What is non-Hodgkin lymphoma? - Lymphoma Association
What is non-Hodgkin lymphoma? - Lymphoma Association
What is non-Hodgkin lymphoma? - Lymphoma Association
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Freephone helpline 0808 808 5555<br />
information@<strong>lymphoma</strong>s.org.uk<br />
www.<strong>lymphoma</strong>s.org.uk<br />
<strong>What</strong> <strong>is</strong> <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>?<br />
<strong>Lymphoma</strong>s are cancers of the lymphatic system and <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> <strong>is</strong> a type<br />
of <strong>lymphoma</strong>. In th<strong>is</strong> leaflet we aim to answer some of the questions people newly<br />
diagnosed with <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>, or their relatives, may have:<br />
● <strong>What</strong> <strong>is</strong> the lymphatic system? (see below)<br />
● <strong>What</strong> <strong>is</strong> <strong>lymphoma</strong>? (page 2)<br />
● <strong>What</strong> causes <strong>lymphoma</strong>? (page 2)<br />
● <strong>What</strong> kinds of <strong>lymphoma</strong> are there? (page 3)<br />
● Who <strong>is</strong> affected by <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>? (page 3)<br />
● <strong>What</strong> <strong>is</strong> high-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>? (page 3)<br />
● <strong>What</strong> <strong>is</strong> low-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>? (page 4)<br />
<strong>What</strong> <strong>is</strong> the lymphatic system?<br />
The lymphatic system <strong>is</strong> made up of tubes<br />
(lymph vessels), glands (lymph nodes) and<br />
other organs including the spleen. The<br />
vessels and glands hold a fluid called lymph.<br />
The lymphatic system helps us to fight<br />
infection – it carries white blood cells<br />
called lymphocytes. It <strong>is</strong> part of our<br />
immune system, the body’s natural<br />
defence against infection. It has a number<br />
of other jobs including:<br />
● draining waste products from around<br />
the body<br />
● draining fluid when there <strong>is</strong> too much in<br />
some parts of the body<br />
● moving waste products and fluid to the<br />
bloodstream to be dealt with elsewhere<br />
● moving around cells and other<br />
substances needed in different parts<br />
of the body.<br />
Figure 1: The lymphatic system<br />
Neck (cervical)<br />
lymph nodes<br />
Lymph vessels<br />
Armpit (axillary)<br />
lymph nodes<br />
Groin (inguinal)<br />
lymph nodes<br />
Thymus<br />
Diaphragm<br />
(muscle that<br />
separates the<br />
chest from<br />
the abdomen)<br />
Spleen<br />
Liver<br />
<strong>What</strong> <strong>is</strong> <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>?<br />
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The lymph nodes act as a sieve in the lymphatic system and are home to large<br />
numbers of lymphocytes. They help to ‘kick start’ your body’s fight against infection.<br />
You might have noticed that you develop lumps in your neck when you have a sore<br />
throat. Th<strong>is</strong> <strong>is</strong> because more lymphocytes have been made to fight the infection and<br />
these have collected in the lymph nodes nearby.<br />
You have lymph nodes and lymph vessels throughout your body. The lymph nodes are<br />
often found in groups. Some of these may be easily felt, particularly under the arms,<br />
in the neck and in the groin; others are deep inside us and can only be seen on scans.<br />
For more detailed information about the lymphatic and immune systems please<br />
ring our helpline (0808 808 5555).<br />
<strong>What</strong> <strong>is</strong> <strong>lymphoma</strong>?<br />
<strong>Lymphoma</strong> <strong>is</strong> a cancer of the lymphatic system. It forms when some of the body’s<br />
lymphocytes become abnormal and collect in large numbers.<br />
Our lymphocytes are always dividing to make new cells to fight infections. Normally<br />
many of these lymphocytes are not useful because they do not target an infection and<br />
they quickly die. <strong>Lymphoma</strong>s grow when something interferes with how a lymphocyte<br />
divides or how long it lives for. The ‘rogue’ lymphocytes divide more quickly than<br />
normal or do not die when they should. They build up in an abnormal way, most often<br />
