What is non-Hodgkin lymphoma cancer?
Non-Hodgkin lymphoma (NHL) is a cancer of the lymphatic system and a type of blood cancer. The lymphatic system is a network of lymphatic vessels (thin tubes) and lymph nodes (bean-shaped glands) that are found throughout the body. A fluid called lymph travels through this system, carrying lymphocytes (infection-fighting white blood cells) to areas of the body where they’re needed.
The lymphatic system forms part of our immune system. It helps to fight off infections and works to remove old or abnormal cells, including cancer cells.
Non-Hodgkin lymphoma affects lymphocytes. It can start in the lymph nodes or lymphatic organs and may spread outside the lymphatic system, becoming advanced cancer.
According to Cancer Research UK, around 14,000 people are diagnosed with non-Hodgkin lymphoma every year in the UK, making it the sixth most common type of cancer in adults. However, the right treatment plan can result in a positive outcome for many.
Differences between Hodgkin lymphoma and non-Hodgkin lymphoma
These two types of cancer have similar names and symptoms because they both affect lymphocytes. Non-Hodgkin lymphoma is more common and tends to affect slightly older patients than Hodgkin lymphoma. It’s also treated differently.
This page contains information about non-Hodgkin lymphoma. Learn about Hodgkin lymphoma here, including symptoms, tests and treatments.
Non-Hodgkin lymphoma cancer early signs and symptoms
The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, often in the armpit, groin or neck.
Most people with a swollen lymph node do not have lymphoma. The lymph nodes often swell up when you’re fighting an infection, which is temporary.
Some people with non-Hodgkin lymphoma have other symptoms too, including:
- Intense sweating in the night
- Unexplained weight loss
- Fever
- Feeling out of breath (breathlessness)
- Very itchy skin
Non-Hodgkin lymphoma can also cause other more general symptoms relating to where it’s affecting. These can include stomach pain, a persistent cough, a rash, tiredness, frequent infections, and excessive bleeding like nosebleeds, heavy periods, or blood spots under the skin.
When to see a doctor
Seek medical advice as soon as possible if you have a swollen lymph node that lasts more than six weeks. You should also see a doctor quickly if you have other symptoms of non-Hodgkin lymphoma, even if it’s been less than six weeks.
For many people, their symptoms are caused by another benign condition (not cancer). But the sooner you see a doctor, the sooner you can get the answers or care you need.
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If you would like to contact us in confidence, we will be happy to answer any of your questions.
What causes non-Hodgkin lymphoma cancer?
Non-Hodgkin lymphoma starts when DNA mutations make cells grow and divide out of control, like other cancers. It’s not always known why these mutations happen in non-Hodgkin lymphoma. But some things increase your chances of being affected, which we call risk factors.
Risk factors for non-Hodgkin lymphoma include:
- Having a weakened immune system
- Certain infections and conditions
- Older age – it’s more common in people older than 50
- Being male – it’s slightly more common in men than women
Anyone can be affected, whether they have risk factors or not. Always seek medical advice if you have symptoms of non-Hodgkin lymphoma.
Diagnosis and tests
How is non-Hodgkin lymphoma cancer diagnosed?
For many people, getting diagnosed with non-Hodgkin lymphoma begins by seeing a doctor about their symptoms. They’ll assess you and, if appropriate, refer you for diagnostic tests such as a biopsy, blood tests, X-rays, CT scan or PET-CT scan. The only way to confirm a diagnosis of non-Hodgkin lymphoma is by having a biopsy.
There are many types of non-Hodgkin lymphoma, which depend on the lymphocyte cells they affect. The two main types are B-cell lymphomas and T-cell lymphomas although B-cell lymphoma are much more common.
There are many different subtypes of non-Hodgkin lymphoma but the more common ones include:
- Diffuse large B-cell lymphoma
- Follicular non-Hodgkin lymphoma
- Marginal zone lymphoma
- Mantle cell non-Hodgkin lymphoma
Your biopsy, along with other diagnostic tests, shows which type you have and helps define the stage and grade of the lymphoma. This helps predict how your cancer might behave and respond to treatment.
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Stages of non-Hodgkin lymphoma cancer
The stages of non-Hodgkin lymphoma describe how far the cancer has spread. It’s based on how many areas are affected and where these areas are.
This includes:
- The lymph nodes – single nodes or multiple nodes within a cluster
- Lymphatic organs – the spleen, thymus or tonsils
- Extranodal organs – such as the lungs, liver, blood, bone marrow, kidneys, and brain
- ·The size of the cancer – large areas of lymphoma are called bulky disease
The stages of non-Hodgkin lymphoma can be complex. Your consultant is the best person to explain the stage of your cancer and what this means for your outlook and treatment.
