Non-Hodgkin's Lymphoma: A Beginner’s Guide

Non-Hodgkin’s Lymphoma (NHL) is a type of blood cancer that starts in the lymphatic system. Lymphatic system is a network of tissues and organs that help flush out toxins and other waste materials from the body. 

The tumor starts at lymphocytes and spreads throughout the body. Many subtypes of NHL exist - Follicular Lymphoma and Diffuse Large B-cell Lymphoma being the most frequent ones. 

NHL or Non-Hodgkin's Lymphoma is a type of blood cancer that can be lethal in nature.

What Are The Symptoms Of Non-Hodgkin's Lymphoma?

Following are the warning signs and symptoms of Non-Hodgkin's Lymphoma:

  • Fatigue
  • Fever
  • Abdominal swelling or pain
  • Cough
  • Night sweats
  • Unintended weight loss
  • Swollen lymph nodes
  • Breathing trouble
  • Anemia
  • Weakness
  • Loss of appetite
  • Itching of the skin

What Causes the NHL?

  • It is not yet sure what exactly causes NHL. For some people, it develops due to a weakened immune system. 
  • NHL occurs when the body makes too many lymphocytes(a type of white blood cell).
  • In a routine, these cells develop and die. New ones are created which take their place. But in the case of NHL, these cells grow and divide very rapidly, and don't usually die. This oversupply of cells causes the lymph nodes to swell.

Where Can NHL Begin?

NHL can begin in the following two cells:

B-Cells: It produces antibodies to fight foreign intruders and prevent several infections. Most lymphomas start at B-cells only. Below are the subtypes of NHL that is concerned with B-cells:

  • Follicular Lymphoma
  • Mantle cell Lymphoma
  • Burkitt Lymphoma
  • Diffuse Large B-cell Lymphoma

T-cells: T-cells are concerned with the direct killing of foreign intruders. NHL occurring in T-cells is extremely rare as compared to B-cells. Subtypes of NHL involving T-cells are as follows:

  • Peripheral T-cell Lymphoma
  • Cutaneous T-cell Lymphoma

What Are The Risk Factors For NHL?

Following are the risk factors associated with Non-Hodgkin's Lymphoma:

1. Age: The risk for NHL increases with age, although it can happen to people of any age group. If you are above the age of 60 years, you are at an elevated risk of getting the disease. 

2. Family History: If you have someone in your family with Lymphoma, you can also have the disease. Therefore, you need to be extra cautious to keep the condition at bay. 

3. Genetic Syndromes: Genetic Syndrome like the following can develop NHL:

  • Down's Syndrome (caused by the presence of complete or partial presence of a third copy of chromosome 21)
  • Klinefelter's Syndrome (caused by the presence of an extra chromosome in men)

4. Bacteria: The presence of the following bacteria in the body can lead to Non-Hodgkin's Lymphoma:

  • Helicobacter Pylori (Related to gastric ulcers and gastritis)
  • Campylobacter Jejuni (Related to food-borne diseases)
  • Borrelia Burgdorferi (Related to Lyme disease)
  • Chalmy Psittaci (Related to psittacosis)

5. Viruses: Below is a list of viruses that can cause NHL:

  • HHV-8
  • SV-40
  • Hepatitis Virus
  • Epstein Barr Virus

6. Certain Disorders:

  • Rheumatoid Arthritis
  • Systemic Lupus Erythematosus
  • Celiac disease
  • Inflammatory bowel disease
  • Psoriasis

7. Exposure To Certain Chemicals: According to a recent survey, exposure to the following chemicals increases the risk of NHL:

  • Benzene
  • Insecticides
  • Pesticides

8. Medications: Certain medications weaken the immune system and make you susceptible to several diseases. If you have undergone any organ implant surgery, your defensive mechanism could have suppressed. It increases the risk of Non-Hodgkin's Lymphoma. 

How Is NHL Diagnosed?

Following tests help diagnose NHL:

Medical History & Physical Examination:

The doctor will ask about your complete medical history. Tell him the symptoms you're experiencing, and also if you are on certain medications. It will reduce the risk of future drug interactions.

Then, you shall undergo a physical examination. The doctor will examine lymph nodes and other possible affected areas. The liver and spleen can become swollen by some bacterial or viral infection. The doctor examines these areas of the body to detect the cause of your symptoms. 

Blood Test:

The doctors sometimes order blood tests to determine the complete blood count of white blood cells. In most cases, blood tests are not sufficient to diagnose the disease. But, then it can be excellent assistance in ruling out other causes of your symptoms. 

Imaging Tests:

The doctor will take a chest x-ray or CT scan to detect the presence of a tumor or swollen lymph nodes. A new test, Positron Emission Tomography(PET), can also help diagnose non-Hodgkin's Lymphoma.


The doctor may take a biopsy of your lymph nodes to detect the cause of the swelling. In this, a small sample of tissue is taken and examined under the microscope. Biopsies are of many types, including:

  • Excision Biopsy: removes the entire lymph node.
  • Incisional Biopsy: removes a small portion of the lymph node.
  • Core Needle Biopsy: removes a small sample of the lymph node with the help of a needle. 
  • Laparoscopic Biopsy: removes all or part of the lymph node. 

What Are The Stages Of NHL?

  • Stage 1: Cancer remains at one lymph node region or to some nearby lymph nodes.
  • Stage 2: Cancer spreads to more than one lymph node region or a surrounding organ. The tumor is limited to either above or below the diaphragm.
  • Stage 3: Cancer spreads to both above and below the diaphragm. It can also spread to the section above the diaphragm or spleen.
  • Stage 4: This is the final stage of non-Hodgkin's Lymphoma. In this stage, cancer spreads to several parts of the body, including several lymph nodes, lungs, liver, and bones. 

How Is NHL Treated?

The best treatment alternative for NHL depends on the type and stage of the Lymphoma. Also, treatment for the disease is not always essential. In some cases, cancer does not spread for years. Frequent health checkups can be helpful in this case to determine the extent of the spread of cancerous cells. 

Treatment alternatives available for the treatment of dangerous lymphomas are as follows:

Chemotherapy: Chemotherapy is given to kill cancerous cells in the body. Both oral and injected forms of the therapy are allowed. Your health condition and personal preference decide the mode of the treatment. The doctor can give you chemotherapy in combination with other treatment alternatives.

Radiation Therapy: High-intensity radiations are used to kill cancer cells and eradicate the tumor. 

Stem Cell Transplant: In this, the doctor gives a massive dose of chemotherapy, which kills cancer cells as well as stem cells. Then, it utilizes a transplant to ensure healthy cells in the body. He can use your cells or donor cells.

Medications: The doctor can give you certain drugs to strengthen your immune system. Some of the medicines approved for NHL are as follows:

  • Adcetris
  • Axicabtagene
  • Bortezomib
  • Belinostat
  • Leukeran
  • Prednisone
  • Romidepsin
  • Vorinostat

Drug combinations utilized in the treatment of NHL are as follows:

  • CVP
  • COPP
  • CHOP
  • ICE
  • R-ICE
  • R-CVP
  • R-CHOP


Tags: Non Hodgkin Lymphoma Treatment, Non Hodgkin's Lymphoma Diagnosis, Non Hodgkin Lymphoma Symptoms, Non Hodgkin Lymphoma Types