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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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This information is about a type of non-Hodgkin lymphoma (NHL)| called small lymphocytic lymphoma. You can also read our information about chronic lymphocytic leukaemia (CLL)|, which is a similar condition and is treated in the same way.
Non-Hodgkin lymphoma is a cancer of the lymphatic system|. This is part of the body’s immune system and helps us fight infection. It's made up of organs such as the bone marrow, thymus, spleen and the lymph nodes (or lymph glands). Lymph nodes are connected by a network of tiny lymphatic vessels that contain lymph fluid. There is also lymphatic tissue in other organs, such as the skin, lungs and stomach.
The lymphatic system
View a large copy of the diagram of the lymphatic system|
There are lymph nodes all over the body. As lymph fluid flows through the lymph nodes, the nodes collect and filter out anything harmful or that the body doesn't need. This includes bacteria, viruses, damaged cells and cancer cells.
Lymph fluid contains cells called lymphocytes. These are a type of white blood cell that help the body fight infection and disease.
Lymphocytes start to grow in the bone marrow, where blood cells are made. The two main types of lymphocyte are B-cells and T-cells. B-cells mature in the bone marrow, while T-cells mature in the thymus gland behind the breast bone. When they're mature, both B-cells and T-cells help fight infections. Lymphoma is a disease in which either T-cells or B-cells grow in an uncontrolled way.
There are many different types of non-Hodgkin lymphomas. They're grouped (or classified) according to certain characteristics. The most widely used classification system is produced by the World Health Organisation|.
Small lymphocytic lymphoma is a cancer of the B-cells. It is rare in people under 50 and more common in men.
This lymphoma is similar to a type of leukaemia called chronic lymphocytic leukaemia (CLL), which is also a cancer of the B-cells.
In lymphoma, the abnormal cells mainly affect the lymph nodes, but in leukaemia the abnormal cells are in the blood and the bone marrow. The spleen can be affected in both conditions.
The causes of small lymphocytic lymphoma are unknown. It's not infectious and cannot be passed on to other people.
The first sign is often a painless swelling in the neck, armpit or groin, caused by enlarged lymph nodes. Sometimes more than one group of nodes is affected. Other symptoms may include loss of appetite| and tiredness (fatigue)|. Some people have night sweats|, unexplained high temperatures (fever) and weight loss|. These are known as B symptoms.
A diagnosis is made by removing an enlarged lymph node (a biopsy) and examining the cells under a microscope. It is a very small operation and may be done under local or general anaesthetic. Biopsies may also be taken from other areas of the body.
Additional tests - including blood tests, x‑rays, scans and bone marrow samples - are then used to find out more about the type of lymphoma and how far it has spread in the body. This information is used to help decide which treatment is most appropriate.
We have more information about tests for non-Hodgkin lymphoma|.
The stage of non-Hodgkin lymphoma describes how many groups of lymph nodes are affected, where they are in the body and whether other organs such as the bone marrow or liver are involved.
One group of lymph nodes is affected. A group of lymph nodes refers to lymph nodes in one area of the body, such as in the armpit, on one side of the neck or in the groin.
Two or more groups of lymph nodes are affected, and they are all either above or below the diaphragm. The diaphragm is a sheet of muscle under the lungs.
The lymphoma is in lymph nodes both above and below the diaphragm.
The lymphoma has spread beyond the lymph nodes to other organs, such as the bones, liver or lungs.
B symptoms As well as giving each stage a number, doctors also use either the letter A or B to show whether or not you have specific symptoms. If you have weight loss, fevers or night sweats, the letter B will be added next to the stage. If you don't have these symptoms, the letter A is added.
Non-Hodgkin lymphomas are also divided into two groups; low-grade and high-grade. Low-grade lymphomas are usually slow-growing and high-grade lymphomas grow more quickly.
Small lymphocytic lymphoma is a low-grade lymphoma and usually develops very slowly.
