Non-Hodgkin lymphoma is a blood cancer that begins in the white blood cells called lymphocytes. It used to be called non-Hodgkin’s disease. It is 1 of the 2 main groups of lymphoma. The other group is Hodgkin lymphoma.
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Overview
Most commonly, non-Hodgkin lymphoma starts in a lymph node at one or more places in the body. It can spread through the lymphatic system from one group of lymph nodes to another. It can also spread to other lymph tissue, particularly in the bone marrow and spleen, or to lymph nodes in the liver.
Sometimes, non-Hodgkin lymphoma starts in or spreads to tissue in an organ outside the lymphatic system, such as the stomach, bowel, skin, bone, or brain and spinal cord (central nervous system). This is known as extranodal non-Hodgkin lymphoma.
Hodgkin lymphoma
The 2 main types of lymphoma are non-Hodgkin and Hodgkin. Non-Hodgkin lymphoma is more common. The 2 types look different when the diseased cells are examined under a microscope. An abnormal lymphocyte called a Reed-Sternberg cell is usually found in Hodgkin lymphoma, but not in non-Hodgkin lymphoma.
This section is only about non-Hodgkin lymphoma. Learn more about Hodgkin lymphoma.
What is blood cancer?
Cancer is a disease of the cells. Cells are the body’s basic building blocks – they make up tissues and organs. The body constantly makes new cells to help us grow, replace worn-out tissue and heal injuries.
Normally, cells multiply and die in an orderly way, so that each new cell replaces one lost. Cancer develops when cells become abnormal and keep growing. These abnormal cells may turn into cancer.
When a cancer begins in abnormal blood cells, it is known as a blood cancer. The 3 main groups of blood cancers are lymphoma, leukaemia and myeloma.
Lymphoma is cancer of the body’s lymphatic system. It happens when white blood cells called lymphocytes become abnormal. This means they grow uncontrollably and form a lump (tumour), usually in a lymph node.
If these abnormal lymphocytes continue to build up, they can spread and form a tumour in another part of the lymphatic system or, sometimes, in an organ outside the lymphatic system, such as the liver or lung. This is still non-Hodgkin lymphoma, not another type of cancer.
Sometimes other types of cancer spread to the lymph nodes. This is not lymphoma. For example, breast cancer that has spread to the lymph nodes is still called breast cancer.
How lymphoma starts
How lymphoma spreads
Lymphoma can travel through the lymphatic system (or sometimes through the blood vessels ) to other parts of the body.
The lymphatic system
Non-Hodgkin lymphoma is a cancer of the lymphatic system. The lymphatic system is part of the immune system, which protects the body against disease and infection. The lymphatic system is made up of a network of vessels, tissues and organs.
Lymph vessels – These thin tubes are found throughout the body and in organs such as the spleen, liver, thymus and bone marrow. Lymph vessels carry lymph fluid around the body.
Lymph fluid – This clear fluid travels to and from the tissues in the body, carrying nutrients throughout the body and taking away bacteria, viruses, abnormal cells and cell debris.
Lymph nodes – Also called lymph glands, these small, bean-shaped structures are made up of lymph tissue. There are about 600 lymph nodes found in groups along the lymph vessels, including in the neck, underarms, chest, abdomen (belly) and groin. Lymph nodes filter lymph fluid before emptying most of the fluid into the bloodstream.
Other lymph tissue – As well as lymph nodes, lymph tissue is found in other parts of the body:
- bone marrow – produces blood cells
- thymus – a gland that helps produce a type of white blood cell known as a T-cell
- spleen – stores white blood cells, filters waste products from the blood, and destroys old blood cells, abnormal cells and bacteria
- tonsils – trap germs entering through the nose and mouth
- digestive system – stores immune cells.
The lymphatic system
The role of blood cells
Bone marrow is the soft, spongy material inside bones. It makes stem cells, which are a very early form of blood cells. Stem cells usually grow into 1 of 3 main types of blood cells: red blood cells, white blood cells and platelets. Each type of blood cell has a specific job to do.
White blood cells are part of the immune system and help fight infections. There are different types of white blood cells and they have different roles. The lymph nodes, lymph tissue and lymph fluid all contain the white blood cells known as lymphocytes.
Types of lymphocytes include:
- B-cells – make antibodies to fight infection
- T-cells – attack invaders (antigens) by killing them directly or by helping B-cells make antibodies
- natural killer (NK)-cells – rarer lymphocytes that specialise in killing diseased cells, including cancer cells.
Diseases such as lymphoma or treatments such as chemotherapy can lower the number of blood cells in the body and cause:
- a low level of white blood cells (neutropenia), which makes you more likely to get infections
- a low level of red blood cells (anaemia), which may make you look pale and feel tired, breathless and dizzy
- a low level of platelets (thrombocytopenia), which means you bruise or bleed easily.
For more information about all types of blood cancers and the role of blood cells, visit the Leukaemia Foundation.
Types of blood cells
The blood contains different types of cells, which all play different roles in the body.
Common types of non-Hodgkin lymphoma
There are more than 60 types of non-Hodgkin lymphoma, based on whether the lymphocyte affected is a B-cell, T-cell or rarely, NK-cell. It is also classified by how fast the lymphoma is growing (the grade). Knowing the type of non-Hodgkin lymphoma you have will help your doctors plan your treatment. The most common types are described below.
