Non-Hodgkin lymphoma

Diagnosis

Non-Hodgkin lymphoma diagnosis often begins with a physical exam that checks for swollen lymph nodes in the neck, underarms and groin and an enlarged spleen or liver. Other tests and procedures include blood tests, imaging tests and taking a sample of tissue for lab testing.

Blood tests

Blood tests can sometimes show whether non-Hodgkin lymphoma cells are present. Blood tests may be used to test for viruses, including HIV, hepatitis B virus and hepatitis C virus. The presence of a virus may affect treatment options. Blood tests also measure levels of lactate dehydrogenase (LDH), which is often higher in people with lymphoma.

Imaging tests

Imaging tests make pictures of the body. They can show the location and extent of non-Hodgkin lymphoma. Tests might include MRI, CT and positron emission tomography (PET) scans.

Biopsy

Your healthcare professional may suggest a lymph node biopsy or a biopsy of other tissue to look for cancer cells. A biopsy is a procedure to remove a sample of tissue for testing in a lab. A lymph node biopsy involves removing all or part of a lymph node. Samples may be taken from other parts of the body depending on symptoms and imaging test results. In the lab, tests may show whether you have non-Hodgkin lymphoma.

Bone marrow biopsy and aspiration

Bone marrow biopsy and aspiration are procedures that involve collecting cells from the bone marrow. The cells are sent for testing.

In a bone marrow aspiration, a needle is used to draw a sample of the fluid. In a bone marrow biopsy, a needle is used to collect a small amount of the solid tissue. The samples most often come from the hip bone.

Lumbar puncture

A lumbar puncture is a procedure to collect fluid from around the spinal cord. A lumbar puncture, also called a spinal tap, uses a needle. A healthcare professional inserts the needle between two bones in the lower back and draws out some of the fluid that surrounds the brain and spinal cord. This fluid is called cerebrospinal fluid. The fluid goes to a lab where it's tested for cancer cells.

For non-Hodgkin lymphoma, a lumbar puncture may be done if you have neurological symptoms. It also may be done if you are at higher risk of lymphoma of the central nervous system.

Testing lymphoma cells in the lab

Lymphoma cells collected from a biopsy or a bone marrow aspiration and biopsy go to a lab for testing. In the lab, specialized tests look for specific things about the cells. The healthcare team uses the results to decide on the type of lymphoma that you have.

To decide whether the cells are non-Hodgkin lymphoma cells, the healthcare professionals in the lab look for:

• Proteins on the surface of the cancer cells. Non-Hodgkin lymphoma cells have certain proteins on their surfaces that help identify them. These proteins are known as markers. The markers can help tell the type of non-Hodgkin lymphoma.
• Changes in the cancer cell DNA. Cancer happens when cells get changes in their DNA. Lab tests can show which DNA changes are present in the lymphoma cells.

Treatment

Treatments for non-Hodgkin lymphoma may include a "watch and wait" approach, chemotherapy, immunotherapy and targeted therapy. Other treatments may include CAR-T cell therapy, bone marrow transplant, also called bone marrow stem cell transplant, and radiation therapy. Which treatment is best for you depends on the type of non-Hodgkin lymphoma you have and the extent of your cancer, called the stage. Your healthcare team also considers how quickly the cancer is growing, your overall health and what you prefer.

Treatment might depend on whether the cancer is aggressive or indolent. Aggressive lymphomas grow quickly and may have more symptoms. Indolent lymphomas grow slowly and may not have symptoms at first. Some indolent lymphomas can change into aggressive lymphomas.

Watch and wait

If your lymphoma seems to be growing slowly and doesn't cause symptoms, you might not need treatment right away. Instead, you may have checkups every few months. The checkups help your healthcare team watch your condition and see if your cancer is growing.

Chemotherapy

Chemotherapy treats cancer with strong medicines. There are many chemotherapy medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.

For many types of non-Hodgkin lymphoma, chemotherapy is the first treatment. Sometimes it's combined with targeted therapy.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy may be a treatment for some types of non-Hodgkin lymphoma. It may be combined with chemotherapy or other medicines. Immunotherapy also may be used when other treatments haven't worked, called refractory lymphoma, or for lymphoma that comes back after treatment, called relapsed lymphoma.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

For non-Hodgkin lymphoma, targeted therapy may be used alone. But more often it's combined with chemotherapy. This mix may be your first treatment. It also may be an option for some refractory or relapsed non-Hodgkin lymphomas.

CAR-T cell therapy

Chimeric antigen receptor (CAR)-T cell therapy trains the immune system cells to fight lymphoma. This treatment begins with removing some white blood cells, including T cells, from the blood.

The cells are sent to a lab. There, the cells are treated so that they make special receptors. The receptors help the cells recognize a marker on the surface of the lymphoma cells. Then the cells go back into the body. There, they find and destroy the non-Hodgkin lymphoma cells.

CAR-T cell therapy may be an option for some refractory or relapsed non-Hodgkin lymphomas.

Bone marrow transplant

A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. These cells replace cells hurt by chemotherapy and other treatments. Stem cells can come from your own body, called an autologous transplant. Stem cells also can come from a donor, called an allogeneic transplant.

