Ignacio first noticed the signs of his non-Hodgkin's lymphoma when he had trouble breathing and was coughing a lot during football practice. At first, Ignacio was scared when he heard that non-Hodgkin's lymphoma is a form of cancer. But he quickly learned that it's highly treatable, especially if it's caught early, as his was. Ignacio was relieved when his doctor told him that the odds were good that he'd be cured.

What Is Non-Hodgkin's Lymphoma?

A lymphoma is a cancer of the lymphatic system. The lymphatic system is a part of the body's immune system and helps filter out bacteria, viruses, and other unwanted substances. Most people don't notice the workings of their lymphatic systems; in fact, the only time you may be aware of your lymphatic system is when the lymph nodes (which are sometimes referred to as glands) swell up. This often happens when a person is sick — a sign that the lymphatic system is working hard to filter harmful substances out of the body.

Non-Hodgkin's lymphoma is a disease in which cancer cells form in a person's lymphatic system and start to grow uncontrollably. There are several different types of lymphomas. Some lymphomas involve a particular type of cell; these are grouped under the heading Hodgkin's disease. All other forms of lymphoma fall into the non-Hodgkin's grouping. The different forms of non-Hodgkin's lymphoma depend on such things as what the cells look like under a microscope.

No one really knows what causes non-Hodgkin's lymphoma. Doctors have identified some risk factors (things that may increase a person's chances of developing a particular condition) for non-Hodgkin's lymphoma. These include conditions that weaken the immune system, such as acquired immunodeficiency syndrome (AIDS), taking immune-suppressing medications following organ transplants, and exposure to certain viruses, such as Epstein-Barr virus (the virus that usually causes mono). People who have a brother or sister who has had the disease are also more likely to get non-Hodgkin's lymphoma.

Of course, just because you've had mono or an organ transplant doesn't mean you'll get the disease: Most people with non-Hodgkin's lymphoma don't have any of these risk factors.

Signs and Symptoms of Non-Hodgkin's Lymphoma

The signs and symptoms of non-Hodgkin's lymphoma vary from person to person depending on the type of lymphoma and where a tumor is located. Some people may feel stomach pain, constipation, and decreased appetite. Others may have trouble breathing, difficulty swallowing, and notice coughing, wheezing, or chest pain. Other symptoms may include:

• painless swollen lymph nodes
• fever, chills, or night sweats
• itchy skin 
• weight loss despite eating normally
• tiredness
• bone or joint pain
• recurring infections

The symptom that some people notice first is swollen lymph nodes — usually in the neck, armpits, and groin. Of course, swollen lymph nodes do not usually mean cancer — they're most often a sign of a common illness, like an infection. In fact, all of the symptoms of non-Hodgkin's lymphoma can also be caused by other conditions, which is why only a doctor can determine what's really wrong.

How Is It Diagnosed?

In addition to doing a physical examination, the doctor will ask you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history. If your family doctor suspects non-Hodgkin's lymphoma, he or she will refer you to an oncologist (pronounced: on-kol-uh-jist), a doctor who specializes in the treatment of cancer. The oncologist will then do tests to diagnose the problem.

If a person has swollen lymph nodes, the doctor may want to perform a biopsy if the swelling does not go down after other treatments. A biopsy is a type of test where a doctor removes a tiny bit of tissue from the body and sends it out to a laboratory for a specialist to examine. Depending on the type of biopsy a person has, a doctor may use local anesthesia (where only a part of the body is numbed) or general anesthesia (where a person is asleep) to ensure the person doesn't feel any pain.

Biopsies used to test for non-Hodgkin's lymphoma include excisional biopsy (where the doctor opens the skin to remove an entire lymph node) or incisional biopsy (where the doctor removes only a part of the lymph node). Another type of biopsy, fine needle aspiration (where a doctor uses a very thin needle to suction out a small amount of tissue from the lymph node) is used on some rare occasions to diagnose non-Hodgkin's lymphoma. Doctors sometimes also perform a bone marrow biopsy, where a needle is used to take samples of the soft tissue found in a person's bone.

Some doctors may do other tests to diagnose non-Hodgkin's lymphoma, including:

• blood tests
• a chest X-ray, a simple procedure in which the person lies on a table while an X-ray machine takes an image of the chest
• a computerized tomography (CT or CAT) scan, which rotates around the patient and creates an X-ray picture of the inside of the body from different angles
• an ultrasound, which uses high-frequency sound waves to create pictures of the inside of the body
• a magnetic resonance imaging (or MRI) scan, which uses magnets and radio waves to allow doctors to see inside the body.
• a gallium scan, which uses the injection of a material known as gallium and can help show tumors and inflammation
• a bone scan to detect bone changes
• a positron emission tomography (PET) scan, which can tell the difference between normal and abnormal cells based on metabolic activity

Once doctors have made a diagnosis of non-Hodgkin's lymphoma, they use what's called a "staging system" to determine how much the disease has affected the body. Knowing what stage the disease is at helps the doctor decide on a form of treatment.

How Is It Treated?

The most common treatment for non-Hodgkin's lymphoma is chemotherapy. Chemotherapy kills or stops the growth of cancer cells. Patients are also sometimes treated with radiation therapy. In addition, some people may have surgery to remove tumors.

For some patients who are receiving very aggressive chemotherapy or radiation treatments, doctors may perform bone marrow or stem cell transplants to replace cells damaged by the chemotherapy or radiation. These transplants involve taking the cells from bone marrow or blood that has either been taken from the patient or has been donated by another person. These cells are then inserted into the patient's bloodstream to replace those that have been damaged or destroyed.

In a few special situations (such as high-risk patients or patients whose cancer has come back), doctors are using a new type of therapy called immunotherapy (or biological therapy) to treat teens with non-Hodgkin's lymphoma. In immunotherapy, doctors use substances that occur naturally in the body to build up a person's natural resistance to disease. Although the substances used in immunotherapy occur naturally in a person's body, the ones used in this medical procedure are often manufactured in a laboratory.

What to Expect

If you've been diagnosed with non-Hodgkin's lymphoma, you know how scary having the disease can be at times. There's a lot to deal with emotionally. Plus, appointments, tests, and treatment schedules can be tiring, and the treatments you have to get can make you feel lousy.

People who are being treated with chemotherapy or radiation can expect certain side effects. Most side effects of treatment are temporary — although, as with all medical treatments, each person is unique and experiences side effects differently. The severity of side effects and how long they last depends on the individual and type of medicine and treatment that a doctor prescribes.

The most common short-term side effects of chemotherapy are nausea, vomiting, or a flu-like feeling. Some people feel weak or dizzy after their treatments, or they run a fever. Others get sores in their mouths or suddenly don't feel much like eating. It's also common for people to lose some or all of their hair. The short-term side effects of radiation can be similar to those of chemotherapy, although the side effects of radiation are usually more localized, meaning they affect only the area that receives the radiation treatment. People can continue to feel side effects for weeks after their treatment ends.

Tell your doctor if you experience any side effects of treatment. Your doctor can also discuss any long-term side effects of the type of treatment you are having.

If you have or have had non-Hodgkin's lymphoma, it's important to see your doctor regularly for the years following treatment. Occasionally, cancer may return, and follow-up appointments with your cancer specialist can help you catch it early if it does.

Although non-Hodgkin's lymphoma can be an aggressive disease, treatments have improved in recent years — and researchers are constantly developing new and improved approaches to curing the disease. Today, the percentage of people who are cured is about 70% or higher. And, for certain types of non-Hodgkin's lymphoma, the cure rate is 90%.

Reviewed by: Donna Patton, MD
Date reviewed: June 2007

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