Having advanced non-Hodgkin lymphoma doesn’t always mean a negative outlook. Some types of stage 4 lymphoma are treatable with the right plan.
Stages of non-Hodgkin lymphoma
Stage 1 | Also known as early-stage:
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Stage 2 | Also known as early-stage:
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Stage 3 | Also known as advanced:
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Stage 4 | Also known as advanced or metastatic:
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Non-Hodgkin lymphoma cancer treatment overview
How is non-Hodgkin lymphoma cancer treated?
- Chemotherapy – anticancer (cytotoxic) drugs that destroy cancer cells
- Targeted therapy – a specialised group of drugs that attack or block certain processes in the cancer cells, causing them to die
- Immunotherapy – therapies that help your body’s immune system recognise and fight the cancer
- Radiotherapy – high-energy radiation beams that are targeted at tumours
- Surgery – removing a lymph node for further testing, to drain fluid build-up on the chest, or, very rarely, to treat non-Hodgkin lymphoma
- Stem cell transplants – Given alongside high-dose chemotherapy to support the body and help it to recover more quickly
Chemotherapy uses cytotoxic (anti-cancer) drugs to destroy cancer cells. It’s the most common non-Hodgkin lymphoma treatment and is usually given along with an immunotherapy antibody drug called rituximab. In some cases, it’s combined with other treatments, such as radiotherapy (chemoradiation) and steroids.
If initial treatment doesn’t improve your condition, you may have a course of high-dose chemotherapy. Although intensive chemotherapy can successfully treat non-Hodgkin lymphoma, you’ll need a stem cell transplant alongside this treatment.
Radiotherapy uses targeted, high-energy radiation beams to destroy cancer cells and is a common treatment option for non-Hodgkin lymphoma.
Radiotherapy can be given on its own to target large areas of lymphoma (bulky disease), or in combination with chemotherapy, or after chemotherapy to prevent your cancer returning.
Targeted or biological therapies are specialised drugs designed to attack or block processes that cancer depends on to survive and grow.
Monoclonal antibodies are the main targeted therapy for non-Hodgkin lymphoma. Other targeted therapies, such as tyrosine kinase inhibitors, Bcl-2 inhibitors and PI3k inhibitors, can be combined to control or kill lymphoma cells.
You may need to continue targeted maintenance therapy for several years after your cancer is in remission. Your doctor will explain this in more detail to you.
Immunotherapies help your immune system to recognise and fight cancer. CAR–T cell therapy is a cell transfusion that uses modified immune cells from your blood to treat some forms of relapsed non-Hodgkin lymphoma.
Surgery is usually only needed for help in getting a diagnosis by enabling a larger biopsy or to treat some complications of treatment. Most patients however do not undergo surgery as part of their treatment.
Stem cells are the ‘source’ that platelets and white and red blood cells develop from. A stem cell transplant is sometimes used in treating lymphoma as a way of supporting your body through the chemotherapy, enabling it recover more quickly.
The most common type uses cells previously collected from you (autologous transplant). Much less commonly a donor is used (allogeneic).
If your cancer has become resistant to treatment or recurred, it’s called relapsed or refractory non-Hodgkin lymphoma. At GenesisCare, you can receive palliative drug treatment or radiotherapy for advanced non-Hodgkin lymphoma to reduce your cancer’s progress and ease any symptoms.
For some advanced cancers, we use specialist tests, such as liquid biopsy or genomic testing, to understand the genetic makeup of cancer cells. This helps identify which drugs could work against the particular genetic mutations in your cancer, allowing us to start effective treatment without delay.
There may be opportunities to access clinical trials for the newest treatments for non-Hodgkin lymphoma. Clinical trials can be considered a suitable treatment option if you’ve exhausted standard therapies or evidence suggests the trial treatment will be more successful at treating your condition.
Side effects of non-Hodgkin lymphoma cancer treatment
No treatment is without side effects. Your doctor will explain these to you depending on your treatment plan, together with the ways your treatment plan and supportive care can help to manage or minimise these.
Non-Hodgkin lymphoma cancer risk factors
Risk factors are things that increase your chances of getting a condition.
