Non- Hodgkin’s lymphoma

Your doctor will likely ask you about your personal and family medical history. He or she may then have you undergo tests and procedures used to diagnose non-Hodgkin's lymphoma, including:

Physical exam. Your doctor checks for swollen lymph nodes, including in your neck, underarm and groin, as well as for a swollen spleen or liver.

Blood and urine tests. Blood and urine tests may help rule out an infection or other disease.

Imaging tests. Your doctor may recommend imaging tests to look for signs of lymphoma cells elsewhere in your body. Tests may include CT, MRI and positron emission tomography (PET).

Lymph node test. Your doctor may recommend a lymph node biopsy procedure to remove all or part of a lymph node for laboratory testing. Analyzing lymph node tissue in a lab may reveal whether you have non-Hodgkin's lymphoma and, if so, which type.

Bone marrow test. A bone marrow biopsy and aspiration procedure involves inserting a needle into your hipbone to remove a sample of bone marrow. The sample is analyzed to look for non-Hodgkin's lymphoma cells.

Lumbar puncture (spinal tap). If there's a concern that the lymphoma may affect the fluid around your spinal cord, your doctor might recommend a procedure to remove some of the fluid for testing. During a spinal tap, the doctor inserts a small needle into the spinal canal in your lower back.

Several non-Hodgkin's lymphoma treatments are available. Which treatment or combination of treatments is best for you will depend on the particulars of your lymphoma, such as the types of cells involved and whether your lymphoma is aggressive. Your doctor also considers your overall health and your preferences.

If your lymphoma appears to be slow growing (indolent) and doesn't cause signs and symptoms, you might not need treatment right away. Instead, your doctor may recommend regular checkups every few months to monitor your condition and whether your cancer is advancing.

If your non-Hodgkin's lymphoma is aggressive or causes signs and symptoms, your doctor may recommend treatment. Options may include:

Chemotherapy

Chemotherapy is a drug treatment that kills cancer cells. It can be given orally or by injection. Chemotherapy drugs can be used alone, in combination with other chemotherapy drugs or combined with other treatments.

Chemotherapy is a common initial treatment for non-Hodgkin's lymphoma. It might also be an option if your lymphoma comes back after your initial treatments.

For people with non-Hodgkin's lymphoma, chemotherapy is also used as part of a bone marrow transplant, also known as a stem cell transplant. Very high doses of chemotherapy drugs can help prepare your body for the transplant.

Radiation therapy

Radiation therapy uses high-powered energy beams, such as X-rays and protons, to kill cancer cells. During radiation therapy, you lie on a table and a large machine moves around you, directing the energy beams to specific points on your body.

For certain types of non-Hodgkin's lymphoma, radiation therapy may be the only treatment you need, particularly if your lymphoma is slow growing and located in just one or two spots. More commonly, radiation is used after chemotherapy to kill any lymphoma cells that might remain. Radiation can be aimed at affected lymph nodes and the nearby area of nodes where the disease might progress.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

For non-Hodgkin's lymphoma, targeted drugs can be used alone, but are often combined with chemotherapy. This combination can be used as your initial treatment and as a second treatment if your lymphoma comes back.

Engineering immune cells to fight lymphoma

A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body's germ-fighting T cells, engineers them to fight cancer and infuses them back into your body.

CAR-T cell therapy might be an option for certain types of B-cell non-Hodgkin's lymphoma that haven't responded to other treatments.

Bone marrow transplant

Bone marrow transplant, also known as a stem cell transplant, involves using high doses of chemotherapy and radiation to suppress your bone marrow and immune system. Then healthy bone marrow stem cells from your body or from a donor are infused into your blood where they travel to your bones and rebuild your bone marrow.

For people with non-Hodgkin's lymphoma, a bone marrow transplant might be an option if other treatments haven't helped.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.