What is non-Hodgkin lymphoma?

Lymphoma is a cancer of the lymphatic system. The lymphatic system is part of the immune system, which helps protect the body against infections. The lymphatic system is made up of lymph vessels, lymph fluid and lymph nodes.

Lymph fluid contains white blood cells (called lymphocytes) which help your body fight infections. If you have lymphoma, your white blood cells grow and multiply in an uncontrolled way, causing tumours and/or replacing normal white blood cells. This stops the immune system from functioning normally.

Tumours caused by lymphoma usually grow in lymph nodes. However lymphoma can also affect other organs of the body, especially the spleen, liver and bone marrow, and sometimes the nervous system and spinal cord.

About 5000 people are diagnosed with lymphoma in Australia every year; more than 4 in 5 cases are non-Hodgkin lymphoma.

What’s the difference between Hodgkin and non-Hodgkin lymphoma?

Lymphoma is often classified by the way cancerous white blood cells look under a microscope. A certain type of cell called a Reed-Sternberg cell is found in most cases of Hodgkin lymphoma, but it is not found in non-Hodgkin lymphoma.

Non-Hodgkin lymphoma is not a single disease; it has different classifications depending on which white blood cells are growing abnormally.

The 2 main subtypes of white blood cells are T-cells and B-cells, so the main classifications of non-Hodgkin lymphomas are T-cell lymphomas and B-cell lymphomas.

Within these classifications, there are many more subtypes. Each lymphoma subtype is different in terms of the body parts commonly affected, symptoms, treatment, and expected outcome (prognosis).

How is lymphoma different from leukaemia?

Lymphoma and leukaemia are both blood cancers, affecting white blood cells. However, lymphoma usually starts in white blood cells circulating in the lymphatic system, while leukaemia usually starts in the bone marrow.

What are the symptoms of non-Hodgkin lymphoma?

The first sign of non-Hodgkin lymphoma is often an enlarged, painless lymph node — often in the neck, armpit, or groin.

Other symptoms of non-Hodgkin lymphoma may include:

• recurrent fevers
• severe night sweats
• unexplained weight loss
• generalised itch
• fatigue

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When should I see my doctor?

The symptoms listed above can be caused by many other things. It doesn’t necessarily mean you have cancer if you experience any of the symptoms.

However, if your symptoms persist for more than 2 weeks or you are concerned, see your doctor.

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What causes non-Hodgkin lymphoma?

No one knows exactly what causes non-Hodgkin lymphoma.

There are a few risk factors that can increase your chance of developing non-Hodgkin lymphoma including:

• a weakened immune system (referred to as immunosuppression)
• certain viral infections such as Epstein-Barr virus (EBV), HTLV-1 (human T-cell lymphotropic virus 1), hepatitis C and human herpesvirus 8
• a family history of lymphoma

Most people with these risk factors don't develop lymphoma, and many people diagnosed with lymphoma don't have any risk factors.

How is non-Hodgkin lymphoma diagnosed?

If your doctor suspects you might have non-Hodgkin lymphoma, they may refer you for investigations and tests.

At your first visit, your doctor may carry out a physical exam to look for any lumps or bumps in your neck, armpits, abdomen or groin.

You might then have blood tests to check your blood count and your kidney and liver function.

You may also have imaging scans such as ultrasounds, x-rays, CT scans or MRI scans. This will depend on your symptoms and what your doctor finds during the physical exam. The purpose of these scans is to look for evidence of cancer.

In some cases, your doctor may suggest a lumbar puncture (sometimes called a ‘spinal tap’) to check for signs of cancer in the area around your spinal cord.

Lymphoma can only be formally diagnosed with a biopsy. This usually involves removing, or taking a sample of, one or more lymph nodes. A specialist doctor (pathologist) can then examine them under a microscope for signs of cancer.

If you are diagnosed with lymphoma, your doctor will assign it a ‘stage’ based on how far the cancer has spread and a ‘grade’ based on how fast it is growing. Whether you have symptoms is also taken into consideration.

Staging and grading helps your doctor design the best treatment plan for you.

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How is non-Hodgkin lymphoma treated?

Non-Hodgkin lymphoma can be treated using a combination of treatments, designed by your doctor.

The treatment plan depends on many factors, including:

• the type of lymphoma
• its stage and grade
• which body parts are affected
• your age and general health

Your doctor might consider treatments such as:

• chemotherapy — using strong medicines to kill cancer cells
• radiotherapy — using x-rays, gamma rays or proton beams to kill cancer cells in a specific area
• targeted therapy — using medicines designed to target specific features of cancer cells
• steroids — taking anti-inflammatory medicines called corticosteroids can shrink tumours and make chemotherapy more effective. Steroids may also be prescribed in some circumstances to treat nausea and vomiting (side effects caused by other cancer treatments).
• stem cell transplant — an uncommon, complicated procedure aimed at replacing damaged stem cells in your immune system with healthy ones. Healthy stem cells may be taken from your own body or, less commonly, from a donor.

In some cases of very slow-growing lymphomas, your doctor may suggest a period of ‘watchful waiting’. This means not starting treatment until there are signs that the lymphoma is growing more quickly.

You may have frequent check-ups to look for signs of cancer growth. Many people live this way for years without needing treatment.

Can non-Hodgkin lymphoma be prevented?

As no one knows exactly what causes non-Hodgkin lymphoma, it can't be prevented.

What are the complications of non-Hodgkin lymphoma?

Non-Hodgkin lymphoma and its treatments can cause a range of complications, including:

• Immunosuppression — Treatment for non-Hodgkin lymphoma may weaken your immune system (immunosuppression). You may need to be extra careful to avoid people who are sick with infections, since these can be more serious for someone who is immunosuppressed.
  Some vaccines are not suitable for people who are immunosuppressed. Speak to your doctor before getting any vaccinations while you’re being treated for cancer.
• Infertility — Chemotherapy and radiotherapy affect fast-growing cells, including reproductive cells, which form eggs and sperm. These effects can be temporary or permanent.
  If you want to have children in the future, speak to your doctor about preserving your fertility before starting treatment.
• Secondary cancer — Radiotherapy can increase your chance of developing another unrelated cancer in the future.
• Organ damage — Chemotherapy and radiotherapy can occasionally cause long-term damage to organs such as your heart and lungs.

You may experience many or none of these complications. Your doctor can give you more information and advice about the benefits and disadvantages of treatment for non-Hodgkin lymphoma.

Resources and support

For information, advice and support for non-Hodgkin lymphoma, visit these organisations:

• Lymphoma Australia
• Leukaemia Foundation
• Cancer Council
• Peter MacCallum Cancer Centre
• Carers Australia