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Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma (also called non-Hodgkin’s lymphoma or NHL) is cancer that develops in the lymphatic system from cells called lymphocytes, which are a type of white blood cell that helps the body fight infections.

NHL can develop in many parts of the body, including the lymph nodes, bone marrow, spleen, thymus and digestive tract.

Non-Hodgkin lymphoma types

Lymphomas are classified based on the type of lymphocyte involved as well as several other factors, including cell size and how the cancer grows.

Non-Hodgkin lymphoma includes all kinds of lymphomas except Hodgkin lymphoma (also known as Hodgkin’s disease), which is marked by the presence of an abnormal lymphocyte called the Reed-Sternberg cell (or B lymphocyte).

Types of non-Hodgkin lymphoma

There are more than 30 distinct types of non-Hodgkin lymphoma, which can be divided into aggressive (fast-growing or high grade) or indolent (slow-growing or low grade) types.

NHL is further divided according to the cell type involved. There are two main types of lymphocytes: B-lymphocytes (or B cells) and T-lymphocytes (or T cells). Most types of non-Hodgkin lymphomas develop from B cells.

  • Some forms of B-cell NHL include: Diffuse large B-cell lymphoma, Follicular lymphoma, Burkitt lymphoma, Immunoblastic large cell lymphoma, Precursor B-lymphoblastic lymphoma and Mantle cell lymphoma.
  • Some forms of T-cell NHL include: mycosis fungoides, anaplastic large cell lymphoma, peripheral T-cell lymphoma and precursor T-lymphoblastic lymphoma.

Non-Hodgkin lymphoma symptoms

Some common non-Hodgkin lymphoma symptoms include:

  • Fever
  • Swelling in the lymph nodes in the neck, underarms, groin
  • Night sweats (often soaking the sheets) and/or chills
  • Persistent fatigue, lethargy, feeling of tiredness
  • Loss of appetite, nausea, vomiting
  • Unexplained weight loss
  • Abdominal pain or swelling, feeling of fullness
  • Skin rash or itchy skin (pruritus)
  • Coughing or shortness of breath
  • Headaches
  • Difficulty moving parts of the body
  • Pain in the chest, abdomen or bones for no known reason

Swollen lymph nodes, a fever and night sweats may also be symptoms of the cold and flu. However, unlike the cold and flu, non-Hodgkin lymphoma symptoms typically do not go away. If you have symptoms that persist for more than two weeks, or symptoms that are recurring and becoming more intense, you should see your doctor.

Dramatic weight loss in a short amount of time, such as losing more than 10 percent of your normal weight in less than six months, is also a sign to seek medical attention. Sometimes, the only NHL symptom present is constant fatigue.

SVC syndrome

Lymphomas may occur anywhere in the network of lymph vessels throughout the body. Tumors or swollen lymph nodes in the chest area may squeeze the superior vena cava (SVC), a major vein feeding into the heart.

When this happens, the blood coming from the head, arms and chest may get backed up and cause swelling, or turn the skin to a bluish-red color. This condition may possibly become severe and require medical treatment, especially if the oxygen supply to the brain becomes restricted.

B symptoms

B symptoms are a group of general symptoms that may be indicators of a rapidly developing lymphoma. B lymphoma symptoms are often identified during the staging process to help determine an overall prognosis and guide treatment decisions.

The staging process generally rates the extent and spread of cancer using Roman numerals I-IV. The staging of NHL is unique in that it also assigns the letters A and B to each stage. The letters refer to whether or not certain symptoms are present.

The letter B indicates that a person is experiencing one or more of the following symptoms: drenching night sweats, fever or unexplained weight loss. If none of these symptoms are present, then the letter A is used. B symptoms may be signs of a more advanced cancer.

Non-Hodgkin lymphoma risk factors


  • Age: Individuals age 60 and older are at an increased risk for developing the disease.
  • Gender: Men have a slightly greater chance of developing the disease than women.
  • Race: NHL is more common in Caucasians than African Americans.


  • Autoimmune disease (e.g., rheumatoid arthritis, lupus)
  • Viruses, infection (e.g., HIV/AIDS, Helicobacter pylori (H. pylori) infection, Epstein-Barr virus, human T-cell leukemia/lymphoma virus, human herpes virus 8, hepatitis C virus)


  • Inherited immune disorder (e.g., hypogammaglobulinemia, Wiskott-Aldrich syndrome)


  • Exposure to certain chemicals (e.g., pesticides, fertilizers, herbicides, insecticides)


  • Immunosuppressant drugs (e.g., administered after an organ transplant)

Non-Hodgkin lymphoma stages

Making an educated treatment decision begins with the stage, or progression, of the disease. The grade and stage of non-Hodgkin lymphoma are important factors in evaluating treatment options.

Our cancer doctors use a variety of diagnostic tests to evaluate non-Hodgkin lymphoma and develop an individualized treatment plan.

Staging and grading non-Hodgkin lymphoma

Grading NHL

Grading NHL is important because it helps us understand the growth pattern and aggressiveness of the cancer cells. We will determine whether the lymphoma is low grade (indolent or slow growth rate), intermediate grade (moderate growth rate) or high grade (aggressive or rapid growth rate). It’s important to keep in mind that while aggressive NHL often requires more immediate and intensive treatment, the disease tends to respond well to treatment.

Staging NHL

NHL staging is the process of identifying the location of the tumor, the size of the tumor and whether the disease has spread from the original site to other parts of the body. The Cotswold system (formerly the Ann Arbor Staging System) characterizes the stages of non-Hodgkin lymphoma by the number of lymph nodes involved and the regions affected by the cancer.

In earlier stages of NHL, the lymph nodes affected are all on one side of the diaphragm (the breathing muscle beneath the lungs). In contiguous lymphoma, the cancerous lymph nodes are next to each other. In non-contiguous lymphomas, the cancerous lymph nodes are not next to each other, but are on the same side of the diaphragm. In more advanced stages of non-Hodgkin lymphoma, the disease may be on both sides of the diaphragm.

Additional staging factors for NHL

In addition to the numerical NHL staging component, we may also use the letters A, B, E and S to help describe the cancer. The letters A and B indicate the presence or absence of certain symptoms. The letters E and S refer to the spread of the disease beyond the lymph nodes.

  • A & B: The letter B indicates the presence of one or more of the following symptoms: drenching night sweats, fever or unexplained weight loss. The letter A is used if there is no evidence of B symptoms.
  • E & S: The letter E indicates the disease affects extranodal tissues or organs (areas outside of the lymph system). The letter S is used if the disease has spread to the spleen.

If the disease is considered “bulky” (greater than 10 cm in size), it is designated with an “X.”