Non-Hodgkin’s lymphoma, or NHL for short, is a rare cancer of the tissue that makes up or surrounds the lymph nodes, among other organs. The causes of the disease have not yet been precisely clarified. Since it can occur with very different manifestations, prognosis and therapy always depend on the individual case.
What is non-Hodgkin’s lymphoma?
By non-Hodgkin’s lymphoma, physicians mean malignant tumors of the so-called lymphoid cells. These are present in various places in the body, including the lymph nodes and their immediate surroundings. Lymphatic cells are also found in the gastrointestinal tract or in the throat, for example. They are responsible for the body’s immune system. If a malignant disease of these cells cannot be diagnosed as the well-known Hodgkin’s lymphoma, it is automatically a non-Hodgkin’s lymphoma. However, both equally designate malignant tumors. Non-Hodgkin lymphomas are divided into nodal (originating directly from the lymph nodes) and extranodal (not originating from the lymph nodes). After the initial local appearance of the tumor, the cancer cells continue to spread through the bloodstream.
Causes
The exact causes of non-Hodgkin’s lymphoma are not yet clear. However, various risk factors exist that, according to experts, may increase the likelihood of developing NHL. These include infections with certain viruses, such as the Epstein-Barr virus or the HI virus. Chronic inflammation of the stomach lining after a bacterial infection can also lead to an increased risk of NHL. Damage to the genetic material, for example through radioactive exposure, constant contact with certain chemical agents and also long-term smoking can contribute to the development of the disease, as can increasing age. Most NHL patients are 70 years of age or older.
Typical symptoms and signs
Schematic diagram showing the anatomy and structure of lymph nodes. Click to enlarge. Non-Hodgkin’s lymphoma initially causes no specific symptoms and therefore often goes undetected. Often, generalized lymph node swelling is the only symptom of the malignant disease. Unlike the lymph node swelling of infectious diseases, the lymph nodes in non-Hodgkin’s lymphoma are swollen but do not hurt. People with non-Hodgkin’s lymphoma also show an increased tendency and susceptibility to infection. Some patients also report diffuse symptoms such as those that can occur with local inflammation or colds. These include loss of appetite, fatigue and tiredness. These complaints are due to anemia. Likewise, some of those affected lose weight unintentionally. Other symptoms that may occur with non-Hodgkin’s lymphoma include pallor and generalized itching. Some patients also suffer from night sweats. The severity of these symptoms can vary greatly. For example, only a light and discrete film of sweat may form on the skin, or the bed linen may be completely soaked with sweat. In connection with night sweats, sleep disturbances also often occur, as those affected wake up either due to the sweating or the subsequent feeling of cold. However, all of these symptoms are by no means specific to non-Hodgkin’s lymphoma, but can also occur in other nonmalignant diseases.
Diagnosis and course
The lymph nodes are usually routinely examined by the physician for various diseases. Non-Hodgkin’s lymphoma is diagnosed in most cases by swollen lymph nodes. A tissue sample provides the attending physician with reliable information about the presence of the disease. A comprehensive physical examination is then performed to determine how far the disease has progressed. This includes a blood test, as well as X-rays and ultrasound. How the disease progresses in detail depends largely on how malignant the tumor actually is. If NHL is left untreated, the disease spreads throughout the body via the blood and ultimately leads to the patient’s death. Life expectancy is only a few months if the course is unfavorable and the tumor is so-called highly malignant.
Complications
Various complications can occur as a result of non-Hodgkin’s lymphoma.They are either directly caused by the cancer or are side effects of therapeutic measures. The disease-related sequelae caused by non-Hodgkin’s lymphoma depend on the spread of the disease and which areas of the body are affected by it. Thus, the size and location of the Hodgkin’s lymphoma determines how much pressure is exerted on the adjacent structures as well as their functions. It is not uncommon for non-Hodgkin’s lymphoma to have complications from treatment of the cancer. These are the side effects of chemotherapy and radiotherapy. This increases the risk that the Hodgkin’s lymphoma will develop into leukemia in the further course of the disease. It usually appears about ten years after the start of treatment. Radiation therapy can lead to lung cancer, breast cancer or skin cancer. Radiation therapy not infrequently causes side effects that appear shortly after treatment. These include gastrointestinal problems such as nausea and vomiting, hair loss, and irritation of the skin. Possible late effects include pneumonia, heart inflammation, infertility, or hypothyroidism. In addition to radiation therapy, however, chemotherapy for non-Hodgkin’s lymphoma can also trigger complications. Tissues with rapid cell turnover such as skin, mucosa and bone marrow are particularly affected. This becomes noticeable through nausea, vomiting and complete hair loss.
When should you see a doctor?