in one or more lymph nodes. Th<strong>is</strong> makes the lymph nodes enlarge (swell).<br />
<strong>Lymphoma</strong> can affect lymph nodes in all parts of the body. It can also affect other<br />
organs such as the spleen or the bone marrow. Although <strong>lymphoma</strong> <strong>is</strong> normally found<br />
in the lymphatic system, it can grow in other areas of the body too. For example,<br />
<strong>lymphoma</strong> can affect the stomach, the liver, the skin or the nervous system. D<strong>is</strong>ease<br />
in areas outside of the lymph nodes <strong>is</strong> called extranodal <strong>lymphoma</strong>.<br />
Like other cancers, <strong>lymphoma</strong> can prevent the part of the body that <strong>is</strong> affected from<br />
working properly. For example, <strong>lymphoma</strong> in the bone marrow might stop it making<br />
new blood cells as well as it should.<br />
<strong>What</strong> causes <strong>lymphoma</strong>?<br />
In most cases the cause of <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> <strong>is</strong> unknown. A few less common<br />
kinds of <strong>lymphoma</strong> grow as a result of particular viral infections.<br />
Although anyone can develop a <strong>lymphoma</strong>, some people are more at r<strong>is</strong>k. Th<strong>is</strong> <strong>is</strong><br />
usually because they have another medical condition that interferes with their immune<br />
system. For example, people who have HIV (human immunodeficiency virus) and<br />
AIDS (acquired immune deficiency syndrome) are more at r<strong>is</strong>k of developing certain<br />
types of <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>.<br />
Many research studies have suggested other possible links, such chemicals in the<br />
workplace or a higher r<strong>is</strong>k in some families. For most <strong>lymphoma</strong>s no links have so<br />
far been proven. It <strong>is</strong> likely to be a long time before scient<strong>is</strong>ts fully understand what<br />
causes <strong>lymphoma</strong>.<br />
<strong>What</strong> <strong>is</strong> <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>?<br />
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For now it <strong>is</strong> important you know:<br />
● You have not done anything to yourself to cause <strong>lymphoma</strong>.<br />
● You did not inherit it from your parents.<br />
● You didn’t catch <strong>lymphoma</strong> and you can’t pass it on to anyone else.<br />
For more detailed information about the causes of <strong>lymphoma</strong> please ring our<br />
helpline (0808 808 5555).<br />
<strong>What</strong> kinds of <strong>lymphoma</strong> are there?<br />
There are many different types of <strong>lymphoma</strong>. <strong>Lymphoma</strong>s are classified (sorted and<br />
grouped) by:<br />
● what the cells look like under a microscope<br />
● what chemicals or proteins are on the surface of the cells<br />
● what changes have happened to the genes in the cells.<br />
Th<strong>is</strong> information helps your special<strong>is</strong>t know exactly which <strong>lymphoma</strong> you have. Th<strong>is</strong> <strong>is</strong><br />
important because some types can affect the body differently and they often need to<br />
be treated differently too.<br />
There are two main categories of <strong>lymphoma</strong> – <strong>Hodgkin</strong> <strong>lymphoma</strong> and <strong>non</strong>-<strong>Hodgkin</strong><br />
<strong>lymphoma</strong>. In <strong>Hodgkin</strong> <strong>lymphoma</strong>, particular abnormal cells (called <strong>Hodgkin</strong> and<br />
Reed–Sternberg cells) are usually seen under the microscope. Any other <strong>lymphoma</strong> <strong>is</strong><br />
called a <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> because these particular cells are not seen.<br />
There are lots of different types of <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>. An expert <strong>lymphoma</strong><br />
patholog<strong>is</strong>t will arrange more lab tests to work out exactly which type of <strong>lymphoma</strong><br />
you have.<br />
The rest of th<strong>is</strong> leaflet gives information that <strong>is</strong> just about <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>.<br />
