Non-Hodgkin lymphoma (non-Hodgkin’s disease)

What is non-Hodgkin lymphoma?

Non-Hodgkin lymphomas are blood cancers of lymphocytes, which are white blood cells that circulate throughout the blood and bone marrow. Lymphocytes are responsible for controlling your immune system and fighting off infections.

Lymphocytes are commonly found within the main part of the body’s “drainage” system called lymph nodes, as well as in other kinds of body tissue. Therefore, many people diagnosed with lymphoma will have the disease in more than one area of the body.

These cancers are called “non-Hodgkin” because they have a different appearance from that of Hodgkin lymphomas.

Non-Hodgkin lymphoma may be difficult to diagnose and it’s very important to get an accurate subtype diagnosis. Penn Medicine’s lymphoma experts are leaders in treating non-Hodgkin lymphoma and develops personalized treatment plans for each individual.

Types of non-Hodgkin’s disease

Non-Hodgkin lymphomas are classified based on the type of lymphocyte that they arise from: B cell or T cell.

B cell lymphomas are much more common than T cell lymphomas. Very rarely, non-Hodgkin lymphomas can arise from natural killer (NK) cells, which are another cell of the immune system. When a person is faced with a foreign cell or virus, B cells produce antibodies that stick to those cells and identify them as foreign. B cells also act as “memory cells,” which help the body recognize a foreign cell or virus the next time it is present.

T cells are responsible for killing cells as well as regulating B cells. Although it is not clear exactly how all types of non-Hodgkin lymphoma develop, it seems these immune system cells develop the ability to make many copies of themselves without a signal to do so. They can form cancerous lymph nodes or tumors, unlike when lymph nodes become enlarged due to normal inflammation.

Risk factors of non-Hodgkin lymphoma

Though the cause of non-Hodgkin lymphoma is not completely clear, there may be some factors that increase a person’s risk of developing non-Hodgkin lymphoma.

  • Age: Non-Hodgkin lymphomas are more commonly diagnosed with increasing age
  • Immunosuppression: People who have other diseases of the immune system, or take drugs that lower the immune system may be at an increased risk

Infections: People with Epstein-Barr Virus (which causes infectious mononucleosis or “mono”), Hepatitis C Virus, Human T-lymphotropic Virus (HTLV), and Human Immunodeficiency Virus (HIV) may have an increased risk of developing non-Hodgkin lymphoma

How is non-Hodgkin’s disease diagnosed?

Non-Hodgkin lymphoma is diagnosed by review of a lymph node biopsy by pathologists and other lymphoma diagnosis specialists. Their analysis will include the shape of the lymphoma cells, immunohistochemistry (expression of protein on the lymphoma cells) and sometimes cytogenetics (DNA changes in lymphoma cells).

Non-Hodgkin lymphoma has four different stages as classified by the Ann Arbor Staging System:

  • Stage I. Single lymph node region or organ involved with disease.
  • Stage II. Two or more lymph node regions involved on the same side of the diaphragm (the muscle that controls breathing and that separates the chest from the abdomen).
  • Stage III. Lymph node regions involved on both sides of the diaphragm.
  • Stage IV. Significant involvement of an organ that is not considered part of the lymphatic system (like the lung or liver) or any organ involvement along with lymph node involvement.
  • Additional designations:
    • “B”: Unexplained fevers, chills, drenching night sweats, weight loss or fatigue
    • “E”: Non-lymph node disease that fits into a single area of radiation therapy
    • “X”: Bulky (large) mass, frequently in the mediastinum (chest)

Non-Hodgkin’s disease diagnosis at Penn Medicine

Is non-Hodgkin’s lymphoma curable?

Your lymphoma treatment for non-Hodgkin lymphoma greatly depends on its subtype, stage and whether it is aggressive or indolent. Treatments for non-Hodgkin lymphoma include:

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