Occasionally it may change (transform) into a high-grade non-Hodgkin lymphoma, which needs more intensive treatment.
If the lymphoma is not causing symptoms, you may not need treatment immediately. Early treatment at this stage doesn’t help people to live longer and can cause side effects.
You will be seen regularly by your cancer specialist or GP, and treatment will be advised when you start to get symptoms. It may be some time before this happens, and some people may never need any treatment.
After treatment, many people have a time with no signs of active disease, which is known as remission. If the lymphoma comes back it can be treated again. This can give another period of remission and the lymphoma can often be controlled in this way for many years.
Chemotherapy| is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is an important treatment and can often get the lymphoma into remission.
It is often given in combination with a drug called rituximab|, which is a monoclonal antibody.
Chemotherapy can be given as tablets or into a vein (intravenously). You may be given just one type of chemotherapy drug or you may be given two or more drugs together (combination chemotherapy|).
Chemotherapy treatments for small lymphocytic lymphoma include:
Cyclophosphamide and fludarabine can be given on their own or in combination (FC). They can be given as tablets or as an injection into a vein. Sometimes the monoclonal antibody rituximab is given with fludarabine and cyclophosphamide. This is called FCR chemotherapy.
Another commonly used treatment for small lymphocytic lymphoma is a chemotherapy drug called chlorambucil. It comes as tablets and is usually given on its own.
Monoclonal antibodies| are drugs that recognise, target and stick to particular proteins on the surface of cancer cells, and can stimulate the body’s immune system to destroy the cell.
Rituximab| is a monoclonal antibody used to treat small lymphocytic lymphoma. It's given as a drip into a vein (intravenous infusion). It is usually given with fludarabine and cyclophosphamide (FCR).
Alemtuzumab| is another monoclonal antibody that is sometimes used. It can be given as an intravenous infusion or as an injection under the skin (cutaneous injection).
Steroids| are drugs that are often given with chemotherapy to help treat lymphomas. They also help you feel better and can reduce feelings of sickness (nausea)|.
Some people with lymphoma may have treatments using their own stem cells| or stem cells from a donor|. Stem cells are a special type of blood cell that can make all the other types of blood cells.
This treatment is not suitable for everyone and is not done routinely. Doctors take into account a person's general health and age before recommending them.
Some people have some of their own stem cells collected and stored. This allows them to have higher doses of chemotherapy to destroy the lymphoma cells.
After the chemotherapy, their stem cells are returned by a drip (like a blood transfusion) to help their blood cells recover from the effects of chemotherapy. This is called an autologous transplant.
Some people may have treatment using stem cells from another person (a donor). This is called an allogeneic transplant.
Radiotherapy| is the use of high-energy rays to destroy cancer cells, while causing as little harm as possible to the healthy cells.
It may be used as a first treatment if the lymphoma cells are contained in one or two groups of lymph nodes in the same part of the body (stage 1 or 2). In some people, this may cure the lymphoma.
Radiotherapy can also be used to treat lymphoma that has come back in one area of lymph nodes.
New treatments for small lymphocytic lymphoma are being researched all the time. Your doctor may invite you to take part in a clinical trial| to compare a new treatment against the best available standard treatment.
Your doctor must discuss the treatment with you, and have your informed consent before entering you into a trial.
Before any trial is allowed to take place, it must be approved by a research ethics committee, which protects the interests of those taking part.
You may decide not to take part or to withdraw from the trial at any stage. You will then receive the best standard treatment available.
Everyone has their own way of dealing with their illness and the different emotions| they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse. You can also contact our cancer support specialists| or the organisations listed below for more information and support.
The Lymphoma Association| gives emotional support, advice and information on all aspects non-Hodgkin lymphoma. Has a national network of people with lymphoma and local groups.
Leukaemia CARE| is a national group promoting the welfare of people with leukaemia and related blood disorders, including non-Hodgkin lymphoma. Has regional support groups in many counties.
This section has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.