Non-Hodgkin lymphoma
Dr. med. Julia Schwarz is a freelance writer in the medical department.
More about the experts All content is checked by medical journalists.Non-Hodgkin lymphoma (NHL) is a malignant tumor that affects lymphoid tissue. There are a variety of different forms of non-Hodgkin lymphoma with different prognoses. Swollen lymph nodes and the so-called B symptoms (fever, night sweats, weight loss) are typical of non-Hodgkin lymphoma. Men get sick more often than women. The average age of onset is around 60 years. The therapy depends on the degenerate cell type and the stage of the disease. Read everything you need to know about non-Hodgkin lymphoma here.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. C84C85C82C83
Non-Hodgkin lymphoma - description
The term “non-Hodgkin lymphoma” does not describe a single disease, but is rather an umbrella term for a large number of different forms (non-Hodgkin lymphoma), which differ significantly, especially with regard to their prognosis. Basically, non-Hodgkin lymphoma is a malignant tumor that affects the lymphoid tissue. Theoretically, the tumor can occur anywhere in the body where there is lymphatic tissue (bone marrow, thymus, spleen, lymph nodes, tonsils, lymph tissue in the digestive tract). Most often, however, non-Hodgkin lymphoma develops in the lymph nodes. The lymph nodes work like small filters in the lymph system, in which degenerate lymphoma cells (lymphocytes) “get stuck” and multiply there.
The lymphatic system plays a crucial role in the immune system. Lymph cells (lymphocytes) are white blood cells (leukocytes) that recognize and mark harmful foreign substances (e.g. pathogens). Doctors differentiate between B and T lymphocytes. While the B-lymphocytes are mainly responsible for the production of antibodies, T-lymphocytes attack pathogens in the body directly. Non-Hodgkin lymphomas can be both degenerate B and T lymphocytes.
Non-Hodgkin lymphomas are classified according to their malignancy and the type of cell from which the lymphoma originates. There is B-cell non-Hodgkin lymphoma and T-cell non-Hodgkin lymphoma, which is a little rarer. In addition, a distinction is made between low-malignant (less malignant) and highly-malignant (more malignant) non-Hodgkin lymphoma. For example, B-cell non-Hodgkin lymphoma can be either low-malignant or high-malignant. The same is true for T-cell non-Hodgkin lymphoma.
Low-grade non-Hodgkin lymphomas are by far the most common (70 percent of cases). This type of cancer is less malignant. Low-grade non-Hodgkin lymphoma usually grows slowly and is often symptom-free at first. The term "low malignant" is somewhat misleading, however, because the slow cell division of these lymphomas means that the treatment is generally much worse than that of the highly malignant non-Hodgkin lymphomas. Therefore, healing is often only possible in the early stages.
In highly malignant non-Hodgkin lymphomas, the degenerate cells divide particularly quickly. Their growth is aggressive and they crowd out healthy cells.However, the highly malignant non-Hodgkin lymphomas respond much better to treatment than the low malignant ones, so that healing can be achieved in all stages of the disease.
Non-Hodgkin lymphoma - classification of different forms
There are many different types of non-Hodgkin lymphoma. The most important non-Hodgkin lymphomas are mentioned in this overview:
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B-cell non-Hodgkin lymphoma |
T-cell non-Hodgkin lymphoma | |
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low malignant |
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highly malignant |
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Non-Hodgkin lymphoma - symptoms
Non-Hodgkin's lymphoma symptoms vary depending on the form. However, permanent, painless, enlarged lymph nodes, especially in the neck area, are typical. However, other lymph nodes can also be affected, for example in the armpit, groin, chest and abdomen.
Swollen lymph nodes are by no means always an indication of cancer. They also occur temporarily with infections. Then they hurt slightly when palpating and the swelling decreases noticeably just a few days after the infection.
The painlessly enlarged lymph nodes in non-Hodgkin lymphoma, on the other hand, continue to enlarge in the course of the disease. They are difficult to move under the skin - unlike lymph nodes that are enlarged due to infections.
In addition to enlarged lymph nodes, non-Hodgkin lymphoma symptoms also include other complaints, which are summarized under the term B symptoms. B symptoms are a combination of three typical symptoms that can occur in general with cancer, but also in chronic infections. The B symptoms often run in episodes. So the symptoms can go away for a few days and then reappear.
B symptoms:
- Fever: Fever above 38 ° C without an obvious cause such as an infection.
- Night sweats: Heavy sweating at night means that those affected wake up soaking wet, have to change their pajamas and make the bed fresh.
- Weight Loss: A weight loss of more than ten percent of your body weight in the previous six months.
