details of your treatment and progress.
It's important that you discuss anything unusual and don't worry needlessly. Please use your clinic appointment to discuss any concerns you may have about your recovery and return to your usual lifestyle.