What is non-Hodgkin lymphoma (NHL)?

Non-Hodgkin lymphoma (NHL), sometimes called non-Hodgkin's lymphoma, is a cancer of the lymphatic system. The lymphatic system is part of the body's immune system. NHL develops in white blood cells called lymphocytes.

Non-Hodgkin lymphoma is the fifth most common cancer in the UK. Around 13,500 people are diagnosed with it each year. There are many types of NHL. Some grow very slowly and may not need treatment for months or years. Other types grow quickly and need treatment soon after diagnosis.

We have more information about how non-Hodgkin lymphoma develops.

We also have information about another type of lymphoma called Hodgkin lymphoma.

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Symptoms of non-Hodgkin lymphoma (NHL)

The most common symptom of non-Hodgkin lymphoma is a painless swelling in the lymph nodes in one area of the body, such as the neck, armpit or groin.

If you are worried about NHL, we have more information about the signs and symptoms of lymphoma.

Causes of non-Hodgkin lymphoma (NHL)

Doctors do not know the exact causes of NHL. But there are risk factors that can increase your chance of developing it.

Having one or more risk factors does not mean you will get non-Hodgkin lymphoma. Also, having no risk factors does not mean you will not develop NHL.

We have more information about causes and risk factors for NHL.

Diagnosis of non-Hodgkin lymphoma (NHL)

If you have symptoms, you usually begin by seeing your GP. If they think your symptoms could be caused by cancer, they may arrange for you to have blood tests or scans. Your doctor will refer you to hospital for tests and for specialist advice and treatment.

If you think you may be pregnant, let your doctor know. Some tests and treatments can be harmful to a baby in the womb. Pregnant women can often still have tests and treatments for lymphoma. But, it is important to talk to your doctor so that you can plan your care safely. We have more information about cancer and pregnancy.

Biopsy for lymphoma

The most important test for diagnosing lymphoma is a biopsy. A doctor or nurse will take a sample of tissue from the affected area. The most common place to take a biopsy from is an enlarged lymph node. This is called a lymph node biopsy. You may have all or a part of the lymph node removed. The tissue will be sent to a laboratory for testing.

Further tests for lymphoma

You will have more tests before you start treatment for lymphoma. Some tests help to show the stage of the lymphoma. You may have other tests, such as blood tests or x-rays to check your general health and how well your heart, lungs, liver and kidneys are working.

Information from these tests help your doctors plan your treatment safely and effectively.

You may have some of the following tests:

  • CT scan

    A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of your body.

  • PET-CT scan

    A PET-CT scan gives more detailed information about the part of the body being scanned.

  • MRI scan

    An MRI scan uses magnetism to build up a detailed picture of areas of your body.

  • Bone marrow sample

    A doctor or nurse takes a small sample of bone marrow from the back of the hip bone (pelvis). The sample is sent to a laboratory to be checked for abnormal cells.

  • Lumbar puncture

    A lumbar puncture is when a hollow needle is inserted between the bones of the lower back. It is done to take a sample of the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord. In some types of non-Hodgkin lymphoma, the lymphoma cells may get into this fluid.

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

Staging and grading of non-Hodgkin lymphoma (NHL)

The results of your tests help your doctors find out how many areas of the body are affected by lymphoma and where these areas are. This is called staging.

Lymphomas are also grouped as either low-grade or high-grade.

We have more information about staging and grading of non-Hodgkin lymphoma.

Types of non-Hodgkin lymphoma

There are many different types of NHL. Your doctors need to know which type you have so they can give you the best treatment.

We have more information about the different types of NHL.

Treatment for non-Hodgkin lymphoma (NHL)

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.

If you have HIV and lymphoma, your lymphoma doctors and HIV doctors will work together to plan your treatment. We have more information about what this might involve.

Treating lymphoma will depend on:

Types of treatment you may have include:

  • Watch and wait

    During watch and wait, you do not need to start treatment straight away. Instead, you have regular tests and appointments to monitor the lymphoma and check for signs that you need to start treatment.

  • Chemotherapy

    Chemotherapy is often used to treat lymphoma. It uses anti-cancer (cytotoxic) drugs to destroy lymphoma cells.

  • Steroids

    Steroids are drugs given with chemotherapy to help treat lymphoma.

  • Targeted therapies

    Targeted therapies are drugs that use unique features of the cancer to find and destroy cancer cells.

  • Radiotherapy

    Radiotherapy treats cancer by using high-energy rays that destroy cancer cells, while doing as little harm as possible to normal cells.

  • Stem cell transplant

    There are two types of stem cell transplant. One uses your own stem cells. The other uses stem cells from someone else (a donor). It may be used to treat types of NHL that do not respond well to the most commonly used chemotherapy treatments.

You may have some treatments as part of a clinical trial.

After non-Hodgkin lymphoma (NHL) treatment

You have regular follow-up appointments after treatment. These appointments are a good opportunity for you to talk to your doctor or nurse about any concerns you have. Your doctor will want to know how you are feeling generally, and to check you are recovering from any side effects of treatment.

Late effects

Sometimes a side effect may continue or develop months or years after treatment. This is called a late effect.

We have more information about long-term and late effects of treatment for lymphoma.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.

Getting support

Everyone has their own way of dealing with 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.

Macmillan is also here to support you. If you would like to talk, you can:

The organisations below also offer information and support:

  • Blood Cancer UK

    Blood Cancer UK is a blood cancer research charity that provides information and support on any type of blood cancer.

  • Lymphoma Action

    Lymphoma Action gives emotional support, advice and information on all aspects of Hodgkin lymphoma and non-Hodgkin lymphoma. It has a national network of people with lymphoma, and local groups.

About our information

  • References

    Below is a sample of the sources used in our non-Hodgkin lymphoma (NHL) information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    National Institute for Health and Care Excellence (NICE). Guideline NG46. Haematological cancers: improving outcomes. 2016.

    National Institute for Health and Care Excellence (NICE). Guideline NG52. Non-Hodgkin’s lymphoma: diagnosis and management. 2016.

    Treleaven, et al. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. British Journal of Haematology. 2011.

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Anne Parker, Consultant Haematologist; and Professor Rajnish Gupta, Macmillan Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Reviewed: 31 January 2018
Reviewed: 31/01/2018
Next review: 31 July 2020
Next review: 31/07/2020