Do you have these symptoms? Let's talk about Non-Hodgkin Lymphoma (NHL)

Have you ever noticed a lump or swelling in your neck, armpit, or groin? You may have also felt tired or achy. These things can be normal, but sometimes they can be symptoms of a type of blood cancer called Non-Hodgkin Lymphoma (NHL) . Don't worry, let's keep this simple.

What is Non-Hodgkin Lymphoma (NHL)? Let's understand it simply!

Simply put, Non-Hodgkin Lymphoma (NHL) is a group of blood cancers that develop in the lymphatic system of our body. You may have heard of a type of cancer called lymphoma. NHL is one of the two main types of lymphoma. These cancers start in cells called lymphocytes , a type of white blood cell in our body. These lymphocytes are like the police officers of our body. They are the ones who protect us by fighting off diseases and infections.

Now imagine, what happens if there is a change, a mutation, in the genes inside these lymphocyte cells? That is when these abnormal lymphoma cells start to form. These usually develop in our lymph nodes. That is where these cells gather and form tumors. However, this is not only in the lymph nodes, but it can also develop in other organs of our lymphatic system, such as the thymus gland, the spleen, or in lymph tissue in other places. The most important thing is that if these NHLs are not treated properly, they can spread throughout the body.

But there is no need to worry. With new treatments available, many people with NHL are recovering and living longer. Sometimes, treatment can completely ``cure`` the disease. Other times, the goal of treatment is to control the disease, put it in ``remission``, and keep it that way for as long as possible.

What are the main types of NHL?

You might be surprised to learn that there are over 70 types of NHL! Doctors classify them based on the type of lymphocyte that is affected:

• B-cell lymphoma: This cancer develops from B cells. B-cells are a type of cell that makes antibodies to fight off germs in our bodies. B-cell lymphoma accounts for 85% of NHL diagnoses.
• T-cell lymphoma: This cancer develops from T cells. T cells are a type of cell that targets and attacks germs and foreign invaders and helps B cells make antibodies.

Doctors also classify B-cell and T-cell lymphomas as "aggressive" and "indolent ." Aggressive NHLs spread more quickly than indolent NHLs. Therefore, aggressive NHLs usually require more intensive treatment.

How common is this disease called NHL?

It is actually a relatively common type of cancer. For example, in the United States, it is expected that there will be about 80,620 new cases of NHL in 2024. It is also the 11th most common cancer in the world. Non-Hodgkin lymphoma is much more common than Hodgkin lymphoma , another type of lymphoma.

What are the symptoms of Non-Hodgkin Lymphoma?

The most common symptom is a painless swelling or lump in the neck, armpit, or groin. This is a sign that the lymph nodes in those areas are swollen. Other symptoms depend on where the lymphoma cells are located. Additional NHL symptoms may include:

• Constant fatigue
• Chest pain
• Cough
• Difficulty breathing (dyspnea)
• Stomach pain or bloating
• Feeling full even after eating a little
• An unexplained fever (especially a fever over 39.5 degrees Celsius (103 Fahrenheit) that does not subside after two hours or more with home treatment, or if the fever has been present for more than two days)
• Sweating at night so much that the sheets get wet
• Unexplained weight loss of about 10% of body weight (within 6 months)

The important thing to remember is that many of these symptoms can be caused by other conditions. Having one or more of these symptoms doesn't necessarily mean you have NHL. However, if you notice any changes in your body, especially something new that has been going on for several weeks, it's wise to see a doctor right away.

What are "B" symptoms?

When doctors diagnose lymphoma, they also look for "B" symptoms . These "B" symptoms are:

• Unexplained fever
• Excessive sweating at night
• Weight loss for no reason

Whether or not you have these symptoms will help your doctor determine what type of NHL you have and what the best treatment is.

Why does Non-Hodgkin Lymphoma occur?

Non-Hodgkin Lymphoma is caused by your body producing too many lymphocytes (B-cells, T-cells, or rarely, natural killer (NK) cells). This is due to acquired genetic mutations in the genes that affect lymphocyte development. "Acquired" means that it is not something you are born with, but something that happens during your life.

When lymphocytes become abnormal, they divide and multiply rapidly, eventually forming tumors. These tumors usually start in the lymph nodes. Because our lymphatic system is connected to almost every part of our body, Non-Hodgkin Lymphoma often spreads to other organs in the lymphatic system.

What are the risk factors for developing NHL?

