Non-Hodgkin lymphoma is the most common type of lymphoma and one of the most diagnosed cancers in the United States. The disease affects the lymph system, your body’s germ-fighting network. Non-Hodgkin lymphoma is highly treatable, especially in its early stages.
What is non-Hodgkin lymphoma?
Non-Hodgkin lymphoma—sometimes called NHL cancer or non-Hodgkin’s—usually starts in the lymph nodes or lymph tissue. It causes your white blood cells (lymphocytes) to grow abnormally and form tumors, making it difficult for your body to fight infection.
Tumors can grow anywhere you have lymph tissue, including your:
- Lymph nodes
- Adenoids and tonsils
- Bone marrow
- Digestive tract, including stomach and intestines
Causes and risk factors
In most cases, scientists don’t know the exact cause of non-Hodgkin lymphoma. Genetic changes (mutations) can lead to a type of non-Hodgkin lymphoma called follicular lymphoma in which cells form a circular pattern. Genetic changes may also cause other types of lymphoma.
Risk factors for non-Hodgkin lymphoma include:
- Age (more common after age 60)
- Autoimmune diseases that cause the immune system to attack the body
- Bacterial infection (bacterium Helicobacter pylori)
- Exposure to toxins such as pesticides and industrial chemicals
- Family history of non-Hodgkin lymphoma (parent, child, or sibling with diagnosis)
- Viruses (Epstein-Barr and HIV, the virus that causes AIDS)
- Weakened immune system due to HIV, organ transplant, and some drugs, including chemotherapy drugs and medicines to treat rheumatoid arthritis
Many people may first notice a lump or pain in a lymph node in the armpit, neck, or groin. Other symptoms of non-Hodgkin lymphoma may include:
- Night sweats
- Unexplained weight loss
Researchers have identified more than 70 types of non-Hodgkin lymphoma. It often begins in one of two types of white blood cells:
- B cells: These cells produce antibodies to fight infections. Most types of non-Hodgkin lymphoma develop in B cells.
- T cells: These cells attack and kill viruses and other foreign invaders.
B-cell types are the most common and include:
- Diffuse large B-cell lymphoma (DLBCL): DLBCL is the most common type of non-Hodgkin lymphoma. It grows quickly but responds well to treatment.
- Follicular lymphoma: This type usually grows slowly and is rare in young people. It responds well to treatment but can be hard to cure.
- Mantle cell lymphoma (MCL): MCL can be hard to treat. It’s more common in males in their 60s or 70s.
- Burkitt lymphoma: The most common type of this rapidly growing lymphoma affects people in central Africa who have the Epstein-Barr virus. A rare form of the disease affects people in other parts of the world. Another type affects some people with AIDS or HIV.
T-cell lymphomas are more rare and include:
- Peripheral T-cell lymphoma: A group of rare and aggressive lymphomas, this type typically affects people over age 60. Peripheral means it occurs outside of the bone marrow, usually in the lymph nodes, spleen, or digestive system.
- Cutaneous T-cell lymphoma: This rare group of lymphomas start in the skin. Symptoms include red, scaly patches on the skin. The most common types are Sézary syndrome and mycosis fungoides.
To diagnose non-Hodgkin lymphoma, your doctor performs a physical exam and asks about your personal and family medical history. You may also need certain tests, including:
- Blood tests: These tests show how advanced the cancer is and if you have any signs of infection. Blood tests can measure levels of white and red blood cells, the amount of inflammation in the body. These tests can also check your kidney and liver function and look for infections (hepatitis B or C or HIV) that may affect your treatment plan.
- Biopsy: Your doctor may remove all or part of a lymph node to look for cancer cells and determine the type of non-Hodgkin lymphoma. A biopsy is the only way to confirm a non-Hodgkin lymphoma diagnosis.
- Bone marrow biopsy or aspiration: During aspiration, doctors use a thin, hollow needle to remove a small amount of bone marrow (spongy material inside bones). A biopsy involves removing a small amount of bone removed along with bone marrow. These tests can determine the extent (stage) of lymphoma.
- Imaging: Imaging tests provide detailed pictures of the body that help doctors measure the size and extent of a tumor. Imaging can also show if cancer has spread to other areas of the body. Imaging tests include CT scan, MRI, and PET.
Watch and wait
Non-Hodgkin lymphoma sometimes grows slowly, so doctors may recommend a "watch and wait" approach, also known as watchful waiting or active monitoring. Evidence shows treating non-Hodgkin lymphoma before symptoms appear doesn’t offer any benefits. Doctors may also recommend a watch and wait approach for non-Hodgkin lymphoma that returns after treatment.
While you'll have regular doctor visits and tests, you may not need treatment unless you develop symptoms or changes in your blood counts.
If you need treatment, options depend on the stage of the cancer and your overall health. Stages describe the extent to which cancer has spread. They are:
- Stage I: Cancer in one lymph node group or one organ outside the lymph system
- Stage II: Either cancer in two or more lymph node groups on same side of the diaphragm or one organ and nearby lymph nodes, possibly affecting other lymph nodes
- Stage III-IV: Cancer in lymph nodes on both sides of the diaphragm or spread throughout the body (considered the same stage because treatment is the same)
- Progressive or refractory: Cancer grows or spreads during treatment
- Recurrent or relapsed: Cancer that returns after treatment
Treatment may include:
- Chemotherapy: These drugs destroy cancer cells. You receive chemotherapy drugs through an injection in the vein or in pill form.
- Immunotherapy: This approach helps your immune system fight off cancer. Immunotherapy treatments include antibodies, drugs that help your body develop antibodies, and targeted therapies that block cancer cells from multiplying.
- Targeted drug therapy: Targeted drugs and other substances can often stop the growth of cancer cells or kill them while minimizing harm to surrounding healthy tissue. Doctors often recommend targeted therapy in combination with chemotherapy for non-Hodgkin lymphoma.
- Radiation therapy: Radiation uses focused beams of energy to target and kill cancer. Doctors carefully plan treatments to pinpoint the location of the cancer and reduce harm to nearby healthy tissue.
- Stem cell transplant: A stem cell transplant (also called a bone marrow transplant) may be an option if other treatments haven’t worked. The doctor extracts damaged stem cells (blood-forming cells in the bone marrow) and replaces them with healthy cells from either the patient or a donor. Stem cell transplant is typically reserved for more advanced non-Hodgkin lymphoma.
- Chimeric antigen receptor (CAR) T-cell therapy: This promising new therapy combines genetically modified CAR with your own T-cells or donor T-cells. Doctors remove T-cells, a manufacturer reprograms, and infuse them back into your body. CAR T-cell therapy may be an option if other treatments haven’t worked.
- Clinical trials: Clinical trials available at some medical centers may give eligible patients access to promising treatments not widely available.
Other helpful organizations
The below organizations offer additional information and resources for non-Hodgkin lymphoma patients and their loved ones.