Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma is disease in which malignant (cancer) cells form in the lymph system. The lymph system is part of the body’s immune system. The immune system protects the body from foreign substances, infection, and diseases. The following is all part of the lymph system:

  • Lymph: Colorless, watery fluid that carries lymphocytes (type of white blood cell) through the lymph system. Lymphocytes protect the body against infection.
  • Lymph nodes: Small bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along lymph vessels, found throughout body. Clusters of lymph nodes are found in the neck, underarm, abdomen, pelvis and groin.
  • Spleen: An organ located on the left side of the abdomen near the stomach, that filters blood, makes lymphocytes, stores blood cells and destroys old blood cells.
  • Thymus: An organ in which lymphocytes grow and multiply. The thymus is located in the chest behind the breastbone.
  • Tonsils: Two small masses of lymph tissue at the back of the throat. The tonsils make lymphocytes.
  • Bone marrow: The soft spongy tissue in the center of the large bones. Bone marrow makes white blood cells, red blood cells and platelets.

Stages of Non-Hodgkin Lymphoma

  • Stage I: There is only one lymph node in one part of the body (such as under the arm or in the neck).The lymph node is not in the chest or abdomen (belly). There is no metastasis (spread of tumor to a different location in body).
  • Stage II: There is spread to other nearby lymph nodes. Or there are two or more lymph nodes located on the same side of the diaphragm (breathing muscle that separates the chest and abdomen).
  • Stage III: The lymphoma started in the chest or abdomen. If located in the abdomen, it has spread and cannot be surgically removed. Another possibility is two or more lymph nodes on both sides of the diaphragm.
  • Stage IV: The lymphoma has spread from its original location to the bone marrow or central nervous system.

Signs and symptoms

Depending on its location in the body, some of the signs and symptoms could be:

  • Swollen lymph nodes: Painless, near the collarbone, or in neck, chest, underarm or groin

  • If located in chest there could be cough, shortness of breath, difficulty breathing or chest pain

  • If located in the abdomen there could be pain, bloating, nausea, vomiting, constipation or diarrhea

Tests to help diagnose Non-Hodgkin Lymphoma

  • Physical exam and history: The health care provider will check general signs of health, assess for any lumps or anything else that seems unusual. They will also get history of past illnesses, health habits and any family history of illness or cancer.

  • CT scan: A computer assisted X-ray that shows detailed pictures inside the body, such as neck, chest, abdomen and pelvis. A dye may be injected into a vein or swallowed to help the organ and tissues show up more clearly.

  • PET scan (positron emission tomography): An X-ray that helps to show where the malignant tumor cells are in the body. A small amount of radioactive glucose (sugar) is injected into the vein. The scanner will then make pictures where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells. The PET scan has three steps:

    1. Injection of radioactive glucose

    2. A waiting period of 30-60 minutes

    3. Scanning by the PET machine. 

  • Chest X-ray: An X-ray of the organs and bones inside the chest.

  • Blood tests:

    • CBC (complete blood count) checks the number of red blood cells (oxygen carriers), platelets (cells that help the blood clot properly) and white blood cells (infection fighters)

    • Sedimentation rate can help measure how much inflammation is in the body

    • Blood chemistry studies measures amounts of certain substances released into the blood by organs and tissues in the body

All these tests are usually done at time of diagnosis to rule out other diseases, and are also done throughout treatment to monitor response and to monitor for possible side effects of treatment.

  • Lymph node biopsy: Removal of all or part of a lymph node. There are different types of biopsies.

    • Excisional biopsy: Removal of an entire lymph node

    • Incisional biopsy: Removal of part of a lymph node

    • Core biopsy: Removal of tissue from a lymph node using a wide needle

    • Fine needle aspiration biopsy: Removal of tissue from a lymph node using a thin needle

A pathologist will look at the tissue under the microscope to look for cancer cells. Reed - Sternberg cells are common in classical Hodgkin lymphoma.

  • Bone marrow aspiration and biopsy: Sometimes done to help determine if the Hodgkin lymphoma cells are in the bone marrow, the blood producing factory in the body. A special needle is inserted into one of the bones (typically the back of the hip bone) and a small amount of marrow (liquid part) is aspirated into a syringe. The biopsy includes taking a small piece of bone and sending it to lab for review. Since the procedure is uncomfortable most patients are given pain medicine or sedated during procedure.

  • Lumbar puncture: This is a procedure done to collect a sample of cerebral spinal fluid from the spinal column. This procedure is typically done under sedation but can also be done awake with local anesthesia. The sample of cerebral spinal fluid is checked for the presence of non-Hodgkin lymphoma cells. 

  • Pleural or peritoneal fluid assessment: Sometimes non-Hodgkin lymphoma can spread to the thin membranes inside the pleural (chest) or peritoneal (abdomen) cavities, causing fluid to accumulate. Testing is done by inserting needle through skin into the chest or abdomen and withdrawing small amount of fluid. Most patients are sedated for this. Sometimes this test is done in place of a tumor biopsy in some situations. 

How is it treated?