Common types of B-cell lymphomas
Around 85% of all non-Hodgkin lymphomas are B-cell lymphomas. The most common types of B-cell lymphomas are diffuse large B-cell (about 1 in 3 cases) and follicular lymphoma (about 1 in 5 cases).
Subtype | Growth (grade) | How does it start? |
| diffuse large B-cell | fast-growing; intermediate-grade | the structure of the lymph node is disrupted and the lymphoma cells spread throughout the lymph node |
| follicular | usually slow-growing; low-grade | cells grow slowly in circular groups called follicles |
| small lymphocytic lymphoma (SLL)/ chronic lymphocytic leukaemia (CLL) | slow-growing; low-grade | SLL starts in the lymph nodes and CLL mainly starts in the bone marrow |
| marginal zone | slow-growing; low-grade | starts in the moist tissue (mucosa) that lines some body organs and cavities |
| mantle cell | can look low-grade, but act high-grade | develops in the outer edge (mantle zone) of lymph nodes |
| Burkitt | fast-growing; high-grade | lymph nodes enlarge in many parts of the body |
For information about nodular lymphocyte predominant B-cell lymphoma (previously called nodular lymphocyte predominant Hodgkin lymphoma), see Hodgkin Lymphoma.
Common types of T-cell lymphomas
Around 15% of all non-Hodgkin lymphomas are T-cell lymphomas. Some of the most common subtypes are shown below. It can be challenging to diagnose the specific subtype of T-cell lymphoma and it may take some time.
Subtype | Growth (grade) | How does it start? |
| peripheral T-cell, not otherwise specified | fast-growing; intermediate-grade or high-grade | often occurs as widespread enlarged, painless lymph nodes |
| anaplastic large cell | fast-growing; high-grade | can occur throughout the body or on the skin |
| angioimmunoblastic (also called follicular helper T-cell lymphoma, angioimmunoblastic type | fast-growing; high-grade | occurs in lymph nodes, can cause skin rashes and produce abnormal proteins |
| cutaneous (skin) T-cell | slow-growing; low-grade | primarily affects the skin; starts as red, scaly patches or raised bumps that can be itchy |
Who gets non-Hodgkin lymphoma?
Each year in Australia, about 6660 people are diagnosed with non-Hodgkin lymphoma. It is more common in men than women. Most cases occur in adults aged 60 and older. Some types are more common in young adults and children. Non-Hodgkin lymphoma is the 6th most common cancer diagnosed in Australia.
What causes non-Hodgkin lymphoma?
The causes of non-Hodgkin lymphoma are largely unknown. Research shows that people with certain risk factors are more likely to develop it.
Most people with known risk factors don’t develop non-Hodgkin lymphoma, and some people who do get it have no known risk factors. Non-Hodgkin lymphoma is not contagious.
Weakened immune system – The risk of developing non-Hodgkin lymphoma is higher if your immune system isn’t working properly. This can happen if you have an autoimmune disease, such as rheumatoid arthritis or coeliac disease, or if you take medicines that suppress the immune system after an organ transplant.
Certain infections – Infections with some viruses and bacteria can slightly increase the risk of developing some types of non-Hodgkin lymphoma. These infections include:
- Helicobacter pylori
- HTLV-1 (human T-cell lymphotropic virus 1)
- hepatitis C
- Epstein-Barr virus
- HHV-8 (human herpesvirus 8).
Family history – Having a parent, brother or sister who has had non-Hodgkin lymphoma slightly increases a person’s risk of developing it. However, this family link is rare.
Breast implant-associated cancer – Having a textured breast implant is linked with a rare type of lymphoma called breast implant associated-anaplastic large cell lymphoma (BIA–ALCL). This includes having an implant for a breast enlargement or to reconstruct the breast after surgery for breast cancer.
Although it develops in the breast, BIA–ALCL is a type of lymphoma, not a type of breast cancer. The risk of developing an anaplastic large cell lymphoma following an implant is small. This can happen many years after having the implant.
If you have an implant, the Therapeutic Goods Administration (TGA) recommends you monitor your breasts for any changes, such as sudden fluid collection. Every year, ask your surgeon or GP to check the implants.
The Therapeutic Goods Administration (TGA) has more information about BIA–ALCL on their website (visit tga.gov.au and search “BIA–ALCL for consumers”). The TGA also has an online hub with up-to-date information about breast implants and their safety. If you are concerned about the safety of your implants, talk to your surgeon.
For an overview of what to expect at every stage of your care for B-cell lymphoma, visit Cancer Care Guides: Hodgkin and diffuse large B-Cell lymphoma. This is a short guide to what is recommended, from diagnosis to treatment and beyond.
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Dr Puja Bhattacharyya, Haematology Staff Specialist, Western Sydney Local Health District, Blacktown Hospital; A/Prof Christina Brown, Haematologist, Royal Prince Alfred Hospital and The University of Sydney; Dr Susan Carroll, Senior Staff Specialist, Radiation Oncology, Royal North Shore Hospital and The University of Sydney; Jo Cryer, Clinical Nurse Consultant, Haematology, St George Hospital; Marie Marr, Consumer; Katelin Mayer, Clinical Nurse Consultant, Cancer Outreach Team, Nelune Comprehensive Cancer Centre, Sydney; Vanessa Saunders, 13 11 20 Consultant, Cancer Council NSW; Elise Toyer, Haematology Clinical Nurse Consultant, Blacktown Hospital.
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