Non-Hodgkin's Lymphoma

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What is Non-Hodgkin's Lymphoma?

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Non-Hodgkin's Lymphoma usually arises from the lymphocytes found within the lymph nodes or lymphoid tissue within other organs.

Lymph nodes are groups of lymphatic cells held together by connective tissue, and are distributed throughout the body. Lymph fluid is produced when the blood passes through the tissues. Most of the cellular content of the blood (white cells, red cells and platelets) stays within the blood vessels, some of the liquid content (water, proteins, antibodies, fats) and some white cells pass through and bathe the tissues in nutrients.

The lymphatic fluid is collected by the lymphatic vessels and channeled to the local lymph nodes, where it is filtered and passed onwards to the next set of lymphatic vessels. The direction of drainage is from the periphery to central, with the lymph ultimately emptying into the subclavian vein via the thoracic duct in the chest. The lymph nodes produce lymphocytes which produce antibodies.

There are 2 types of lymphocytes. B-cells are produced by lymph nodes and are responsible for producing antibodies. T-cells attack and kill foreign cells (sometimes cancer cells, sometimes transplanted organs) and are partly responsible for sensitizing B-cells to produce antibodies against foreign substances. When these cells malfunction, they can produce antibodies to normal tissues, causing auto-immune disease.

Most (90%) cases of Non-Hodgkin's lymphoma derive from B-cells.

The many different types of Non-Hodgkin's lymphoma. They are usually graded as low grade, intermediate grade and high grade.

The low grade lymphomas are usually slow growing and therefore compatible with a long life expectancy. They are not usually curable, but respond to treatment with long remission periods usually achievable.

High grade lymphomas usually respond rapidly to treatment and a good proportion are curable. Please see our section on 'What is Cancer?' in the haematology or oncology suites for further explanation.

Who gets Non-Hodgkin's Lymphoma?

It is relatively uncommon, occurring in approx 3 per 100 000 and occurs in different age groups. It is generally a disease of adults (the risk increasing with age). It occurs with sex incidence being slightly more common in men.

Geographically, the tumour is found worldwide, with variation depending on the underlying cause. For instance Burkitt's lymphoma is more common in Africa.

Predisposing Factors

The cause of most cases of Non-Hodgkin's lymphoma is unknown although a number of predisposing factors have been identified. These are:

Some types of NHL (Non-Hodgkin's lymphoma) (e.g. Burkitt's lymphoma) have been shown to contain particles of the Epstein-Barr Virus.

HIV/AIDS predisposes to NHL, possibly as a result of the immune suppression but the virus itself may be implicated.

Immune suppression from anti-rejection drugs.

Exposure to certain chemicals.

Previous anti-cancer treatment.

Certain genetic and chromosomal abnormalities.

Progression

This type of tumour spreads by passage through the lymphatic channels to adjacent lymph nodes. As the spleen is an important organ of the lymphatic system, it may also be involved. Later in the disease, it may spread via the bloodstream to the liver, other organs and bone.

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