Non-Hodgkin Lymphoma: Things you need to know

Overview

What is Non-Hodgkin lymphoma ?

Non-Hodgkin lymphoma (NHL) is a form of malignancy that commonly emerges within lymph nodes and lymphatic tissues situated in body organs like the stomach or skin. On certain occasions, NHL affects the bone marrow as well as the bloodstream. Rather than being a singular ailment, NHL represents a heterogeneous collection of hematological cancers originating from lymphocytes, which are a component of the immune system’s white blood cells. Lymphoma cells have the potential to manifest in either a solitary location or multiple sites throughout the body. Non-Hodgkin’s lymphoma can be curable sometimes, depending on various factors such as the specific subtype, stage, and individual response to treatment.¹Overview| Researched based study from Lls.org

Types

Types of Non-Hodgkin lymphoma

• Indolent Lymphoma
• Aggressive Lymphoma

Indolent lymphomas

• Indolent lymphoma has a tendency to advance and disseminate at a gradual pace, exhibiting minimal symptoms.

Subtypes of indolent lymphoma

• Follicular lymphoma-It is a type of lymphoma characterized by a highly indolent or slow-growing nature. This lymphoma originates in B lymphocytes.
• Lympho-plasmacytic lymphoma-It is a low-grade B-cell lymphoproliferative neoplasm distinguished by the presence of monoclonal IgM monoclonal gammopathy.
• Marginal zone lymphoma-Originates in B lymphocytes located in a specific region of lymphatic tissue known as the marginal zone. The prognosis for patients aged 70 years or older may be less favorable.
• Primary cutaneous anaplastic large cell lymphoma-Manifests as a skin-limited condition, which can either present as a benign nodule that resolves spontaneously or spread to multiple areas on the skin, requiring treatment.²Types| Researched based study from Cancer.gov

Aggressive lymphomas

• Aggressive lymphoma demonstrates rapid growth and dissemination, accompanied by pronounced signs and symptoms that can be severe.

Subtypes of aggressive lymphoma

• Follicular large cell lymphoma, stage III-This exhibits a more accelerated growth rate and is typically managed as a high-grade lymphoma.
• Diffuse large B-cell lymphoma-This is the most prevalent form of non-Hodgkin lymphoma, known for its rapid growth within the lymph nodes. It frequently extends to other organs such as the spleen, bone marrow, etc.
• Anaplastic large cell lymphoma-Additionally, the cancer cells are characterized by the presence of a surface marker called CD30 and it originates in T-lymphocytes.
• Extranodal NK-/T-cell lymphoma-In the majority of cases, tumor cells within this condition contain the Epstein-Barr virus. It occurs in the region surrounding the nose
• Lymphomatoid granulomatosis-Predominantly, this type of cancer primarily targets the lungs, where it invades the blood vessels and causes tissue destruction.
• Angioimmunoblastic T-cell lymphoma-This particular type of lymphoma initiates in T cells and may be accompanied by elevated levels of gamma globulin in the bloodstream.
• Peripheral T-cell lymphoma-It originates in T cells.
• Intravascular large B-cell lymphoma-Cancer of microvasculature in the skin, brain, etc.
• Lymphoblastic lymphoma-Originates from either T cells or B cells, resulting in an excessive presence of lymphoblasts in the nodes of the lymph.
• Adult T-cell leukemia/lymphoma-Lymphoma caused by a retrovirus that infects human T cells.
• Primary effusion lymphoma-B-cell lymphoma that manifests within a substantial accumulation of fluid.
• Mantle cell lymphoma-B-cell lymphoma that originates in the lymph nodes and then metastasizes to the spleen, stomach, etc.
• Burkitt lymphoma-A highly aggressive form of B-cell lymphoma that impact various organs such as the jaw, ovaries, etc.
• Posttrans plantation lymphoproliferative disorder-Occurs in organ transplantation patients who need immunosuppressants for a lifetime.
• True histiocytic lymphoma-An uncommon, highly malignant variant that exhibits poor response to therapy.
• Plasmablastic lymphoma-A very aggressive type of B-cell lymphoma that is usually seen in HIV patients.

