What Is Non-Hodgkin's Lymphoma?

Do you feel a strange swelling in your neck, armpit, or groin? If so, there is a chance you may have non-Hodgkin’s lymphoma.

Non-Hodgkin's lymphoma is a cancer of the lymphatic system that affects white blood cells. It is given different names depending on the type and severity. 

Keep reading to find out more about non-Hodgkin’s lymphoma, its types, stages, symptoms, and how it is diagnosed and managed. 

Overview

Non-Hodgkin lymphoma is a type of cancer that affects the lymphatic system, a series of tubes, and small organs called lymph nodes that are part of your immune system.

In non-Hodgkin lymphoma, a type of white blood cell called lymphocytes starts to grow abnormally, accumulating in parts of your lymphatic system such as the lymph nodes.^1,2

While not the most frequent cancer, non-Hodgkin lymphoma is relatively common, comprising 1 in every 25 new cancer cases each year. 

Most cases of non-Hodgkin lymphoma are considered very treatable and are managed with common cancer therapies such as chemotherapy and radiotherapy. 

Types of non-Hodgkin's lymphoma

There are more than 60 types of non-Hodgkin’s lymphoma based on what cells are affected, how they look, and how fast the cancer spreads.^1,2

Non-Hodgkin lymphoma can affect two types of lymphocytes:

• B cells: most common, about 9 of 10 are B-cell lymphomas
• T cells and natural killer (NK) cells: less common, about 1 in 10 are either T-cell or NK cell lymphomas 

B-cell lymphomas

Depending on how fast the cancer spreads, B-cell lymphomas are further classified into indolent lymphomas and aggressive lymphomas.

Indolent lymphomas, also known as low-grade, grow slowly. The most common are:

• Follicular lymphoma (FL)
• Marginal zone lymphoma (MZL)
• Gastric mucosa-associated lymphoid tissue (MALT) lymphoma
• Chronic lymphocytic leukaemia (CLL)

When the lymphoma grows faster, they are known as aggressive, or high-grade, lymphomas. The most common aggressive B-cell lymphomas are:

• Diffuse large B-cell lymphoma (DLBCL)
• Mantle cell lymphoma (MCL)
• Lymphoblastic lymphoma
• Burkitt lymphoma (BL)

T-cell lymphomas

Non-Hodgkin lymphomas can also affect T cells. Depending on whether they originated in the skin or not they are subcategorised into either primary cutaneous or systemic.

Types of T-cell lymphomas include:

• Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS)
• Angioimmunoblastic T-cell lymphoma (AITL)
• Cutaneous T-cell lymphoma (CTCL)

Stages of non-Hodgkin's lymphoma

Following your diagnosis, your doctor will then determine the stage of your condition. This is to define how serious it is and the best way to treat it.¹ The stages are as below:

• Stage I: only one lymph node group or organ outside the lymphatic system is affected
• Stage II: two or more lymph node groups on the same side of the diaphragm are affected
• Stage III: lymph node groups on both sides of the diaphragm are affected or affect lymph nodes above the diaphragm and the spleen
• Stage IV: the lymphoma has spread to one or more organs such as the lung, bone marrow, or liver

If your non-Hodgkin lymphoma affects the blood or bone marrow, your doctor may use the stages of chronic lymphocytic leukaemia (CLL) to describe the severity. 

Causes of non-Hodgkin's lymphoma

Like other cancers, non-Hodgkin lymphoma is caused by changes in the genetic material of cells, specifically white blood cells known as lymphocytes.^3,5 As a result, the cells grow uncontrollably, eventually affecting your lymph nodes and potentially other parts of the body. 

Signs and symptoms of non-Hodgkin's lymphoma

The most common sign of non-Hodgkin’s lymphoma is a swollen lymph node, usually with no pain. It is usually found in the neck, armpit, or groin.^1,4 

Other symptoms may include:

• Chills
• Weight loss
• Fatigue
• Swollen abdomen
• Loss of appetite
• Chest pain
• Breathlessness 
• Coughing
• Frequent, severe infections
• Bruising or bleeding easily

Management and treatment for non-Hodgkin's lymphoma

The treatment you are given may depend on your type of non-Hodgkin lymphoma and how severe it is. If your lymphoma is low grade (indolent) and you feel well, your doctor may instead opt for “watching and waiting” as it may be years until you have symptoms that significantly affect your quality of life.^6,8

The most common treatments for non-Hodgkin lymphoma are:

• Chemotherapy uses a combination of medicines to kill cancer cells. Your treatment may consist of only chemotherapy or also include radiotherapy or monoclonal antibody therapy
• Radiotherapy is usually given for early-stage lymphoma that is limited to one part of the body
• Monoclonal antibody therapy may be a treatment option in combination with chemotherapy depending on your type of non-Hodgkin lymphoma. A common treatment is the antibody rituximab
• Steroids are often given in combination with chemotherapy to make it more effective

Following treatment, you will have regular appointments with our doctor to check on your recovery and look for signs that the cancer is coming back. At first, you may be asked to come in every few weeks or months but your check-ups will become less frequent over time. 

Diagnosis of non-Hodgkin's lymphoma

If following a physical examination your doctor suspects you have non-Hodgkin lymphoma, you may be referred to a hospital for a biopsy. This involves taking a small sample of tissue to be studied in the laboratory.⁶

If you test positive for non-Hodgkin’s lymphoma, you may be asked to undergo further tests to determine the severity, stage, and spread. This may include:

• Blood tests 
• Chest X-ray 
• Bone marrow sample 
• CT scan
• MRI scan 
• PET scan 
• Lumbar puncture

Risk factors

Some factors may contribute to your risk of developing non-Hodgkin lymphoma.^1,2 These are known as risk factors. They include: 

• A weakened immune system, either due to a medical condition such as HIV, autoimmune conditions such as rheumatoid arthritis, or treatments such as immunosuppressants
• Infections such as those caused by Epstein-Barr virus, human T-cell lymphotropic virus (HTLV), and Helicobacter pylori
• Autoimmune conditions (conditions where our immune system starts to destroy healthy cells)  like Coeliac disease
• Earlier cancer treatment such as chemotherapy and radiotherapy
• Having had a breast implant, which may lead to a type of lymphoma known as anaplastic large cell lymphoma

FAQs

How can I prevent non-Hodgkin's lymphoma?

There is no known way to prevent non-Hodgkin’s lymphoma, though you may lower your chances by reducing your risk of certain infections and maintaining a healthy immune system. Following a healthy lifestyle such as being physically active and following a healthy diet may also decrease your risk of developing non-Hodgkin lymphoma. 

How common is non-Hodgkin's lymphoma?

Non-Hodgkin’s lymphoma is the sixth most common cancer in the UK, with around 22 in every 100,000 people being diagnosed each year. Non-Hodgkin’s lymphoma is slightly more common in people assigned male at birth (AMAB) than assigned female at birth (AFAB).⁷

When should I see a doctor?

If you have noticed a painless swelling in your neck, armpit, or groin, or any other symptoms such as fatigue, chest pain, or breathlessness, please see a doctor. Though it may not be non-Hodgkin lymphoma, it is important that you get a diagnosis for your symptoms so they may be promptly addressed and the risk of complications is reduced. 

Summary

Non-Hodgkin lymphoma is a type of cancer that affects the lymphatic system. It is a diverse, complex condition that can cause a wide variety of symptoms. Due to this, your response to treatment may vary, though the outcome is often positive. Being diagnosed with cancer can be a difficult experience. Please be aware that you can seek additional help and support from organisations such as Lymphoma Action and Leukemia & Lymphoma Society.