Non-Hodgkin's Lymphoma

What Is Non-Hodgkin's Lymphoma?

Non-Hodgkin's lymphoma is a type of cancer. Lymphoma is a general term for cancers that develop in the lymphatic system.

The lymphatic system is part of the body's immune system. It helps the body fight disease and infection. The lymphatic system includes a network of thin tubes that branch, like blood vessels, into tissues throughout the body. Lymphatic vessels carry lymph, a colorless, watery fluid that contains infection-fighting cells called lymphocyte. Along this network of vessels are small organs called lymph node. Clusters of lymph nodes are found in the underarms, groin, neck, chest, and abdomen. Other parts of the lymphatic system are the spleen, thymus, tonsils, and bone marrow. Lymphatic tissue is also found in other parts of the body, including the stomach, intestines, and skin.

Cancer is a group of many related diseases that begin in cells, the body's basic unit of life. To understand non-Hodgkin's lymphoma, it is helpful to know about normal cells and what happens when they become cancerous. The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes cells keep dividing when new cells are not needed, creating a mass of extra tissue. This mass is called a growth or tumor. Tumors can be either benign (not cancerous) or malignant (cancerous).

In non-Hodgkin's lymphoma, cells in the lymphatic system become abnormal. They divide and grow without any order or control, or old cells do not die as cells normally do. Because lymphatic tissue is present in many parts of the body, non-Hodgkin's lymphoma can start almost anywhere in the body. Non-Hodgkin's lymphoma may occur in a single lymph node, a group of lymph nodes, or in another organ. This type of cancer can spread to almost any part of the body, including the liver, bone marrow, and spleen.

Symptoms

The most common symptom of non-Hodgkin's lymphoma is a painless swelling of the lymph nodes in the neck, underarm, or groin.
Other symptoms may include the following:

• Unexplained fever
• Night sweats
• Constant fatigue
• Unexplained weight loss
• Itchy skin
• Reddened patches on the skin
  

Diagnosis

If non-Hodgkin's lymphoma is suspected, the doctor asks about the person's medical history and performs a physical exam. The exam includes feeling to see if the lymph nodes in the neck, underarm, or groin are enlarged. In addition to checking general signs of health, the doctor may perform blood tests.

The doctor may also order tests that produce pictures of the inside of the body.

These may include:

• X-ray: Pictures of areas inside the body created by high-energy radiation
• CT scan: A series of detailed pictures of areas inside the body. The pictures are created by a computer linked to an x-ray machine.
• MRI (magnetic resonance imaging): Detailed pictures of areas inside the body produced with a powerful magnet linked to a computer.
• Lymphangiogram: Pictures of the lymphatic system taken with x-rays after a special dye is injected to outline the lymph nodes and vessels.

A biopsy is needed to make a diagnosis. A surgeon removes a sample of tissue so that a pathologist can examine it under a microscope to check for cancer cells. A biopsy for non-Hodgkin's lymphoma is usually taken from a lymph node, but other tissues may be sampled as well. Sometimes, an operation called a laparotomy may be performed. During this operation, a surgeon cuts into the abdomen and removes samples of tissue to be checked under a microscope.

A patient who needs a biopsy may want to ask the doctor some of the following questions:

• Why do I need to have a biopsy?
• How long will the biopsy take? Will it hurt?
• How soon will I know the results?
• If I do have cancer, who will talk with me about treatment? When?

Types of Non-Hodgkin's Lymphoma

Over the years, doctors have used a variety of terms to classify the many different types of non-Hodgkin's lymphoma. Most often, they are grouped by how the cancer cells look under a microscope and how quickly they are likely to grow and spread. Aggressive lymphomas, also known as intermediate and high-grade lymphomas, tend to grow and spread quickly and cause severe symptoms. Indolent lymphoma, also referred to as low-grade lymphomas, tend to grow quite slowly and cause fewer symptoms.

Staging

If non-Hodgkin's lymphoma is diagnosed, the doctor needs to learn the stage, or extent, of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Treatment decisions depend on these findings.

The doctor considers the following to determine the stage of non-Hodgkin's lymphoma:

• The number and location of affected lymph nodes;
• Whether the affected lymph nodes are above, below, or on both sides of the diaphragm (the thin muscle under the lungs and heart that separates the chest from the abdomen); and
• Whether the disease has spread to the bone marrow, spleen, or to organs outside the lymphatic system, such as the liver.

In staging, the doctor may use some of the same tests used for the diagnosis of non-Hodgkin's lymphoma. Other staging procedures may include additional biopsies of lymph nodes, the liver, bone marrow, or other tissue. A bone marrow biopsy involves removing a sample of bone marrow through a needle inserted into the hip or another large bone. A pathologist examines the sample under a microscope to check for cancer cells.

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