Risk Factors

Several factors influence the risk of developing non-Hodgkin's lymphoma:

• Weakened immune system: Certain inherited conditions or drugs used after an organ transplant may increase the risk of developing non-Hodgkin's lymphoma.
• Age: Although non-Hodgkin's lymphoma can occur in young people, the chance of developing this disease increases with age. Most people with non-Hodgkin's lymphoma are older than 60.
• Certain infections:Having certain types of infections increases the risk of developing non-Hodgkin's lymphoma:
  • Human immunodeficiency virus (HIV): HIV is the virus that causes AIDS. People who have HIV infection are at much greater risk of some types of non-Hodgkin's lymphoma.
  • Epstein-Barr virus (EBV): Infection with EBV has been linked to an increased risk of non-Hodgkin's lymphoma. In Africa, EBV infection is linked to Burkitt's lymphoma.
  • Helicobacter pylori: H. pylori are bacteria that can cause stomach ulcers. They also increase a person's risk of lymphoma in the stomach lining.
  • Human T-cell leukemia/lymphoma virus type 1 (HTLV-1): Infection with HTLV-1, a virus that infects T cells (a type of white blood cell), increases a person's risk of non-Hodgkin's lymphoma and leukemia.
  • Hepatitis C virus: Some studies have found an increased risk of non-Hodgkin's lymphoma in people with hepatitis C virus. More research is needed to understand the role of hepatitis C virus.

Symptoms

Common symptoms of non-Hodgkin's lymphoma include the following:

• Coughing, trouble breathing, or chest pain
• Fever
• Pain, swelling, or a feeling of fullness in the abdomen
• Soaking night sweats
• Swollen, painless lymph nodes in the neck, armpits, or groin
• Unexplained weight loss
• Weakness and tiredness that don't go away

Other health problems may also cause these symptoms. A person with any of these symptoms should see a health care provider so the problem can be diagnosed and treated as early as possible.

Screening and Diagnosis

Currently, there are no screening methods for non-Hodgkin's lymphoma.

If symptoms suggest non-Hodgkin's lymphoma, the doctor will ask for personal and family medical history and may order one or more of the following tests:

• Physical exam: The doctor checks for swollen lymph nodes in the neck, underarms, and groin, and also checks for a swollen spleen or liver.
• Blood tests: Doctors check for specific substances in the blood that indicate cancer is present.
• X-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• Biopsy: The doctor removes a sample of lymph nodes to look for cancer cells. A biopsy is the only way to know for sure if lymphoma is present.

Staging

If the biopsy shows non-Hodgkin's lymphoma cells, it is important to know the stage (extent) of the disease to plan the best treatment. Staging may involve having more tests.

• Bone marrow biopsy: The doctor uses a thick needle to remove a small sample of bone and bone marrow from the hipbone or another large bone. A pathologist looks for lymphoma cells in the sample.
• CT scan: Doctors often use CT scans to take pictures of tissue inside the body. An x-ray machine linked to a computer takes several pictures. The pictures may show a tumor, abnormal fluid, swollen lymph nodes, or if the cancer has spread to other parts of the body.
• Magnetic resonance imaging (MRI): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
• Ultrasound: This procedure uses high-energy sound waves bounced off internal tissues or organs to make echoes. The echoes form a picture called a sonogram. The picture can be printed to be looked at later.
• Lumbar puncture (spinal tap): Doctors may remove a sample of cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). A laboratory checks the fluid for lymphoma cells.
• PET scan: Doctors use a PET scan to find cancer that has spread. The patient receives a small amount of radioactive sugar by injection. A machine makes computerized pictures of the sugar being used by cells in the body. Cancer cells use sugar faster than normal cells, and areas with cancer look brighter on the pictures.

Stages of Non-Hodgkin's Lymphoma

Stage I: The cancer cells are in one lymph node group (such as in the neck or underarm). Or, if the cancer cells are not in the lymph nodes, they are in only one part of a tissue or organ.

