The basics of non-Hodgkin lymphoma

Non-Hodgkin lymphoma is a type of cancer that starts in the lymphocyte (a kind of white blood cell in the lymph system).

About the lymph system

The lymph system is made of tissues and organs that make, store and carry white blood cells to help fight infections and clean germs out of the body. The bone marrow, spleen, thymus and lymph nodes are all part of the lymph system. It also includes lymphatic vessels. These are a network of thin tubes that carry lymph fluids and white blood cells—like blood vessels carry blood throughout your body. The lymph system is made up mostly of two kinds of lymphocytes—T-lymphocytes and B-lymphocytes (also called T-cells and B-cells). Non-Hodgkin lymphoma happens when these cells change to become abnormal and grow out of control.

Non-Hodgkin lymphoma often starts in the lymph nodes. But, it can spread to other parts of the lymph system.

Common symptoms you may have

With non-Hodgkin lymphoma, you may have painless lumps or bumps under the skin, often in the neck, armpit or groin. These are swollen lymph nodes. Remember, people can get swollen lymph nodes for other reasons, so swollen lymph nodes don’t always mean you have non-Hodgkin lymphoma.

Some other symptoms include:

• Fever
• Sweating a lot at night
• Losing weight without trying
• Feeling very tired
• Belly (abdominal) pain or swelling
• Chest pain
• Coughing
• Trouble breathing

It’s important to get checked out by your doctor if you have any of these symptoms.

Tests your doctor may run

The doctor will do an exam to see if your lymph nodes, liver or spleen are swollen. Other tests may also be ordered, like:

• A biopsy of the lymph node. The doctor will take out part or all of a lymph node (sometimes part of other tissue, too) to check for cancer cells. Testing the lymph node can help tell if a person has non-Hodgkin lymphoma and what type. A biopsy is usually done in the hospital with local anesthesia. This means the area around the node is numbed. Sometimes medication is given to make the person sleepy during the biopsy.
• Blood tests.
• Chest X-ray. This is done to see if there are swollen lymph nodes in the chest.
• CT scan, MRI or PET scan*. One or more of these scans may be ordered to see if you have swollen lymph nodes anywhere else in your body.
• Bone marrow biopsy. This checks if the cancer has spread to the bone marrow. A doctor will numb the area and put a needle into a bone (often a hip bone) to take out a sample. Sometimes medication is given to make the person sleepy during the biopsy.
• Spinal tap (also called a lumbar puncture). For a spinal tap, a small needle is put into an area around the spine (the spinal canal). Some fluid is taken out to look for cancer cells.

Stages of non-Hodgkin lymphoma

After the test results come back, the doctor can tell what type of non-Hodgkin lymphoma you have and how far the cancer has spread or what stage the cancer is in. The answers will help the doctor know what treatment may be best for you. The stages are:

• Stage I.  Non-Hodgkin lymphoma cells are found in just one lymph node or a group of nodes right near each other. It can also be stage one if non-Hodgkin lymphoma cells are not in lymph nodes but are found in other tissue or another organ like the lung. It’s not stage I if there are cancer cells in the liver or bone marrow.
• Stage II. Non-Hodgkin lymphoma cells are found in two or more lymph nodes or lymph node groups, but they are on one side (the same side) of the diaphragm. The diaphragm is the thin muscle that is between the lungs and heart (the chest) and the stomach (abdomen). It can also be Stage II if non-Hodgkin lymphoma cells are found in a nearby organ on the same side.
• Stage III. Non-Hodgkin lymphoma cells are found on both sides of the diaphragm and/or in one part of a nearby tissue or organ.
• Stage IV. Non-Hodgkin lymphoma cells are found in the lymph nodes and have spread to more parts of the body or aren’t in any nodes but are found in the liver, blood or bone marrow.

If non-Hodgkin lymphoma was gone and came back, it is called a relapse or recurrent non-Hodgkin lymphoma.

Your treatment options

You and your doctor will decide on a treatment plan that’s best for you. This may depend on things like:

• What type of non-Hodgkin lymphoma you have
• What stage your cancer is in
• How fast the cancer is growing or spreading
• Your age
• Your overall health

Treatment will often include some type of chemotherapy (medications that fight cancer). You may also receive a biologic or biosimilar medication like a monoclonal antibody. Some patients will need radiation. In some cases, a bone marrow (stem cell) transplant is an option.

These treatments have possible side effects. They can vary based on which treatment you receive. These side effects can also vary from person to person. Tell your doctor about any side effects that you experience.

You can play an active role in your treatment by learning more about non-Hodgkin lymphoma. This is an important part of successfully treating and managing your condition.

We’re here to help.

Your CVS Specialty® CareTeam is always available to answer your questions. They can also help you manage side effects and help you feel your best. If you want to learn more about your condition or treatment, talk to your doctor or contact your CareTeam.