Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma, previously known as non-Hodgkin disease, is a blood cancer that starts in the lymphatic system.¹

The lymphatic system is part of the immune system and includes your lymph glands and organs such as the spleen. Its functions include:¹

• Removal of cellular waste
• Carrying nutrients
• Production of immune cells to help fight infections.

The lymphatic system contains white blood cells called lymphocytes. Non-Hodgkin lymphoma starts in these lymphocytes and causes abnormal lymphocytes, which typically reside in the lymph glands.¹ The abnormal cells grow and multiply, leading to lymph node swelling.¹

The lymph nodes are the most common part of the body to be affected.¹But non-Hodgkin lymphoma can also involve the spleen and other extra-nodal sites such as the central nervous system, bone, and stomach.¹Non-Hodgkin lymphoma can also cause systemic symptoms such as fevers, drenching night sweats, lethargy, and weight loss.¹

Non-Hodgkin Lymphoma is different from Hodgkin lymphoma and is more common.¹

Your GP will probably refer you to a specialist if they are concerned about your symptoms and risk factors for non-Hodgkin lymphoma. Your doctors will perform a complete physical examination and may also order tests to help them make a diagnosis.¹ These tests may include a lymph node biopsy. There are two different types of lymph node biopsy:¹

• Excision biopsy –This is when the lymph node, or part of it, is removed with surgery
• Core biopsy –A needle is inserted into a lymph node to remove cells and tissue. This approach is used when it would be difficult to remove the entire lymph node in surgery

If a biopsy confirms non-Hodgkin lymphoma, you may need further tests, including:¹

• Blood tests –You will likely have a blood count, which assesses the number of red cells, white cells and platelets in the blood, they may also help determine if your kidneys and liver are working well
• Imaging tests – These might include an ultrasound to help guide the needle during a core biopsy, a chest X-ray to see if the lymphoma has spread to lymph nodes in your chest or lungs, and a PET-CT scan of your chest, abdomen and pelvis to work out how far the lymphoma has spread - this helps create a detailed picture of your body
• Bone marrow biopsy – A sample of bone marrow is taken from the pelvic bone and examined under a microscope

If you are found to have lymphoma, your doctor will explain which of the four stages you have and how far your cancer has progressed. Stage 1 is the least advanced stage, while Stage 4 is the most advanced stage.¹

Doctors also give non-Hodgkin lymphoma a letter A or B:¹

• A means you have none of the ‘B-symptoms’ of lymphoma, which are frequent unexplained fevers, regular night sweats and losing weight very quickly.
• B means you are experiencing some or all the above symptoms.

Fertility preservation

Depending on your age and personal wishes, referral to a fertility specialist to arrange urgent semen cryopreservation (sperm freezing), oocyte cryopreservation (egg freezing) or in vitro fertilization (IVF) to facilitate embryo collection and storage may be warranted, as many types of chemotherapy for lymphoma can cause temporary (or permanent) infertility.^1,2

The treatment offered for non Hodgkin lymphoma depends on a number of factors including the stage and grade, location, severity of symptoms, age, and overall health.¹ Common treatment options for non Hodgkin lymphoma include:

Active monitoring - If you are diagnosed with a low grade lymphoma, your treating doctor may recommend monitoring the cancer with regular check-ups rather than commencing treatment.¹

Chemotherapy - Chemotherapy is an approach to cancer therapy which involves the administration of medicine, usually orally or by injection, which is intended to kill cancer cells or minimise their growth and spread. Chemotherapy can be used in conjunction with other cancer treatments.³

Immunotherapy - Immunotherapy is a type of treatment that is intended to help your own immune system fight cancer. There are different types of immunotherapy for cancer that work in different ways.⁴

Radiation therapy - Radiation therapy may be offered in the early stages of cancer treatment, or after it has started to spread. There are different radiation therapy techniques which may be suitable for different cancer types at different stages.⁵

Surgery - Surgery may be used to help treat lymphomas that have started in organs such as the spleen, thyroid or stomach, and that have not spread from these organs. It can sometimes also be used to treat certain types of skin lymphomas.⁶

Targeted therapy - This type of treatment is designed and aims to attack specific cancer cells. Targeted therapy medicines mimic antibodies that our bodies naturally produce that target and attach to proteins on cancer cells, making it easier for our immune system to find and destroy the cancer.¹

Steroids - Steroids are chemicals naturally made in the body that can also be produced in a lab and then used as a medicine. Steroids may be used to increase the effect of chemotherapy, seek to destroy lymphoma, and to help treat certain potential side effects.¹

Stem cell transplant - A stem cell transplant may be recommended if your Non-Hodgkin Lymphoma comes back or doesn’t respond to other treatments.¹ For stem cell transplant your bone marrow has to be destroyed with a high dose chemotherapy treatment. This gets rid of the damaged or destroyed blood stem cells in the bone marrow, which are then replaced with healthy stem cells that can turn into bone marrow. These can be your own blood stem cells or from a donor.¹

We understand that a cancer diagnosis may be life-changing for you. It’s natural to feel fear, anxiety, sadness, anger and frustration.¹ We strive to offer a high-quality, personalised care experience, designed to help you achieve the best possible clinical outcomes.

Your care team aims to get to know you as a person. At GenesisCare we believe care should be focused on you, the individual, not the condition. We don't want you to feel alone. Our nursing and oncology team are here to help support you before, during, and after your cancer treatment.

Your care will be managed by a multidisciplinary team of passionate healthcare professionals with experience in oncology which may include: haematologists, radiation oncologists, medical oncologists, registered nurses, radiation therapists, physicists, and a dedicated team of support staff.

Please contact your local GenesisCare centre for more details on the services available. View a list of our centres here.