People with non-Hodgkin lymphoma also report a general feeling of fatigue. The patients feel exhausted noticeably quickly and are no longer able to perform well. Even everyday tasks are then perceived as too physically strenuous. Constant fatigue despite getting enough sleep is also typical of non-Hodgkin lymphomas.
Itching of the skin on many parts of the body can be particularly annoying for the patient. The exact causes for this are not yet known. The degenerated blood cells may release chemical substances in the vicinity of the sensitive skin nerves and thus trigger itching. This phenomenon affects around ten to 25 percent of patients.
In the advanced stages of non-Hodgkin's lymphoma, the degenerated cells can also affect various other organs such as the spleen, liver, nervous system, and bone marrow. A massive enlargement of the spleen (splenomegaly) is typical. In addition, blood formation that takes place in the bone marrow can be disturbed (pancytopenia). The consequences are anemia, a lack of functional white immune cells (leukocytes) and a lack of blood platelets (thrombocytopenia). This sometimes causes general weakness, frequent infections, and bleeding.
Non-Hodgkin Lymphoma - Causes and Risk Factors
The causes for the occurrence of non-Hodgkin lymphoma have not yet been fully clarified. In many cases, however, there is very likely a connection between a (mostly viral) infection and non-Hodgkin lymphoma.
Since seniors are particularly likely to develop non-Hodgkin lymphoma, old age is considered a risk factor for non-Hodgkin lymphoma. Non-Hodgkin lymphoma is ultimately triggered by changes (mutations) in the genetic material of a lymph cell. The mutation stimulates the abnormal growth of the cell and blocks healthy functions. The cause of pathogenic changes in the cell nucleus is often an infection with the Epstein-Barr virus.
Degeneration of cells generally becomes a problem when the body's defenses are weakened. This can be the case, for example, if a person is infected with the HI virus (HIV). The HI viruses also seem to increase the cells' tendency to change. It is estimated that people with HIV infection are at a thousand times greater risk of developing non-Hodgkin lymphoma than those who are immune to health. Highly malignant B-cell Burkitt's lymphoma is particularly common in HIV-positive people. A weak immune system caused by immunosuppressive drugs or toxic substances (pesticides, aromatic hydrocarbons such as benzene) can also contribute to the development of non-Hodgkin lymphoma.
A special form of lymphoma, the low malignant B-cell MALT lymphoma (Mucosa Associated Lymphoid Tissue), is clearly related to the colonization of the gastric mucosa by the bacterium Helicobacter pylori. In this form of lymphoma, antibiotic therapy that eliminates the bacterium at an early stage of the disease may be sufficient to cure the lymphoma.
Non-Hodgkin Lymphoma - Examination and Diagnosis
The right person to contact if you suspect non-Hodgkin lymphoma is your general practitioner or a specialist in internal medicine and oncology. Just by describing the symptoms, the doctor receives important information about your state of health. There are numerous other diseases that can cause lymph node swelling. These include other cancers, chronic infections such as tuberculosis, and viral infections such as Pfeiffer's glandular fever. If you suspect non-Hodgkin lymphoma, the doctor will ask you about your medical history. Possible questions can be, for example:
- Have you noticed any swelling on your neck?
- Have you recently woken up sweaty at night?
- Have you accidentally lost weight in the past six months?
- Do you often have a fever?
- Have you had frequent nosebleeds or bleeding gums recently?
A physical examination is usually carried out after the first interview. The doctor will primarily look for enlarged lymph nodes by carefully palpating. Since the liver and spleen can also be enlarged in non-Hodgkin's lymphoma, he will try to feel them in the upper abdomen in order to estimate their size.
Blood test
Blood tests are a quick and inexpensive method of diagnosing non-Hodgkin lymphoma. In the course of the disease, the degenerated blood cells displace the healthy cells in the bone marrow. A possible anemia can then be detected by a lowered hemoglobin value (Hb). Hemoglobin binds the oxygen in the blood to itself. It is found in the red blood cells that use it to transport oxygen in the body. The normal value for men is 14.0 to 17.5 milligrams per deciliter (mg / dl), for women 12.0 to 15.5 mg / dl. In addition, a lack of blood platelets (thrombocytopenia) and white immune cells (leukocytopenia) can develop in the course of the disease. A blood test can reveal these changes as well. An immunohistochemical examination of the blood can also distinguish whether it is a B- or T-cell lymphoma.
