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Understanding Non-Hodgkin Lymphoma
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Understanding Non-Hodgkin Lymphoma

Learn about the various types of non-Hodgkin lymphoma (NHL), including common signs, how this type of blood cancer is diagnosed, and how it progresses, so that you can make informed decisions regarding your care.

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Symptoms of Non-Hodgkin Lymphoma

Some individuals with lymphoma may experience noticeable symptoms, while others might not notice any changes at all. Recognizing the symptoms of lymphoma can significantly improve your chances of a favorable outcome.

Lymphoma can develop in the lymph nodes, spleen, digestive system, or bone marrow. The symptoms of NHL can vary depending on where the cancer originates and may include: 

  • Painless swelling of lymph nodes in your neck, armpits, or groin
  • Fatigue
  • Night sweats and chills
  • Unexplained weight loss
  • Severe or frequent infections
  • Easy bruising or bleeding
  • Swollen abdomen
  • Nausea and vomiting
  • Shortness of breath or cough

If you experience any of these symptoms that do not resolve after a couple of weeks, it is important to schedule an exam with your doctor. They will conduct tests to rule out other conditions that may cause these symptoms. If your symptoms do not improve, you may be referred to a hematologist for further evaluation.

Diagnosing Non-Hodgkin Lymphoma

Several tests and procedures are used to diagnose lymphoma, including:

  • Physical examination: The doctor will check for swollen lymph nodes in areas such as the neck, armpits, and groin, as well as for signs of a swollen spleen or liver.
  • Urine and blood tests: These can help determine if an infection or a non-cancerous disease causes symptoms.
  • Imaging tests: Tests such as CT scans, MRIs, and PET scans are performed to identify the location of cancer growth and to determine if it has spread to other areas of the body.
  • Biopsy: A lymph node biopsy may be recommended to remove either the entire lymph node (excisional biopsy) or part of a lymph node (incisional biopsy) for laboratory testing. A local anesthetic is typically used for lymph nodes located just under the skin, while deeper lymph nodes in the chest or abdomen may require general anesthesia.
  • Bone marrow biopsy: This involves inserting a needle into the hipbone to remove a sample of bone marrow for analysis.

Depending on your specific situation, your doctor may also request additional tests and procedures to confirm the diagnosis of lymphoma.

Biopsy results will determine whether non-Hodgkin lymphoma is present and its subtype. Understanding the specific type is crucial for selecting the most effective treatments.

Subtypes of Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma can be categorized into several subtypes based on the characteristics of the lymphoma cells, including the type of cell from which the lymphoma originated, its appearance, the presence of specific proteins on the cell surface, genetic makeup, and the speed of its progression. Identifying the subtype is very important as it impacts the recommended treatment approach.

Non-Hodgkin lymphoma typically begins in lymphocytes, which are a type of white blood cell essential to the immune system. Lymphocytes consist of B cells, T cells, and Natural Killer (NK) cells. The type of lymphocyte involved plays a significant role in determining the subtype of NHL:

  • B cells: Fight off infections and account for about 90% of non-Hodgkin lymphoma cases.
  • T cells: Help B cells produce antibodies and represent about 10% of NHL cases in the United States.
  • NK cells: Mutations in NK cells are rare, accounting for about 1% of NHL cases.

Non-Hodgkin lymphomas are also described by their growth rate, with rapidly growing lymphomas called “aggressive” and slow-growing lymphomas called “indolent.”

Types of Indolent (Slow-Growing) Non-Hodgkin Lymphomas

Follicular Lymphoma

Follicular lymphoma, the most common indolent non-Hodgkin lymphoma, is a slow-growing type that starts in B lymphocytes. It primarily affects lymph nodes and may spread to the bone marrow or spleen. Most patients diagnosed with follicular lymphoma are aged 50 or older. In some cases, follicular lymphoma may go away without treatment, and patients are monitored for any signs of recurrence. Treatment becomes necessary if symptoms occur after the cancer disappears or following initial treatment. Occasionally, follicular lymphoma can transform into a more aggressive form, such as diffuse large B-cell lymphoma.

Other common indolent subtypes of NHL include:

  • Cutaneous B-cell lymphoma
  • Hairy cell leukemia
  • Cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome)
  • Marginal zone B-cell lymphoma
  • Lymphomatoid granulomatosis
  • Waldenström macroglobulinemia (lymphoplasmacytic lymphoma)
  • Primary central nervous system lymphoma
  • Lymphoplasmacytic lymphoma/Waldenström macroglobulinemia
  • Gastric mucosa-associated lymphoid tissue (MALT) lymphoma
  • Chronic lymphocytic leukemia/small-cell lymphocytic lymphoma (CLL/SLL)

Aggressive (Fast-Growing) Non-Hodgkin Lymphomas

Diffuse Large B-cell Lymphoma

Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma, characterized by rapid growth in the lymph nodes, and it often affects the spleen, liver, bone marrow, or other organs. Symptoms may include fever, night sweats, and weight loss, collectively referred to as "B symptoms."

Other common aggressive subtypes of NHL include:

  • Anaplastic large-cell lymphoma
  • Lymphoblastic lymphoma
  • Mantle cell lymphoma (MCL)
  • Peripheral T-cell lymphoma (PTCL)
  • Acquired immune deficiency syndrome (AIDS)-associated lymphoma
  • Burkitt lymphoma
  • Transformed follicular and transformed mucosa-associated lymphoid tissue (MALT) lymphomas
  • Central nervous system (CNS) lymphoma

Non-Hodgkin Lymphomas of the Skin

Sometimes, non-Hodgkin lymphoma begins only in the skin, rather than in other organs or tissues. This condition, known as skin lymphoma (or cutaneous lymphoma), is not a type of skin cancer.

Cutaneous T-cell lymphomas (CTCLs) are the most common type of skin lymphoma, typically appearing as a red and dry rash, and can affect large areas of the body. While the disease can affect women, it is most commonly found among men in their 40s, 50s, and 60s.

Several subtypes of CTCL include: 

  • Mycosis fungoides
  • Sezary syndrome (SS)
  • Adult T cell leukemia-lymphoma (ATLL)
  • Primary cutaneous anaplastic large cell lymphoma (C-ALCL)
  • Lymphomatoid papulosis
  • Subcutaneous panniculitis-like T-cell lymphoma
  • Extranodal NK/T-cell lymphoma, nasal type
  • Primary cutaneous peripheral T-cell lymphoma, rare subtypes

Cutaneous B-cell lymphomas (CBCLs), which are less common, can cause lumps in the skin, usually in one or two areas of the body. There are four subtypes of CBCLs, which include:

  • Primary cutaneous marginal zone B-cell lymphoma
  • Primary cutaneous follicle center lymphoma
  • Primary cutaneous diffuse large B-cell lymphoma, leg type
  • Primary cutaneous diffuse large B-cell lymphoma, other

Understanding your NHL subtype is important since it influences the type of treatment you will receive.