Definition

Lymphomas are cancers of the lymphatic system. The lymphatic system drains excess fluid from tissues. It also helps protect against infections.

Non-Hodgkin lymphoma is a name that applies to many types of lymphomas. These types are based on the cell that is involved and the patterns of growth.

In general, these types can be classified as:

• Slow growing lymphomas, also known as indolent lymphomas
• Aggressive lymphomas
• Highly aggressive lymphomas

These cancers are different from Hodgkin lymphoma.

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Causes

Cancer occurs when cells in the body divide out of control or order. If cells keep dividing, a mass of tissue forms. These are called growths or tumors. If the tumor is cancer, it is called malignant. It can invade nearby tissue and spread to other parts of the body.

The cause of non-Hodgkin lymphoma is unknown. DNA mutations that occur after birth may be related to this cancer. These mutations can occur as a result of exposure to radiation or cancer-causing chemicals. They may also occur with age or for no apparent reason.

Risk Factors

Most people who develop non-Hodgkin lymphoma have no known risk factors. Men and people age 60 to 70 years old are at increased risk. The following factors may also increase your chance of developing this condition:

• Frequent and accumulating exposure to certain types of chemicals, such as herbicides, pesticides, benzene, and chlorinated organic solvents
• Infections involving the immune system, such as HIV/AIDS and Epstein-Barr virus
• History of chemotherapy, radiation therapy, or immunosuppressive therapy
• Chromosomal translocations, which occur when DNA breaks off one chromosome and becomes attached to another
• A parent who has had non-Hodgkin lymphoma, especially if it occurred at an early age
• Celiac disease —gluten enteropathy or gluten intolerance
• Chronic infections, such as systemic lupus erythematosus, rheumatoid arthritis, and Sjogren syndrome
• Obesity

Symptoms

Symptoms include:

• Painless swelling of the neck, underarm, groin, or any other lymph node-bearing regions of the body
• Unexplained fever
• Profuse sweating
• Constant fatigue
• Unexplained weight loss
• Itchy skin, especially on the legs and feet
• Red patches on the skin
• Chest pain or shortness of breath
• Bruising

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. It will include an exam of your lymph nodes.

Your bodily fluids and tissues may be tested. This can be done with:

• Excisional or incisional biopsy
• Fine needle aspiration (FNA)
• Bone marrow biopsy
• Lumbar puncture
• Immunohistochemistry
• Flow cytometry
• Cytogenetics and/or molecular genetic studies
• Blood tests

Imaging tests are used to view internal structures. Some may use contrast material to make structures easier to see. Imaging tests may include:

• Chest x-ray
• CT scan
• MRI scan
• FDG PET/CT scan
• Bone scan
• Ultrasound

Treatment

Treatments depend on the stage and type of cancer. The type is determined in part by a microscopic exam and other studies. Talk with your doctor about the best plan for you. Treatment options include:

Prevention

There are no guidelines for preventing non-Hodgkin lymphoma. To reduce your risk, avoid exposure to chemicals such as herbicides, pesticides, benzene, and chlorinated organic solvents. If you have celiac disease, maintain your gluten-free diet. This diet will minimize stimulation of your immune system from exposure to gluten.