Non-Hodgkin Lymphoma - Types, Symptoms, Causes, Diagnosis, and Treatment

What Is Non-Hodgkin Lymphoma?

Nonhodgkin lymphoma (NHL) is a peculiar form of cancer that specifically focuses on the lymphatic system. The lymphatic system encompasses lymphatic vessels and lymph nodes, which hold an integral role in contributing to the body’s immunity. Lymphatic fluid streams through these vessels, which are rich in a particular type of white blood cell called lymphocytes. Lymphocytes are the target cells in non-Hodgkin lymphoma. The cancerous development of these lymphocytes triggers an exponential growth often leading to the piling up of immature, impaired, and nonfunctional lymphocytes within the lymphatic system giving rise to non-Hodgkins lymphoma.

What Are the Symptoms of Non-Hodgkin Lymphoma?

• Swollen lymph nodes are the characteristic feature of NHL, as excess lymphocytes pile up, causing them to swell. They are painless and present with huge lumps that can be seen near the underarm, neck, and pubic area.

• Uncontrolled fevers, rising to 103 Fahrenheit, which is associated with fatigue.

• Weight loss for no reason.

• Profuse sweating at night times.

• Pain in the chest, abdomen, persistent cough.

NHL symptoms are commonly seen in any other health condition. Hence approaching the doctor at the earliest could rule out the cause.

What Are the Causes of Non-Hodgkin Lymphoma?

The exact cause of NHL is unknown, but some of the risk factors make the lymphocytes in the lymphatic system grow excessively and out of control. This excess growth of lymphocytes forms lumps (tumors) throughout the body. And the risk factors include:

• Excessive use of immunosuppressant drugs.

• Bacterial and viral infections.

• Genetic mutations are acquired over time.

Generally, lymphocytes have a certain amount of life span, after which they die, and new ones replace the dead lymphocytes, but in NHL, old lymphocytes do not die, and new lymphocyte productions take place. These excess lymphocytes pile up in lymph nodes, causing enlargement of lymph nodes.

There are two types of lymphocytes, namely T-lymphocytes (which protect the body by killing foreign bodies) and B-lymphocytes (which produce antibodies to fight against infection). Treatment depends on whether the NHL would develop in B-cells or T-cells.

How to Diagnose Non-Hodgkin Lymphoma?

When the person faces the symptoms and approaches the doctor, then the doctor would suggest the following tests to confirm NHL:

1) Physical Examination: In this, doctors ask about the family history, underlying medical conditions, medication used for the health problems, and habits. Afterward, the doctor will personally examine the swollen lymph nodes by palpation (touch) near the neck, underarms, and pelvic region.

2) Lymph Node Biopsy: A small piece of a lymph node is removed and sent to the lab to determine the type of NHL and its stage. It can be done in the following methods:

• Incisional Biopsy: A small part of the lymph node is removed for laboratory analysis.

• Excisional Biopsy: Entire lymph node is removed for laboratory examination.

• FNAC (Fine Needle Aspiration Cytology): A long thin hollow needle is inserted into the lymph node, and a small amount of tissue is drawn through the needle and sent to the lab for cancer cell detection.

• Bone Marrow Biopsy: It includes both bone marrow aspiration, where a small amount of fluid is drawn from bone marrow and tested for cancer cells, and bone marrow biopsy, in which a small piece of bone, including the marrow (usually taken from the pelvic area) is removed out using a large needle and send to the lab for diagnosis. Bone marrow biopsy is indicated to check whether the cancer cells have reached the bone marrow.

3) Spinal Tap Test: Also called as lumbar puncture test, this is done to determine the presence of cancerous lymphoma cells in cerebrospinal fluid, a fluid that acts as a cushion and protects the brain.

4) Imaging Test: Such as CT (computed tomography), MRI (magnetic resonance imaging), PET scan (positron emission tomography), X-rays, ultrasound, and bone scans are used in the diagnosis of NHL.

5) Blood Investigations: Blood tests do not diagnose NHL but help to know about the general health of the patient and also to rule out certain infections. CBP (complete blood picture) is commonly indicated.

6) LDH (Lactate Dehydrogenase): High levels of LDH are detected in lymphomas.

What Is the Treatment for Non-Hodgkin Lymphoma?

Treatment usually depends on the type and stage of NHL.

1. Chemotherapy: It is the primary option for treating NHL. Drugs are given orally or in the form of injections. Chemotherapy, when combined with bone marrow transplantation, gives better results. The drugs include:

   1. Corticosteroids: Prednisone, Methylprednisolone.

   2. Alkylating Agents: Cyclophosphamide, Bendamustine.

   3. Anti Metabolites: Gemcitabine, Methotrexate.

   4. Analogs of Purine: Pentostatin, Fludarabine.

2. Radiation Therapy: A high-energy beam of rays is used to kill cancer cells. These rays can be X-rays, gamma rays, proton rays, or photon rays. The doctor decides what type of rays are used for the treatment. In external beam radiation, patients are made to lie flat on the table, and the radiation machine revolves around the affected organ (lymph nodes and the surrounding tissues). These high-energy X-rays kill the cancer and make the cancer shrink in size. Radiation therapy is often combined with chemotherapy in NHL.

3. Targeted Drug Therapy: These drugs are mainly targeted towards cancer cells. Usually, a normal cell turns into cancerous cells because of the abnormality or malformations in the cells' DNA (deoxyribose nucleic acid). These drugs mainly interrupt the functions and division of the cancer cells, thereby causing them to die. These drugs include Proteasome inhibitors, BTK inhibitors, and EZH2 inhibitors.

4. Immunotherapy: Immunotherapy uses the body's immune system to fight against cancer. Immunotherapy drugs like monoclonal antibodies, antibodies targeting CD52, CD30, and CD20, elevate the immunity of the patients and help in fighting against the cancerous lymphoma cells.

5. Stem Cell Transplant: Also called bone marrow transplantation, in which healthy bone marrow cells, either from the patient's own body or from the donor, are collected and injected into the blood. These healthy cells travel along the blood and help in the formation of new bone marrow.

6. Palliative Care in NHL: Palliative also known as supportive care, is nothing but the care taken to support the patient to overcome the symptoms of NHL along with treatment side effects. Especially in NHL, patients suffer from infections and low blood cell count. Hence care must be taken to eliminate the infections (using antibiotics) and to improve the blood count by blood transfusions.

Large doses of chemotherapy drugs along with radiation are used to suppress the body’s immunity system.

Conclusion

Non-Hodgkin lymphoma is a fatal disease, where the disease undergoes periods of remission and flare-ups. Early detection of NHL can give good treatment results. In conditions of distant metastases avoiding risk factors, making changes in the lifestyle, and undergoing palliative care can improve the life expectancy of the patient.