Non-Hodgkin’s Lymphoma

Non-Hodgkin’s Lymphoma (NHL) begins in the lymphatic system, which is part of the immune system and comprises a network of glands and vessels spread throughout the body. When the affected lymphocytes start to multiply abnormally, they lose their infection-fighting qualities, making the body more susceptible to infection.

Lymphomas can originate anywhere in the body where there is lymphatic tissue. It mostly happens at the lymph nodes, spleen, liver, bone marrow, thymus, adenoids, tonsils, and along the digestive tract. The most prevalent types of NHL are Diffuse large B-cell lymphoma and follicular lymphoma. NHL generally affects adults, but children can get it too.

The most typical symptom of NHL is swollen lymph nodes, usually in the groin, neck, or armpit. Other symptoms may include, among others: abdominal pain or swollen abdomen, chest pain or pressure, persistent fatigue, fever, night sweats, pruritus, and unexplained weight loss. 

A biopsy is the only method to confirm Non-Hodgkin’s Lymphoma. The surgeon performs a lymph node biopsy, and the pathologist checks the tissue sample for cancerous cells, type of lymphoma, and more. Special lab tests might also specify gene mutations or specific chromosome changes.  This information assists the medical team to plan the appropriate treatment.

Diagnosis

The patient might undergo a series of further tests and procedures to determine the extent of the disease: 

  • Bone marrow aspiration and biopsy – during the procedure, the doctor uses a needle to collect a sample of bone marrow, usually from the hipbone to help determine if NHL has affected the bone marrow.
  • Spinal fluid test- during the tap, the doctor collects a sample of fluid that surrounds the brain and spinal cord. The sample is tested to see if the NHL had spread to the spinal cord and brain.
  • Peritoneal (inside the abdomen) or pleural (inside the chest) or fluid sampling- the doctor removes a fluid sample from the abdomen or chest for further pathological examination.
  • Blood tests -usually include the customary Complete Blood Count (CBC), blood chemistry tests, lactate dehydrogenase (LDH) level.  Sometimes also tests to check infection with viruses, such as hepatitis B, hepatitis C, or HIV. Infections with these viruses may affect treatment options.
  • Imaging tests- such as an ultrasound, CT, MRI, bone scan, chest X-ray, or a PET CT can indicate whether cancer has metastasized to organs outside the lymph system, such as the bone marrow, liver, lungs, or other parts of the body.

Treatment

The purpose of the available treatment is to kill lymphoma cells that have spread or may spread to the brain, spinal cord, chest, or other organs. Treatment options include chemotherapy with or without monoclonal antibodies, radiation therapy, and a stem cell transplant.  Some patients with a specific cancer mutation might benefit from immunotherapy. Some patients can benefit from targeted therapy according to particular factors in the patient’s tumor. For some uncommon types of NHL, the doctors might recommend radioimmunotherapy (RIT): monoclonal antibodies that carry radioactive isotopes that allow delivering radiation directly to the cells. For most patients, there is also the option of clinical trials with new medications and combination treatments.

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