Non-Hodgkin’s Lymphoma – Diagnosis and Treatment

Diagnosis

Checking the Body for Swelling

A doctor feels the neck, underarms, and groin to check for swollen lymph nodes.

The doctor may also press on the belly to see if the spleen or liver is larger than normal. These signs can point to trouble in the lymph system or in other organs.

Testing Blood and Urine

Doctors perform blood and urine tests to look for things that may show an infection or another health problem. These tests help rule out other causes besides lymphoma and give clues about the patient’s overall health before more tests.

Scans and X-rays to View Inside

Doctors use imaging to search for lymphoma cells throughout the body. Tests such as CT, MRI, and PET scans check for swollen lymph nodes or lumps deep inside.

A chest X-ray provides a simple look at organs in the chest area.

Imaging tests help to:

• Find lymphoma in places you cannot feel.
• Guide a biopsy.
• Help with staging the disease.

Taking a Lymph Node Sample

Doctors usually perform a biopsy to confirm non-Hodgkin lymphoma. During this test, they remove some or all of a lymph node.

Experts in a lab examine the sample to find cancer cells and determine the specific type, such as:

• Waldenström macroglobulinemia
• B-cell lymphoma
• Follicular lymphoma
• Mantle cell lymphoma
• T-cell lymphoma
• Mucosa-associated lymphoid tissue (MALT) lymphoma
• Diffuse large B-cell lymphoma (DLBCL)
• Small lymphocytic lymphoma (SLL)

Collecting Bone Marrow Samples

A doctor uses a special needle to take fluid and a tiny piece of bone, often from the hip, to check if the disease has spread.

Lab experts study these samples for lymphoma or related bone marrow cancers like chronic lymphocytic leukemia (CLL).

Sampling Spinal Fluid

Doctors may perform a lumbar puncture, or spinal tap, to take out some spinal fluid with a fine needle in the back if they think the lymphoma may have reached the fluid around the brain and spinal cord, such as in CNS lymphoma.

Treatment

Chemotherapy Medications

Doctors use chemotherapy medicines to destroy cancer cells. They usually give these drugs through a vein, though some are available as pills. For many people with non-Hodgkin lymphoma, doctors often try chemotherapy first.

In some cases, they mix chemotherapy with other medicines, like targeted therapies, to increase effectiveness. Doctors may combine different chemotherapy drugs based on the type of lymphoma and its growth speed.

Common chemotherapy drugs for non-Hodgkin lymphoma include:

• Alkylating agents (e.g., agents that interfere with DNA replication).
• Anthracycline antibiotics (used to disrupt cancer cell growth).
• Vinca alkaloids (interfere with cell division).
• Corticosteroids (used to reduce inflammation and support treatment response).

Doctors choose medicines after reviewing a person’s health and the type of lymphoma. Chemotherapy can cause side effects, such as tiredness, nausea, and hair loss, but these usually go away after treatment.

Immune System-Based Treatments

Immunotherapy helps the body’s immune system find and fight cancer cells. Sometimes, cancer cells can hide from the immune system.

Immunotherapy medicines help immune cells, like T cells, spot and attack the cancer. People with certain types of non-Hodgkin lymphoma might get immunotherapy if other treatments haven’t helped.

Examples of immunotherapy for this cancer:

• Monoclonal antibodies (target specific proteins on cancer cells to help the immune system attack them).
• Immunomodulatory agents (alter the immune response to slow cancer growth).

Doctors may give these treatments alone or with other medicines, usually in the hospital or at an outpatient clinic. Some immunotherapy medicines might cause side effects such as chills, fever, and allergic reactions.

Treatments Targeting Cancer Cell Changes

Doctors use targeted therapy medicines that focus on specific changes in cancer cells. These drugs block certain proteins or signals that cancer cells need to grow and survive.

For non-Hodgkin lymphoma, targeted therapy might be used alone or combined with chemotherapy.

Some targeted therapies include:

Drug Name	How it Works
Monoclonal Antibodies	Targets CD20 on B cells to help destroy lymphoma.
Immunomodulatory Agents	Affects immune system and cancer cell growth.

Doctors may choose targeted therapy as a first treatment or if the cancer returns, depending on the type of lymphoma and past treatments. Common side effects include skin rash, diarrhea, and a higher risk of infection.

Custom T Cell Therapy (CAR-T)

Doctors use CAR-T cell therapy to treat some forms of non-Hodgkin lymphoma, especially when other treatments have not worked.

They remove some white blood cells from the patient’s blood, then change the cells in a lab so they can find and kill lymphoma cells. The cells are then returned to the patient’s body.

Key steps in CAR-T treatment:

1. Collecting T cells from the blood.
2. Modifying the cells in a lab.
3. Returning the cells to the patient.
4. Modified cells attack the lymphoma.