Symptoms

Symptoms of Non-Hodgkin’s lymphoma

• Exhaustion
• Loss of weight
• Shivering or cold sensations
• Swelling in the abdominal area
• Early satiety after consuming small quantities of food
• Chest discomfort or pressure
• Swelling of lymph nodes
• Breathlessness or coughing
• Severe or recurrent infections
• Easily bruised or prone to bleeding

Certain individuals with Non-Hodgkin lymphoma may exhibit B symptoms, which include:

• Fever in the absence of an underlying infection
• Profuse night sweats
• Unintentional weight loss.³Symptoms| Researched based study from Cancer.org

Causes

Causes of Non-Hodgkin lymphoma

• Non-Hodgkin lymphoma originates from modifications in the genetic material of cells.
• These changes can be of genetic origin, acquired during one’s lifetime due to external factors, or may occur spontaneously without a known cause.
• The genetic changes that contribute to non-Hodgkin lymphoma generally develop during a person’s lifetime.
• The alterations commonly arise due to contact with different factors like radiation, cancer-causing substances, or infections.⁴Causes| Researched based study from Cancercenter.com

Prevalence

Prevalence

• NHL was ranked as the 5th to 9th most prevalent malignancy in the majority of countries worldwide.
• An estimated 544,000 novel cancer cases were attributable to cancer in the year 2020.
• Occurrence rates exhibited a greater prevalence in males compared to females.
• Although the highest incidence rates were observed in Australia, New Zealand, Northern America, Northern Europe, and Western regions in Africa, Western Asia, and Oceania displayed the highest mortality rates.
• An estimated 260,000 fatalities were attributable to NHL in 2020.⁵Prevalence| Researched based study from Wiley.com

Diagnosis

Non-Hodgkin lymphoma Diagnosis

Biopsy

• During a biopsy, a portion or the entirety of the enlarged lymph node is surgically extracted, usually under local anesthesia, and subsequently examined by a pathologist to determine the presence of cancerous cells.
• If non-Hodgkin lymphoma is confirmed, additional tests will be conducted to assess the extent of its spread.

Blood tests

• Blood samples will be collected to assess the patient’s overall health, measure the levels of red and white blood cells, and platelets, and evaluate the functioning of body organs.

Chest X-ray & CT, MRI scan

• These are performed to detect the spread of cancer.

PET scan

• This scan evaluates the cellular activity in various regions of the body, providing information on the extent of cancer spread and the effectiveness of treatment.

Lumbar puncture

• This is performed with a slender needle and involves obtaining a sample of cerebrospinal fluid from the spinal area to examine its contents for the presence of lymphoma cells.⁶Diagnosis| Researched based study from Nhs.uk

Treatment

Treatment for Non-Hodgkin’s lymphoma

Chemotherapy

• Chemotherapy, also known as chemo, involves the administration of anti-cancer drugs, typically through intravenous injection or oral ingestion, to treat lymphoma.
• Commonly utilized medications for lymphoma treatment include alkylating agents, corticosteroids, anthracyclines, platinum drugs, etc.

Radiotherapy

• A therapy in which radiation of very high energy is used to eliminate cancer cells or impede their growth.
• External radiation therapy utilizes an external machine to direct radiation toward the specific cancer-affected area of the body.

Immunotherapy

• An antineoplastic therapy that harnesses the inherent defenses of the individual’s immune response network to counteract the ailment.
• It entails employing substances generated by the organism or synthesized in a laboratory setting to augment, direct, or reinstate the organism’s intrinsic protective mechanisms against cancer.

Targeted therapy

• Targeted therapy is a treatment modality that employs drugs or substances to selectively target and combat specific cancer cells.
• Targeted therapies generally impose reduced harm on healthy cells.

Plasmapheresis

• When the blood becomes thickened due to an excess of antibody proteins, plasmapheresis is performed.
• Plasmapheresis encompasses the extraction of surplus plasma and immune globulins from the bloodstream, aiming to reinstate optimal blood viscosity and enhance circulation.

Antibiotics

• Antibiotics are administered to address infections and cancer resulting from bacterial and other microorganism-related causes.

Surgery

• Surgical intervention may be utilized as a therapeutic strategy to excise the lymphoma in individuals diagnosed with either slow-growing or fast-growing non-Hodgkin lymphoma.

Stem cell transplant

• Stem cell transplant is a procedure that involves administering high doses of chemotherapy and/or total-body irradiation to eliminate cancerous cells, followed by the infusion of healthy blood-forming cells to replace those destroyed during the cancer treatment process.⁷Treatment| Researched based study from Nlm.nih.gov

Diet

• Strive to consume 5-10 portions of fruits and vegetables daily.
• Make it a priority to incorporate cruciferous vegetables into the diet on a near-daily basis.
• Adequate fluid intake is notably crucial during the duration of oncological therapy.
• Opt for a regular intake of small, frequent meals or snacks, aiming for four to six throughout the day.
• If solid food presents challenges, consider consuming high-calorie liquids like smoothies, soups, or juices.
• Incorporate calorie-dense sources such as olive oil and nut spreads to enhance calorie intake while prioritizing healthy fats.⁸Diet| Researched based study from Lls.org

