Non-Hodgkin’s lymphoma (NHL) is a type of blood cancer that develops from the lymphatic system. This system is a network of vessels throughout your body that work as part of your immune system, carrying fluid containing infection-fighting white blood cells, called lymphocytes, to where they detect a threat.
In NHL, these lymphocytes become dysfunctional and multiply out of control. They can then collect in different areas of the lymphatic system known as the lymph glands, and this can cause swelling you can see and feel in certain areas of the body. The consequence is that the lymphatic system becomes less able to fight infections.
There are two types of lymphoma – NHL and Hodgkin’s lymphoma – and around 4 in 5 of cases are the NHL type.
NHL can occur at any age, but your chance of developing the condition increases over the age of 50, with just over a third of cases being diagnosed in people over 75. It’s fairly common in the UK, within the top 10 most common cancers and accounts for 1 in 25 of all cancers, with men being more commonly affected than women.
In most cases, we don’t know what causes NHL. There are certain factors that can put you at higher risk, such as having a weakened immune system, either from a condition such as cancer, or from medication such as chemotherapy. It can run in families and glandular fever, a common throat infection caused by the Epstein-Barr virus, may increase your risk as can hepatitis C. It does not appear to run in families.
You may notice swollen lymph glands – these sit in your neck, armpit and groin area. These swell when you have an infection, as part of lymphocyte production in defence, but healthy lymph nodes responding to infection will feel rather tender to touch, you may have other signs of infection, and they will shrink again after two weeks.
In contrast, lymph nodes that are swollen due to NHL are usually painless and persistent and this is usually the first symptom of NHL.
Other symptoms can include night sweats, unexplained weight loss, poor appetite, persistent fevers, marked fatigue and itching all over the body. There may also be excessive bleeding and an increased risk of infection.
You should book an appointment urgently with your doctor if you notice any of these general signs or you have one or more lymph nodes that are swollen for more than a couple of weeks, especially if you weren’t unwell when it started.
Your doctor will ask detailed questions about your symptoms, medical history and family history. They will examine your lymph glands looking for enlargement of these glands at particular points in your body. They will organise blood tests. If there are any concerns of blood cancer, they will refer you urgently to specialists called haematologists who will do a biopsy of one of your swollen glands to see if there are abnormal cells in it. If this confirms NHL then further tests are done including ones such as a CT or MRI scan, blood tests and a bone marrow biopsy. These are done to ‘stage’ the NHL and see if it has spread to other parts of the body.
The treatment depends on the type of NHL, how much it has spread and your overall fitness and health. Chemotherapy is one option, where medications are designed to kill cancerous cells. Radiotherapy uses high energy radiation to damage cancerous cells and stop them growing. Targeted therapy is designed to seek and destroy vulnerable cancer cells and a combination of two or event three of these may be appropriate - treatment will be adapted to each individual case. Other treatment options include using monoclonal antibodies, stem cell transplant and – uncommonly – surgery. There is also an option in NHL of having no treatment at all (called ‘watch and wait’) if you feel well and have no symptoms apart from swollen glands.
NHL can be divided by how quickly it grows, and this guides treatment. High-grade NHL is where the cancer grows quickly and aggressively and treatment needs to be initiated straight away. This is usually more effective and curable than low-grade NHL where the cancer grows slowly, and symptoms may not present for some time. This one is harder to cure but may not require treatment straight away.
With any cancer diagnosis, one of the first questions people ask is will I survive it? The chance of survival with NHL is good, with nearly 4 in 5 surviving after the first year, and around half are alive after 10 years which is encouraging considering that many of those diagnosed are aged 70 and over.
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