Non-Hodgkin lymphoma (NHL)

NHL usually starts in the lymph nodes. These are part of the system in the body that protects us from infection and disease. Several areas of lymph nodes around the body may be affected.

The most common symptom of lymphoma is a painless swelling in the lymph nodes in the neck, armpit or groin. But sometimes NHL can affect other parts of the body. ainful swollen lymph nodes soon after drinking alcohol. Find out more in our information about possible signs and symptoms of lymphoma.

If you have symptoms, you usually start by going to your GP. They may arrange for you to have blood tests or scans. Your GP will refer you to hospital for tests and for specialist advice and treatment.

At the hospital, the cancer doctor will ask about any symptoms, your general health and any illnesses you have had. They will also examine you.

If you think you may be pregnant, tell your GP or cancer doctor. Some tests and treatments for lymphoma can be harmful to a baby in the womb. You can usually still have tests and treatment for lymphoma while pregnant. But it is important to talk to your cancer doctor so they can plan your care safely.

Waiting for test results can be a difficult time, we have more information that can help.

The most important test for diagnosing lymphoma is a biopsy. A doctor or nurse removes a small piece of tissue or a sample of cells from the area of the body they want to check.

Usually this is from an enlarged lymph node. You may have all or part of the lymph node removed. You may have a local anaesthetic to numb the area, or a general anaesthetic and a small operation. Your cancer doctor or specialist nurse will explain the type of biopsy that is best for you.

You will have more tests before you start treatment for lymphoma. These help your cancer team plan your treatment safely and effectively.

Some tests check your general health and how well your heart, lungs, liver and kidneys are working. This includes blood tests to check:

• the levels of different blood cells in your blood
• whether you have certain infections linked to lymphoma, such as HIV and hepatitis.

Other tests find out more about the stage of the lymphoma. You may have some of the following tests.

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your doctor or cancer specialist or nurse will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment.

Often treatment involves a combination of cancer drugs. Sometimes other treatments may be used. You may have some treatments as part of a clinical trial.

Some cancer treatments for lymphoma can affect the ability to get pregnant or make someone pregnant (fertility). If there is a risk your treatment might affect your fertility, your cancer doctor or specialist nurse should talk to you about this before you start treatment.

The following general information explains how different stages of HL are treated. It does not cover all situations. Your treatment plan will also depend on the specific type of NHL you have.

If you have early stage, low grade NHL you do not always need to start treatment straight away. This is because low grade lymphomas usually grow slowly. Instead, you will be monitored for signs that you need to start treatment. This is called watch and wait.

Some people may be offered radiotherapy if the affected lymph nodes are close together, even if they do not have any symptoms. This often makes the lymphoma disappear completely. Some people are cured after radiotherapy alone. If radiotherapy is not suitable for you, your treatment options will be the same as those used for advanced lymphoma.

Treatment for advanced stage, low grade NHL usually depends on whether you have symptoms or not.

If you are not having problems with symptoms, your doctor may ask you to choose between:

• delaying treatment until symptoms develop – this is called watch and wait
• having treatment with a targeted therapy drug called rituximab.

If you have symptoms, the most commonly used treatments are:

• chemotherapy with rituximab or a similar targeted drug – sometimes called chemoimmunotherapy
• rituximab on its own.

Sometimes radiotherapy may also be used to shrink an area of lymphoma if it is causing symptoms.

Treatment is often successful at shrinking the lymphoma so that you feel better and have fewer symptoms. This is called remission. Remission may last years. But treatment will not fully cure lymphoma and eventually the lymphoma may come back. It can be treated again and may be put into remission again.

Advanced stage, low grade NHL can be controlled for a long time in this way. Most people have a good quality of life between courses of treatment.

Rarely, some low grade lymphomas can change and become high grade over time. This is called transformation. If this happens, the lymphoma is treated as a high grade lymphoma.

High grade NHL is usually fast-growing and needs to be treated straight away. The aim is to make the lymphoma disappear completely. This is called complete remission.

High grade NHL is usually treated with a combination of the following cancer drugs:

• chemotherapy
• steroids
• targeted therapy drugs such as rituximab and polatuzumab.

Treatment can often shrink high grade lymphoma quickly. Sometimes, radiotherapy is given after chemotherapy. This is usually if:

• the lymph nodes were very enlarged (bulky)
• there was an area of lymphoma outside the lymph nodes before you had chemotherapy.

Radiotherapy may also be used if the lymphoma is only in 1 area of the body.

Low grade NHL nearly always comes back or starts to grow again at some point after treatment. It cannot usually be cured. You can have further treatment to control the lymphoma. This can often keep people feeling well for long periods of time. Some people have monitoring rather than starting more treatment straight away.

Treatment can often cure high grade NHL. But, in some people, the lymphoma comes back. This is called a relapse or a recurrence. If this happens, it may be possible to have more treatment to try to cure it. The treatment is usually more intensive. This is to try to get the lymphoma into remission. Intensive treatments include:

• CAR-T cell therapy
• stem cell transplant.

Non-Hodgkin lymphoma prognosis

People sometimes search for non-Hodgkin lymphoma statistics to help them understand what might happen to someone in their situation. This is called prognosis. Doctors cannot predict exactly what will happen in the future. But they may use some of the following types of statistics to help them make an estimate:

• NHL survival rates — this is the number of people who are alive after certain periods of time after a non-Hodgkin lymphoma diagnosis. It includes people who have no signs of lymphoma and also people who have lymphoma that has come back.
• NHL recurrence or relapse rates — this is the number of people whose non-Hodgkin lymphoma has come back after certain periods of time after treatment.
• NHL mortality — this is the number of people who have died because of non-Hodgkin lymphoma during a certain period of time.

You may find this information helpful, but not everyone wants or needs this type of information. Statistics can be worrying and difficult to understand. They may help you understand your chances of a possible outcome. But they do not tell you what will definitely happen to you.

If you want information about lymphoma statistics, or you find numbers online that might apply to you, it is best to talk about them with your cancer doctor or nurse. They can explain:

• which statistics apply to someone with your diagnosis
• what the information may mean to you
• how this may affect any treatment decisions you are thinking about.