Non-hodgkin’s lymphoma (NHL)

Non-Hodgkin’s Lymphoma patient

Facts and figures of non-hodgkin’s lymphoma

6th most common cancer in adults in the UK, approximately 12,800 new cases diagnosed each year, which accounts for around 4% of all new cancer cases. Slightly higher incidence in men. Age related, can occur at any age but 60% are diagnosed in the over 60 years age group. There are 60 different types of NHL and they can behave differently.

Most NHL cases are B cell lymphomas, but there are a group of T cell lymphomas that more commonly occur in teenagers and young adults. Most common site is the lymph nodes in the neck, but often found in the liver or spleen and can occur in other body organs. Approximately 33% of patients will have lymphoma in organs outside of the lymphatics.

Abnormal lymphocytes collect in lymph nodes and other places such as the bone marrow and spleen. The causes are unknown but risk factors include a weakened immune system, HIV and AIDS, auto immune diseases, previous Hodgkin’s lymphoma or leukaemia and having a first degree relative diagnosed with NHL slightly increases the risk.

Non-Hodgkin’s Lymphoma Symptoms

  • Swelling/lump in the neck, groin or axilla, usually painless – most common presenting symptom, particularly lymph nodes in the neck.
  • Night sweats/fever.
  • Unexplained weight loss.
  • Persistent tiredness.
  • Increased incidents of infection.
  • Persistent cough/breathlessness.
  • Persistent itching.

Diagnosis of Non-Hodgkin’s Lymphoma

Investigations may include:

  • Physical examination.
  • Biopsy –tissue sample taken from the lymph node and sent for analysis.
  • Blood tests.
  • Bone marrow biopsy.
  • Liver biopsy.
  • Chest X-ray.
  • Lymphangiogram.
  • CT scan.
  • MRI scan.
  • Laparotomy.

Non-hodgkin’s lymphoma treatment

Depends on several factors:

  • Stage of the disease.
  • Age and general health.

Monitoring

In some cases of slow growing NHL that are not causing any symptoms, the initial treatment is to monitor the patient and treat at some stage if required.

Chemotherapy

Chemotherapy is the main treatment; there are many different regimens and the drugs used will depend on the type of NHL. The most common is CHOP –Cyclophosphamide, Doxorubin (Doxorubicin Hydrochloride), Vincristine and Prednisolone. This has been found to be highly effect for aggressive lymphomas and has been used for a long time. It is sometimes given without the doxorubicin (CVP) in patients that have pre-existing cardiac conditions.

Radiotherapy

Radiotherapy may be recommended if there are lymphomas cells in only one or two areas of lymph nodes in one part of the body. It may be given after chemotherapy and sometimes this is to reduce the risk of recurrence. Radiotherapy is occasionally used to shrink large lymph nodes for symptom control.

Stem cell transplant

Stem cell transplant may be an option if the lymphoma is in remission but likely to recur, if the lymphoma is in second remission or has not responded to other treatments.

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