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What is Non-Hodgkin Lymphoma?

Non-Hodgkin lymphoma (NHL) is one of the most common cancers in the United States, accounting for about 4 percent of all cancer cases. More than 95 percent of cases occur in adults but certain types are common among children. NHL is the name of a group of blood cancers that develop in the white blood cells (lymphocytes). There are approximately 60 different subtypes of NHL. Most subtypes fall within two main groups, named for the cell where the lymphoma originates: B-cell lymphomas or T-cell lymphomas. NHL can be either indolent (slow growing) or aggressive (fast growing).

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Risk Factors, Signs and Symptoms

Risk Factors

Risk factors are characteristics or exposures of an individual that can increase the likelihood of developing a disease. Certain cancer risk factors, such as smoking, can be changed.

Other cancer risk factors, such as a person’s age or family history, cannot be. Having one or even many risk factors does not mean that a person will definitely get the disease, and many people who are diagnosed with non-Hodgkin lymphoma have few if any risk factors.

The following are risk factors that have been associated with non-Hodgkin lymphoma (NHL):

Age
Although people of any age can be diagnosed with NHL, people are often diagnosed when they are 60 or older.

Gender
NHL occurs more frequently in men than women, but there are certain types of NHL more common in women. Reasons for this are not known.

Geography
NHL is more common in North America and northern Europe, and least common in Asian countries. Worldwide, NHL is more common in developed countries.

Race and Ethnicity
In the United States, whites are more prone to developing NHL than African Americans or Asian Americans/Pacific Islanders.

Radiation Exposure
Exposure to atomic bombs and nuclear reactor accidents can increase your risk of developing a number of cancers, including NHL, leukemia, and thyroid cancers. People treated with radiation therapy for certain cancers also have a slightly increased risk of developing NHL.

Chemical Exposure
Exposure to chemicals such as benzene, certain herbicides (weed killers) and insecticides (insect killers) may be linked to an increased risk of NHL. In addition, chemotherapy drugs used in the treatment of other cancers may increase the risk of developing NHL. It is not clear whether the association between chemotherapy drugs and the development of NHL is related to the original cancer itself or a side effect of treatment.

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Diagnosis and Staging

Diagnosis

Doctors are able to diagnose lymphomas based on how they look under a microscope, the chromosome features of the lymphoma cells, and the presence of certain chemicals on the surface of the cells. In order to make an accurate diagnosis, your doctor will perform a physical exam, and may order blood tests, biopsies, and imaging tests to confirm the exact type and stage of your disease. Sometimes, non-Hodgkin lymphomas may be difficult to diagnose. Consult with your doctor to ensure that accurate testing is completed to receive the right treatment for you.

In order to diagnose NHL, your doctor will order several tests, including a physical exam, blood tests, biopsies, and imaging tests to confirm the exact type and stage of your disease. This will help the doctor determine the best treatment options for you. Two kinds of biopsies are used to diagnose NHL:

  • Lymph Node Biopsy - The doctor will remove a piece of the lymph node and examine it under a microscope. This is the only way to know for sure if the swelling is caused by cancer. 
  • Bone Marrow Biopsy - The doctor will insert a needle into your hipbone to check to see if lymphoma cells have travelled and are present in your bone marrow. 

If a biopsy confirms an NHL diagnosis, your doctor may recommend additional tests to find out how far the disease has spread. These other tests could include a chest x-ray, CT scan, MRI, PET scan, or blood tests. NHL can be difficult to diagnose and may require multiple tests.

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Treatment and Side Effects Management

Treatment

Your doctor will recommend treatment options based on the stage of your NHL, your overall health and your treatment preferences. In all cases, treatment should be individualized for you.

If your disease is diagnosed early, categorized as an indolent (slow growing), and you have no symptoms, your doctor may recommend a watch and wait approach. This means your doctor may not recommend any treatment at the time of diagnosis.

If immediate treatment is required, there are a number of options. It may be helpful to create a treatment plan to address the short- and long-term goals of managing your cancer. Talk through the options with your doctors in order to develop a treatment plan that is right for you. It is okay to seek a second opinion to discuss your diagnosis or treatment options.

When you talk with your doctors, ask questions if you do not understand any aspect of treatment or the medical terms they are using. One of the best ways to improve communication with your health care team is to prepare questions before your visits. It is also helpful to write down notes when your doctor talks so you can remember what was said. You may want to bring a friend or family member to take notes for you.

Questions to Ask Your Doctor:

  • What stage is my NHL?
  • What type of treatment do you recommend at this time?
  • How often and where will the treatment take place? Will I have to stay overnight in the hospital for any part of the treatment? 
  • What are the goals of my treatment?
  • What are the side effects of treatment?
  • Will I need someone to take care of me at any point during this treatment?
  • Do you recommend a clinical trial at this time?
  • How will my cancer affect my quality of life?
  • What will my treatment cost and how much will my insurance cover?

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