Non-Hodgkin’s Lymphoma

Information on non-hodgkin’s lymphoma, one of the 15 health conditions covered by the VA for Camp Lejeune victims.

This information comes from an aggregate of professional sources, including Cancer.org, the Mayo Clinic and the National Institutes of Health (NIH).

From Cancer.org:

Non-Hodgkin lymphoma (also known as non-Hodgkin’s lymphoma, NHL, or sometimes just lymphoma) is a cancer that starts in cells called lymphocytes, which are part of the body’s immune system. Lymphocytes are in the lymph nodes and other lymphoid tissues (such as the spleen and bone marrow).

The main types of lymphomas are:

• Hodgkin lymphoma (also known as Hodgkin’s lymphoma, Hodgkin disease, or Hodgkin’s disease), which is named after Dr. Thomas Hodgkin, who first described it
• Non-Hodgkin lymphoma

These different types of lymphomas behave, spread, and respond to treatment differently. Doctors can usually tell the difference between them by looking at the cancer cells under a microscope. In some cases, sensitive lab tests may be needed to tell them apart.

From Mayo Clinic:

Many different subtypes of non-Hodgkin’s lymphoma exist. The most common non-Hodgkin’s lymphoma subtypes include diffuse large B-cell lymphoma and follicular lymphoma.

Non-Hodgkin’s lymphoma symptoms may include:

• Painless, swollen lymph nodes in your neck, armpits or groin
• Abdominal pain or swelling
• Chest pain, coughing or trouble breathing
• Fatigue
• Fever
• Night sweats
• Weight loss

Normally, lymphocytes go through a predictable life cycle. Old lymphocytes die, and your body creates new ones to replace them. In non-Hodgkin’s lymphoma, your lymphocytes don’t die, but continue to grow and divide. This oversupply of lymphocytes crowds into your lymph nodes, causing them to swell.

B cells and T cells – Non-Hodgkin’s lymphoma can begin in the:

• B cells. B cells fight infection by producing antibodies that neutralize foreign invaders. Most non-Hodgkin’s lymphoma arises from B cells. Subtypes of non-Hodgkin’s lymphoma that involve B cells include diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma and Burkitt lymphoma.
• T cells. T cells are involved in killing foreign invaders directly. Non-Hodgkin’s lymphoma occurs less often in T cells. Subtypes of non-Hodgkin’s lymphoma that involve T cells include peripheral T-cell lymphoma and cutaneous T-cell lymphoma.

Whether your non-Hodgkin’s lymphoma arises from your B cells or T cells helps to determine your treatment options. In most cases, people diagnosed with non-Hodgkin’s lymphoma don’t have any obvious risk factors, and many people who have risk factors for the disease never develop it. Some factors that may increase the risk of non-Hodgkin’s lymphoma include:

• Medications that suppress your immune system. If you’ve had an organ transplant, you’re more susceptible because immunosuppressive therapy has reduced your body’s ability to fight off new illnesses.
• Infection with certain viruses and bacteria. Certain viral and bacterial infections appear to increase the risk of non-Hodgkin’s lymphoma. Viruses linked to increased non-Hodgkin’s lymphoma risk include HIV and Epstein-Barr virus. Bacteria linked to an increased risk of non-Hodgkin’s lymphoma include the ulcer-causing Helicobacter pylori.
• Chemicals. Certain chemicals, such as those used to kill insects and weeds, may increase your risk of developing non-Hodgkin’s lymphoma. More research is needed to understand the possible link between pesticides and the development of non-Hodgkin’s lymphoma.
• Older age. Non-Hodgkin’s lymphoma can occur at any age, but the risk increases with age. It’s most common in people in their 60s or older.

From the NIH:

Exams and Tests –

The doctor will perform a physical exam and check body areas with lymph nodes to feel if they are swollen. The disease may be diagnosed after biopsy of suspected tissue, usually a lymph node biopsy. Other tests that may be done include:

• Blood test to check protein levels, liver function, kidney function, and uric acid level
• Complete blood count (CBC)
• CT scans of the chest, abdomen and pelvis
• Gallium scan
• PET (positron emission tomography) scan

If tests show you have NHL, more tests will be done to see how far it has spread. This is called staging. Staging helps guide future treatment and follow-up.

Treatment depends on:

• The specific type of lymphoma
• The stage when you are first diagnosed
• Your age and overall health
• Symptoms, including weight loss, fever, and night sweats

You may receive chemotherapy, radiation therapy, or both. Or you may not need any immediate treatment. Your doctor can tell you more about your specific treatment. Radioimmunotherapy may be used in some cases. This involves linking a radioactive substance to an antibody that targets the cancerous cells and injecting the substance into the body.

High-dose chemotherapy may be given when NHL returns after treatment or does not respond to the first treatment. This is followed by an autologous stem cell transplant (using your own stem cells) to rescue the bone marrow after the high-dose chemotherapy. With certain types of NHL, these treatment steps are used at first remission to try and achieve a cure.

Blood transfusions or platelet transfusions may be required if blood counts are low.

Outlook (Prognosis) –

Low-grade NHL usually cannot be cured by chemotherapy alone. Low-grade NHL progresses slowly and it may take many years before the disease gets worse or even requires treatment. The need for treatment is usually determined by symptoms, how fast the disease is worsening, and if blood counts are low. Chemotherapy can often cure many types of high-grade lymphomas. If the cancer does not respond to chemotherapy, the disease can cause rapid death.

Possible Complications –

NHL itself and its treatments can lead to health problems. These include:

• Autoimmune hemolytic anemia
• Infection
• Side effects of chemotherapy drugs

Keep following up with a doctor who knows about monitoring and preventing these complications.