What to know about non-Hodgkin lymphoma
It can develop at any age and is common in children and young adults. The risk, however, increases as a person ages, and more than half of those with the disease are 65 or older when they receive the diagnosis.
Non-Hodgkin lymphoma is more common in males — about 1 in 42 develop it, while the disease occurs in about 1 in 54 females.
This article explains what non-Hodgkin lymphoma is and outlines the types, symptoms, and treatment options. It also looks at the latest statistics regarding prognosis and outlook.
Understanding non-Hodgkin lymphoma
Non-Hodgkin lymphoma makes up around 4% of all cancer cases in the U.S.
Non-Hodgkin and Hodgkin are the two main types of lymphoma.
Lymphomas are cancers that begin in white blood cells called lymphocytes. These cells are a part of the lymphatic system, which is part of the immune system.
As well as contributing to the fight against infections and diseases, the lymphatic system helps fluids, including blood, move around the body.
Lymphoma can develop in any area of the body that contains lymph tissue, including the:
- lymph nodes, which exist throughout the body — in the chest, abdomen, and pelvis, for example
- spleen, which creates lymphocytes and other immune cells
- bone marrow, where new blood cells form
- thymus, a gland in the upper chest that plays a role in developing lymphocytes
- adenoids and tonsils, which fight against infection in the back of the throat
- digestive tract, as some areas contain lymph tissues
Without treatment, non-Hodgkin lymphoma can spread throughout the body. The blood can transport cancerous white blood cells to distant areas.
Types of non-Hodgkin lymphoma
There are many types of non-Hodgkin lymphoma. They fall into two main groups, based on whether the affected white blood cells are B cells or T cells.
Doctors also classify lymphomas based on how fast they grow. Any type can be slow-growing (indolent) or fast-growing (aggressive).
B cell types
According to the Cancer Support Community, around 85% of non-Hodgkin lymphoma cases in the U.S. start in B cells. Below are the two most common types.
Diffuse large B cell lymphoma
Around 1 in 3 cases of non-Hodgkin lymphoma are this type. It usually starts as a lump in a lymph node.
Sometimes, diffuse large B cell lymphoma starts in the intestine, bone, brain, or spinal cord. It grows quickly but usually responds well to treatment.
Almost 20% of lymphomas in the U.S. are this type, which starts in the lymph nodes and bone marrow.
Follicular lymphoma usually grows slowly and responds to treatment, but it is difficult to cure and may come back.
Less common types of B cell non-Hodgkin lymphoma include:
- mucosa-associated lymphatic tissue lymphoma
- small cell lymphocytic lymphoma, or chronic lymphocytic leukemia
- intravascular large B cell lymphoma
- mantle cell lymphoma
- Burkitt's lymphoma
- hairy cell leukemia
- primary central nervous system lymphoma
- mediastinal (thymic) large B cell lymphoma
- lymphoplasmacytic lymphoma, or Waldenstrom macroglobulinemia
- nodal marginal zone B cell lymphoma
- splenic marginal zone lymphoma
- extranodal marginal zone B cell lymphoma
- primary effusion lymphoma
T cell types
The Cancer Support Community report that T cell types account for fewer than 15% of all non-Hodgkin lymphoma cases in the U.S. Subtypes include:
- Peripheral T cell lymphoma: Also known as generic T cell lymphoma, this is the most common type of T cell lymphoma, and there is a range of further subtypes.
- Cutaneous T cell lymphoma: This type includes T cell lymphomas that primarily affect the skin, but they can also affect the blood, lymph nodes, and internal organs.
Other types of lymphoma that affect the T cells include:
- anaplastic large cell lymphoma
- angioimmunoblastic T cell lymphoma
The symptoms of non-Hodgkin lymphoma often depend on the specific type and where it is in the body.
Some people experience no symptoms before the cancer has become advanced.
Common symptoms of non-Hodgkin lymphoma include:
- enlarged lymph nodes
- a swollen belly
- feeling full after eating very little
- bruising easily
- shortness of breath
- a cough
- frequent infections
- unexplained weight loss
A person with a B cell type may also have a fever that comes and goes and severe night sweats.
The symptoms of cutaneous T cell lymphoma tend to include enlarged lymph nodes, dry skin, itching, and a red rash.
A biopsy is the only way to diagnose non-Hodgkin lymphoma. This involves taking a sample of cells using a small needle.
A pathologist will then examine this sample under a microscope to check for signs of the condition.
After making a diagnosis of non-Hodgkin lymphoma, the doctor will perform a number of tests to see how far the cancer has progressed. Doctors call this staging.
Staging may involve imaging tests, such as X-rays or MRI scans.
The healthcare team may also perform blood tests, bone marrow biopsies, or heart and lung function tests.
There are four stages of non-Hodgkin lymphoma. Stage 1 is the least advanced, while stage 4 is the most advanced. The American Cancer Society provides details about the stages of this condition.
Often, doctors recommend combining treatments, and the best combination will depend on a number of factors, including:
- the type and stage of the lymphoma
- the person's overall health and fitness levels
Causes and risk factors
The medical community does not know what causes non-Hodgkin lymphoma, but a number of things make it more likely to develop.
The risk factors for non-Hodgkin lymphoma include:
- being older, as most people who receive the diagnosis are 65 or older
- being male
- carrying excess weight and having an unhealthful diet
- having bacterial infections, such as with Helicobacter pylori
- having viral infections, such as with the Epstein-Barr virus
- having an autoimmune disorder, such as rheumatoid arthritis
- having received an organ transplant
- having had cancer treatment before
- having been exposed to radiation
- having an immunodeficiency disorder, such as AIDS
The term "5-year survival rate" refers to the percentage of people who live for at least 5 years after receiving a diagnosis.
The overall 5-year survival rate for non-Hodgkin lymphoma is 71%. However, it is important to remember that this figure is based on averages.
A person's outlook depends on the type and stage of the cancer, among other factors. A doctor can provide more detailed information based on factors specific to each person.