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Non-Hodgkin's Lymphoma: Types, Symptoms, Causes, Treatment, Hodgkin's Vs Non-Hodgkin's Lymphoma

Non-Hodgkin lymphoma (NHL) is a group of blood cancers that includes all types of lymphoma except Hodgkin's lymphomas. NHL develops when tumours develop from the lymphocytes - a type of white blood cell. Non-Hodgkin's lymphoma is more common than the other general type of lymphoma, Hodgkin's lymphoma [1] .

Non-Hodgkin's lymphoma can also spread to other parts of your lymphatic system, such as the lymphatic vessels, tonsils, adenoids, spleen, thymus and bone marrow. In some cases, organs outside of the lymphatic system are also affected.

Types Of Non-Hodgkin's Lymphoma

Non-Hodgkin's lymphoma is of different types and is classified based on the way the cells appear under the microscope. Most types of the condition are categorized as either B-cell lymphoma or T-cell lymphoma [2] .

The most common types of B-cell lymphomas are diffuse, large B-cell lymphoma and follicular lymphoma.

Following are the other subtypes of non-Hodgkin's lymphoma.

  • Chronic lymphocytic leukaemia
  • Diffuse large B-cell lymphoma
  • Burkitt's lymphoma
  • Cutaneous B-cell lymphoma
  • Cutaneous T-cell lymphoma
  • Follicular lymphoma
  • Waldenstrom macroglobulinemia
  • Extranodal marginal zone B-cell lymphoma
  • Lymphoplasmacytic mantle cell lymphoma
  • Mediastinal large b-cell lymphoma
  • Marginal zone b-cell lymphoma
  • Small lymphocytic lymphoma

Symptoms Of Non-Hodgkin's Lymphoma

The most common signs and symptoms of the condition are as follows [3] :

  • Swollen lymph nodes in your neck, armpits or groin
  • Night sweats
  • Chest pain
  • Coughing
  • Difficulty breathing
  • Abdominal pain or swelling
  • Fatigue
  • Weight loss
  • Fever

Causes Of Non-Hodgkin's Lymphoma

Similar to its cousin Hodgkin's lymphoma, non-Hodgkin's lymphoma also raises ambiguity behind its cause and development [4] . It occurs when the body makes too many abnormal lymphocytes which continue to grow and divide, causing the lymph nodes to enlarge.

In some cases, medical experts point out the cause as being a weakened immune system. Lymphocytes go through a normal and predictable life cycle, that is, when old lymphocytes die, your body creates new ones to replace them. And in the case of non-Hodgkin's lymphoma, the lymphocytes don't die but continue to grow and divide. This oversupply of lymphocytes crowds into your lymph nodes, causing them to swell [5] .

Risk Factors Of Non-Hodgkin's Lymphoma

Some factors that may increase the risk of non-Hodgkin's lymphoma are as follows [6] :

  • Infection with certain viruses and bacteria, particularly with HIV, Epstein-Barr virus, or Helicobacter pylori
  • Certain chemicals, such as those used to kill insects and weeds
  • Older age
  • Medications that suppress your immune system

Diagnosis Of Non-Hodgkin's Lymphoma

The doctor will enquire about your personal and family medical history and may advise you to undergo tests and procedures to diagnose non-Hodgkin's lymphoma, and they are as follows [7] :

  • Physical exam, to check for swollen lymph nodes in your neck, underarm and groin, as well as for a swollen spleen or liver.
  • Imaging tests such as X-ray, CT, MRI and positron emission tomography (PET) to look for tumours in your body.
  • Blood and urine tests to rule out an infection or other diseases.
  • Lymph node test to check whether a biopsy is required.
  • Bone marrow test to check for the presence of the cells in your marrow.

Staging Non-Hodgkin's Lymphoma

After determining the extent of the condition through the diagnosis, the condition will be assigned a stage, which will help the doctor in determining the prognosis and treatment options [8] .

  • Stage 1: The cancer is limited to one lymph node region or a group of nearby nodes.
  • Stage 2: The cancer is present in two lymph node regions, or cancer has invaded one organ and the nearby lymph nodes. However, it is limited to a section of the body either above or below the diaphragm.
  • Stage 3: In this stage, cancer would have moved to the lymph nodes both above and below the diaphragm.
  • Stage 4: This is the most advanced stage of non-Hodgkin's lymphoma and cancer has affected several portions and also other parts of the body, such as the liver, lungs or bones.

Treatment For Non-Hodgkin's Lymphoma

The suitable treatment option depends on the type and stage of the disease, your overall health, and your preferences. If your non-Hodgkin's lymphoma is aggressive or causes signs and symptoms, your doctor may recommend the following treatments [9] [10] :

  • Chemotherapy
  • Radiation therapy
  • Bone marrow transplant
  • Other drug therapies such as biological therapy called rituximab etc.

