Non-Hodgkins Lymphoma

DIAGNOSIS, TREATMENTS, CAUSES

In non-Hodgkin’s lymphoma, the white blood cells that fight infection, start to multiply abnormally and begin to collect in certain parts of the lymphatic system, such as the lymph nodes.

Overview

Non-Hodgkin’s lymphoma is a lymphatic malignancy, where tumours begin to develop from the lymphocytes or white blood cells; this condition affects the immune functions within the body. It has a higher prevalence than Hodgkin’s lymphoma. In India, non-Hodgkin’s lymphoma is one of the top ten cancers.

In non-Hodgkin’s lymphoma, the lymphocytes, which are white blood cells that fight infection, start to multiply abnormally and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands).

The difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma is marked by the presence of a type of abnormal cell called the Reed-Sternberg cell in patients with Hodgkin’s lymphoma.

Symptoms

Depending on the type of lymphoma and its location, non-Hodgkin’s lymphoma can present with a variety of signs and symptoms. The following are some of the most prevalent symptoms:

Swollen lymph nodes
Pain, discomfort and bloating in the abdomen
Shortness of breath
Fever
Sweating during the night and chills
Unintentional weight loss
Bone and joint pain
Fatigue

Types

There are several subtypes of non-Hodgkin’s lymphoma, and they are categorised based on the site of their origin, the appearance of lymphoma cells under the microscope, the chromosome features of the tumour cells and specific bioprotein components present on the surface of lymphoma cells.

The main subtypes of non-Hodgkin’s lymphoma include Burkitt’s lymphoma, cutaneous lymphoma, diffuse large B-cell lymphoma, lymphoblastic lymphoma, follicular lymphoma, mucosa-associated lymphoid tissue (MALT) lymphoma, adult T-cell lymphoma, mantle cell lymphoma, anaplastic large cell lymphoma and Waldenström’s macroglobulinemia.

We have the best non-Hodgkin’s lymphoma specialists who are skilled in devising a customised treatment plan for different subtypes of non-Hodgkin’s lymphoma.

Causes

Researchers have discovered that non-Hodgkin’s lymphoma is associated with a few risk factors in general, but the exact causes of the disease are still unknown. Many patients with this disease have no clear risk factors, and those who do have numerous risk factors may never get diagnosed with NHL. The following are some of the things that may raise an individual’s chances of developing NHL:

Age: With age increases the risk of developing non-Hodgkin’s lymphoma. When persons are diagnosed, they are usually 60 years or older.
Immunosuppressants: Prolonged usage of immunosuppressants may increase the risk of non-Hodgkin’s lymphoma.
Infections: HIV, Epstein-Barr virus, and Helicobacter pylori infections have all been associated with increased risk of non-Hodgkin’s lymphoma.
Exposure to Harmful Chemicals: Certain chemicals, such as weed and bug killers, can raise the likelihood of non-Hodgkin’s lymphoma development.

Diagnosis

In a few cases, non-Hodgkin’s lymphoma disease progresses slowly. On the other hand, a few NHLs progress more readily. Following are the few testing methods used for NHL diagnosis:

a. Medical History and Physical Exam: During the physical examination, the doctor makes note of the symptoms experienced by the patient, risk factors, and other medical issues. The lymph nodes and other parts of the body that could possibly be affected by NHL, such as the spleen and liver, will be examined with extra attention.

b. Biopsy: Biopsy is the only approach to receive a definitive diagnosis of non-Hodgkin’s lymphoma. A small sample of tissue from the abnormal lymph nodes is collected and examined under a microscope during the procedure.

c. Imaging Tests: To acquire images of the inside of the body, imaging tests such as x-rays, MRI, ultrasound, and PET/CT are indicated. These imaging tests help in detecting enlarged lymph nodes, determining the state of the disease, monitoring the efficacy of the treatment given and looking for the signs of a recurrence.

d. Blood Tests: Although not used to diagnose NHL, blood tests help in assessing the disease progression.

e. Bone Scan: A bone scan is recommended if the patient is experiencing bone pain or if lab results indicate that the disease has spread to the bones.

