Non-Hodgkin’s Lymphoma

Non-Hodgkin's lymphoma is a type of cancer that starts in the lymph system. The lymph system is part of the immune system.  In this type of lymphoma, tumors start for a cell type called lymphocytes. They are a form of white blood cell.
In 2018, the estimated number of new Non-Hodgkin’s Lymphoma cases was 74,680 in the US. In the US, 71.4% of patients survive after 5 years or more of being diagnosed with Non-Hodgkin’s Lymphoma. This means out of 100 patients with Non-Hodgkin’s Lymphoma, about 71 patients have survived the disease for 5 years or more.
Risk factors
There are certain factors that increase the chances of having Non-Hodgkin’s lymphoma.

• Drugs that muffle the immune system. These drugs are typically used in patients that have received organs by transplant.  These medications increase the risk of having lymphoma because they have suppressed the patient’s natural ability to fight off disease.   
• Infection. Infection with the bacteria Helicobacter pylori has been connected to a higher chance of having this type of cancer. The HIV and Epstein-Barr viruses have been associated with higher rates of non-Hodgkin's lymphoma.
• Chemicals. Chemicals like herbicides and pesticides have potentially been associated with non-Hodgkin's lymphoma. There is ongoing research into the connection between these chemicals and non-Hodgkin's lymphoma.
• Older age. Non-Hodgkin's lymphoma is more common in people over 60 compared to younger people.

Symptoms
There are certain symptoms and signs associated with Non-Hodgkin's lymphoma. These include painless enlarged lymph nodes in the neck, underarms or groin, belly discomfort/swelling, pain in a patient’s trunk, shortness of breath, coughing, feeling tired all the time, higher body temperature, sweating at night, unplanned loss of weight.
Diagnosis
There are certain tests that a doctor might use to see if a patient has non-Hodgkin's lymphoma.

• A physical checkup. A doctor will look for swollen lymph nodes in the neck, armpits or groin. The doctor will also look for an enlarged liver or spleen.
• Blood and urine tests. Tests looking at a patient’s bodily fluids will aid in excluding other causes or diseases.
• Diagnostic imaging. A doctor will use machines/techniques to see what is going on inside a patient’s body.  These techniques include X-ray, CT and positron emission tomography.
• Lymph node biopsy. A piece of lymph node will be removed from the body to help find out information about the disease.
• Bone marrow biopsy.  A sample of bone marrow is collected from the hip bone. The sample is used to find cancer cells.

Depending on the severity of the disease a doctor and patient may decide to wait to treat non-Hodgkin's lymphoma. This is called a wait-and-see tactic. The doctor will monitor the patient every few months to watch the cancer. They will make sure that the cancer is not advancing.  If the disease is hard-hitting or causes the signs and symptoms of the disease described above, treatment may be advocated by the doctor.
Treatment options
The treatment options for Non-Hodgkin's lymphoma include the following:

• Chemotherapy. These are medications that are used to kill the cancer cells. They can be injected or taken by mouth. Chemotherapy can be taken alone, with other medications or with radiation therapy.
• Radiation therapy. This is a release of energy in the form of waves or particles. This energy injures cancer cells and prevents them from growing. Examples of this therapy this include X-rays and protons.
• Bone marrow transplant. Bone marrow transplant/ stem cell transplant.  This is when abnormal or unhealthy bone marrow is replaced by hardy and healthy cells.

Before a transplant there are a few steps that are taken.  Progenitor or stem blood cells are collected. Chemotherapy or radiation is then used to kill off the sickly cells. The healthy stem cells are then injected back into the body and help to recreate healthy bone marrow cells.      

• Additional drug therapy.
  • Biologic therapy helps the body’s natural defenses fight cancer. Examples of biologic therapy are rituximab (Rituxan) and ibrutinib (Imbruvica).
  • Radioimmunotherapy drugs directly attach to cancer cells and deliver precise radiation to kill the cancer cells. An example of this drug is ibritumomab tiuxetan (Zevalin).

 
References:
“Cancer Stat Facts: Non-Hodgkin Lymphoma.” National Institutes of Health National Cancer Institute, 2019, https://seer.cancer.gov/statfacts/html/nhl.html
“Non-Hodgkin's lymphoma.” Mayo Foundation for Medical Education and Research, 2019.
https://www.mayoclinic.org/diseases-conditions/non-hodgkins-lymphoma/symptoms-causes/syc-20375680
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Web links about Non-Hodgkin’s Lymphoma
Non-Hodgkin Lymphomas
https://www.merckmanuals.com/home/blood-disorders/lymphomas/non-hodgkin-lymphomas

Non-Hodgkin lymphoma  https://medlineplus.gov/ency/article/000581.htm