Non-Hodgkin lymphoma overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]
Overview
Classification
Non-Hodgkin lymphoma may be classified according to updated REAL / WHO classification into 2 groups: B-cell neoplasms and T-cell and putative NK-cell neoplasms. Non-Hodgkin lymphoma may be classified based on rate of growth into 2 Groups: low-grade or indolent lymphoma and high-grade or aggressive lymphoma.
Causes
There are no established causes for Non-Hodgkin lymphoma.
Risk Factors
The known risk factors in the development of Non-Hodgkin lymphoma are weakened immune system, autoimmune disorders, certain infections and previous cancer treatment. Other possible risk factors include family history of Non-Hodgkin lymphoma, exposure to pesticides, exposure to trichloroethylene, diet, obesity, hair dyes, and occupational exposures.
Diagnosis
Staging
According to the Ann arbor staging system, there are four stages of Non-Hodgkin lymphoma based on the number of nodes and extra nodal involvement.
Symptoms
The most common symptom of Non-Hodgkin lymphoma is a painless swelling of the lymph nodes in the neck, underarm (axilla), or groin. Other symptoms of Non-Hodgkin lymphoma may include fever, weight loss, poor appetite, night sweats, constant fatigue, itchy skin, reddened patches on the skin, cough, shortness of breath, abdominal pain or swelling, constipation, nausea, vomiting, headache, concentration problems, personality changes, and seizures.
Physical Examination
Common physical examination findings of Non-Hodgkin lymphoma include fever, pruritus, petechiae, chest tenderness, abdominal tenderness, hepatomegaly, splenomegaly, peripheral lymphadenopathy, seizures, and central lymphadenopathy.
Laboratory Tests
Laboratory tests for Non-hodgkin lymphoma include complete blood count (CBC), blood chemistry studies, HIV blood test, and Hepatitis B blood test.
Chest X Ray
Presence of nodules and pleural effusion on chest x ray may be suggestive of Non-Hodgkin lymphoma.
CT
Chest, abdomen, and pelvis CT scan may be helpful in the diagnosis of Non-Hodgkin lymphoma.
MRI
MRI scan may be helpful in the diagnosis of Non-Hodgkin lymphoma.
Ultrasound
On ultrasound, Non-Hodgkin lymphoma is characterized by hepatomegaly and splenomegaly.
Other Imaging Findings
PET and Bone scan may be helpful in the diagnosis of Non-Hodgkin lymphoma.
Other Diagnostic Studies
Other diagnostic studies for the diagnosis of Non-Hodgkin lymphoma include bone marrow aspiration and biopsy and lumbar puncture.
Treatment
Medical Therapy
The predominant therapy for Non-Hodgkin lymphoma is chemotherapy. Adjunctive radiation, immunotherapy, and stem cell transplantation may be required.
Surgery
Surgical intervention is not recommended for the management of Non-Hodgkin lymphoma.