General Information About Adult Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma is a type of cancer that forms in the lymph system. The lymph system is part of the immune system. It helps protect the body from infection and disease.

The lymph system is made up of the following:

Lymph: Colorless, watery fluid that travels through the lymph vessels and carries lymphocytes (white blood cells).
Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
Lymph nodes: Small, bean-shaped structures that are found along a network of lymph vessels throughout the body. Groups of lymph nodes are found in the neck, underarm, mediastinum, abdomen, pelvis, and groin.
Spleen: An organ on the left side of the abdomen near the stomach that makes lymphocytes and stores blood cells.
Tonsils: Two small masses of lymph tissue at the back of the throat. There is one tonsil on each side of the throat.
Bone marrow: The soft, spongy tissue in the center of certain bones. White blood cells, red blood cells, and platelets are made in the bone marrow.

There are two general types of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphoma.

Non-Hodgkin lymphoma grows and spreads at different rates and can be indolent or aggressive.

Indolent lymphoma tends to grow and spread slowly, and has few signs and symptoms.

Aggressive lymphoma grows and spreads quickly, and has signs and symptoms that can be severe.

Indolent Non-Hodgkin Lymphoma

Follicular lymphoma:

Follicular lymphoma is the most common type of indolent non-Hodgkin lymphoma.
It is a very slow-growing type of non-Hodgkin lymphoma. It affects the lymph nodes and may spread to the bone marrow or spleen.
The patient is closely watched for signs or symptoms related to the disease.
Treatment is needed if signs or symptoms occur.
Sometimes follicular lymphoma can become a more aggressive type of lymphoma, such as diffuse large B-cell lymphoma.

Lymphoplasmacytic lymphoma (Waldenström macroglobulinemia):

In lymphoplasmacytic lymphoma, lymphocytes that are turning into plasma cells make large amounts of a protein called monoclonal immunoglobulin M (IgM) antibody.
High levels of IgM antibody in the blood cause the blood plasma to thicken, causing symptoms like trouble seeing or hearing, heart problems, shortness of breath, headache, dizziness, and numbness or tingling of the hands and feet.
Patients with lymphoplasmacytic lymphoma should be checked for hepatitis C virus infection.

Marginal zone lymphoma:

This begins in B lymphocytes in a part of lymph tissue called the marginal zone.
This can arise from lymph nodes (Nodal), outside of lymph nodes (Extra-nodal) or spleen (Splenic).
Commonest type of Extra-nodal type is called Gastric MALT lymphoma. This begins in the stomach. Patients with Gastric MALT lymphoma may also have a stomach infection called Helicobacter gastritis that cause this lymphoma.

Primary cutaneous anaplastic large cell lymphoma:

This type of non-Hodgkin lymphoma is in the skin only.

Aggressive non-Hodgkin lymphomas

Diffuse large B-cell lymphoma:

Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma.
It grows quickly in the lymph nodes and often the spleen, liver, bone marrow, or other organs are also affected.
Signs and symptoms of diffuse large B-cell lymphoma may include fever, drenching night sweats, and weight loss. These are also called B symptoms.

Primary mediastinal large B-cell lymphoma:

This is a type of diffuse large B-cell lymphoma that forms behind the breastbone.
It may press on the airways and cause coughing and trouble breathing. Most patients with primary mediastinal large B-cell lymphoma are women who are age 30 to 40 years.

Burkitt lymphoma:

Burkitt lymphoma is a type of B-cell non-Hodgkin lymphoma that grows and spreads very quickly.
It may affect the jaw, bones of the face, bowel, kidneys, ovaries, or other organs.
It is linked to the Epstein-Barr virus that causes ‘Mono’ or infectious mononucleosis.
It can also be seen in patients who have AIDS.
Burkitt lymphoma occurs most often in children and young adults.

Mantle cell lymphoma:

Mantle cell lymphoma is a type of B-cell non-Hodgkin lymphoma that usually occurs in middle-aged or older adults.
Can involve lymph nodes, spleen, bone marrow, blood, and sometimes, intestines.
Patients with mantle cell lymphoma have too much of a protein called cyclin-D1 that can be used for diagnosing this lymphoma.
In some patients who do not have signs or symptoms of lymphoma, delaying the start of treatment does not affect the prognosis.

T Cell Lymphomas:

These are much less common, arise from T lymphocytes (another type of lymphocytes)
Can be seen in blood, involve the lymph nodes or organs outside of lymph nodes.
These are more difficult to treat.

Signs and symptoms of adult non-Hodgkin lymphoma

Check with your doctor if you have any of the following:

Swelling in the lymph nodes in the neck, underarm, groin, or stomach.
Fever for no known reason.
Drenching night sweats.
Feeling very tired.
Weight loss for no known reason.
Skin rash or itchy skin.
Pain in the chest, abdomen, or bones for no known reason.
When fever, drenching night sweats, and weight loss occur together, this group of symptoms is called B symptoms.

Other signs and symptoms of adult non-Hodgkin lymphoma may occur and depend on the following:

Where the cancer forms in the body.
The size of the tumor.
How fast the tumor grows.

Tests to help diagnose and stage adult non-Hodgkin lymphoma

Physical exam and health history
Complete blood count (CBC): a blood sample is checked for the number of red blood cells, white blood cells, and platelets
Blood chemistry studies: a blood sample is checked to measure the amounts of salts (electrolytes), liver function, kidney function, sugar.
LDH test: another important blood test in lymphoma.
Hepatitis B and hepatitis C test
HIV test
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, pelvis, and lymph nodes
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
Bone marrow aspiration and biopsy: The removal of bone marrow and a small piece of bone by inserting a needle into the hipbone or breastbone. A pathologist views the bone marrow and bone under a microscope to look for signs of cancer.
Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to check for cancer cells.

Factors affecting prognosis (chance of recovery) and treatment options

The prognosis and treatment options depend on the following:

The patient's signs and symptoms, including whether or not they have B symptoms (fever for no known reason, weight loss for no known reason, or drenching night sweats).
The stage of the cancer (the size of the cancer tumors and whether the cancer has spread to other parts of the body or lymph nodes).
The type of non-Hodgkin lymphoma.
The amount of lactate dehydrogenase (LDH) in the blood.
Whether there are certain changes in the genes.
The patient’s age, sex, and general health.
Whether the lymphoma is newly diagnosed, continues to grow during treatment, or has recurred (come back).

Stages of Adult Non-Hodgkin Lymphoma

After adult non-Hodgkin lymphoma has been diagnosed, tests are done to find out whether cancer cells have spread within the lymph system or to other parts of the body.

The following stages are used for adult non-Hodgkin lymphoma:

Stage I: Cancer is found in one or more lymph nodes in a group of lymph nodes
Stage II: cancer is found in two or more groups of lymph nodes that are either above the diaphragm or below the diaphragm.
Stage III: cancer is found in groups of lymph nodes both above and below the diaphragm
Stage IV: cancer has spread throughout one or more organs outside the lymph system such as the bone marrow, liver, lung.