If you need information about <strong>Hodgkin</strong> <strong>lymphoma</strong> instead, please see our website<br />
or ring our helpline (0808 808 5555).<br />
Who <strong>is</strong> affected by <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>?<br />
Non-<strong>Hodgkin</strong> <strong>lymphoma</strong>s are much more common than <strong>Hodgkin</strong> <strong>lymphoma</strong>s. More<br />
than 12,000 people are diagnosed with <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> each year in the UK.<br />
Non-<strong>Hodgkin</strong> <strong>lymphoma</strong>s are more common in people aged over 55. They are now one<br />
of the most common cancers in people over the age of 75.<br />
There are many different types of <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> – some of them grow quickly<br />
and others grow slowly. Doctors call these high-grade (fast-growing) <strong>non</strong>-<strong>Hodgkin</strong><br />
<strong>lymphoma</strong> or low-grade (slow-growing) <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>.<br />
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<strong>What</strong> <strong>is</strong> high-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>?<br />
Non-<strong>Hodgkin</strong> <strong>lymphoma</strong> <strong>is</strong> called ‘high grade’ when the cells appear to be dividing<br />
quickly. These <strong>lymphoma</strong>s are also sometimes called ‘aggressive’ <strong>non</strong>-<strong>Hodgkin</strong><br />
<strong>lymphoma</strong>s. Some types of high-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> will grow faster than<br />
others.<br />
The most common high-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> <strong>is</strong>:<br />
● diffuse large B-cell <strong>lymphoma</strong>.<br />
Other high-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>s include:<br />
● Burkitt <strong>lymphoma</strong><br />
● lymphoblastic <strong>lymphoma</strong><br />
● peripheral T-cell <strong>lymphoma</strong><br />
● mantle cell <strong>lymphoma</strong>.<br />
High-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>s are more common in people aged over 50,<br />
but they can occur at any age, even in children. Although the terms ‘high grade’ and<br />
‘aggressive’ sound alarming, these d<strong>is</strong>eases can respond very well to treatment.<br />
High-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> can be cured in many cases.<br />
<strong>What</strong> <strong>is</strong> low-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>?<br />
Non-<strong>Hodgkin</strong> <strong>lymphoma</strong> <strong>is</strong> called ‘low grade’ when the cells appear to be dividing<br />
slowly. Th<strong>is</strong> means that low-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> can take a long time<br />
to develop. These <strong>lymphoma</strong>s are also sometimes called ‘indolent’ <strong>non</strong>-<strong>Hodgkin</strong><br />
<strong>lymphoma</strong>s.<br />
The most common low-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> <strong>is</strong>:<br />
● follicular <strong>lymphoma</strong>.<br />
Other low-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>s include:<br />
● small lymphocytic <strong>lymphoma</strong> / chronic lymphocytic leukaemia<br />
● lymphoplasmacytic <strong>lymphoma</strong> (sometimes known as Waldenström’s<br />
macroglobulinaemia)<br />
● marginal zone <strong>lymphoma</strong>s including MALT <strong>lymphoma</strong>s.<br />
Early-stage low-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> can be cured in some cases. However,<br />
most people have advanced-stage low-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> by the time they<br />
are diagnosed.<br />
The stage of a <strong>lymphoma</strong> shows how many different groups of lymph nodes or other<br />
parts of you the <strong>lymphoma</strong> <strong>is</strong> affecting. Only one area (or sometimes two areas)<br />
affected <strong>is</strong> called early stage; three or more areas (and sometimes two areas) affected<br />
<strong>is</strong> called advanced stage.<br />
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Advanced-stage low-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong>s are more difficult to completely<br />
cure. They are chronic (long-term) illnesses that are not always active but rarely go away<br />