If growths appear in the chest and abdomen or on the neck, throat, and groin, non-Hodgkin’s lymphoma may be the cause. The affected person should see a doctor quickly and have the symptoms clarified. The physician can diagnose the non-Hodgkin’s lymphoma using the typical examination methods and, if necessary, consult other specialists. People who have been exposed to high levels of radioactive radiation either at work or as a result of an accident are particularly at risk. Contact with chemical substances and infection with certain viruses and bacteria are also risk factors that must be clarified in connection with the symptoms described. If the symptoms occur in connection with immunosuppressant or cytostatic therapy, the responsible physician must be consulted. The same applies to HIV infections and certain autoimmune diseases such as Sjögren’s syndrome. Depending on the type and severity of the accompanying symptoms, the general practitioner will involve other physicians, for example orthopedists, gastroenterologists, dermatologists and ear, nose and throat specialists. If psychological problems arise as a result of the disease, the doctor will also refer the patient to a therapist. After successful treatment of non-Hodgkin’s lymphoma, physiotherapeutic measures are indicated to compensate for any movement disorders and to re-strengthen the body that has been weakened by the chemotherapy. Because of the relatively high risk of recurrence, medical monitoring is necessary even after completion of therapy.
Treatment and therapy
After an NHL diagnosis has been made, the attending physician can initiate appropriate treatment. Exactly what this looks like depends on the exact nature of the disease and how advanced it is. If the physician diagnoses a form of NHL that is not aggressive and also progresses slowly, it may be that initially no therapy is necessary, provided the patient has no symptoms. However, regular monitoring of the patient’s health is strongly advised, as it can change rapidly and treatment will still need to be started. A very malignant NHL disease can, among other things, be coupled with chemotherapy and treated with a so-called antibody therapy. In the latter, antibodies are designed to help the immune system destroy the cancer cells. Radioimmunotherapy can also be used as a supportive measure. If the tumor is localized, it may be possible to remove it surgically before the cancer cells spread further. In most cases, however, chemotherapy or, alternatively, radiation therapy must be administered to completely remove the cancer. Even in the case of a cure, comprehensive follow-up care should be performed regularly to prevent a relapse. Non-Hodgkin’s lymphoma tends to recur even after extensive therapy.
Outlook and prognosis
The prognosis for non-Hodgkin lymphoma is considered unfavorable.The average life expectancy is reduced despite the best possible medical care given the current state of treatment options. If no comprehensive therapy takes place, the life expectancy is shortened by another. Death can then be expected within a few months. The patient needs cancer treatment to prevent the pathogen from spreading. According to current scientific guidelines, a cure is not possible for this disease. It is documented that a new outbreak of the cancer is to be expected within a few years, although treatment measures already introduced have been successful. Regular check-ups are therefore necessary in order to be able to start the next cancer therapy immediately at the first signs and irregularities. In coping with the disease, patients with a healthy lifestyle and a balanced diet have shown the best success so far. In addition to the side effects of cancer therapy, the knowledge that symptoms will return places an enormous emotional burden on the person affected. Therefore, cooperation with a psychotherapist is advisable for an improved prognosis. Otherwise, the risk of suffering a psychological secondary disease is increased. This, in turn, has a negative impact on the physical processes and the success of the necessary therapeutic measures.
Prevention
Since the causes of non-Hodgkin’s lymphoma are not yet fully understood and the causes are diverse, prevention in the strict sense is not possible. However, risk factors such as smoking can be minimized by lifestyle changes. If the first signs of an NHL disease are noticed, such as swollen lymph nodes, a doctor should be consulted immediately. The earlier the disease is detected, the more favorable the prognosis.
Follow-up care
In most cases, the person affected by non-Hodgkin’s lymphoma has very few and usually limited measures of direct aftercare available to him or her. This is a very rare disease that has not yet been fully researched. Therefore, the affected person should see a doctor at an early stage to avoid other complications and also to avoid further spread of the tumor. Most of the affected persons depend on various measures with which the tumor can be removed. During the treatment, most of the affected persons depend on the support and care of their own family. Especially psychological support is very important to prevent depression and other psychological upsets. Even after the successful removal of the non-Hodgkin’s lymphoma, regular check-ups with a doctor should take place in order to possibly detect and remove further tumors in the body at an early stage. If there is an existing desire to have children, genetic testing and counseling are advisable to possibly prevent the recurrence of the disease. Non-Hodgkin’s lymphoma can also reduce the life expectancy of the affected person in some cases.
Here’s what you can do yourself
Non-Hogdkin’s lymphoma (NHL) is a cancer in which patients can do a number of things in their daily lives to improve their general well-being and thus their quality of life. This applies to physical complaints as well as to the psychological state. However, if over-the-counter medications or dietary supplements are used, prior consultation with the attending physician is strongly recommended. In the physical area, it is often necessary to reduce the consequences of therapies such as surgery, chemotherapy and radiotherapy as best as possible. A healthy diet and adequate drinking play an important role here, as does sufficient sleep. In addition, the physical exercises learned in a possibly prescribed physiotherapy can also be continued at home. Strengthening the immune system and avoiding infections in addition very important. Here, sports or at least regular exercise are important. Infections from people in the immediate vicinity who have the flu, a gastrointestinal infection or another contagious disease should be avoided. On the psychological front, patients are often not over the severity of their illness, even though therapies may have been completed long ago. Self-help groups or discussions with relatives or friends can help here.Socializing is also an important factor: both for quality of life and as a distraction from non-Hodgkin’s lymphoma cancer.
