Non-Hodgkin lymphoma (NHL) is a name for a group of cancers which arise from lymphocytes (white blood cells) and usually develops in organs associated with the lymphatic system like the spleen, tonsils, or lymph nodes. 

 NHL is distinct from Hodgkin lymphoma for the following reasons:

• pathologic features,

• epidemiology,

• common sites of involvement,

• clinical behaviour,

• and treatment.

 

Symptoms

The most common symptom of non-Hodgkin's lymphoma is an enlarged swelling of lymph nodes of the neck, underarm or groin area.  The swellings are not painful - however there may be some other symptoms such as:

 

• fever

• weight loss and poor appetite

• Constant fatigue

• Night sweats

• Extremely itchy skin

• Reddened, dark, or thick patches on the skin[1]

• Chronic abdominal pain

• Coughing or trouble breathing

• Swelling in the legs

• Anemia

Diagnosis:

If non-Hodgkin's lymphoma is suspected, the doctor will ask questions to determine the medical history of the patient.  The doctor will also feel to determine if the lymph nodes of the neck, underarm, or groin are enlarged.

The doctor may also order a number of tests - for instance for NHL the doctor may order a complete blood count.  In addition the doctor may screen for the presence of lactate dehydrogenase (LDH) - since 50% of patients have elevated serum LDH levels

Diagnosis is usually done by way of a biopsy.  During the procedure a surgeon removes a small sample of the tissue so that it can be examined under a microscope.  Sometimes it may be necessary to also remove a small amount of bone marrow - to see if the cancer has spread.  The information obtained fromt the biopsy will allow the doctor to "stage the cancer" (i.e. help determine the stage of the cancer).  In turn this will help map out a course of treatment.

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Different stages of Non Hodgkin's Lymphoma:

Stage I: cancer is confined to one (lymph node) area.

Stage II: Cancer is found in two or more lymph node areas on the same side of the diaphragm or in one area or organ outside the lymph nodes and in the lymph nodes around it.

Stage III: Cancer is found in lymph node areas on both sides of the diaphragm. The cancer may also have spread to an area or organ near the lymph node or to the spleen.

Stage IV: Cancer has spread to more than one organ outside the lymph system or cancer has spread to only one organ outside the lymph system, but lymph nodes far away from that organ also are involved.

If non-Hodgkin's lymphoma is suspected, the doctor asks about the person's medical history and performs a physical exam. The exam includes feeling to see if the lymph nodes in the neck, underarm, or groin are enlarged. In addition to checking general signs of health, the doctor may perform blood tests.

Excisional biopsy NHL specimen Biopsy: A biopsy is needed to make a diagnosis. A surgeon removes a sample of tissue, which a pathologist can examine under a microscope to check for cancer cells. A biopsy for non-Hodgkin's lymphoma is usually taken from lymph nodes that are enlarged, but other tissues may be sampled as well. Biopsies in internal lymph nodes can also be taken as needle biopsies under the guidance of CT scans. Rarely, an operation called a laparotomy may be performed. During this operation, a surgeon cuts into the abdomen and removes samples of tissue to be checked under a microscope.

 

Treatment:

Treatment of non-Hodgkin's lymphoma is usually done by chemotherapy, radiation therapy, or a combination of these treatments.  For some patients especially where recurrence (cancer keeps coming back following treatment), the doctor may prescribe: Hematopoietic stem cell transplantation (HSCT), or Bone marrow transplantation (BMT). 

Remission of NHL for more than three years usually means that the patient is cured.  Cases of recurrence following three years is rare.