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The A to Z of Non-Hodgkin Lymphoma

By Shaniqua Williams

Posted on November 03rd, 2018

After the recent Monsanto controversy, people are afraid of developing non-Hodgkin's lymphoma. We aim to inform readers about this disease and raise awareness about it so that people will remain safe.

Non-Hodgkin lymphoma, also known as Lymphoma or just NHL, is a type of cancer that starts in the lymphocytes, which are the white blood cells and are responsible for proper functioning of the body's immune system.

In this type of cancer, some of the white blood cells divide abnormally. The white blood cells have been designed to have a resting time, but in people who have lymphoma, some of these cells divide continuously and so their number is higher than usual. Because they start dividing before they reach maturity, they cannot effectively fight infection. These abnormal white blood cells start collecting in the lymph nodes, the spleen, the bone marrow or other organs growing into tumors.

Staging of NHL

Each non-Hodgkin's lymphoma is assigned a stage depending on how serious the disease is. This helps the doctor determine the treatment options and prognosis.

  • Stage I- the disease is limited to one lymph node or a group of nearby nodes.
  • Stage II - the disease is located in two lymph node regions, or one organ and the nearby lymph nodes.
  • Stage III - the disease has moved above and below the diaphragm and/or it has reached the spleen.
  • Stage IV - the disease is in several portions of one or more organs and tissues. Other organs and parts of the body might be affected, such as the liver, lungs or bones.

Symptoms of Non-Hodgkin Lymphoma

NHL has many symptoms and signs, depending on the stage of the disease and its location, but sometimes there might be no symptoms until the tumor grows quite large. Many of the signs might even be confused with other diseases and affections, such as an infection. Only after a thorough check, the doctor will be able to give a correct diagnostic.

Some common symptoms of NHL include:

  • Weight loss
  • Feeling very tired
  • Chills
  • Enlarged lymph nodes
  • Feeling full after eating a small meal
  • Swollen abdomen
  • Coughing
  • Shortness of breath
  • Chest pressure and pain
  • Frequent or severe infections
  • Easy bleeding or bruising

Causes of Non-Hodgkin Lymphoma

Non-Hodgkin Lymphoma does not have a specific cause but doctors believe that a weakened immune system plays an important role.

Still, there are some risk factors that can be taken into consideration:

  • Medications that suppress the immune system, such as immunosuppressive therapy after an organ transplant.
  • Infection with certain bacteria and viruses and bacteria such as the ulcer-causing Helicobacter pylori, HIV and Epstein-Barr infection.
  • Chemicals, such as those found in Roundup, may increase the risk of developing non-Hodgkin's lymphoma.
  • Older age. Non-Hodgkin's lymphoma is most common in people 60 or over.

Types of Non-Hodgkin Lymphoma

The treatment for non-Hodgkin Lymphoma depends on the nature of the disease. For this the doctor has to determine what type of lymphocyte has been affected (B Cells or T Cells) and how fast the lymphomas grow and spread (indolent or aggressive).

B Cell or T Cell NHL

  • B cells. B cells produce antibodies to fight infection neutralizing foreign invaders. Usually, NHL arises from B cells and can be divided into diffuse large B-cell lymphoma, mantle cell lymphoma, follicular lymphoma and Burkitt lymphoma.
  • T cells. T cells directly kill foreign invaders. Subtypes of NHL that involve T cells include cutaneous T-cell lymphoma and peripheral T-cell lymphoma.

Indolent vs. Aggressive NHL

  • Indolent lymphomas. Because these types of lymphomas grow and spread slowly might not need to be urgently treated right away. They can be watched closely and see their development. Follicular lymphoma is the most common type of indolent lymphoma in the US.
  • Aggressive lymphomas. These types of lymphomas grow and spread quickly and they usually need to be treated right away. Diffuse large B cell lymphoma, shortened DLBCL, is the most common type of aggressive lymphoma in the US.

Unfortunately, some types of lymphoma, such as mantle cell lymphoma, do not fit neatly into either of these categories.

Treatment for Non-Hodgkin Lymphoma

If the Non-Hodgkin Lymphoma causes symptoms and signs or is the aggressive type, the treatment will include one or several of the following:

  • Chemotherapy

Chemotherapy is a drug treatment that is injected or given orally. Its aim is to kill cancer cells and the side effects depend on the type of drugs given. The patient might experience hair loss and nausea, but also lung damage, heart damage, fertility problems or even leukemia.

  • Radiation therapy

During radiation therapy, high-powered energy beams (protons and X-rays) are used to kill cancer cells. During this procedure, the patient will be positioned on a table, while the machine will direct the radiation beams at precise points on the body, such as the affected lymph nodes and the surrounding area where the disease might progress. The typical radiation treatment includes hospital visits to the hospital five days per week for a few weeks, with a radiation session of 30 minutes.

Side effects of radiation therapy include hair loss in the area where the radiation is aimed, skin redness, fatigue, but also heart disease, thyroid problems, stroke, infertility or even breast or lung cancer.

  • Bone marrow transplant

Bone marrow transplant (stem cell transplant) is another treatment option. First, the patient has to undergo high doses of radiation therapy or chemotherapy to suppress the bone marrow. Then healthy bone marrow stem cells will be harvested from the patient or a donor and then infused back into the body and start rebuilding new bone marrow.

  • Drug therapy

Biological therapy can also be used to help the body's immune system fight the disease. Rituximab (Rituxan) is a monoclonal antibody which attaches to the B Cells making them more visible to the immune system. Although the antibody lowers the number of B cells, it forces the body to produce new healthy ones to replace them. This makes the cancerous B cells less likely to occur.

Some doctors prescribe Radioimmunotherapy drugs which are made of monoclonal antibodies. They carry radioactive isotopes which allow the antibody to attach to cancer cells and deliver radiation directly to the cells. An example of a radioimmunotherapy drug used to treat non-Hodgkin's lymphoma is ibritumomab tiuxetan (Zevalin).

Follow-up after NHL Treatment

After completing your treatment for Non-Hodgkin Lymphoma, you should still see your doctor on a regular basis and have tests done to check for signs for cancer recurrence or developing new cancer. People who suffered from Non-Hodgkin Lymphoma have an increased risk of developing other types of cancer such as lung cancer, melanoma skin cancer, kidney cancer, colon cancer, bladder cancer, thyroid cancer, leukemia, Hodgkin disease, bone cancer or cancers of the neck and head.

Women who had treatment with chest radiation before the age of 30 are at risk of developing breast cancer. The American Cancer Society recommends these women yearly breast MRI, mammograms and breast exams.

Some people might never get their NHL completely cured. For them, it is imperative to get regular treatments with radiation, chemo or other therapies to keep the lymphoma under control and to relieve the symptoms. Your doctor will perform blood tests and imaging tests such as CT scans or PET/CT.

Early Detection of Non-Hodgkin Lymphoma

The best way to detect Non-Hodgkin Lymphoma in its early stage is to pay attention to the symptoms, especially a bump or lump under the skin, usually in the armpit, in the groin or on the side of the neck. Having regular check-ups is of utmost importance for people with risk factors, such as HIV infection, autoimmune disease, organ transplant or prior cancer treatment.