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Non-Hodgkin Lymphoma

Ignacio first noticed the signs of his non-Hodgkin lymphoma when he had trouble breathing and was coughing a lot during football practice. He also started getting a fever but didn't know why. His parents took him to the doctor. After doing tests and a biopsy, Ignacio's doctors diagnosed him with non-Hodgkin lymphoma.

At first, Ignacio was scared when he heard that non-Hodgkin lymphoma is a kind of cancer. But he quickly learned that it's treatable, especially if it's caught early. Most people who have it can be cured.

What Is Non-Hodgkin Lymphoma?

A lymphoma is a cancer of the lymphatic system, which is a part of the body's immune system. It helps filter out bacteria, viruses, and other unwanted substances. When someone has non-Hodgkin lymphoma, cancer cells form in the lymphatic system and start to grow.

Most of the time, you're only aware of your lymphatic system when the lymph nodes swell. This often happens when a person is sick — a sign that the lymphatic system is working hard to filter harmful substances out of the body.

There are several different types of lymphomas. A lymphoma can be Hodgkin lymphoma or non-Hodgkin lymphoma. Doctors tell which kind of lymphoma someone has based on the way the cells look.

How Do People Get It?

No one really knows what causes non-Hodgkin lymphoma. Doctors know that some things may increase a person's chances of getting it, like having AIDS or other conditions that weaken the immune system.

People with a brother or sister who has had non-Hodgkin lymphoma are also more likely to get it. Of course, having a sibling with the disease doesn't mean you will get it. Non-Hodgkin lymphoma isn't contagious — you can't catch it from or give it to someone.

Signs of Non-Hodgkin Lymphoma

The signs of non-Hodgkin lymphoma vary from person to person depending on the type of lymphoma and where a tumor is in the body. Some people may feel stomach pain, have constipation, and be less hungry than usual. Others may have trouble breathing, have a hard time swallowing, cough or wheeze, or feel chest pain.

Other signs of lymphoma may include:

  • swollen lymph nodes that don't hurt
  • fever, chills, or night sweats
  • itchy skin
  • weight loss despite eating normally
  • tiredness
  • bone or joint pain
  • lots of infections

For many people with lymphoma, the first sign is swollen lymph nodes. They're usually in the neck, armpits, and groin. But swollen lymph nodes do not usually mean someone has cancer. Most of the time, swollen lymph nodes are a sign of an infection or other common illness.

Because all the signs of lymphoma can be caused by other conditions, only a doctor can figure out what's really wrong.

What Do Doctors Do?

If your family doctor thinks you might have non-Hodgkin lymphoma, he or she will send you to an oncologist — a doctor who specializes in cancer. The oncologist will then do tests to be sure of what's wrong.


If someone's swollen lymph nodes don't go down after other treatments, the oncologist may want to do a biopsy.

Doctors do different kinds of biopsies to test for non-Hodgkin lymphoma, including:

  • excisional biopsy, where the doctor opens the skin to remove an entire lymph node
  • incisional biopsy, where the doctor removes only a part of the lymph node
  • fine needle aspiration, where a very thin needle suctions out a small amount of tissue from the lymph node
  • core biopsy, where a wider needle is used to remove tissue from a lymph node
  • bone marrow biopsy, where a needle is used to take samples of the soft tissue found in a bone

During a biopsy, the doctor will use anesthesia  so the patient feels no pain. Depending on the kind of biopsy, this might be local anesthesia (where part of the body is numbed) or general anesthesia (where a person is asleep).

Other Tests

A doctor also may do these tests to help decide if someone has non-Hodgkin lymphoma:

  • blood tests
  • a chest X-ray
  • a computerized tomography (CT or CAT) scan
  • an ultrasound, which uses high-frequency sound waves to create pictures of the inside of the body
  • a magnetic resonance imaging (MRI) scan
  • a bone scan to find any bone changes
  • a positron emission tomography (PET) scan, which can tell the difference between normal and abnormal cells based on metabolic activity
  • a gallium scan, if the doctor thinks a PET might not be a good option. In this test, a radioactive material called gallium is injected into the body to help show tumors and inflammation. 

After a diagnosis  of non-Hodgkin lymphoma, doctors use what's called a "staging system" to figure out how much the disease has affected the body. For example, a cancer at stage one hasn't affected as much of the body as a cancer at stage four. Knowing the stage of the disease helps the doctor choose the best treatment.

How Is It Treated?

Teens with non-Hodgkin lymphoma usually are treated in a pediatric cancer center by a team of experts in childhood cancers.

Some of the treatments they can get are:

  • Chemotherapy ("chemo") kills or stops the growth of cancer cells. This is the most common treatment for people with non-Hodgkin lymphoma.
  • Radiation therapy is used to shrink tumors and stop the growth of cancer cells.
  • Targeted immunotherapy (sometimes called biological therapy). With this type of cancer treatment, doctors give patients special medicines that identify ("tag") the cancer cells so that the body's own immune system can find them and fight them off.

For people getting a lot of chemo or radiation treatments, doctors may do bone marrow transplants or stem cell transplants. These transplants replace cells damaged by chemo and radiation.

In a transplant, doctors put healthy new bone marrow or blood cells into the patient's bloodstream through an IV. These new cells are either taken from the patient before treatment or donated by someone else.

What to Expect

If you have non-Hodgkin lymphoma, you know how scary it can feel. There's a lot to deal with emotionally. On top of that, appointments and tests can be tiring, and treatments might make you feel lousy.

People who are being treated with chemotherapy or radiation can expect side effects from these treatments. Most side effects are temporary and will go away after a few weeks. But, as with all medical treatments, each person feels them differently. How strong side effects are and how long they last depends on the person and the treatment involved.

The most common short-term side effects of chemo are feeling sick and throwing up. Most patients get medicines to prevent this. Cancer treatment also can cause lower blood counts, which can put people at risk for infection or bleeding.

Some people feel weak or dizzy after their treatments, or they have a fever. Others get mouth sores in or don't feel much like eating. It's also common for patients to lose some or all of their hair.

The short-term side effects of radiation can be similar to those of chemotherapy, except they usually affect just the area being treated. So if someone is getting radiation around the abdomen, he or she may feel sick or throw up. But people getting radiation in the area of the neck are less likely to feel sick or throw — but more likely to get mouth sores.

Tell your doctor if you have any side effects of treatment.

Some people have long-term side effects from cancer treatments. For example, some cancer treatments can affect fertility. Your doctor will let you know if your treatment might have long-term side effects (also called "late effects").

People who have had non-Hodgkin lymphoma need to keep seeing an oncologist for several years after treatment. Occasionally, cancer may return. Follow-up appointments with a cancer specialist can help doctors treat it early if it does.

Non-Hodgkin lymphoma can be an aggressive disease. The good news is that treatments have improved in recent years. Researchers are constantly developing new and better ways to treat it. Today, most people who have non-Hodgkin lymphoma can be cured.

Reviewed by: Jonathan L. Powell, MD
Date Reviewed: 01-10-2016

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