Non - Hodgkin's Lymphoma

The impact non-Hodgkin lymphoma has on a patient depends largely on the type of the disease and the type of treatment prescribed. Because lymphoma affects B cells or T cells, it may make it difficult for a patient to fight off infection.

Some cases of indolent, or slow-growing, lymphoma require only active surveillance and no immediate treatment. Other cases require aggressive treatment, such as high-dose chemotherapy and stem cell transplantation. These types of treatments often cause side effects, such as nausea, weight loss and a compromised immune system. Because lymphoma affects the lymphatic system, another symptom of non-Hodgkin lymphoma that may occur is lymphedema, which is swelling caused by a buildup of lymphatic fluid.

Non-Hodgkin lymphoma has dozens of types and subtypes, each depending on whether cancer started in B lymphocytes or T lymphocytes, which are white blood cells that help the body fight off disease. Most cases of non-Hodgkin lymphomas are B-cell lymphomas. Lymphomas are also characterized by how aggressive (fast-growing) or how indolent (slow-growing) they are. Diffuse large B-cell lymphoma, considered an aggressive lymphoma, is the most common form of non-Hodgkin lymphoma.

The primary difference between Hodgkin and non-Hodgkin lymphomas is whether Reed-Sternberg cells are found in a lymph node biopsy. Reed-Sternberg cells are found in patients diagnosed with Hodgkin lymphoma. These mutated B cells are very large compared to other cells. The various shapes of Reed-Sternberg cells often help pathologists determine the specific type of Hodgkin lymphoma. A common variety of these cells has at least two nuclei, giving them the appearance of owls’ eyes. Reed-Sternberg cells are named for the two scientists who first identified them under a microscope.

Leukaemia and lymphoma share many common symptoms and characteristics. Both diseases are considered blood cancers, or liquid cancers, and originate in lymphocytes, which are the white blood cells that help the body fight off disease. In patients with leukaemia and lymphoma, white blood cells grow out of control and crowd out healthy cells. When the mutated cells are found in the blood, the disease is diagnosed as leukaemia. When the cells are found in the lymph nodes, the cancer is considered a lymphoma.

Leukemic cells are more likely to remain in the blood and circulate throughout the body. Lymphoma cells may also circulate, but they are more likely than leukemic cells to develop solid tumours in the lymph system, such as in lymph nodes or the spleen.

• Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. There are 4 stages for NHL: stages I through IV (1 through 4).
• As explained in Symptoms and Signs, each stage may also be further divided into “A” and “B” categories, based on whether or not the person is experiencing specific B symptoms.

• Stage I: The lymphoma is found in 1 lymph node region. Or, the lymphoma has invaded 1 extra lymphatic organ or site (identified using the letter “E”) but not any lymph node regions (stage IE); this is rare in Hodgkin lymphoma.

• Stage II: Any of the following conditions applies:

  • Stage II: The lymphoma is in 2 or more lymph node regions on the same side of the diaphragm.

  • Stage IIE: The lymphoma involves 1 organ and its regional lymph nodes (lymph nodes located near the site of the lymphoma), with or without lymphoma in other lymph node regions on the same side of the diaphragm.
  • Stage II bulky: Either stage II or stage IIE applies, plus there is a mass in the chest. The mass is either larger than one-third the diameter of the chest or larger than 10 centimetres (cm). A centimetre is roughly equal to the width of a standard pen or pencil.
• Stage III: There is lymphoma in lymph node areas on both sides of the diaphragm, meaning above and below it.
• Stage IV: The lymphoma has spread to 1 or more organs beyond the lymph nodes. Hodgkin lymphoma usually spreads to the liver, bone marrow, or lungs.

The treatment of NHL depends on the type, subtype, and stage of NHL, possible side effects, and the person’s overall health. Watchful waiting may be an option for some patients with slow-growing or indolent lymphoma who are otherwise healthy and do not have any symptoms. Chemotherapy is the main treatment for NHL. Radiation therapy is sometimes given after or during chemotherapy, depending on the subtype. Treatment may include immunotherapy/targeted therapy, such as monoclonal antibodies with or without chemotherapy, antibody-drug conjugates, radioimmunotherapy, or chimeric antigen receptor (CAR) T-cell therapy. Bone marrow/stem cell transplantation may also be considered. Clinical trials are an option to consider for treatment and care for all stages of lymphoma, whether for initial treatment or for a disease that has come back or recurred.

Talk with your doctor about all treatment options. The side effects of NHL treatment can often be prevented or managed with the help of your health care team. This is called supportive care or palliative care and is an important part of the overall treatment plan.

Absorbing the news of a cancer diagnosis and communicating with your health care team are key parts of the coping process. Seeking support, organizing your health information, making sure all of your questions are answered, and participating in the decision-making process are other steps. Talk with your health care team about any concerns. Understanding your emotions and those of people close to you can be helpful in managing the diagnosis, treatment, and healing process.

Even if you’ve completed treatment, your doctors will still want to watch you closely. It’s very important to go to all your follow-up appointments because HL can sometimes come back even many years after treatment.

Some treatment side effects might last a long time or might not even show up until years after you have finished treatment. These doctor visits are a good time to ask questions and talk about any changes or problems you notice or concerns you have.