Non- Hodgkin’s lymphoma

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Overview

Non-Hodgkin lymphoma (NHL) is a neoplasm of the lymphoid tissues originating from B cell precursors, mature B cells, T cell precursors, and mature T cells.

Non-Hodgkin lymphoma comprises various subtypes, each with different epidemiologies, etiologies, immunophenotypic, genetic, clinical features, and response to therapy. It can be divided into two groups, 'indolent' and 'aggressive,' based on the disease's prognosis.

The most common mature B cell neoplasms are Follicular lymphoma, Burkitt lymphoma, diffuse large B cell lymphoma, Mantle cell lymphoma, marginal zone lymphoma, primary CNS lymphoma. The most common mature T cell lymphomas are Adult T cell lymphoma, Mycosis fungoides.

The natural history of these tumors shows significant variation. Indolent lymphomas present with waxing and waning lymphadenopathy for many years, whereas aggressive lymphomas have specific B symptoms such as weight loss, night sweats, fever and can result in deaths within a few weeks if untreated. Lymphomas that usually have indolent presentations include follicular lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, and splenic marginal zone lymphoma. Aggressive lymphomas include diffuse large B cell lymphoma, Burkitt lymphoma, precursor B and T cell lymphoblastic leukemia/lymphoma, and adult T cell leukemia/lymphoma, and certain other peripheral T cell lymphomas. 

Up to two-thirds of patients present with peripheral lymphadenopathy. Rashes on the skin, increased hypersensitivity reactions to insect bites, generalized fatigue, pruritus, malaise, fever of unknown origin, ascites, and effusions are less common presenting features. Approximately half of the patients develop the extranodal disease (secondary extranodal disease) during the course of their disease, while between 10 and 35 percent of patients have primary extranodal lymphoma at diagnosis. Primary gastrointestinal (GI) tract lymphoma may present with nausea and vomiting, aversion to food, weight loss, fullness of abdomen, early satiety, visceral obstruction related symptoms. Patients may even present with features of acute perforation and gastrointestinal bleeding, and at times with features of malabsorption syndrome. Primary central nervous system (CNS) lymphoma may present with headaches, spinal cord compression features, lethargy, focal neurologic deficits, seizures, and paralysis.

Symptoms

Swollen lymph nodes in your neck, armpits or groin.

Abdominal pain or swelling.

Chest pain, coughing or trouble breathing.

Persistent fatigue.

Fever.

Night sweats.

Unexplained weight loss.

Causes

Non-Hodgkin lymphoma is caused by a change (mutation) in the DNA of a type of white blood cell called lymphocytes, although the exact reason why this happens isn't known.

DNA gives cells a basic set of instructions, such as when to grow and reproduce.

The mutation in the DNA changes these instructions, so the cells keep growing. This causes them to multiply uncontrollably.

The abnormal lymphocytes usually begin to multiply in one or more lymph nodes in a particular area of the body, such as your neck, armpit or groin.

Over time, it's possible for the abnormal lymphocytes to spread into other parts of your body, such as your:

bone marrow

spleen

liver

skin

lungs

stomach

brain


Risk factors

Age. Getting older is a strong risk factor for lymphoma overall, with most cases occurring in people in their 60s or older . ...

Gender. ...

Race, ethnicity, and geography. ...

Family History. ...

Exposure to certain chemicals and drugs. ...

Radiation exposure. ...

Having a weakened immune system. ...

Autoimmune diseases.

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Complications

Some people treated for non-Hodgkin lymphoma experience long-term problems, even if they have been cured.

Weakened immune system

Having a weakened immune system is a common complication of non-Hodgkin lymphoma and can become more severe while you're being treated.

But your immune system will usually recover in the months and years after treatment.

If you have a weak immune system, you're more vulnerable to infections and there's an increased risk of developing serious complications from infections.

It's important to report any symptoms of an infection to your GP or care team immediately, as prompt treatment may be needed to prevent serious complications. 

This is particularly important in the first few months after treatment.

Symptoms of infection include:

a high temperature

headache

aching muscles

diarrhoea

tiredness

a painful blistering rash

Vaccination

You should make sure all of your vaccinations are up-to-date.

But it's important to speak to your GP or care team about this because it may not be safe for you to have "live" vaccines until several months after your treatment finishes.

Live vaccines contain a weakened form of the virus or organism being vaccinated against.

Examples of live vaccines include the:

shingles vaccine

BCG vaccine (against tuberculosis)

MMR vaccine (against measles, mumps and rubella)

Infertility

Chemotherapy and radiotherapy for non-Hodgkin lymphoma can cause infertility. This is sometimes temporary, but it can be permanent.

Your care team will estimate the risk of infertility in your specific circumstances and talk to you about your options.

In some cases, it may be possible for men to store samples of their sperm and for women to store their eggs before treatment so these can be used to try for a baby afterwards.

Second cancers

Having treatment for non-Hodgkin lymphoma can increase your risk of developing another type of cancer in the future. This is known as a second cancer.

The risk of getting cancer is particularly increased after cancer treatment because chemotherapy and radiotherapy damage healthy cells, as well as cancer cells.

This damage can then cause the affected cells to become cancerous many years after treatment.

You can help reduce your risk of a second cancer by adopting a healthy lifestyle through not smoking, maintaining a healthy weight with a balanced diet, and getting regular exercise.

You should report any symptoms that might suggest another cancer to your GP at an early stage and attend any cancer screening appointments you're invited to.

Other health problems

Treatment for non-Hodgkin lymphoma can increase your risk of getting certain conditions at a younger age than normal, such as:

heart disease

lung disease

Having a cancer diagnosis can also increase your risk of depression.

You should report unexpected symptoms, such as increasing shortness of breath, to your GP.


Prevention

There’s no known way to prevent NHL. It may be possible to lower your risk for the condition by avoiding known risk factors such as obesity and HIV:

Using barrier methods each time you engage in sexual activity can lower your chances of contracting HIV.

Avoiding intravenous drug use or using clean needles when injecting drugs can lower your chances of contracting HIV or hepatitis C.

The following actions can help prevent obesity and may protect against lymphoma:

staying at a moderate weight

keeping physically active

following a nutritious diet with lots of fruit, vegetables, and whole grains, and limited sugary drinks, red or processed meats, and highly processed foods