Facts
Non-Hodgkin lymphoma (NHL) is cancer that begins in lymphocytes, white blood cells that are an important part of the body’s infection-fighting immune system.
Seattle Cancer Care Alliance (SCCA) offers comprehensive treatment from a team of experts for all types of non-Hodgkin as well as Hodgkin lymphoma.
What is non-Hodgkin lymphoma?
In people with lymphoma, something goes wrong inside the lymphocytes.
- Lymphocytes are a type of white blood cell made in the bone marrow and found in the blood and lymph tissue.
- In lymphoma, the lymphocytes don’t mature and can’t carry out their normal immune functions defending against infection.
- The lymphoma cells don’t die off like they should but instead collect in the lymph nodes.
- NHL can spread through the lymph system to other lymph nodes and outside the lymph nodes to the bone marrow, lungs or liver.
- NHL can be cured or controlled for many years in many people who have the disease.
Your lymph system
To understand lymphoma, it helps to have a basic knowledge of the lymph system.
Types
It’s important to correctly identify the type and subtype of your lymphoma to determine which treatments are most likely to be effective.
There are two main types of lymphoma:
- Hodgkin lymphoma, which involves Reed-Sternberg cells, abnormal B cells
- Non-Hodgkin lymphoma, in which there are no Reed-Sternberg cells
Within NHL, there are about 60 types and subtypes based on:
- Whether the disease originates from B cells or T cells
- Whether it is fast or slow growing
- How and where the cells grow in the body
- The genetic characteristics and other molecular features of the cells affected
- Their appearance under a microscope
Learn about subtypes
With each subtype of NHL, there are small nuances that matter for your treatment. Over time, physicians who specialize in NHL gain deep knowledge of these subtleties. Things like knowing which therapies to use and when to use them. How to tell whether your treatment is working. Or if you’re likely to get unusual side effects.
Physicians develop this expertise in part by treating many people each year with the same disease. It’s nearly impossible for an oncologist who treats many kinds of cancer to know every detail about a rare NHL subtype. They might see only one patient with that subtype every five years. Here, our NHL specialists see many every year, year after year, building a wealth of experience.
Symptoms
Symptoms of NHL can come on very quickly. Some people are diagnosed with the disease within days to weeks of getting symptoms. Some types of NHL come on slowly over several months.
NHL symptoms may be similar to symptoms caused by other conditions that are not related to cancer. Check with your doctor if you feel concerned about any symptoms you have.
Diagnosing
If your doctor suspects you may have lymphoma, they will do a physical exam to look for signs of the disease and ask about your health history.
To confirm the presence of lymphoma, you will need a biopsy. This means removing part or all of a lymph node or a small sample of tissue surgically or with a needle. Experts in identifying blood-related cancers (hematopathologists) look at the cells under a microscope to diagnose the disease and accurately identify the type.
If you have lymphoma, you may need more tests to identify the type or subtype. These include an immunohistochemistry study; immunophenotyping, or flow cytometry; and cytogenetic analysis.
Stages
Staging means finding out how far lymphoma has spread in your lymph system or other parts of your body. Accurate staging allows your doctors to choose the most appropriate therapy for you — and help you avoid therapy that is not likely to be effective in your situation.
NHLs range from stage I to stage IV, with I being the least advanced and IV being the most advanced.
Doctors may add a letter after your stage to describe more about your disease.
- E (such as “stage IIIE”) means your cancer is outside your lymph nodes (extranodal).
- S (such as “stage IIIS”) means the cancer is in your spleen.
If your lymphoma comes back after treatment, it is called recurrent or relapsed. Your doctor will order imaging or other tests to restage it.