Doctors use CAR-T cell therapy only for certain people. It may cause side effects such as fever and confusion, but can offer another chance for treatment when other options do not work.

Replacing Bone Marrow Stem Cells

Doctors perform a bone marrow transplant, also called a stem cell transplant, to restore healthy stem cells after high doses of chemotherapy.

They often consider this procedure when non-Hodgkin lymphoma returns or does not improve with other treatments.

The transplant can use a person’s own stem cells (autologous) or stem cells from a donor (allogeneic).

Main points about bone marrow transplant:

• It helps build back the body’s ability to make blood cells.
• Doctors may recommend it after strong chemotherapy or radiation.
• They perform careful testing to find a good stem cell match if using a donor.

Possible side effects include infection, low blood counts, and tiredness.

High-Energy Beam Treatment

Doctors use radiation therapy with powerful energy beams, like X-rays or protons, to destroy cancer cells.

It can be a main treatment if the lymphoma is slow-growing and limited to one or two places in the body.

Sometimes, people get radiation after chemotherapy to kill any remaining cancer cells. Radiation can also help lower pain and other symptoms.

Radiation therapy involves:

• Lying on a table while a machine focuses the beams on affected areas.
• Treatments are often given five days a week for several weeks.
• Typical side effects are skin redness and tiredness, which go away afterward.

Alternative Medicine

Some people use alternative medicine to help manage stress and side effects when dealing with non-Hodgkin lymphoma. Common options include:

• Art therapy
• Exercise
• Meditation
• Music therapy
• Relaxation techniques
• Spiritual support

These methods do not cure the disease, but they may improve comfort and well-being. Always discuss choices with a healthcare provider.

Coping and Support

Understanding Non-Hodgkin Lymphoma

Learning about non-Hodgkin lymphoma can help people feel more comfortable with their treatment choices.

They can talk to their care team and look up trusted sources for information, like the National Cancer Institute or the Leukemia & Lymphoma Society.

Reading up can make it easier to follow along with doctors’ advice and make choices that fit personal needs.

Building a Reliable Support Network

Connecting with friends, family, and others with similar experiences provides both practical and emotional help. Support might include rides to appointments, help around the house, or a listening ear.

Many people benefit from joining a group or talking with others who understand what living with lymphoma is like. Regular support can help improve quality of life during and after treatment.

Setting Achievable Targets

Setting small, reachable goals can help. These might include attending a weekly yoga class, finishing a book, or keeping up with a favorite hobby. The purpose is to have a sense of control and accomplishment.

For example, someone who finds full-time work challenging might try working reduced hours or volunteering instead.

Making Time for Self-Care

Taking care of oneself is important. This could mean getting enough sleep, eating healthy foods, or making time to relax.

Using a daily or weekly schedule can help balance activity with needed rest. It’s okay to say no or limit activities when feeling tired or stressed.

Staying Engaged and Moving

Staying active, both physically and socially, can help manage stress and boost mood. This can include taking walks, gardening, or meeting up with friends.

If feeling well enough, people are encouraged to keep up with activities that bring happiness. Keeping busy can promote better well-being and may help during times of remission.

Getting Ready for Your Visit

Steps You Can Take Before Your Appointment

Preparing before seeing a healthcare professional can make the visit more helpful. Here are some things a person can do:

• Gather Information on Symptoms: Make a list of all symptoms, such as swelling, night sweats, repeated fevers, tiredness, weight loss, rash, coughing, or swollen lymph nodes. Note when the symptoms started and how often they occur.

• Track Personal Details: Write down any major life changes, recent stress, or possible exposures to illnesses. This could include past infections like hepatitis C virus or H. pylori, or having an autoimmune disorder.

• List All Medications: Prepare a table listing all current medicines, vitamins, or supplements and their dosages.

Name of Medicine	Dosage	Reason for Taking
Example: Ibuprofen	200 mg daily	Headache relief

• Check for Special Instructions: Ask if there are any steps to take before the appointment, such as fasting or avoiding certain foods.

• Bring Support: Having a friend or family member join can help remember important information or ask additional questions.

• Prepare Questions: Write questions to ask about symptoms, possible need for “watchful waiting,” risk factors, treatment choices, and side effects.
  Some examples include:
  • What type of lymphoma is this?
  • How fast is the disease progressing?
  • What are the treatment options and their side effects?
  • Will further tests be needed?

Questions Your Healthcare Professional May Ask

The healthcare provider will likely ask about symptoms and health background. Some examples are:

• Are the symptoms always present, or do they come and go?
• How severe are the issues, such as weakness, tiredness, or fever?
• Has anything helped make symptoms better, or made them worse?
• Has the patient had many infections in the past?
• Is there any known exposure to chemicals, toxins, or a family history of illnesses?

Being ready with this information helps the provider make a diagnosis and decide if more tests are necessary. The provider may also check for things like swollen lymph nodes or signs of infection during the visit.