Non-Hodgkin's Lymphoma

Symptoms of Non-Hodgkin’s Lymphoma vary, depending on the area of the body affected by the disease. Common symptoms include:

• Painless swelling of lymph nodes, most commonly in the neck, underarm or groin. These may be seen or felt as lumps under the skin
• Night sweats
• Abdominal pain or swelling
• Chest pain or pressure
• Unusual bruising
• Breathlessness and coughing, especially when lying flat
• Unexplained fever
• Extreme fatigue
• Unexplained weight loss
• Itchy skin or reddened patches on the skin

Make an appointment with your doctor if you are experiencing any of the symptoms above, especially if you have a lump on your body that hasn’t gone away. While enlarged lymph nodes are much more commonly caused by infections than lymphoma, it is still important to have your symptoms checked by your doctor.

Your doctor will conduct various tests and procedures to diagnose Non-Hodgkin’s Lymphoma. These can include:

• Medical history and physical exam: Your doctor will most likely ask for a complete medical history, including information about your symptoms, risk factors and other medical conditions. Next, the doctor may conduct a physical exam, paying special attention to the size and condition of your lymph nodes and other places of the body that might be affected, including the spleen and liver.
• Blood and urine tests: Blood and urine tests may be done to help rule out an infection or other disease.
• Imaging tests: Your doctor may recommend imaging tests to look for tumors in your body. Imaging tests may include X-ray, computerized tomography (CT) scan, magnetic resonance imaging (MRI) or positron emission tomography (PET).
• Lymph node biopsy: Your doctor may recommend a biopsy procedure to remove either a small piece of a lymph node or the whole node for testing. Analysing lymph node tissue in a lab can reveal whether you have lymphoma and, if so, can reveal which type it is.

After being diagnosed with Non-Hodgkin’s Lymphoma, your doctors will also need to find out where the lymphoma is in your body, how many groups of lymph nodes are affected, and whether or not it has spread to other organs. This process is called staging. Staging is very important because the treatment and your outlook for survival depend on the exact type and stage of the cancer.

Non-Hodgkin’s Lymphoma is commonly staged from I to IV:

• Stage I: In Stage I, lymphoma is found in only one lymph node area or in only one area or organ outside the lymph nodes.
• Stage II: In Stage II, lymphoma is found in two or more lymph nodes on the same side of the diaphragm or the lymphoma extends from a single lymph node or single group of lymph nodes into a nearby organ.
• Stage III: In Stage III, lymphoma is found in lymph node areas on above and below the diaphragm. Lymphoma may have also spread into areas or organs adjacent to lymph nodes, such as the spleen.
• Stage IV: In Stage IV, the lymphoma has spread (metastasised) via the bloodstream to organs outside the lymph system, such as the bone marrow, brain, skin, or liver.

Your treatment options are determined based on your personal circumstances, including the type and stage of your lymphoma, your age and your overall health. The American Cancer Society suggests getting a second professional opinion to help you feel more confident with the treatment plan you choose.

The main types of treatment for Non-Hodgkin’s Lymphoma are:

• Active surveillance (also called watchful waiting): Some types of Non-Hodgkin’s lymphoma grow very slowly and may not cause symptoms for years. Because of this, you may not need to start treatment straight away. Instead, you will have regular check-ups with your specialist and only begin treatment once symptoms develop.
• Chemotherapy: Chemotherapy uses drugs to kill cancer cells, and is the main form of treatment for Non-Hodgkin’s Lymphoma. Chemotherapy drugs can be given alone or in combination with other treatments.
• Radiation therapy: Radiation therapy is sometimes used on its own, or with chemotherapy, to treat patients with early stage Non-Hodgkin’s Lymphoma. This is an intensive form of treatment that uses high-energy rays to kill cancer cells. Using radiotherapy decreases the chances of the lymphoma returning after treatment.
• Stem cell transplant: Stem cell transplant is an intensive form of treatment and is only a viable option for those who are in good general health and whose lymphoma is difficult to treat with chemotherapy alone. This procedure involves very high doses of chemotherapy or radiation with the goal of killing the lymphoma cells that may not be killed with standard doses. Afterwards, healthy stem cells, either your own or from a donor, are injected into your body where they can form new healthy blood cells.
• Monoclonal antibodies: Monoclonal antibodies are man-made versions of the antibodies made by the immune system to help fight infections. Although in this case, instead of attacking germs, they are designed to attack lymphoma cells. For Non-Hodgkin’s Lymphoma treatment, Rituximab is the most commonly used form of monoclonal antibodies. It is often used alongside chemotherapy, but can also be used on its own.

The majority of people with Non-Hodgkin’s Lymphoma do not have any of the known risk factors associated with the disease. This means that, for now, there is no proven way to protect against and prevent Non-Hodgkin’s Lymphoma.

However, the American Cancer Society holds that avoiding known risk factors is still the best preventative measure one can take to reduce the risk of developing Non-Hodgkin’s Lymphoma. Some known risk factors are:

• Medications that suppress your immune system: Immunosuppressive therapy, given after an organ transplant, increases the risk of developing lymphoma. This is because medicines that suppress your immune system reduce your body’s ability to fight off new illnesses.
• Previous cancer treatment: Treatment of cancers with radiation and chemotherapy can increase a person’s risk of developing Non-Hodgkin’s Lymphoma many years later. Speak with your doctor about whether the benefits of these treatments outweigh your risk of developing lymphoma.
• Infection: Certain viral and bacterial infections are linked with an increased risk of Non-Hodgkin’s Lymphoma. Viruses that can increase the risk of this disease include human immunodeficiency virus (HIV) and Epstein-Barr virus. Bacteria associated with non-Hodgkin's Lymphoma include Helicobacter pylori. As HIV is spread mostly through unprotected sex and by drug users sharing contaminated needles, it is a highly preventable cause of immune deficiency.
• Autoimmune disease: Macmillan Cancer Support list several autoimmune disorders, including rheumatoid arthritis, Sjogren’s syndrome and Hashimoto’s thyroiditis, as risk factors of Non-Hodgkin’s Lymphoma. While doctors don’t fully understand why this is, taking measures to prevent autoimmune diseases can help lower your risk of Non-Hodgkin’s Lymphoma.