A bone marrow transplant may be an option for some relapsed or refractory non-Hodgkin lymphomas. Chemotherapy or radiation therapy is typically done before the transplant to suppress the immune system and bone marrow.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points in your body.

For certain types of non-Hodgkin lymphoma, radiation therapy may be the only treatment you need. This may be true if your lymphoma is in just one or two spots and grows slowly.

People with non-Hodgkin lymphoma also may need radiation after chemotherapy to kill any lymphoma cells that might remain. Radiation also can relieve symptoms and improve quality of life.

Side effects of treatment

Treatments for non-Hodgkin lymphoma may have side effects. These may include nausea, vomiting, fatigue, fever, rash, diarrhea, infection and more.

More-serious side effects from treatments may include:

• Bone marrow suppression. When the bone marrow is suppressed, it can't produce enough blood cells, including white blood cells. White blood cells help fight infections, so with a lower amount, you are at a higher risk of infections.
• Febrile neutropenia. Febrile neutropenia is a serious condition that can happen in people being treated for cancer. Febrile means having a fever. Neutropenia means having a low number of neutrophils, which are white blood cells that help fight infections. In febrile neutropenia, the body is trying to fight an infection but doesn't have enough neutrophils.
• Medicine toxicity. Some medicines used to treat cancer can be harmful to the body. They can cause organ damage and other issues. Whether a medicine is toxic depends on the type and how much you take. There are many different medicine options. Your healthcare team can work with you to find the right medicines for you.
• Reactivating viruses. If you have had a viral infection such as hepatitis B or hepatitis C in the past, some treatments can cause the virus to become active again. This can lead to liver inflammation, liver damage and other complications.
• Tumor lysis syndrome. Tumor lysis syndrome is a serious condition that can happen when cancer cells break down quickly after treatment. When these cells die, they release substances into the bloodstream that can overwhelm the body. This can lead to issues with the kidneys and other organs. You may take medicines to treat or prevent harmful side effects.
• Infertility. Some lymphoma medicines can cause issues with fertility. If you are concerned about fertility, talk about your options with your healthcare professional before beginning treatment.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Alternative medicine

No alternative medicines have been found to cure non-Hodgkin lymphoma. But alternative medicine may help you cope with a cancer diagnosis and the side effects of cancer treatment. Talk with your healthcare team about your choices, such as:

• Art therapy.
• Exercise.
• Meditation.
• Music therapy.
• Relaxation exercises.
• Spirituality.

Coping and support

With time, you'll likely find what helps you cope with the uncertainty and worry of a cancer diagnosis. Until then, you may find that it helps to:

Learn enough about non-Hodgkin lymphoma to make decisions about your care

Ask your healthcare team about your cancer, including your test results, treatment options and, if you want, your prognosis. As you learn more about non-Hodgkin lymphoma, you may become more confident in making treatment decisions.

Keep friends and family close

Keeping your close relationships strong can help you deal with your non-Hodgkin lymphoma. Friends and family members can provide the practical support you may need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by having cancer.

Find someone to talk with

Find someone who is willing to listen to you talk about your hopes and worries. This person may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

Ask your healthcare team about support groups in your area or contact organizations such as the American Cancer Society, Blood Cancer United and the Lymphoma Research Foundation. Find support online through Mayo Clinic Connect, which is a community where you can connect with others for support, practical information and answers to everyday questions.

Preparing for your appointment

Make an appointment with a healthcare professional if you have any symptoms that worry you.

If your healthcare professional thinks you might have non-Hodgkin lymphoma, you may be referred to a doctor who specializes in diseases that affect blood cells, called a hematologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer, called an oncologist.

Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of anything you need to do ahead of time. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down important personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements you're taking and the doses.
• Take a family member or friend along. It can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

For non-Hodgkin lymphoma, some basic questions to ask include:

• Do I have non-Hodgkin lymphoma?
• What type of non-Hodgkin lymphoma do I have?
• What is the stage of my non-Hodgkin lymphoma?
• Has my non-Hodgkin lymphoma spread to other parts of my body?
• Will I need more tests?
• What are the treatment options?
• How much could each treatment prolong my life or increase my chances of a cure?
• What are the potential side effects of each treatment?
• How will each treatment affect my daily life?
• What treatment options have shown the best results?
• What would you recommend to a friend or family member in my situation?
• Should I see a specialist?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

Don't hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

• When did your symptoms begin?
• Do your symptoms happen all the time or do you have them now and then?
• How bad are your symptoms?
• What, if anything, seems to make symptoms better?
• What, if anything, seems to make symptoms worse?
• Have you had any fevers, night sweats or weight loss?
• Have you noticed any lumps, swelling or pain anywhere in your body?
• Have you had any chest pain, coughing or trouble breathing?
• Have you had any recent infections?
• Do you have any other health conditions, such as diabetes, heart disease or kidney disease?
• What are your biggest worries about your diagnosis or treatment?

Living with non-Hodgkin lymphoma?

Connect with others like you for support and answers to your questions in the Blood Cancers & Disorders support group on Mayo Clinic Connect, a patient community.

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