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What is non-Hodgkin lymphoma?
Chapter 01
What is non-Hodgkin lymphoma?
Non-Hodgkin lymphoma, previously known as non-Hodgkin disease, is a blood cancer that starts in the lymphatic system.
The lymphatic system is part of the immune system and includes your lymph glands and organs such as the spleen. Its functions include:
- removal of cellular waste
- absorbing digestive fat
- 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. The abnormal cells grow and multiply, leading to lymph node swelling.
The lymph nodes are the most common part of the body to be affected. But non-Hodgkin lymphoma can also involve the spleen and other extra-nodal sites such as the central nervous system, bone, and lungs. Non-Hodgkin lymphoma can also cause systemic symptoms such as fevers, drenching night sweats, lethargy, and weight loss.
Non-Hodgkin Lymphoma is different from Hodgkin lymphoma and is more common, with a different type of treatment.
Types of non-Hodgkin lymphoma
There are many sub-types of types of non-Hodgkin lymphoma, which differ according to how fast they spread and the severity of symptoms.
These are three types of lymphocytes:
- B-cells – These make antibodies that fight infection in the body.
- T-cells – These help B-cells make antibodies and kill antigens that shouldn’t be in the body.
- Natural Killer (NK) cells – These specialise in killing cancer cells.
- B-cell lymphomas – These make up around 85% of all non-Hodgkin lymphomas.1
- The most common B-cell lymphomas are:
- Diffuse large B-cell lymphoma – fast-growing and disrupts the structure of the lymph node
- Follicular lymphoma – usually grows slowly and cells grow in groups called follicles.
- Less common B-cell lymphomas are:
- Burkitt’s lymphoma – lymph nodes enlarge in many parts of the body
- Marginal zone lymphoma – starts in the tissue that lines some organs
- Mantle cell lymphoma – develops in the outer edge of some lymph cells
- Small lymphocytic lymphoma (SLL) – starts in the lymph nodes
- Chronic lymphocytic leukaemia (CLL) – usually starts in the bone marrow
- The most common B-cell lymphomas are:
- T-cell lymphomas – These make up around 15% of all non-Hodgkin lymphomas2. They include:
- Angioimmunoblastic lymphoma – most common T-cell lymphoma and occurs in lymph nodes
- Anaplastic Large Cell lymphoma – can occur anywhere in the body or on the skin
- Peripheral T-cell lymphoma – often large, painless lymph nodes
- Cutaneous (skin) T-cell lymphoma – causes itchy patches on the skin
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Symptoms of non-Hodgkin lymphoma
Non-Hodgkin lymphoma can cause different symptoms depending on where it’s found in the body. The most common sign is a painless swelling of the lymph nodes, particularly on the neck or groin, or in the armpit.
Other signs and symptoms may include:
- fever
- night sweats
- weight loss
- fatigue
- persistent coughing
- shortness of breath
- itching or skin rashes
- abdominal pain or swelling
Some symptoms of non-Hodgkin lymphoma are referred to as ‘B symptoms’. These symptoms can help doctors predict the severity of the disease. They include:
- frequent, unexplained fevers
- regular night sweats that leave you drenched
- losing large amounts of weight very quickly
Having any of these symptoms doesn’t mean you have non-Hodgkin lymphoma, but you should see your doctor for a check-up.
What causes non-Hodgkin lymphoma?
It’s not known exactly what causes non-Hodgkin lymphoma. However, some factors appear to increase the risk of getting non-Hodgkin lymphoma. These include:
- Weakened immune system – Autoimmune diseases such as rheumatoid arthritis or a weakened autoimmune system from taking medication can slightly increase your risk
- Certain viruses – The Epstein-Barr virus which causes glandular fever, hepatitis C, HHV-8 (human herpesvirus 8), HIV and HTLV-1 (human T-cell lymphotropic virus 1) may increase the risk
- Family history – Having a first-degree relative who has had non-Hodgkin lymphoma slightly increases the risk of developing it
- Genetics – Specific genes are believed to play a role in the development of the disease. Sometimes genes can mutate when they’re exposed to certain chemicals
Diagnosis
Chapter 02
Diagnosing non-Hodgkin lymphoma
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. These tests may include a lymph node biopsy. There are two different types of lymph node biopsy:
- 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:
- Blood tests – You will likely have a Full Blood Count (FBC), which assesses the number of red cells, white cells and platelets in the blood. Blood tests may also help determine if your kidneys and liver are working well.
- Imaging tests – These might include an ultrasound to find other swollen lymph nodes, and a PET-CT scan of your neck, chest, abdomen and pelvis to work out how far the Hodgkin 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.
- Cardiac testing – An echocardiogram (ultrasound of the heart) or gated heart pool test (nuclear medicine scan of the heart) is usually performed to appraise your baseline cardiac function, prior to chemotherapy
- 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.
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.
Doctors also give non-Hodgkin lymphoma a letter A or B.
- 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.
Treatments options
Chapter 03
Treatments for non-Hodgkin lymphoma
Treatment may not be needed immediately for non-Hodgkin lymphoma. If your lymphoma is low grade, your doctors might take a watch-and-wait approach. In this case, you will receive regular check-ups but will only receive treatment if you need it.
The primary treatment for intermediate or high-grade non-Hodgkin lymphoma is chemotherapy. Other treatments that may be offered include:
- cellular therapy
- chemotherapy for non-Hodgkin lymphoma
- radiation therapy
- stem cell or bone marrow transplant
- steroids
- targeted therapy