completely. Doctors usually aim to control advanced-stage low-grade <strong>non</strong>-<strong>Hodgkin</strong><br />
<strong>lymphoma</strong> rather than cure it. People with low-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> often go<br />
for months or even years at a time when they feel well and don’t need any treatment.<br />
Acknowledgement<br />
We are grateful to Drs Chr<strong>is</strong> Hatton and Graham Collins, consultant haematolog<strong>is</strong>ts,<br />
Oxford University Hospitals NHS Trust, who reviewed our booklets High-grade<br />
<strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> and Low-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> on which th<strong>is</strong><br />
information <strong>is</strong> based. We also w<strong>is</strong>h to thank all those people affected by <strong>lymphoma</strong><br />
who have helped us to develop our information.<br />
More information about <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong><br />
We produce a range of booklets including Low-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> and<br />
High-grade <strong>non</strong>-<strong>Hodgkin</strong> <strong>lymphoma</strong> as well as various information leaflets on specific<br />
types of <strong>lymphoma</strong>. Our booklets and leaflets also offer information on treatment and<br />
on living with <strong>lymphoma</strong>. To download or order more information v<strong>is</strong>it our website at<br />
www.<strong>lymphoma</strong>s.org.uk or ring our freephone helpline (0808 808 5555).<br />
Selected references<br />
The full l<strong>is</strong>t of references <strong>is</strong> available on request. Please contact us via email<br />
(publications@<strong>lymphoma</strong>s.org.uk) or telephone 01296 619409 if you would like a copy.<br />
Swerdlow SH, et al (eds). WHO Classification of Tumours of Haematopoietic and<br />
Lymphoid T<strong>is</strong>sues. 2008. IARC, Lyon.<br />
Hatton C, et al. <strong>Lymphoma</strong>. 2008. Health Press: Oxford.<br />
Cancer Research UK. Non-<strong>Hodgkin</strong> <strong>lymphoma</strong>s – UK incidence stat<strong>is</strong>tics 2010. Available<br />
at: www.cancerresearchuk.org/cancer-info/cancerstats/types/nhl (accessed April 2013).<br />
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How we can help you<br />
We provide:<br />
● a freephone helpline providing information and emotional support 0808 808 5555<br />
(9am–6pm Mondays–Thursdays; 9am–5pm Fridays) or information@<strong>lymphoma</strong>s.org.uk<br />
● information sheets and booklets about <strong>lymphoma</strong> (free of charge)<br />
● a website with forums – www.<strong>lymphoma</strong>s.org.uk<br />
● the opportunity to be put in touch with others affected by <strong>lymphoma</strong> through our<br />
buddy scheme<br />
● a nationwide network of <strong>lymphoma</strong> support groups.<br />
How you can help us<br />
We continually strive to improve our information resources for people affected by <strong>lymphoma</strong><br />
and we would be interested in any feedback you might have on th<strong>is</strong> article. Please v<strong>is</strong>it<br />
www.<strong>lymphoma</strong>s.org.uk/feedback or email publications@<strong>lymphoma</strong>s.org.uk if you have<br />
any comments. Alternatively please phone our helpline on 0808 808 5555.<br />
We make every effort to ensure that the information we provide <strong>is</strong> accurate but it<br />
should not be relied upon to reflect the current state of medical research, which <strong>is</strong><br />
constantly changing. If you are concerned about your health, you should consult<br />
your doctor.<br />
The <strong>Lymphoma</strong> <strong>Association</strong> cannot accept liability for any loss or damage resulting<br />
from any inaccuracy in th<strong>is</strong> information or third party information such as<br />
information on websites which we link to. Please see<br />
our website (www.<strong>lymphoma</strong>s.org.uk) for more<br />
information about how we produce our information.<br />
© <strong>Lymphoma</strong> <strong>Association</strong><br />
PO Box 386, Aylesbury, Bucks, HP20 2GA<br />
Reg<strong>is</strong>tered charity no. 1068395<br />
Updated: May 2013<br />
Next planned review: 2015<br />
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