There are several factors that increase the risk of developing Non-Hodgkin Lymphoma. A "risk factor" is a characteristic, activity, or condition that increases the likelihood of developing a disease. For example, the following are more likely to develop NHL:

• People over 60 years of age (the risk of NHL increases with age)
• For men
• For white people (this is something that is said in foreign studies)

Other possible risk factors are:

• Weakened immune system: A weakened immune system due to conditions such as HIV can increase the risk of NHL. Also, taking immunosuppressive medications after an organ transplant is a risk factor.
• Autoimmune diseases: People with diseases such as inflammatory bowel disease (IBD), rheumatoid arthritis, and psoriasis are at increased risk of developing NHL.
• Infections: Bacterial and viral infections such as H. pylori infection, human T-lymphotropic virus Type I, hepatitis C, and Epstein-Barr virus have been found to be associated with NHL.
• Exposure to pesticides: Some research has shown that people with high exposure to herbicides and insecticides may have a slightly increased risk of developing NHL.
• Family history: If one of your parents, brothers, sisters, or children has lymphoma or another blood cancer, you may also be at increased risk.

How is Non-Hodgkin Lymphoma diagnosed?

Diagnosing Non-Hodgkin Lymphoma is a multi-step process. First, tests will be done to rule out other common conditions that could be causing your symptoms. For example, swollen lymph nodes are more likely to be caused by an infection than lymphoma. Once your doctor has determined that you have Non-Hodgkin Lymphoma, they will do more tests to find out the type and how far it has spread (the `stage`).

Other tests or procedures you may have to diagnose Non-Hodgkin Lymphoma include:

• Physical exam: Your doctor will ask about your symptoms and check for signs of Non-Hodgkin Lymphoma, such as swollen lymph nodes.
• Blood tests: Blood tests, such as a complete blood count (CBC), can give you an idea of ​​your overall health. They can also look for viruses associated with Non-Hodgkin Lymphoma or substances in your blood that indicate tissue damage caused by the disease.
• Imaging tests: These tests show where cancer cells are inside your body. Depending on where the lymphoma cells are, you may need a CT scan, MRI, ultrasound scan, or PET scan.
• Biopsy: The only way to know for sure if the abnormal cells are NHL is with a biopsy. In this, the doctor takes a small piece of tissue from a lymph node or affected area and sends it to a laboratory. There, a pathologist examines the tissue under a microscope to see if there are lymphoma cells.
• Immunophenotyping: This test helps identify specific types of NHL. It classifies cancer cells based on the markers (antigens) on their surface.

What are the stages of Non-Hodgkin Lymphoma?

The test results help doctors determine the stage of the cancer (cancer staging). The stage of the cancer is used to plan treatment and give an idea of ​​the expected outcome (prognosis). The stages of Non-Hodgkin Lymphoma are as follows:

• Stage I: Cancer cells are present in one lymph node region or organ in the lymphatic system. Or, lymphoma is present in one region of a single organ outside the lymphatic system.
• Stage II: There is lymphoma in two or more lymph node groups on the same side of (or near) the diaphragm.
• Stage III: There are cancer cells in the lymph nodes above and below the diaphragm, or in the lymph nodes above the diaphragm and in the spleen.
• Stage IV: The lymphoma has spread to at least one organ outside the lymphatic system, such as the liver or lungs.

What are the treatments for Non-Hodgkin Lymphoma?

There are several treatments for Non-Hodgkin Lymphoma. The treatment you need depends on factors such as the type of NHL, the stage of the cancer, and your overall health. Treatment options include:

• Active surveillance: If you have indolent non-Hodgkin lymphoma and are not showing any symptoms, your doctor may delay starting treatment. This is called active surveillance or "watchful waiting." Doctors will monitor your health regularly, so they can start treatment as soon as symptoms appear.
• Chemotherapy: Chemotherapy is a treatment that uses drugs to kill cancer cells throughout the body. This is the most common treatment for NHL. You may receive chemotherapy alone or in combination with other treatments.
• Targeted therapy: These treatments target specific weaknesses in cancer cells and destroy them. Monoclonal antibody therapy is a commonly used targeted therapy for NHL.
• Immunotherapy: This treatment stimulates your body's own immune system to fight cancer cells. CAR-T cell therapy is a type of immunotherapy commonly used for NHL. Bispecific antibodies are a new class of drugs that target your own T-cells to kill cancerous lymphoma cells.
• Radiation therapy: This treatment uses high-energy rays from a machine to kill cancer cells. This may be enough for early-stage NHL. Doctors also use this method to kill lymphoma cells that may remain after chemotherapy.
• Chemotherapy with stem cell transplantation: In this treatment, high doses of chemotherapy are given to treat the cancer. Then, the immature blood cells that have been damaged by chemotherapy are replaced with healthy stem cells from your own body or from a donor. You may need this transplant if other NHL treatments have not helped.