This treatment aims to harness your body’s immune system to kill the lymphoma cells by forming a link between the immune system and the lymphoma cell. These treatments include Chimeric Antigen Receptor (CAR) T cell therapy, or bispecific T cell engager therapies.
Chemotherapy is a common form of treatment for non-Hodgkin lymphoma. It is used differently for different grade lymphomas. For example, it may be given together with radiation therapy, steroids, targeted therapy, or immunotherapy.
Radiation therapy may be your primary treatment if your lymphoma is caught early. If the lymphoma is detected later, it may be used with chemotherapy.
Depending on how you respond to other treatments, your doctor may suggest stem cell treatment. Stem cells are removed from your blood, stored while you have further chemotherapy or radiation therapy and then put back into your body.
These can be used alongside chemotherapy to help increase the effectiveness and reduce nausea and vomiting. They come in tablet form or can be given intravenously.
Targeted drug treatments attack specific features of cancer cells. They don’t harm the useful cells in your body, meaning there are often fewer side effects than with chemotherapy. It can be given alongside chemotherapy.
Your treatment with GenesisCare
Chapter 04
Your treatment with GenesisCare
We understand that a cancer diagnosis can be emotional and life changing. It’s natural to feel disbelief, anxiety, sadness, anger and loneliness. At GenesisCare, we strive to strengthen your confidence, settle your emotions and create care experiences that give you the best possible outcomes.
Our care team will know your name and get to know who you are as a person. We don’t want you to feel alone when you’re at GenesisCare. Your nursing team and oncology team are here to support you before, during and after your cancer treatment. We are here to guide you to get you the support you need from experts such as psychologists, exercise physiologists, physiotherapists and dietitians.
Please contact your local GenesisCare centre for more details on the services available. View a list of our centres here.

Side effects
Chapter 05
Side effects
Side effects of chemotherapy
Whether you experience side effects and how severe they are depends on the type and dose of chemotherapy treatment you are given and your reaction from one treatment cycle to the next. Most side effects are short term and can be managed. These may include:
- fatigue
- nausea or vomiting
- constipation or diarrhoea
- hair loss
- reduced immunity which can lead to infection
- easily bruising or bleeding
- weight changes
- skin changes
- mood changes
- sores and pain around the mouth.
These symptoms tend to improve gradually once treatment stops and the normal, healthy cells recover. Talk to your doctor or nurse if you feel upset or anxious about how long treatment is taking or the impact of side effects.
What can I do to help my chemotherapy treatment go smoothly?
- Get as much rest as possible
- Aim for a wholefood, varied diet, but we also encourage you to eat foods that interest you rather than what you think you should eat
- Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
- Drink lots of water
- Reach out to support groups and others who have had chemotherapy.
- Ask your team about topical treatments for skin if you are getting irritation or pain
- Stay out of the sun as much as possible throughout your treatment.
- Record your side effects in a diary or journal
- Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve your mood. Plan your exercise for times in the day when you know you have more energy
- It is important to acknowledge when you are fatigued and rest when you need to
- Ask for and accept help from family, friends and neighbours
- Be open with employers about your treatment and discuss flexible working options if you need them
Side effects of radiation therapy
General side effects of radiation therapy include:
- soreness and swelling around the treatment area
- tiredness and lethargy for a few weeks after you finish
Specific side effects (depending on the area being treated) include:
- digestive issues – reduced appetite, pain, discomfort, or bloating
- change in bowel habits
- nausea or vomiting
- radiation therapy in the neck can increase the risk of an underactive thyroid gland
Most of these side effects will ease soon after treatment is finished. Your team will discuss any long-term considerations with you.
Side effects of stem cell transplant
Side effects from a stem cell transplant can also include the side effects from chemotherapy or radiation therapy that may be performed before the transplant. These may include:
- nausea and vomiting
- stomach cramps
- infection
Side effects of steroids
These may include:
- problems sleeping
- mood changes
- weight gain
- heartburn
Side effects of targeted therapy
The side effects may vary depending on the type of targeted therapy you have and how your body reacts. These may include:
- diarrhoea
- fatigue
- nausea
- numbness or tingling
- headaches
- skin rashes
Side effects of immunotherapy
These may include:
- fatigue
- bowel issues
- headaches
- fever or chills
- nausea or vomiting
- weight loss
- itching or localised rashes
Helpful services
Chapter 06
Helpful services
Other Non-Hodgkin lymphoma information, resources and support services are available to assist you during your cancer journey. These include:
Cancer Council
13 11 20
Australian Cancer Research Foundation
02 9223 7833
Leukaemia Foundation
1800 620 420
Lymphoma Australia

References
- American Cancer Society https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/b-cell-lymphoma.html
- American Cancer Society https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/b-cell-lymphoma.html
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Radiation therapy kills cancer cells. It’s used in the early stages of cancer treatment or after it has started to spread.

Condition
Blood cancer
Blood cancers affect blood, bone marrow and lymph nodes. Cancerous cells prevent your blood from carrying out its normal functions.

Condition
Hodgkin’s lymphoma
The main difference between Hodgkin lymphoma and non-Hodgkin lymphoma is that the cancer affects different white blood cells.

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