Difference Between Non-Hodgkin's Lymphoma And Hodgkin's Lymphoma

With two similar-sounding names, Hodgkin lymphoma and non-Hodgkin lymphoma can easily be confused. The central difference between the two conditions is the presence of a type of abnormal cell called the Reed-Sternberg cell - which is only present in Hodgkin's lymphoma. The remaining differences between the two conditions are as follows [10] :

  • Non-Hodgkin lymphoma is more common than Hodgkin lymphoma.
  • The majority of non-Hodgkin patients are over the age of 55 when first diagnosed, whereas the median age for diagnosis of Hodgkin lymphoma is 39.
  • Non-Hodgkin lymphoma may arise in lymph nodes anywhere in the body, whereas Hodgkin lymphoma typically begins in the upper body, such as the neck, chest or the armpits.
  • Hodgkin lymphoma is often diagnosed at an early stage and is therefore considered one of the most treatable cancers. Non-Hodgkin lymphoma is typically not diagnosed until it has reached a more advanced stage.

On A Final Note...

Non-Hodgkin's lymphoma can never be prevented. However, one can prevent the onset of the condition by avoiding risk factors such as obesity and HIV.

View Article References
  1. [1] Turtle, C. J., Hanafi, L. A., Berger, C., Hudecek, M., Pender, B., Robinson, E., ... & Soma, L. (2016). Immunotherapy of non-Hodgkin’s lymphoma with a defined ratio of CD8+ and CD4+ CD19-specific chimeric antigen receptor–modified T cells. Science translational medicine, 8(355), 355ra116-355ra116.
  2. [2] Ramos, J. C., Ambinder, R. F., Sparano, J., Lee, J. Y., Kaplan, L. D., Wachsman, W., ... & Chadburn, A. (2019). Response-Adapted Therapy with Infusional EPOCH Chemotherapy Plus Rituximab in HIV-Associated, B-Cell Non-Hodgkin's Lymphoma.
  3. [3] Advani, R., Flinn, I., Popplewell, L., Forero, A., Bartlett, N. L., Ghosh, N., ... & Tran, T. (2018). CD47 blockade by Hu5F9-G4 and rituximab in non-Hodgkin’s lymphoma. New England Journal of Medicine, 379(18), 1711-1721.
  4. [4] Papageorgiou, A., Ziogas, D. C., Mavragani, C. P., Zintzaras, E., Tzioufas, A. G., Moutsopoulos, H. M., & Voulgarelis, M. (2015). Predicting the outcome of Sjogren’s syndrome-associated non-Hodgkin’s lymphoma patients. PLoS One, 10(2), e0116189.
  5. [5] Ferri, C., Sebastiani, M., Giuggioli, D., Colaci, M., Fallahi, P., Piluso, A., ... & Zignego, A. L. (2015). Hepatitis C virus syndrome: A constellation of organ-and non-organ specific autoimmune disorders, B-cell non-Hodgkin’s lymphoma, and cancer. World journal of hepatology, 7(3), 327.
  6. [6] Staiger, A. M., Ziepert, M., Horn, H., Scott, D. W., Barth, T. F., Bernd, H. W., ... & Stein, H. (2017). Clinical impact of the cell-of-origin classification and the MYC/BCL2 dual expresser status in diffuse large B-cell lymphoma treated within prospective clinical trials of the German high-grade non-Hodgkin's lymphoma study group. Journal of Clinical Oncology, 35(22), 2515-2526.
  7. [7] Nair, R., Arora, N., & Mallath, M. K. (2016). Epidemiology of non-Hodgkin's lymphoma in India. Oncology, 91(Suppl. 1), 18-25.
  8. [8] Chow, V. A., Rajendren, J., Shields, A., Fisher, D. R., Appelbaum, F. R., Cassaday, R. D., ... & Stevenson, P. A. (2017). A Phase II Trial Evaluating the Efficacy of Radioiodinated Tositumomab (Anti-CD20) Antibody, Etoposide and Cyclophosphamide Followed By Autologous Transplantation, for High-Risk Relapsed or Refractory Non-Hodgkin's Lymphoma.
  9. [9] Persico, M., Aglitti, A., Caruso, R., De Renzo, A., Selleri, C., Califano, C., ... & Masarone, M. (2018). Efficacy and safety of new direct antiviral agents in hepatitis C virus–infected patients with diffuse large B‐cell non‐Hodgkin's lymphoma. Hepatology, 67(1), 48-55.
  10. [10] Kahl, B. S., Bartlett, N. L., Leonard, J. P., Chen, L., Ganjoo, K., Williams, M. E., ... & Cheson, B. D. (2010). Bendamustine is effective therapy in patients with rituximab‐refractory, indolent B‐cell non‐Hodgkin lymphoma: results from a Multicenter Study. Cancer: Interdisciplinary International Journal of the American Cancer Society, 116(1), 106-114.

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