Non-Hodgkin's lymphoma is a group of cancers that start in lymphocytes -- your immune system’s infection-fighting white blood cells. Doctors divide it into types based on the kind of lymphocyte each one starts in.
- B-cell lymphomas. These grow in B lymphocytes, cells that make proteins called antibodies that help your body find and attack bacteria and other germs.
- T-cell lymphomas. These grow in T lymphocytes, cells that seek out and destroy germs.
Both B cells and T cells are in your lymph nodes -- small, bean-shaped glands located all over your body. You'll find clusters of them in areas like your neck, under your arms, and in your groin.
Another way to group non-Hodgkin's lymphoma is by how fast it grows. For example:
- Indolent lymphomas grow slowly and may not need to be treated right away.
- Aggressive lymphomas grow quickly and need immediate treatment.
Knowing which type of non-Hodgkin's lymphoma you have will help your doctor find the right treatment for you.
B-cell Lymphomas
These are by far the most common type, affecting about 85% of people who have non-Hodgkin's lymphoma.
Diffuse B-cell lymphoma. About 1 of every 3 B-cell lymphomas is this type. It gets its name because the cancer cells spread out (diffuse) all over the lymph node.
Diffuse B-cell lymphoma mainly affects people in their 60s. This cancer grows quickly, but treatments work well against it and can often cure it.
Diffuse B-cell lymphoma has its own subtypes. The most common is primary mediastinal large B-cell lymphoma. It starts in an area called the mediastinum in the middle of your chest.
Follicular lymphoma. This other common B-cell lymphoma mainly affects people 60 and over. It tends to grow slowly, but it can change into a more aggressive form. It's usually not curable, but treatment can manage it to the point where it becomes a chronic disease.
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL). CLL and SLL are basically the same disease. Both cancers grow slowly over many years, but sometimes they turn into a faster-growing type. The only difference is where the cancer cells are found:
- In CLL, lymphocytes are mainly in your blood.
- In SLL, lymphocytes are mainly in your lymph nodes.
Mantle cell lymphoma. This rather rare lymphoma affects mostly men ages 60 and older. The cancer cells grow in the outer edge, or mantle, of B cells in the lymph node follicle. This type grows slowly at first, but it can become aggressive.
Marginal zone lymphomas. These slow-growing lymphomas usually affect people older than 60. Marginal zone lymphomas come in three subtypes:
- Extranodal marginal zone lymphoma starts outside the lymph nodes.
- Nodal marginal zone lymphoma starts inside the lymph nodes.
- Splenic marginal zone lymphoma starts in the spleen and blood.
Burkitt lymphoma. This rare, fast-growing cancer is mainly found in Africa. The kind that affects people in the United States usually starts in your belly. It's different from other lymphomas because it affects more children than adults.
Lymphoplasmacytic lymphoma. Only 1% to 2% of lymphomas are this type. In about half of people with lymphoplasmacytic lymphoma, the cancer cells make a protein that makes the blood very thick, a condition called Waldenström macroglobulinemia. Cancer cells are mainly found in bone marrow, but they also can be in your lymph nodes or spleen.
Central nervous system (CNS) lymphoma. CNS lymphoma affects your brain and spinal cord. It's more common in people who have immune system damage from a disease like AIDS.
T-cell Lymphomas
These less-common cancers affect T lymphocytes.
Peripheral T-cell lymphoma, not otherwise specified: Peripheral T-cell lymphomas are a group of aggressive cancers that start in T cells. The most common one is called “not otherwise specified” because it includes lymphomas that are hard for doctors to put into a single category. This type can affect your lymph nodes, liver, bone marrow, intestines, and skin.
Anaplastic large cell lymphoma: This has different types. One can affect any part of your body, while another only affects your skin. In some people, the cancer makes a protein called anaplastic large cell kinase (ALK). Treatment seems to work better for people who have this protein.
Angioimmunoblastic T-cell lymphoma. This fast-growing type of lymphoma spreads quickly, and it often returns after treatment. Because it affects your immune system, infections are a common problem.
Adult T-cell lymphoma/leukemia. This rare and aggressive type is caused by an infection of the virus human T-cell lymphotropic virus 1. Cancer cells may be in your bones, skin, and blood.
Symptoms
As the cancer cells multiply, your lymph nodes swell up. A painless lump in your neck, underarms, or groin is often the first sign that you have non-Hodgkin's lymphoma, but swelling in these glands alone doesn't mean you have cancer. Swollen glands are more often a sign of infection.
All types of non-Hodgkin's lymphoma can cause symptoms like:
- Tiredness
- Unplanned weight loss
- Night sweats
- Itching
- Unexplained fever
- Infections
- Easy bruising or bleeding
Lymphoplasmacytic lymphoma and other types that grow in your belly also cause swelling and pain.
When lymphoma affects your brain and spinal cord, it can cause:
Primary mediastinal B-cell lymphoma grows in your chest. As the cancer spreads, it puts pressure on your lungs, which can cause shortness of breath and coughing.
Diagnosis
This starts with an exam and a discussion of your symptoms. Your doctor will look for swollen glands in your neck, under your arms, and in your groin area.
Your doctor probably will recommend a biopsy, which is when they take a sample of fluid or tissue to test for cancer. The sample can come from:
- Bone marrow
- A lymph node
- Fluid around your brain and spinal cord
- Fluid inside your chest or belly
A lab technician will look at the size and shape of the cancer cells under a microscope. Other tests look for gene changes inside the cells, which can help pinpoint the right treatment.
These imaging tests look for tumors inside your body:
- X-ray. It uses radiation in low doses to make images of the inside of your body.
- CT, or computed tomography. This is a series of X-rays put together to make a more detailed picture.
- MRI, or magnetic resonance imaging. It uses powerful magnets and radio waves to make pictures of organs and structures inside your body.
- Ultrasound. This uses sound waves to make pictures of the inside of your body.
Based on the results of these tests, your doctor will give your cancer a stage. The stage tells where the cancer is in your body, which helps your doctor find the right treatment.
Treatment
Slower-growing cancers may not need to be treated right away. Your doctor will give you regular checkups to make sure your cancer hasn't grown. More aggressive cancers do need to be treated quickly. Which treatment you get depends on the type of cancer you have.
Some of the most common treatments for non-Hodgkin's lymphoma include:
- CHOP, a combination of four drugs (cyclophosphamide, doxorubicin, vincristine, and prednisone). Sometimes the monoclonal antibody rituximab (Rituxan) is added (called R-CHOP).
- Radiation therapy
- Chemotherapy
- Immunotherapy drugs, such as monoclonal antibodies, immune checkpoint inhibitors, or CAR T-cell therapy
- Targeted drugs
- High-dose chemotherapy plus a stem cell transplant
These treatments can be combined to make them work better.
