Non-Hodgkin Lymphoma

Overview

Non‑Hodgkin Lymphoma (NHL) is a cancer of the lymphatic system, which includes lymph nodes, bone marrow, spleen, and other immune tissues. NHL begins when a lymphocyte—usually a B‑cell, sometimes a T‑cell—undergoes genetic changes and starts growing uncontrollably.

Unlike Hodgkin lymphoma, NHL does not contain Reed–Sternberg cells, and it represents a large group of more than 60 subtypes. These range from slow‑growing (indolent) forms to fast‑growing (aggressive) forms. Treatment and prognosis vary widely by subtype.

NHL is one of the most common blood cancers, representing a major group of lymphoid diseases diagnosed each year.

Understanding the Lymphatic System & Lymphoma Development

The lymphatic system includes:

Lymph nodes (neck, chest, underarms, abdomen, groin)
Spleen, thymus, tonsils
Bone marrow

Lymphocytes normally help your body fight infection. In NHL, genetic changes cause these cells to:

Grow out of control
Lose normal immune function
Build up in lymph nodes and organs
Crowd out healthy cells

Types of Non-Hodgkin Lymphoma

NHL is broadly classified by cell type and growth rate:

By Cell Origin

B‑cell lymphomas (most common; ~85% of NHL)
T‑cell lymphomas (less common)

By Growth Rate

Indolent (slow‑growing) – e.g., follicular lymphoma
Aggressive (fast‑growing) – e.g., diffuse large B‑cell lymphoma (DLBCL)

Because NHL includes many subtypes, your care team will review your exact diagnosis and features to tailor treatment.

Signs & Symptoms

Symptoms vary by subtype but may include:

Painless lymph node swelling in the neck, armpit, or groin
Fever, drenching night sweats, or unexplained weight loss (“B symptoms”)
Fatigue or weakness
Loss of appetite
Fullness or discomfort in the abdomen (enlarged spleen)
Chest pressure, cough, or trouble breathing if chest nodes are enlarged

Some people—especially with indolent disease—may have no symptoms at diagnosis.

Risk Factors

Risk factors for NHL put those in the following groups or with these ailments at an increased risk:

Older Age

(risk rises over age 60)

Caucasian Men

Immune suppression

(HIV, organ transplant, autoimmune diseases)

Exposure to certain chemicals

(e.g., agricultural chemicals, benzene)

Infections

such as EBV, H. pylori, or hepatitis C (in specific subtypes)

How We Diagnose Non-Hodgkin Lymphoma

A precise diagnosis is key, because treatment depends heavily on the subtype.

Evaluation may include:

1. Lymph Node or Tissue Biopsy (Gold Standard)

Confirms lymphoma and identifies the exact subtype.

2. Blood Tests

CBC, kidney/liver function tests, LDH
Viral studies (HIV, hepatitis B/C) if needed

3. Imaging

CT, PET/CT, or MRI to evaluate disease extent

4. Bone Marrow Biopsy

Determines involvement of the marrow

5. Molecular & Genetic Tests

Flow cytometry
Cytogenetics and mutation panels

These analyses help classify the lymphoma and guide therapy.

Staging

NHL is staged using the Ann Arbor lymphoma system, which considers:

Number of lymph node regions involved
Whether disease is above/below the diaphragm
Presence of extranodal sites (organ involvement)

Staging helps determine whether treatment should be localized or systemic.

The staging order is as follows:

Stage I: One lymph node region or one lymphatic structure involved.
Stage IE: Single site outside lymph system.
Stage II: Two or more lymph node groups same side of diaphragm.
Stage IIE: Lymph nodes + nearby organ.
Stage III: Involvement on both sides of diaphragm.
Stage IIIE / IIIS / IIIE,S: Organ involvement and/or spleen involvement.
Stage IV: Widespread organ involvement.

Treatment Overview

Treatment depends on the subtype, stage, growth rate, symptoms, and overall health.

Appropriate for some slow‑growing lymphomas with minimal symptoms.

Often part of frontline therapy, especially for aggressive lymphomas. Examples include CHOP‑based regimens.

Drugs that directly target lymphoma cell markers or pathways, such as:

Rituximab (anti‑CD20)
Other monoclonal antibodies

Used for localized disease or symptom relief.

Autologous or allogeneic transplant may be recommended depending on subtype and response to initial therapy.

Because NHL includes many distinct diseases, your care team will tailor therapy to your specific lymphoma features.

Staying Well During Treatment

Infection prevention

and vaccination review

Symptom management

(fatigue, neuropathy, nausea)

Nutrition & activity guidance

Management of treatment‑related risks

such as tumor lysis syndrome

Prognosis

Outcomes vary by subtype, stage, and patient factors. Advances in targeted therapies, immunotherapy, and risk‑adapted treatment have significantly improved survival in many NHL types.

Follow-Up & Survivorship

After therapy begins, we create a personalized follow‑up plan that may include:

Regular visits and labs

Imaging when indicated

Monitoring for late effects of therapy

Education about signs of relapse

Why Choose Illinois CancerCare

A blood disorder diagnosis can feel overwhelming. At Illinois CancerCare, we are committed to ensuring you never have to face it alone. Providing advanced, comprehensive hematology and oncology care for our patients is at the heart of everything we do. Since 1977, our specialists have focused on individualized, evidence-based treatment plans, access to world-class clinical trials, and thorough follow-up. With Illinois CancerCare, you can move forward with confidence knowing trusted expertise and compassionate support are always close to home.‑based treatment plans, access to world‑class clinical trials, and thorough follow‑up.

Sources & Patient Friendly References

Information sourced from NIH (National Institute of Heath) and NCI (National Cancer Institute).