What is non-Hodgkin lymphoma?

Lymphoma is a cancer of the lymphatic system.

The lymphatic system is part of your immune system, which helps protect your body against infections. The lymphatic system is made up of:

• lymph vessels
• lymph — clear fluid that contains white blood cells (called lymphocytes) which help your body fight infections
• lymph nodes

Tumours caused by lymphoma usually grow in your lymph nodes. But lymphoma can also affect other organs of the body, such as your:

• spleen
• liver
• bone marrow

About 5,000 people are diagnosed with non-Hodgkin lymphoma in Australia every year. It's more common in males than females, and in people aged over 60 years. However, children can also develop non-Hodgkin lymphoma.

What are the different types of lymphoma?

The 2 main types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma.

Non-Hodgkin lymphoma is not a single disease. There are more than 60 sub-types, depending on which white blood cells are growing abnormally — T-cells or B-cells.

The main subtypes of non-Hodgkin lymphomas are:

• T-cell lymphomas
• B-cell lymphomas

Each lymphoma subtype is different in terms of:

• symptoms
• treatment
• expected outcome — also called your prognosis

How is lymphoma different from leukaemia?

Lymphoma and leukaemia are both blood cancers that affect white blood cells. However, lymphoma usually starts in white blood cells in your lymphatic system and causes solid tumours that affect your lymph nodes and other organs. Leukaemia usually starts in your bone marrow and tends to affect the balance of cells in your blood.

What are the symptoms of non-Hodgkin lymphoma?

Symptoms of non-Hodgkin lymphoma can be:

• a painless swelling or lump in a lymph node — often in the neck, armpit, or groin
• fevers
• severe night sweats
• unexplained weight loss
• loss of appetite
• itchy skin
• fatigue (feeling very tired)

What causes non-Hodgkin lymphoma?

The cause of non-Hodgkin lymphoma isn't known.

There are a few factors that can increase your chance of getting non-Hodgkin lymphoma, such as:

• immunosuppression (a weakened immune system)
• a family history of lymphoma
• older age (over 60 years old)

Other risk factors include certain infections, such as:

• Helicobacter pylori
• Epstein-Barr virus (EBV)
• HTLV-1 (human T-cell lymphotropic virus 1)
• hepatitis C
• human herpesvirus 8

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

When should I see my doctor?

See your doctor as soon as possible if you have a lump or swelling anywhere in your body. Also see your doctor if you have symptoms that are worrying you.

How is non-Hodgkin lymphoma diagnosed?

Your doctor will ask about your symptoms and do a physical examination. This will include looking for any lumps or bumps in your:

• neck
• armpits
• tummy
• groin

Biopsy

Non-Hodgkin lymphoma can only be diagnosed with a biopsy. This involves taking a sample from one or more lymph nodes. The biopsy tissue is sent to a laboratory and examined under a microscope for signs of cancer.

Your doctor might use an ultrasound scan to help with the biopsy of your lymph node.

The biopsy result can show which sub-type of non-Hodgkin lymphoma you have.

Other tests

Further tests are needed to see if the lymphoma has spread. This is called 'staging'.

Your doctor might ask you to have blood tests and imaging tests. These might be:

• an x-ray
• a CT scan
• an MRI scan
• a PET scan

In some cases, your doctor may suggest a:

• bone marrow biopsy
• lumbar puncture (sometimes called a 'spinal tap') to check for signs of cancer in the area around your spinal cord

Staging and grading (working out how fast the lymphoma is growing or spreading) helps your doctor design your treatment plan.

The stages of non-Hodgkin lymphoma are:

• Stage 1 — one lymph node group is affected. This can be either above or below your diaphragm.
• Stage 2 — two or more lymph node groups are affected. This can be either above or below your diaphragm.
• Stage 3 — lymph node groups above and below your diaphragm are affected.
• Stage 4 — multiple lymph nodes are affected, and the lymphoma has spread to other parts of your body (such as bone marrow, liver and lungs)

How is non-Hodgkin lymphoma treated?

Non-Hodgkin lymphoma can be treated using a mix of therapies that is planned by your doctor.

The treatment plan depends on many factors, including:

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

Treatments include:

• Chemotherapy — using strong medicines to kill cancer cells.
• Radiotherapy — using radiation to kill cancer cells in a specific area.
• Targeted therapy — using medicines designed to target specific features of cancer cells. Monoclonal antibodies are one type of targeted therapy.
• Corticosteroid treatment — taking anti-inflammatory medicines called corticosteroids can help make chemotherapy more effective.
• Stem cell transplant — a treatment for people whose lymphoma has not responded to treatment or recurred (come back) after treatment.
• Watchful waiting — if your lymphoma is very slow growing, 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.

Talk with your doctor for more information and advice about the benefits and risks of treatments for non-Hodgkin lymphoma.

Living with non-Hodgkin lymphoma

Getting diagnosed with non-Hodgkin lymphoma can be very distressing for you and others around you. You may need to make changes to your life that you hadn't planned to make. This can be stressful and affect your mental health.

Your doctor will be there to support you and will be able to refer you to support services if you need them.

What are the complications of non-Hodgkin lymphoma?

Non-Hodgkin lymphoma and its treatments can cause many different complications. You may experience many or none of these complications.

Weakened immune system

Treatment for non-Hodgkin lymphoma may weaken your immune system. This is called 'immunosuppression'. You may need to be extra careful to avoid other people who are sick. That's because infections can be more serious for someone who's immunosuppressed.

Some vaccines aren't suitable for people who are immunosuppressed. Speak to your doctor before getting any vaccines while you're being treated for cancer.

Fertility problems

Some cancer treatments can affect your fertility. 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

Cancer treatments such as radiotherapy can increase your chance of getting another cancer in the future.

Organ damage

Chemotherapy and radiotherapy can occasionally cause long-term damage to organs such as your heart and lungs. They can also damage your nerves, causing symptoms such as:

• tingling
• numbness
• pain

Can non-Hodgkin lymphoma be prevented?

As the cause of non-Hodgkin lymphoma isn't known, it can't be prevented. There are no screening tests for non-Hodgkin lymphoma.

Resources and support

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

• Lymphoma Australia
• Leukaemia Foundation or call 1800 620 420
• Cancer Council or call 131120

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.