What is non-Hodgkin lymphoma? - Lymphoma Association

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