Non-Hodgkin Lymphoma

• Non-Hodgkin lymphoma is the 6th most common type of cancer in the UK

  Much more common than Hodgkin Lymphoma
• There are more than 60 subtypes of NHL that can be B cell or NK/T cell in origin - B cell lymphoma accounts for 80%
• Prevalence increases with age
• Diffuse large B cell lymphoma is the most common type:

  • Typically presents as a rapidly growing painless mass in older patients
  • More common in men
  • Lymphadenopathy most commonly in the cervical, axilla or inguinal region
  • B symptoms in 1/3 - fevers, weight loss and night sweats
• Risk factors:

  ·       HIV

  ·       Epstein-Barr virus

  ·       Helicobacter pylori infection is associated with MALT lymphoma

  ·       Hepatitis B or C infection

  ·       Exposure to pesticides

  ·       Exposure to trichloroethylene

  ·       Family history
• Lymphadenopathy is the key presenting symptom. The enlarged lymph node or nodes might be in the neck, axilla or inguinal region. They are characteristically non-tender and feel firm or rubbery. 

  B symptoms refer to systemic symptoms of lymphoma:

  ·        Fever

  ·        Weight loss

  ·        Night sweats
• Additional non-specific symptoms can include:

  ·        Fatigue

  ·        Itching

  ·        Cough

  ·        Shortness of breath

  ·        Abdominal pain

  ·        Recurrent infections

  ·        Splenomegaly

  ·        Hepatomegaly
• Reed-Sternberg cells are not seen in NHL
• Diagnosis is via excision biopsy of affected lymph node and staging is via PET CT scan
• Common differences in Hodgkin vs Non-Hodgkin Lymphoma:

  • Reed-Sternberg cells in Hodgkin Lymphoma
  • Non-hodgkin is more common
  • Older age of onset in non-hodgkin
  • Lymphadenopathy in non-hodgkin can be anywhere where as hodgkin as tends to be in the upper body such as the supraclavicular lymph nodes
• Most important subtypes of Non-Hodgkin Lymphoma:

  • Diffuse large B cell lymphoma - typically presents as a rapidly growing painless mass in older patients
  • Burkitt lymphoma - associated with epstein-barr and HIV
  • MALT lymphoma - affects the lymphoid tissue around the stomach