Visual Guide to Non-Hodgkin's Lymphoma

Non-Hodgkin's lymphoma is cancer that starts in your body's lymph system. There are a lot of different kinds, and even doctors can have a hard time telling them apart. While it's typically found in older adults, it's still one of the more common cancers in children. It's not always easy to spot, but great strides in finding and treating it means the outlook now is better than ever.

Think of it as the body's cleaning service. Lymph is a watery liquid that flows between cells and clears out the stuff they don't need anymore. It's carried around in tubes that connect to lymph nodes, which are small bean-shaped filters. These trap waste and germs and help get them out of your body. You have clusters of nodes in your armpits, belly, groin, neck, and pelvis.

This is where it starts, with these white blood cells. Lymphocytes called B cells point out germs, and T cells destroy them. When these disease-fighters are done, they should die off. But with non-Hodgkin's lymphoma, they grow and divide out of control. As you get more and more of them, your lymph nodes may start to swell. Most often, it's in the B cells where things go wrong.

The most common is a swollen lymph node, usually in your armpit, groin, or neck. But these can be painless and easy to overlook. Lymph nodes can also swell when you're fighting an infection, so they're easy to shrug off.

You might also have a fever that won't go away, night sweats that soak your clothes, and weight loss for no reason, and you may be extremely tired.

The lymph system runs throughout the body, so lymphoma can appear almost anywhere. In your stomach, you might throw up or feel full after even a small meal. Lymphoma can make your skin itchy or give you red bumps. When it's in your chest, it can hurt and cause trouble breathing. The key is to notice when something's off and check in with your doctor.

There are more than 30 kinds of non-Hodgkin's lymphomas. They differ by whether it starts in B or T cells, how the cells look, and what kinds of genes and proteins they have. Doctors also look at how fast the cancer grows and spreads. Slow ones are called indolent; faster ones, aggressive. Diffuse large B-cell lymphoma is the most common type. It typically comes on in your 60s. It's aggressive but can be cured.

Your cancer's stage has a big impact on choosing the best treatment. It tells you how advanced the cancer is. At stage I, it's in just one area of lymph nodes. Or it's in one of the lymph system organs, like the tonsils. By stage IV, it's in lymph nodes above and below your diaphragm. That's the thin muscle that separates your chest and belly. It's also in other organs like your liver or lungs.

An A with the number (as in stage IA) means you have no symptoms.

B means you have fever, night sweats, or have lost some weight.

E stands for extranodal, which means the cancer has spread to tissue just outside some lymph nodes.

An X, also called bulky disease, means you have at least one tumor that's larger than 10 centimeters (about 4 inches, or roughly the width of your palm).

This test tells you for sure if you have cancer. Your doctor removes a swollen lymph node, or part of one, for testing. The doctor who looks at the tissue may be able to tell what type of non-Hodgkin's lymphoma you have, too. This is important because your treatment depends on it. But doctors who have less experience with lymphoma can and do get the test results wrong. If you have doubts, ask for a second opinion from a specialist.

These can help your doctor figure out the stage of your lymphoma as well as check on how well your treatment is working. Imaging, like a CT, PET, or MRI scan, looks for traces of cancer in lymph nodes and other parts of your body. Your doctor might do a bone marrow biopsy (taking a sample from your hipbone or breastbone with a needle) to see if cancer has spread into the soft, spongy inner part. You'll likely get blood tests, too.

For a slow-growing lymphoma in the early stages, the best treatment may be no treatment at all. These types could go for years without causing any problems. That doesn't mean you ignore it, though. You'll still have regular checkups so you and your doctor can keep a close eye on things. If you have symptoms or it's a more aggressive type, you'll likely need care right away.

This common treatment uses medicine to kill cancer cells. You typically get it through pills or an IV, though you could also get a shot. You may also get more than one drug. Each chemo medicine attacks cancer in a different way, so using several can be very effective. Because the drugs act throughout your body, they may cause side effects like hair loss, throwing up, and a higher chance of infections.

High-dose chemotherapy can knock out more cancer, but it also wipes out bone marrow, which is where blood cells are made. That's where this treatment comes in. First, your doctor removes and saves some of your young blood cells, called stem cells. (You can also get stem cells from a donor.) When you're finished with chemo, those saved (or new) cells are put into your body to make up for what was lost. It's also called a bone marrow transplant.

These treatments rally your immune system to attack the lymphoma. One approach is to use medications called monoclonal antibodies that glom on to cancer cells. They're like signs that say, "These cells are bad! Get rid of them!" And your body takes it from there. Another method uses antibodies with radiation in them. Once they lock onto a cancer cell, the radiation destroys it.

Cancer cells work differently from normal cells. Targeted drugs take advantage of those differences. For example, proteasome inhibitors keep cancer cells from dividing. Kinase inhibitors get in the way of proteins that help cancer cells grow and thrive. Basically, targeted therapies attack only the cancer and spare your healthy cells. The side effects are often less severe than with chemotherapy.

High-energy beams focus on the cancer to kill it. For an early-stage non-Hodgkin's lymphoma, this may be the only treatment you need. More often though, it's used along with something else, like chemotherapy. Each session lasts only few minutes and doesn't hurt. You typically get it 5 days a week for several weeks.

Your outlook depends on a lot of things, like the type and stage, as well as your age and overall health. Generally speaking though, for non-Hodgkin's lymphoma, the 5-year relative survival rate is 70%. That means compared to every 10 people who don't have NHL, on average, seven people with NHL are still alive after 5 years. The 10-year relative survival rate is 60%. Keep in mind these numbers are not your story.

Even in the best case, when a cure is possible, cancer takes a toll. The disease is challenging physically and emotionally. You may worry about it coming back. It affects your work life and maybe your finances. This is where a survivorship care plan may help. It's a tool you and your doctors can use to map out what comes next. Yes, it's about follow-ups and tests, but it covers your emotional well-being, too.

In most cases, doctors just don't know. Age plays a role -- it's most common in people 60 and older. Things that weaken your immune system may raise your odds as well, like a condition you're born with, an organ transplant, or infections including HIV and bacteria related to stomach ulcers called H. pylori. There also seem to be links to chemicals used on insects and weeds, but we need more research.

There's really not much you can do. Even the things that we know raise your chances are largely out of your control. It isn't simply a matter of healthy eating, though that can't hurt. Likewise, there's no test to find it early on. The best you can do is keep your eye out for symptoms. And if your risk is greater, keep up with your regular doctor's appointments.