What are the side effects of the treatment?

Common cancer treatments for Non-Hodgkin Lymphoma, such as chemotherapy, radiation therapy, and immunotherapy, can cause side effects. Most of these are short-term and go away once treatment is finished. However, some side effects can last longer.

Before starting treatment, be sure to ask your doctor about possible side effects. He/she can explain the benefits of treatment and the risks of side effects.

What will life be like with the NHL? (Outlook/Prognosis)

In some cases, treatment can completely `cure` Non-Hodgkin Lymphoma. This means that all cancer cells are permanently destroyed by treatment. This is often seen after aggressive B-cell lymphomas have been treated. If Non-Hodgkin Lymphoma does come back, it usually happens within the first two years after treatment. Otherwise, it may never come back. However, you will need to have regular check-ups to check for relapses.

Other types of Non-Hodgkin Lymphoma, especially those that spread slowly (indolent), can last a long time. This means you may need to receive treatment continuously or occasionally throughout your life.

But, the most important thing is that although Non-Hodgkin Lymphoma cannot be cured, current treatments allow people to live long, happy lives with the disease . Many people with slow-growing lymphoma die from other causes, even if the lymphoma cannot be cured.

What is the recovery rate from NHL?

According to the US National Cancer Institute, 74% of people with Non-Hodgkin Lymphoma are alive five years after diagnosis.

In general, people diagnosed before the disease has spread live longer than those diagnosed after the cancer has spread. The five-year survival rate for people with early-stage Non-Hodgkin Lymphoma (stages I and II) is between 79% and 87%. For people with advanced-stage disease (stages III and IV), the rate is between 64% and 73%.

How can you take care of yourself as someone with NHL?

There are several things you can do to manage living with Non-Hodgkin Lymphoma. These things won't make your disease go away, but they can help you feel more confident about living with it:

• Eat healthy meals: Food is energy. Eating well is one way to maintain energy. Ask a dietitian for more information or ideas about meals and snacks.
• Get as much rest as possible: Treatments like chemotherapy can make you feel very tired. Rest helps your body recover and regain its strength.
• Manage stress: Living with Non-Hodgkin Lymphoma is not easy. You may be worried about how the disease and treatment will affect your daily life. If you are concerned about your prognosis, talk to your doctor. He or she can answer your questions and tell you about programs that can help, such as support groups.
• Exercise: Regular exercise is one of the best ways to keep your mind and body healthy. Talk to your doctor about the types of exercise and intensity that are right for you.
• Get extra help: If you're living with Non-Hodgkin Lymphoma, look into palliative care. Palliative care provides symptom relief and support for people with cancer, regardless of their stage of disease or prognosis.

When should I see a doctor?

If you are being treated for Non-Hodgkin Lymphoma, see your doctor right away if your symptoms come back or get worse. After your treatment is complete, be sure to attend all follow-up visits as scheduled.

When should you go to an emergency room?

If you have severe symptoms, or if your symptoms get worse without any relief from the things you are doing to reduce your discomfort, go to an emergency room.

Important questions to ask your doctor

Here are some questions you can ask your doctor:

• What type of Non-Hodgkin Lymphoma do I have?
• What is the stage of my disease?
• What treatments do you recommend?
• What are the side effects of those treatments?
• Can my Non-Hodgkin Lymphoma be cured?
• What is the chance of the cancer coming back?

Finding out you have Non-Hodgkin Lymphoma (NHL) can be overwhelming for a number of reasons. There are different types of the disease, each with different outcomes. Some types that spread quickly may require more treatment and may have unpleasant side effects - but are ultimately curable. Other types may not require immediate treatment, but will need to be managed over the long term. There are no easy answers with this diagnosis.

Your doctor can explain how your NHL diagnosis will affect your future health. In the meantime, remember that people with this disease are now living longer. Ask your doctor about your prognosis based on your condition.

Important points to keep in mind (Take-Home Message)

Although Non-Hodgkin Lymphoma (NHL) is something to be afraid of, it is important to be properly informed and seek medical advice promptly. Remember:

• If you have symptoms like unexplained swelling, persistent fatigue, night sweats, or unexplained weight loss , see a doctor.
• Effective treatments for NHL are now available, and many people are living successfully with the disease.
• Talk openly with your doctor and ask all your questions.
• Staying positive and taking good care of yourself is very important on this journey.

You are not alone. We hope this information will give you strength.

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