Treatment

If it is slow-growing non-Hodgkin’s lymphoma, the doctors may recommend monitoring instead of immediate treatment. However, if the condition is aggressive and the tumour is fast-growing, immediate treatment is recommended.

The treatment planning is made based on certain parameters such as subtype of non-Hodgkin’s lymphoma, stage, size and location of the tumour and patient’s age and overall condition. Chemotherapy is the main line of treatment for this disease. Other treatment options include stem cell transplantation, immunotherapy, targeted therapy, radiation therapy and surgery.

a. Chemotherapy: Chemotherapy can be used alone or in combination with other treatments like immunotherapy or radiation therapy, depending on the kind and stage of lymphoma. When treating NHL, a combination of chemo drugs is used in order to achieve a better treatment response.

b. Stem Cell Transplant: Stem cell transplant is one of the treatment options for NHL. High dose chemotherapy not only destroys the cancer cells but also damages the bone marrow cells. Therefore, these bone marrow cells have to be replaced to restore normal blood cell production and other functions. Stem cell transplant replaces the damaged stem cells with healthy ones. Healthy stem cells could be extracted from the patient’s body before the treatment and put back after the chemotherapy (autologous) or received from an HLA-matched donor (allogeneic).

c. Immunotherapy: Immunotherapy alters the body’s immune system in such a way that it starts attacking the cancer cells and destroys them. Since NHL is a lymphatic disease, immunotherapy is a promising treatment option with better treatment response.

d. Targeted Therapy: Targeted therapies are devised based on the unique proteins present on the cancer cell’s surface, specific genes and tumour environment – which are responsible for the growth and survival of cancer cells. Targeted therapy halts the tumour growth and destroys the cancer cells using multiple mechanisms, such as stopping cancer cells from growing, halting the process of angiogenesis and delivering substances that destroy the cancer cells. Targeted therapy is a form of precision medicine that targets the tumour cells while sparing the normal and healthy cells.

e. Radiation Therapy: For people with stage 1 and stage 2 non-Hodgkin’s lymphoma, radiation therapy is administered as primary treatment. Radiation therapy and chemotherapy are frequently used in combination to treat advanced lymphomas. It is also used as a part of palliative care in terminally-ill patients.

f. Surgery: Surgery is a rarely used treatment line for non-Hodgkin’s lymphoma. It may be performed to collect the biopsy sample. Surgery may also be considered for the management of lymphomas in the spleen, thyroid gland and stomach.

FAQs

Is non-Hodgkin’s lymphoma curable?

Both low-grade and high-grade non-Hodgkin’s lymphoma can be treated with positive clinical outcomes. There are multiple treatment options available today, with which, even advanced stage or stage III and stage IV non-Hodgkin’s lymphomas can be treated successfully with excellent survival rates.

After the treatment, a strict follow-up becomes a regimen, which helps in reducing the risk of recurrence.

Is non-Hodgkin’s lymphoma hereditary?

No, non-Hodgkin’s lymphoma does not run in families, according to the studies. However, having a first-degree relative with non-Hodgkin’s lymphoma may slightly increase the risk.

Also, researchers have found a few genetic variations that contribute to the increased risk of non-Hodgkin’s lymphoma. These genetic changes are usually acquired through exposure to cancer-causing chemicals and radiation or infections.

Can non-Hodgkin’s lymphoma come back?

The majority of patients who go into remission from non-Hodgkin’s lymphoma do not relapse. However, some varieties of high-grade non-Hodgkin lymphomas tend to relapse.

Therefore, the patients need to adhere to the follow-up care routine recommended by the doctor. This helps in the early detection of the recurrence and supports proper treatment.

Can non-Hodgkin’s lymphoma spread?

If left untreated, all non-Hodgkin lymphomas can spread to other regions of the lymph system, regardless of how quickly they grow. In advanced stages, non-Hodgkin’s lymphomas spread to organs, such as the liver, brain, and bone marrow.

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Dr. Bhavana Parikh

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