Alternative Treatment

Alternative Treatment methods

• Acupuncture can be administered, entailing the introduction of slender spikes into precise locations on the body for alleviating diverse symptoms, such as minor discomfort and specific types of nausea.
• Yoga that encompasses a well-organized sequence of poses and regulated respiratory practices.
• To enhance hunger, going for a stroll prior to eating can be considered.
• Numerous clinical studies have consistently demonstrated that individuals with cancer who incorporate melatonin into their treatment regimen exhibit improved sleep quality, reduced fatigue, and diminished depressive symptoms.
• Massage therapy has the potential to assist individuals with cancer in effectively managing both physical and mental health symptoms.
• Individuals with lymphoma often incorporate vitamin or mineral supplements into their routine to support their overall health, as malnutrition is a common issue among people with cancer.
• Mistletoe extract, extensively researched in people with cancer, has been found in numerous European clinical trials to enhance the quality of life by mitigating treatment side effects and promoting improved mental well-being.⁹Alternative treatment| Researched based study from Nlm.nih.gov

Complications

Non-Hodgkin lymphoma Complications

• Spinal cord or brain compression in which the spinal cord or brain tissue is subjected to pressure or compression, potentially leading to a range of neurological symptoms and complications.
• An abnormally high number of white blood cells in the bloodstream, which can pose significant risks to a person’s health.
• A condition with a low count of neutrophils, which is considered a serious medical concern due to the increased risk of infection.
• Dysfunction or aberration in the activity of the liver.
• Coagulation of blood within the venous system, which has the potential to result in the occurrence of a thrombus, within a deep vein.
• Blockage or partial obstruction in either the superior or inferior vena cava, major veins that carry deoxygenated blood back to the heart, leading to venous congestion and impaired blood flow.¹⁰Complications| Researched based study from Nlm.nih.gov

Risk

Who are at risk?

• Advancing in age presents a significant risk factor for lymphoma.
• Individuals of Caucasian ethnicity exhibit higher susceptibility.
• The existence of first-degree kin with NHL elevates the likelihood of acquiring cancer.
• Exposure to certain chemicals like benzene, as well as specific insecticides, has been associated with an augmented risk of NHL.
• Individuals who underwent radiation therapy for previous cancer treatments possess a slightly elevated risk of developing NHL later in life.
• Weakened immune systems heighten the vulnerability to NHL.
• Some research suggests a potential link between being overweight or obese and an increased NHL risk.
• On certain occasions, females who have undergone breast augmentation surgery may experience the occurrence of lymphoma within the fibrous tissue (capsule) encasing the implant.
• Certain autoimmune diseases have also been associated with a heightened risk of NHL.¹¹Risk| Researched based study from Cancer.org

Prevention

Prevention of Non-Hodgkin lymphoma

• There is no foolproof approach to pre-empt NHL. However, minimizing the risk of NHL can be achieved by avoiding known HIV risk factors, as infection with the HIV virus increases NHL risk.
• Taking measures to prevent the transmission of the human T-cell lymphotropic virus (HTLV-1) would have a significant impact on reducing the occurrence of NHL.
• Infestation with Helicobacter pylori is associated with certain stomach lymphomas, and treating H. pylori infections with antibiotics and antacids may decrease this risk.
• Sustaining an optimal weight, participating in consistent physical exercise, and embracing a nourishing dietary regimen may also contribute to protecting against lymphoma.¹²Prevention| Researched based study from Cancer.org

Prognosis

Prognosis of Non-Hodgkin lymphoma

• For non-Hodgkin lymphoma, the general five-year relative survival rate stands at 73.8 percent.
• However, personal survival rates can vary based on factors such as lymphoma type, stage, overall health condition, and treatment response.
• Generally, younger age groups tend to have more favorable outcomes compared to older age groups.
• In certain lymphoma types, prognosis considerations extend beyond the cancer’s stage.
• Positive prognostic indicators for most lymphoma types encompass being 60 years of age or younger, having stage 1 or 2 lymphomas, and possessing a normal serum LDH level.⁴Prognosis| Researched based study from Cancercenter.com

Takeaway

Key takeaways

• Non-Hodgkin’s lymphoma is a serious medical condition but it is not necessarily terminal as outcomes vary depending on factors such as the specific subtype, stage, treatment options, and individual response to therapy.
• Medical professionals will assess whether the lymphoma is categorized as indolent or aggressive to determine its characteristics and appropriate treatment approach.
• Timely diagnosis and proper treatment are essential for non-Hodgkin’s lymphoma to effectively manage the disease, improve outcomes, and enhance the overall quality of life for individuals affected by the condition.