Stage II: The cancer cells are in at least two lymph node groups on the same side of—either above or below—the diaphragm (the thin muscle below the lungs and heart that separates the chest from the abdomen). Or, the cancer cells are in one part of an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be cancer cells in other lymph node groups on the same side of the diaphragm.

Stage III: The cancer is in lymph nodes above and below the diaphragm. It also may be found in one part of a tissue or an organ near these lymph node groups.

Stage IV: The cancer cells are found in several organs or tissues in addition to the lymph nodes. Or, it is in the liver, blood, or bone marrow.

Recurrent: The disease returns after treatment.

In addition to these stage numbers, a doctor may also describe the stage as A or B:

• A: The patient has not had weight loss, drenching night sweats, or fevers.
• B: The patient has had weight loss, drenching night sweats, or fevers.

Treatment

At Huntsman Cancer Institute (HCI), non-Hodgkin's lymphoma is treated by a team of specialists, including hematologic oncologists (doctors who specialize in cancers of the blood), medical oncologists, nurses, dietitians, social workers, and other professionals.

These are common treatment options for non-Hodgkin's lymphoma:

• Watchful waiting
• Chemotherapy
• Biological therapy
• Radiation therapy
• Bone marrow/Blood stem cell transplant
• Clinical trials

Watchful waiting

People who choose watchful waiting put off having cancer treatment until they have symptoms. Doctors sometimes suggest watchful waiting for people with indolent lymphoma. People with indolent lymphoma may not require cancer treatment for a long time. By putting off treatment, they can avoid the side effects of chemotherapy or radiation therapy.

If this option is used, the doctor will check the patient regularly, about every three months. The patient will receive treatment if symptoms occur or get worse.

Chemotherapy

Many people with non-Hodgkin's lymphoma are treated with chemotherapy. Chemotherapy uses drugs to destroy lymphoma cells. Depending on the type of lymphoma, the patient may receive a single drug or a combination of two or more drugs.

Watch our introduction to chemotherapy video to learn more about this treatment.

Biological therapy

Biological therapies help the body's immune system fight cancer. Non-Hodgkin's lymphoma is sometimes treated with monoclonal antibodies, which are proteins that bind to cancer cells in the body.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. It can shrink tumors and help control pain.

Two types of radiation therapy are used to treat non-Hodgkin's lymphoma:

• External radiation: A large machine aims the rays at the part of the body where lymphoma cells have collected. This is local therapy because it affects cells in the treated area only.
• Systemic radiation: Some people with lymphoma receive an injection of radioactive material that travels throughout the body. The radioactive material is bound to monoclonal antibodies (biological therapy) that seek out lymphoma cells. The radiation destroys the lymphoma cells.

Bone marrow/Blood stem cell transplant

If non-Hodgkin's lymphoma returns after treatment, a patient may receive bone marrow/blood stem cell transplant. A transplant of a patient's own blood-forming stem cells allows him or her to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in the bone marrow.

Stem cell transplants take place at the hospital. After the patient receives high-dose treatment, healthy blood-forming stem cells are returned to the patient through a tube placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells. Learn more in our video about HCI's Blood and Marrow Tranplant program.

The stem cells may come from the patient's own body or from a donor:

• Autologous stem cell transplantation: This type of transplant uses the patient's own stem cells. The stem cells are removed before high-dose treatment. The cells may be treated to kill lymphoma cells that may be present. The stem cells are frozen and stored. After the patient receives high-dose treatment, the stored stem cells are thawed and returned to him or her.
• Allogeneic stem cell transplantation: This type of transplant uses stem cells from a donor. A patient's brother, sister, or parent may be the donor, or the stem cells may come from an unrelated donor. Doctors use blood tests to be sure the donor's cells will match the patient's cells.
• Syngeneic stem cell transplantation: This type of transplant uses stem cells from the patient's identical twin.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or to ask any questions regarding research studies. For more information visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.