What is Non-Hodgkin's Lymphoma (NHL)?
Non-Hodgkin's lymphoma (also known as non-Hodgkin lymphoma, NHL, or often just lymphoma) is a type of blood cancer that starts in the body's immune system, specifically in the white blood cells called lymphocytes.
Cancer is a disease that starts when cells begin to grow out of control. Cells in nearly any body part can become cancerous and spread. NHL typically begins in the lymph nodes or other lymph tissue and can start anywhere in the body where lymph tissue is found, including:
- Lymph nodes are a bean-sized collection of lymphocytes and other immune system cells throughout the body, e.g., the chest, abdomen, and pelvis, connected through a system of lymphatic vessels
- Bone marrow is the spongy tissue inside certain bones where new blood cells, including lymphocytes, are made
- Digestive tract includes the stomach, intestine, and many other organs that also contain lymph tissue
- Spleen is located under the lower ribs on the left side of the body, makes lymphocytes and other immune system cells, stores healthy blood cells, and filters out damaged blood cells, bacteria, and cell waste
- Thymus is located in front of the heart. These are important in the development of T lymphocytes and located.
- Adenoids and tonsils are a collection of lymph tissue in the back of the throat that helps make antibodies against germs breathed in or swallowed
Non-Hodgkin's lymphoma vs. Hodgkin's lymphoma
The terms non-Hodgkin's and Hodgkin's are used to describe two different types of lymphoma that require different treatments. The type of lymphoma is diagnosed by examining the cancer cells under a microscope.
The presence of a specific type of abnormal cell known as the Reed-Sternberg cell classifies the disease as Hodgkin's lymphoma. Even though both types of lymphoma can be diagnosed at any age, non-Hodgkin's lymphoma is more common in adults over 60, and Hodgkin's lymphoma is typically found in young adults between the age of 15 to 40 and older adults over the age of 55. Both types of lymphoma are also more common in men.
Types of Non-Hodgkin's Lymphoma
The body's lymph system is made up of lymphocytes, a type of white blood cell that helps fight infections. Non-Hodgkin’s lymphoma is divided into more than many differentnt types and further classified into subtypes based on whether the cancer is in the B lymphocytes (B cells) or T lymphocytes (T cells).
- B Lymphocytes (B cells) typically help the body protect against germs (viruses or bacteria) by making proteins known as antibodies. These antibodies attach to the germs and mark them for destruction by the immune system.
- T Lymphocytes (T cells) either destroy germs or abnormal cells in the body or help boost or slow the activity of other immune system cells
Non-Hodgkin's lymphoma is further classified by how the disease progresses:
- Aggressive lymphoma is fast-growing and accounts for roughly 60 percent of all NHL cases. Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive NHL subtype
- Indolent lymphoma is slow-growing, tends to have fewer signs and symptoms, and represents roughly 40 percent of all NHL cases. Follicular lymphoma (FL) is the most common subtype of indolent NHL.
Stages of Non-Hodgkin's Lymphoma
To diagnose non-Hodgkin's lymphoma, our specialists will determine how far the lymphoma has spread through what's called the "staging" process. Non-Hodgkin's lymphoma is staged using the Lugano classification system, based on an older system called the Ann Arbor system.
There are four stages of non-Hodgkin's lymphoma:
- Stage I - The lymphoma is in only one lymph node area or lymphoid organ such as the tonsils (I), or the cancer is found only in one area of a single organ outside of the lymph system (IE)
- Stage II - The lymphoma is in two or more groups of lymph nodes on the same side of the diaphragm, or the lymphoma is in a group of lymph nodes as well as a nearby organ (IIE) and may also affect other groups of lymph nodes on the same side of the diaphragm
- Stage III - The lymphoma is in lymph node areas on both sides of the diaphragm, or lymphoma is in lymph nodes above the diaphragm and the spleen
- Stage IV - The lymphoma has spread widely into at least one organ outside the lymph system, such as the bone marrow, liver, or lung
Signs & Symptoms of Non-Hodgkin's Lymphoma
There are many different types of non-Hodgkin's lymphoma. Therefore, the signs and symptoms may vary depending on the location and stage at diagnosis. Even though non-Hodgkin's lymphoma is more common in men, it can occur in anyone at any age.
The most common non-Hodgkin's lymphoma symptoms typically include:
- Abdominal pain
- Chest pain, coughing, or shortness of breath
- Fatigue or feeling weak
- Nausea or loss of appetite
- Night sweats or chills
- Swollen lymph nodes in the neck, armpits, or groin
- Weight loss
When diagnosing a more advanced or aggressive lymphoma, the signs and symptoms of non-Hodgkin's lymphoma, referred to as "B symptoms," are present and include:
- Night sweats that soak the sheets
- Unexplained weight loss
What Causes Non-Hodgkin's Lymphoma?
Risk Factors for Non-Hodgkin's Lymphoma
While certain risk factors may be present, they alone do not indicate that someone will develop non-Hodgkin's lymphoma. The risk factors that have been linked to non-Hodgkin's lymphoma include:
- Age could be a factor for people over the age of 60
- Gender as non-Hodgkin's lymphoma is more common in men; however, women are at risk for certain types of non-Hodgkin's lymphoma
- Genetics or a family history of a parent, child, or sibling having NHL
- Radiation exposure can increase the risk of developing several types of cancer, including NHL, leukemia, and thyroid cancer. This exposure could have come from nuclear reactor accidents or radiation therapy from some other types of cancer treatment.
- Autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus (SLE or lupus), Sjogren (Sjögren) disease, celiac disease (gluten-sensitive enteropathy)
- Weakened immune systems such as HIV (human immunodeficiency virus), genetic or inherited syndromes (especially in children) such as ataxia-telangiectasia (AT) or Wiskott-Aldrich syndrome, or people who have received an organ transplant are at higher risk for developing certain types of NHL
- Infections and viruses can directly affect the DNA of lymphocytes which help them transform into cancer cells and include:
- Human T-cell lymphotropic virus (HTLV-1) increases the risk of certain types of T-cell lymphoma. HTLV-1 spreads through sex and contaminated blood and can be passed to children through breast milk from an infected mother
- Epstein-Barr virus (EBV) is linked with lymphomas in people also infected with HIV and other less common types of lymphoma
- Human herpesvirus 8 (HHV-8) can also infect lymphocytes, leading to a rare type of lymphoma called primary effusion lymphoma, which is most often seen in patients who are infected with HIV
- Long-term infections can force the immune system to be constantly active, causing an increase in lymphocyte production. The more lymphocytes, the greater the chance for gene mutations that can lead to lymphoma. These infections have been linked to certain types of lymphomas:
- Helicobacter pylori is a type of bacteria known to cause stomach ulcers
- Chlamydophila psittaci (formerly known as Chlamydia psittaci) is a type of bacteria that can cause a lung infection called psittacosis
- Chronic hepatitis C virus (HCV) is a virus that causes an infection in the liver
You cannot prevent NHL, but there are ways to reduce your likelihood of developing it, including using protection when engaging in sexual activities, using clean needles with recreational drug use, maintaining a proper weight, and staying active.
Trust NewYork-Presbyterian for Non-Hodgkin's Lymphoma Care
Research shows that the best treatment starts with an early diagnosis. If you are experiencing symptoms or have a family history of lymphoma or another type of blood cancer, contact a NewYork-Presbyterian specialist near you.