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This article will review the symptoms, causes, and treatment of the condition non-Hodgkin lymphoma. Symptoms of this condition include painless, swollen lymph nodes in the neck, armpits or groin, fever, unexplained weight loss, night sweats, coughing, and shortness of breath, among others.
What is non-hodgkin lymphoma?
Lymphoma is a type of cancer that results from the malignant proliferation of white blood cells. White blood cells are a part of our bodies’ immune system and are important for fighting infection. Lymphomas are sub-classified as Hodgkin or non-Hodgkin lymphomas. These subtypes can be determined by taking a sample of your white blood cells and examining them under the microscope for the presence of Reed Sternberg cells. If these are seen, the lymphoma is classified as Hodgkin lymphoma. If Reed Sternberg cells are not present, the lymphoma is considered non-Hodgkin. Non-Hodgkin lymphoma can progress slowly or aggressively depending on your specific case. This condition can occur in both adults and children.
You should visit your primary care physician to confirm the diagnosis. Afterwards, a referral to a specialist will explain treatment options.
Non-hodgkin lymphoma symptoms
As discussed, non-Hodgkin lymphoma can have a slow onset and progression or progress rapidly. The following symptoms may occur:
- Painless, swollen lymph nodes in neck, armpits, or groin
- Unexplained weight loss
- Night sweats
- Shortness of breath
- Chest pain
- Abdominal fullness
- Skin rash
Non-hodgkin lymphoma causes
Non-Hodgkin lymphoma is a general term used to describe a class of lymphomas where Reed Sternberg cells are seen under the microscope in the population of over-proliferated cells. As such, there are multiple specific types of lymphomas that fall under the category of “non-Hodgkin.” Each of these specific cancers is defined by the type of cell that is overpopulating the body. The following cancers are considered non-Hodgkin lymphoma:
- Follicular lymphoma
- Lymphoplasmacytic lymphoma
- Marginal zone lymphoma
- Primary cutaneous anaplastic large cell lymphoma
- Diffuse large B-cell lymphoma
- T-cell lymphoma
- Burkitt lymphoma
- Mantle cell lymphoma
Non-Hodgkin lymphoma is associated with a number of risk factors including family history, advanced age, male sex, Caucasian race, an inherited autoimmune disease, HIV/AIDS, Epstein-Barr virus, H. pylori infection. Non-Hodgkin lymphoma can also occur in children. It accounts for six to seven percent of childhood cancers.
The following section will provide an overview of the diagnostic process for non-Hodgkin lymphoma. If your provider is suspicious of lymphoma, your provider will first perform a full physical exam to examine the areas of the body where many lymph nodes are found. This includes the tonsils, cervical and axillary regions, and femoral area. Flow cytometry is a blood test that allows the physician to determine the number of cells, the size and shape of the cells, and the presence of tumor markers on the cell surface. Your provider may also have you undergo a bone marrow biopsy, as many of our immune system cells are formed in the bone marrow. If a suspicious lymph node is found, it will likely be sampled or removed for analysis under the microscope. If a cancer is detected, you may undergo further genetic testing on their cancer cells to determine the course of treatment. In order to have your cancer staged, you will also undergo further imaging like a PET scan to determine if cancer has spread to multiple parts of the body.
Treatment options and prevention for non-hodgkin lymphoma
The treatment of non-Hodgkin lymphoma varies depending on which subtype of non-Hodgkin lymphoma is present (listed above) and the stage of cancer at presentation. Treatments for various subtypes include radiation therapy, chemotherapy, immunotherapy, and targeted therapy. Immunotherapy is a process in which the body’s own immune system is used to fight cancer cells. Targeted therapy is a drug that is designed to specifically attack cancer cells, unlike chemotherapy which is engineered to attack all dividing cells. Stem cell transplants are sometimes used after chemotherapy and radiation to replace the over-proliferating cells with normal cells. A newer therapy is CAR t-cell therapy, in which your t-cells, part of the natural immune system, are removed from the body and modified to attack cancer cells before being replaced in the body.
Many of the risk factors for non-Hodgkin lymphoma, such as age, race, gender, and family history, are not within your control. Other risk factors include exposure to radiation, HIV/AIDS, past organ transplantation, and autoimmune conditions. Studies are mixed regarding the validity of other risk factors such as exposure to the chemicals (herbicides, benzene), obesity, and breast implants.
When to seek further consultation for non-hodgkin lymphoma
You should seek further consultation if you feel an enlarged lymph node, experience night sweats, fever of unknown etiology, weight loss, or shortness of breath.
Questions your doctor may ask to determine non-hodgkin lymphoma
- Have you lost your appetite recently?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Any fever today or during the last week?
- Have you experienced any nausea?
- Are you sick enough to consider going to the emergency room right now?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Henry is a first-year resident in the Department of Otolaryngology-Head & Neck Surgery at the University of Pennsylvania. She received her medical degree from the University of Pennsylvania and her BA in political economy from Williams College. As a medical student, she was the editorial manager of an otolaryngology publication and has extensive experience with medical writing. She is currently working on research projects for publication in the sub-specialty fields of otology, head and neck cancer, and facial plastics. Outside the hospital she enjoys fly fishing, squash, hiking, and watching pro tennis.
- Lymphoma. U.S. National Library of Medicine: MedlinePlus. Updated Nov. 5, 2018. MedlinePlus Link
- Adult Non-Hodgkin Lymphoma Treatment-Patient Version. NIH National Cancer Institute. Updated Oct. 19, 2018. National Cancer Institute Link
- Lymphoma. Johns Hopkins Pediatric Oncology. Johns Hopkins Link
- Non-Hodgkin’s Lymphoma Risk Factors. American Cancer Society. American Cancer Society Link