What is non-Hodgkin lymphoma?

Cancer starts when cells change (mutate) and grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. They can spread to other parts of the body, too. This is called metastasis.

Non-Hodgkin lymphoma (NHL) is cancer that starts in the lymphatic system. The lymphatic system is part of the immune system. It helps the body fight infection.

With NHL, cells in the lymphatic system grow out of control. This causes swelling in the lymph nodes. NHL can also start in and form tumors in other parts of the body, like the spleen or bone marrow. It can spread to almost any organ in the body.

Non-Hodgkin lymphoma is different from Hodgkin lymphoma. There are many different types of NHL based on which immune system cell the cancer starts in and other factors. They grow at different rates and are treated in different ways. Testing is needed to know the exact type of NHL a person has before treatment is started.

Who is at risk for non-Hodgkin lymphoma?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change. 

Risk factors for non-Hodgkin lymphoma include:

• Older age

• Being a man

• A history of certain infections, such as the hepatitis C virus, H. pylori, or the Epstein-Barr virus

• A weak immune system because of medicines for organ transplant, HIV infection, or certain inherited syndromes

• Past cancer treatment, such as some kinds of chemotherapy or radiation therapy

• Having certain autoimmune disorders, such as rheumatoid arthritis, lupus, and celiac disease

• Breast implants (this is rare)

Talk with your healthcare provider about your risk factors for NHL and what you can do about them.

Can non-Hodgkin lymphoma be prevented?

There’s no sure way to prevent NHL.

What are the symptoms of non-Hodgkin lymphoma?

Non-Hodgkin lymphoma may not cause symptoms until the cancer has grown very large. Symptoms may also seem like other health problems at first. This is because NHL can cause many different kinds of symptoms. It depends on where it starts in your body.

Here are some common symptoms of NHL:

• Swollen lymph nodes that don’t hurt and don’t go away. These feel like lumps under your skin and are often in the neck, groin, underarm, or above the collarbone.

• Unexplained fever

• Tiredness or weakness

• Infections that keep coming back

• Extreme sweating, especially at night

• Loss of weight without trying

• Rash or itchy skin

Some symptoms depend on where the cancer is. For instance, NHL in the belly (abdomen) can cause:

• Swelling in your belly

• Feeling full after eating only a small amount

• Upset stomach (nausea), vomiting, or stomach pain

• Appetite loss

NHL in the chest can cause:

• Coughing

• Trouble breathing

• Pressure or pain in your chest

• Swelling in your head and arms

Many of these may be caused by other health problems. Still, it’s important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is non-Hodgkin lymphoma diagnosed?

The most common way to find non-Hodgkin lymphoma is when someone sees a healthcare provider because of symptoms. Your healthcare provider will ask you about your health history, your symptoms, risk factors, and family history of disease. A physical exam will be done.

You may also have one or more of these tests:

• Blood tests (many different kinds)

• Lymph node biopsy

• Bone marrow aspiration and biopsy

A biopsy is the only way to tell for sure that you have NHL. Small pieces of tissue are taken out from the tumor and tested for cancer cells. Your results will come back in about 1 week.

After a diagnosis of NHL, you’ll need more tests. These help your healthcare providers learn more about your overall health and the cancer. They're used to find out the exact type and the stage of the NHL. The stage is how much cancer there is, where it is, and how far it has spread (metastasized) in your body. It’s one of the most important things to know when deciding how to treat the cancer.

Once your cancer is staged, your healthcare provider will talk with you about what this means for your treatment. Be sure to ask your healthcare provider to explain the details of your cancer to you in a way you can understand. 

How is non-Hodgkin lymphoma treated? 

Your treatment choices depend on the type of non-Hodgkin lymphoma you have, test results, and the stage of the cancer. The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Radiation and surgery are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy, immunotherapy, and targeted therapy are systemic treatments. You may have just one treatment or a combination of treatments.

Non-Hodgkin lymphoma may be treated with:

• Chemotherapy

• Immunotherapy

• Targeted therapy

• Radiation therapy

• Watchful waiting

• Stem cell transplant

• Surgery (rare)

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects?

Cancer treatments, like chemotherapy and radiation, can damage normal cells. This can cause side effects such as hair loss, mouth sores, and vomiting.

Talk with your healthcare provider about side effects linked to your treatment. There are often ways to manage them. There may be things you can do and medicines you can take to help prevent or control many treatment side effects.

Coping with non-Hodgkin lymphoma

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effects of cancer and its symptoms on your daily life.

Here are tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group in person or online.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.

• Drink plenty of water, fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse

• Signs of an infection, such as a fever

• Side effects of treatment that affect your daily function or don’t get better with treatment

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.

Key points about non-Hodgkin lymphoma

• Non-Hodgkin lymphoma (NHL) is cancer that starts in the lymphatic system. The lymphatic system is part of the immune system. It helps the body fight infection.

• There are many different types of NHL based on which immune system cell the cancer starts in and other factors. They grow at different rates and are treated in different ways. Testing is needed to know the exact type of NHL a person has before treatment is started.

• There is no sure way to prevent NHL. And there are no regular screening tests for it.

• A biopsy is the only way to tell for sure that you have NHL. Small pieces of tissue are taken out from the tumor and tested for cancer cells.

• NHL can be treated with chemotherapy, radiation therapy, immunotherapy, targeted therapy, watchful waiting, and stem cell transplant.

Next steps

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.