Non-Hodgkin Lymphoma (NHL) is a type of cancer that affects the lymphatic system, which is part of the body’s immune system. NHL can occur in any part of the body, but most commonly occurs in the lymph nodes, spleen, and bone marrow.
Symptoms & Diagnosis
Symptoms of NHL can vary depending on where it develops but often include enlarged lymph nodes, fever, weight loss, night sweats, fatigue, coughing, or shortness of breath. Some people may also experience abdominal pain, chest pain or discomfort, or an enlarged abdomen depending on where cancer has spread.
NHL can often be difficult to diagnose, as many of its symptoms mimic other ailments or conditions. In some cases, NHL is found incidentally when a patient is being tested for something else; in others, it can take months before the diagnosis is made. It is important to consult with a doctor if you experience any of the above symptoms, as early detection can greatly improve the effectiveness of treatment.
Stages of NHL
Once a diagnosis of NHL has been made, your doctor will assign a stage to cancer. This is based on how far it has spread and how much it has grown. Knowing the stage helps your doctor determine the best course of treatment for you.
Stage I: In this stage, cancer is only present in one area or lymph node.
Stage II: Cancer is present in two or more areas or lymph nodes on the same side of the diaphragm (the muscle below your lungs that helps you breathe).
Stage III: Cancer has spread to both sides of the diaphragm, and may have spread to other organs as well.
Stage IV: Cancer has spread to other organs in the body, such as the liver or lungs.
If your doctor suspects you have NHL, they will usually begin by performing a physical examination and asking about your medical history. Based on this information, your doctor may order a biopsy of the affected area. During a biopsy, tissue samples are collected from the lymph node or other body parts and examined under a microscope by a pathologist. This is typically the only way to confirm a diagnosis of NHL.
Your doctor may also order other tests, such as an imaging test like a CT scan or MRI, to get a better picture of the affected area and to determine if cancer has spread elsewhere in your body. A bone marrow biopsy may also be done to look for any signs of cancer in the bone marrow.
PET scan, which uses radioactive glucose to detect any areas of cancer activity in the body, may also be done. This test is especially useful for detecting if cancer has spread to other parts of the body. In addition, your doctor may order lab tests, such as a complete blood count, chemistry panel, and immunoglobulin test. These tests can help your doctor get a better understanding of your overall health and make sure you’re healthy enough to undergo treatment if it’s needed.
The treatment for NHL depends on factors such as the stage of cancer, your overall health and age, and the type of NHL you have. Treatment options may include chemotherapy, radiation therapy, targeted therapy, stem cell transplantation, and surgery. It is important to discuss all of your options with your doctor so you can decide which treatment plan is best for you.
Chemotherapy is the use of drugs to kill cancer cells. Chemo may be used alone or in combination with other treatments such as radiation therapy, targeted therapy, or stem cell transplantation. It is typically given as an infusion (a shot into a vein). Depending on the type of drugs used, it is given in cycles (a certain number of days followed by a rest period).
Different regimens of chemotherapy are used to treat NHL, depending on the type and stage of cancer. The most common types of chemo for NHL include CHOP, R-CHOP, and CVP.
CHOP is a type of combination chemotherapy that combines drugs to work more effectively against cancer cells. This regimen involves four drugs: cyclophosphamide, doxorubicin, vincristine, and prednisone. This type of chemo is usually given in cycles over a period of weeks or months.
R-CHOP combines CHOP with the drug rituximab (an anti-cancer antibody). This drug helps to kill cancer cells by attaching itself to them and damaging their DNA. R-CHOP can be used as an initial treatment for NHL or it may be used after other treatments have failed. Lastly, CVP is a chemotherapy regimen that involves cyclophosphamide, vincristine, and prednisone.
The goal of chemotherapy is to kill cancer cells and prevent them from growing or spreading. However, chemo can also damage healthy cells, which can lead to side effects such as nausea, vomiting, diarrhea, hair loss, fatigue, loss of appetite, mouth sores, skin rashes, changes in blood cell counts, and an increased risk of infection.
Stem Cell Transplantation
Stem cell transplantation is a type of treatment option for patients with aggressive forms of NHL or who have not responded to other treatments. During a stem cell transplant, chemotherapy is used to destroy cancer cells in the bone marrow. Then healthy stem cells are injected into the body to help rebuild the bone marrow. The new stem cells will produce healthy red and white blood cells as well as platelets.
This procedure can be done in two ways: autologous (using your own stem cells) or allogeneic (using donor stem cells). Autologous transplants are used for most NHL cases, as it carries less risk of complications. Allogeneic transplants may be used in some cases, but carry a higher risk of side effects due to the increased risk of rejection from the donor stem cells.
Side effects of stem cell transplantation can include nausea, vomiting, diarrhea, fever and chills, hair loss, mouth sores, fatigue, changes in blood cell count, and an increased risk of infection.
Radiation therapy is the use of high-energy particles or waves to kill cancer cells. It is usually given as external radiation (from outside your body) but can also be done internally with radioactive implants. Radiation may be used alone or in combination with chemotherapy or other treatments.
Side effects of radiation therapy can vary depending on the area being treated. Common side effects include fatigue, skin irritation, hair loss in the treated area, and an increased risk of infections due to a weakened immune system. Other potential side effects include nausea, vomiting, diarrhea, and changes in blood cell counts.
Targeted therapies are one of the most effective treatments for most types of NHL, with Riuximab and Obinutuzumab being the main targeted therapies used.
Rituximab and obinutuzumab are monoclonal antibody drugs and a type of immunotherapy. They work by attaching themselves to cancer cells, thereby provoking the immune system to recognize and destroy them. The type of NHL will determine which targeted therapy is the best option for treating cancer.
As compared to other treatment options, targeted therapy is relatively specific and can focus only on cancer cells, leaving healthy cells unharmed. This reduced exposure leads to fewer side effects. However, some possible side effects of targeted therapy include fatigue, chills, fever, joint pain, rash or itching, and an increased risk of infection.
Surgery is rarely used to treat NHL and is typically only done if cancer is confined to one particular area or organ that can be removed without causing major damage.
Surgery is usually performed to remove a tumor or lymph node so that it can be examined under a microscope for cancer cells. During surgery, a surgeon will make a small incision in the affected area and carefully remove the tumor or lymph node. The tissue will then be sent to a lab for analysis. If cancer cells are present, further treatment will be necessary. If the tissue is free of cancer cells, no further treatment may be needed.
Non-Hodgkin Lymphoma can be a difficult diagnosis to receive but there are treatment options available that can help reduce your symptoms and potentially cure your cancer. Make sure you discuss all of your options with your doctor so that you can find the right treatment plan for you. With early detection and prompt treatment, NHL can be effectively managed and treated.