Q&A: Non-Hodgkin's Lymphoma

Non-Hodgkin's lymphoma (NHL) is the fifth most common form of cancer in the United States, and is made up of more than 20 types. The number of cases also has doubled since the early 1970s for unknown reasons, according to the American Cancer Society.

Answering general questions about non-Hodgkin's lymphoma is Luis Eduardo Fayad, M.D., assistant professor of medicine and director of clinical operations in M. D. Anderson's Lymphoma and Myeloma Center.

What is non-Hodgkin's lymphoma?

Non-Hodgkin's lymphoma is cancer of the lymphatic system, part of the immune system that fights disease and infections. The lymphatic system includes:

Lymphocytes- White blood cells that fight infections and disease (Lymphomas are named after the two main types of lymphocytes, B-cell and T-cell)
Lymph fluid- Fluid containing lymphocytes
Lymph nodes- A small mass of lymphatic tissue in the underarm, groin, neck, chest, and abdomen that filters out toxins and stores lymphocytes

How common is non-Hodgkin's lymphoma?

There are approximately 55,000 cases of non-Hodgkin's lymphoma every year in the United States, and approximately 4% of all new cancers are lymphomas.

What age groups are affected by this disease?

Non-Hodgkin's lymphoma can occur at any age, from infancy to adulthood. It is a common childhood cancer that often is diagnosed in children between 7 and 11 years old. The disease occurs in adults age 40 and older in 95% of cases. Men, particularly Caucasians, are more likely to get NHL.

What are the symptoms for non-Hodgkin's lymphoma?

• Painless swelling or enlargement of lymph nodes at neck, underarms or groin
• Excessive night sweats
• Unexplained fever
• Itchy skin
• Unexplained weight loss
• Anemia, low platelets, secondary to bone marrow infiltration
• Stomachache due to stomach involvement
• Pain (sometimes, depending on the anatomic location) that is secondary to:
• • Pressure to bone or organs
  • Obstruction
  • Palpable masses secondary to growth

Are there risk factors?

Possible risk factors for lymphomas, include:

• Having a compromised immune system (AIDS patients and organ transplant recipients)
• Exposure to large amounts of radiation
• On-the-job exposure to pesticides, fertilizer and solvents
• Having had the Epstein-Barr Virus (EBV), which causes infectious mononucleosis (mono)

How are non-Hodgkin's lymphomas categorized?

Lymphomas are categorized according to the cell type (either B or T lymphocytes), by size, shape and pattern of lymphoma cells. They also fall within two categories: indolent (slow-growing) and aggressive (fast-growing).

Where does lymphoma occur?

Lymphoma can occur in any organ, more commonly in lymph nodes, but it also can be extranodal, occurring in areas where there are no lymph nodes, such as the brain, liver, testicles, stomach and nasopharynx. The incidence of extranodal lymphomas is 24%. The most common presentation of extranodal lymphomas is in the gastrointestinal system, followed by lymphomas involving the head and neck areas.

How common is lymphoma of the nasopharynx?

The incidence of lymphomas involving the nasopharynx is less than 1%.

What is the treatment for lymphoma?

Treatment depends on the type of lymphoma and the extent of the disease. Treatment often involves the use of chemotherapy with rituximab (Rituxan) and radiation therapy for the large B-cell lymphomas. (Rituximab is a monoclonal antibody drug that has been federally approved for use in non-Hodgkin's lymphoma. Monoclonal antibodies are designed to hook onto proteins found on the surface of cancer cells and trigger an immune response against the cells.)

Other types of chemotherapy and radiation are used in Hodgkin's disease. The rare T/NK lymphomas (T-cell natural killer lymphomas) have a worse outcome and the treatment is radiation therapy for localized disease with or without chemotherapy. The cure rate fluctuates between more than 80% in Hodgkin's disease patients to less than 30% in some patients with locally advanced T/NK lymphomas.

Describe treatment side effects:

Treatment side effects are mainly fatigue; decrease in blood counts; risk of infection (with chemotherapy); and dry mouth and sore throat (with radiation).

For more information, please contact the M. D. Anderson Information Line at 1-800-392-1611, option 3.

For more detailed information on non-Hodgkin's lymphomas, visit:

National Cancer Institute
The American Cancer Society
The Leukemia and Lymphoma Society