You’re at higher risk of developing non-Hodgkin lymphoma cancer if:
- You have HIV or a condition that weakens your immune system
- You take medicine that suppresses your immune system
- You have an autoimmune condition
- You’ve had certain infections, including Epstein-Barr, human T-cell lymphotropic virus (HTLV), or Helicobacter pylori infection
- You’ve had chemotherapy or radiotherapy
- A close relative was diagnosed with non-Hodgkin lymphoma, although lymphoma is not generally considered a hereditary condition
Non-Hodgkin lymphoma cancer treatment at GenesisCare
We’re the UK’s leading independent provider of private cancer care. By choosing us, you can be reassured that your treatment is managed by a team of specialists working together with you to decide the best personalised care plan for your non-Hodgkin lymphoma diagnosis.
Our approach to world-class care for non-Hodgkin lymphoma cancer includes:
- A personalised plan built around you
- Treatment starting within days if needed
- 14 outpatient cancer centres across the UK
- State-of-the-art facilities specialising in advanced radiotherapy
- Compassionate chemotherapy nurses available 24/7 by telephone
- Integrative cancer care including wellbeing therapies and exercise medicine
- Recognised by all leading private medical insurers with self-pay options available
We’re proud that so many patients rate our care as excellent as we help them through their cancer journey. Find out more about the unique experiences of people who have had their cancer diagnosis or treatment at GenesisCare in our patient stories section.
At GenesisCare, we offer all drug therapies that can be used to treat and manage non-Hodgkin lymphoma, including chemotherapy and the newest treatments. Our expert teams continually review and assess new treatments to make these available to our patients as early as possible.
Depending on the treatment you’re having, it may be given at one of our dedicated private suites staffed by our specialist nurses, who are also available 24/7 on a dedicated on-call telephone service. They’re able to answer any queries during your treatment, including advice about side effects or symptoms and arrange appropriate medical care when needed.
Our centres have all received the Macmillan Quality Environment Mark to reflect the high quality of care we provide for people living with cancer.
We are the leading private provider of radiotherapy in the UK. We offer world-class expertise, state-of-the-art facilities and advanced radiotherapy techniques.
Your treatment will be governed by our expert multidisciplinary teams (MDTs), consisting of oncologists, radiotherapists and medical physicists. They’ll work together to ensure that you receive only the best possible care.
We offer MRIdian radiotherapy for non-Hodgkin lymphoma patients with gastric lymphoma and residual visible disease in thorax, abdomen and pelvis after having chemotherapy.
We’re equipped with the UK’s first MRI MRIdian Linac, exclusively available to patients across the UK at our centre in Oxford and Cromwell Hospital in London. We accept referrals from all over the UK and can help you with transport depending on your treatment and location.
We offer palliative VMAT radiotherapy for patients with advanced non-Hodgkin lymphoma to improve pain management and increase mobility. We understand that fast access to palliative care is paramount and can usually provide treatment within 48 hours of a planning imaging scan.
We support every non-Hodgkin lymphoma patient through their journey with consultant-led integrative cancer care, which combines medical treatment with life-changing approaches including exercise medicine, wellbeing therapies and psychological support.
You’ll have optional access to a wellbeing expert to guide you through holistic therapies of your choice, such as counselling, acupuncture, massage and reflexology, through our unique partnership with the Penny Brohn UK charity.
Our exercise medicine program includes a 12-week personalised plan provided by a specialist physiotherapist, available at selected centres, with techniques shown to improve outcomes for cancer patients and reduce the impact of cancer by enhancing quality of life, reducing fatigue and improving strength.
FAQs
The best person to tell you about your outlook with non-Hodgkin lymphoma is your doctor because they can consider all the factors individual to you.
The outlook for non-Hodgkin lymphoma depends on the type of cancer, and whether it’s low-grade (indolent) or aggressive.
Most people with low grade non-Hodgkin lymphoma live for many years after their diagnosis and not everyone needs treatment. More aggressive non-Hodgkin lymphoma can often be treated successfully too, and the majority of patients can be cured of their disease. However, treatment usually needs to be more intensive.
Terminal cancer can’t be cured, meaning it’s likely to lead to the end of life. It’s often defined as being expected to live less than six months, though people can live longer or shorter than this.
Sometimes non-Hodgkin lymphoma can be cured, and if not, most cases are considered very treatable. For some, their cancer may eventually become terminal if the benefits of treatment no longer outweigh the side effects, or treatment stops working. This is usually many years after diagnosis.
Having a close relative with non-Hodgkin lymphoma slightly increases your risk of getting the condition yourself. However, it’s not usually hereditary, which is when there is a strong history of the cancer running through the family.
Gene mutations that increase your risk of non-Hodgkin lymphoma are more likely to happen within your life, rather than being inherited from your parents.
Reviewed by: Professor Graham Collin
Haematology Consultant
September 2024