Tissue samples
You should always have a doctor examine painlessly swollen lymph nodes. He uses a tissue sample to check whether it is actually a non-Hodgkin lymphoma. To do this, he takes a complete lymph node (lymph node extirpation) and examines it microscopically. In some cases, a tissue sample (biopsy) is also taken from other, possibly diseased tissues (stomach, skin, bone marrow).
Imaging procedures
If a tissue exam confirms the suspicion of non-Hodgkin lymphoma, the doctor will use imaging tests to determine how the disease has spread. An X-ray, an ultrasound examination, and a computed tomography (CT) scan will help determine the stage of non-Hodgkin lymphoma ("staging").
Non-Hodgkin Lymphoma - Staging (Ann-Arbor)
Depending on how far non-Hodgkin lymphoma has already spread in the body, it is assigned to one of four stages. The more lymph node regions are affected, the more advanced the stage and the worse the prognosis. Cure is usually possible for low-malignant lymphomas in stages I and II, and for high-malignant lymphomas in all four stages. Above all, the non-Hodgkin lymphoma life expectancy and the chances of recovery also depend on the general physical condition of the patient.
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stage |
Involvement of the lymph nodes |
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I. |
Involvement of only one lymph node region |
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II |
Lymph node involvement only on one side of the diaphragm: (involvement of the chest or abdomen); |
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III |
Involvement of lymph nodes on both sides of the diaphragm (both chest and abdomen); |
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IV |
Involvement of one or more extralymphatic organs (brain, bones) regardless of the pattern of involvement of the lymph nodes. |
In addition, depending on the originally degenerate cell type, a distinction is made between B-cell non-Hodgkin lymphoma and T-cell non-Hodgkin lymphoma. The therapy plan is drawn up on the basis of this classification according to stage and cell type.
Non-Hodgkin Lymphoma Treatment
Non-Hodgkin lymphoma therapy depends on the type of lymphoma and can therefore vary widely. In general, highly malignant lymphomas respond much better to treatment than the low malignant ones. This is why there is a chance of a cure in all stages of the disease in high-grade non-Hodgkin lymphoma, while in low-grade non-Hodgkin lymphoma this is usually only possible in stages I and II. Since the chances of recovery from non-Hodgkin's lymphoma depend particularly on the general physical condition of the patient, there are always encouraging exceptions.
Chemotherapy and radiation
A low-grade non-Hodgkin lymphoma (stage I and II) can often be cured by radiation alone.
In the case of highly malignant non-Hodgkin's lymphoma and advanced, low-malignant non-Hodgkin's lymphoma (stage III and IV), chemotherapy based on the so-called CHOP scheme is usually necessary. CHOP stands for the combination of various active ingredients (cyclophosphamide, hydroxydaunorubicin, oncovin, prednisolone). If the non-Hodgkin lymphoma is already advanced, the “watch and wait” strategy can also be useful. This means that the lymphoma is not treated with chemotherapy, but the course is observed. This can be done in cases where the lymphoma is growing very slowly.
Antibody therapy
Certain B-cell non-Hodgkin lymphomas benefit from additional antibody therapy. This method is still relatively new. Medicine uses the fact that cancer cells have certain proteins on their surface. The administered antibodies can recognize these proteins and form a complex with the defective cell, whereupon it is destroyed. Patients do not receive the antibody alone, but in combination with chemotherapy.
transplantation
A bone marrow transplant or blood stem cell transplantation can also help some patients. However, these procedures are not yet considered secure enough to be included in the standard procedures.
Non-Hodgkin lymphoma - prognosis and disease course
Non-Hodgkin lymphoma life expectancy varies widely. How well a patient responds to therapy depends on the type of non-Hodgkin lymphoma. Highly malignant non-Hodgkin's lymphomas respond much better to therapy than the slow-growing, low-malignant non-Hodgkin's lymphomas due to the high rate of cell division. In addition, the stage of the disease and the general physical condition have a significant influence on the prognosis. If the general condition of the patient is good, highly malignant non-Hodgkin lymphomas can usually be cured in all stages. On the other hand, there is a prospect of a cure in low-grade non-Hodgkin lymphoma, especially in stages I and II. In advanced stages, the prospect of complete cure is rather low. However, factors such as the age or general condition of the patient also have a major influence on the individual prognosis.
Support groups
The diagnosis of non-Hodgkin lymphoma initially unsettles those affected and their relatives. Many terms are unknown to them and many questions arise. Fateful fellows can answer these questions better than the attending physician. Don't hesitate to ask your doctor about a support group. In many regions there are group meetings for those affected. Another option is a non-Hodgkin lymphoma forum on the Internet, which gives relatives and sick people an opportunity to exchange information about non-Hodgkin lymphoma.
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