Non-Hodgkin Lymphoma treatment at GenesisCare

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.

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

• 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

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.

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

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.

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

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.

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

cancer.org.au

Australian Cancer Research Foundation

02 9223 7833

acrf.com.au

Leukaemia Foundation

1800 620 420

leukaemia.org.au

Lymphoma Australia

https://www.lymphoma.org.au/

References

1. American Cancer Society https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/b-cell-lymphoma.html
   
2. American Cancer Society https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/b-cell-lymphoma.html