Non-Hodgkin Lymphoma: Frequently Asked Questions

What are lymphomas?

Lymphoma is a type of cancer. It starts in the infection-fighting lymphatic system. There are 2 main types of lymphoma. They are Hodgkin and non-Hodgkin. With either type, cells in lymphoid tissue grow out of control.

What is the lymph system?

The lymphatic system is part of the immune system.

It helps the body fight disease and sickness. The lymphatic system consists of a series of thin tubes and clusters of lymph nodes throughout the body. These tubes carry fluid, called lymph, through the lymph nodes and back into the bloodstream. This colorless, watery fluid is rich in white blood cells. Lymphocytes are the main type of cells. They help the body fight off infection. A lymph node is about the size of a pea and has large numbers of lymphocytes. Groups of lymph nodes are found in the stomach, chest, groin, and neck. Some of the body’s internal organs are also part of the lymphatic system. These organs include the bone marrow, spleen, thymus, and tonsils. Other organs, such as parts of the digestive tract, also contain lymph tissue. Lymphoma can start in any part of the body where there is lymphatic tissue.

What is the difference between Hodgkin lymphoma and non-Hodgkin lymphoma?

The cells of each of these diseases look different under a microscope. They also spread differently. Hodgkin tends to spread in a more predictable way and typically not as much as non-Hodgkin.

What is a fine needle aspiration?

A fine needle aspiration (FNA) is a type of biopsy. A biopsy is a test to check for cancer. To do an FNA, the healthcare provider takes a small sample of cells from the tumor or suspicious place. For an FNA, the healthcare provider inserts a very thin, hollow needle into the tumor to collect cells. Then the cells are looked at under a microscope for cancer cells. With lymphoma, sometimes an FNA doesn’t give the healthcare provider enough cells to look at for a clear diagnosis. Because of this, healthcare providers often prefer to use other types of biopsies to diagnose lymphoma.

What is the difference between an excisional and incisional biopsy?

An excisional biopsy is when a surgeon takes out the whole lymph node. An incisional biopsy is when a surgeon takes out only a part of the lymph node or tumor. In both cases, a specialized healthcare provider called a pathologist looks at the cells under a microscope to check for cancer cells. Both of these types of biopsies almost always give the pathologist enough tissue to confirm whether there is cancer, as well as what type it is.

What are the symptoms of lymphomas?

One of the most common symptoms of lymphomas is swelling of the lymph nodes in the neck, groin, or underarms. If the lymphoma is in other organs or tissues, you may have other symptoms such as headaches, cough, shortness of breath, swelling in the stomach, or nausea. You may also experience generalized symptoms, like fever, itchy skin, night sweats, and unexplained weight loss. People may have only some of these symptoms. It is important to remember that all of these symptoms can be caused by other health problems. But if you have any of these, see your healthcare provider.

How is non-Hodgkin lymphoma treated?

There are many different types of non-Hodgkin lymphoma. The treatment of any lymphoma depends on the type of lymphoma and on its stage, which is how far the cancer has spread. Some people with slow-growing lymphomas might not need to be treated right away. In a very early stage, radiation may be the main treatment. A combination of chemotherapy medicines is the most common treatment. There are many different regimens available. There’s also immunotherapy, which uses medicines to help the body's immune system fight the lymphoma. And there are medicines called targeted therapies, which attack specific parts of lymphoma cells. Often, several types of treatment are used together. In rare cases, a surgeon may take out a diseased spleen. In cases when treatment stops working, a healthcare provider may suggest high-dose chemotherapy and a stem cell transplant. This is also called a bone marrow transplant.

Should everyone get a second opinion for a diagnosis of non-Hodgkin lymphoma?

There are many reasons someone might want to ask for a second opinion. Here are some:

• A person is not comfortable with the treatment decision.

• The type of cancer is rare.

• There is more than 1 way to treat the cancer.

How can I get a second opinion?

Here are ways to find someone for a second opinion:

• Ask your healthcare provider for the name of another specialist.

• Call the Cancer Information Service. The number is 800-4-CANCER (800-422-6237). Callers can learn about centers and programs supported by the National Cancer Institute.

• Get names of healthcare providers from the local medical society.

• Get names of healthcare providers from a hospital, medical school, or cancer advocacy group.

• Ask people who have had the same kind of cancer for healthcare providers’ names.

Remember, it is more important to make an informed decision about your healthcare team and treatment than to make a quick decision. Give yourself time to get all the information you need to make the best choice for yourself.