Nodal marginal zone b-cell lymphoma (NMZL)

NMZL may also cause the following symptoms:

• drenching night sweats
• unexplained weight loss.

These are called B symptoms. Along with staging and grading (below), B symptoms can help your cancer team understand:

• how the lymphoma might develop
• which treatments might help.

A change in how you feel or how your body works can be caused by conditions other than NMZL. But always ask your GP to check any ongoing, new or unexplained symptoms.

We are also here if you need someone to talk to. You can:

• call the Macmillan Support Line free on 0808 808 00 00
• chat to our specialists online.

If you have symptoms, you should start by going to your GP. They may arrange for you to have blood tests or scans. If they think cancer may be causing your symptoms, they will refer you to a hospital for tests and for specialist advice and treatment.

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

The most important test for diagnosing lymphoma is a biopsy. A biopsy means testing a small piece of tissue or a sample of cells from an affected area of the body. Sometimes NMZL can be found with a blood test.

Find out more about having a biopsy and other tests in our general general lymphoma information.

Waiting for test results can be a difficult time. It may take up to 2 weeks for the results to be ready.

You may find it helpful to talk to family members or a close friend. Your specialist nurse can also provide support.

You can talk to one of our cancer support specialists for free on 0808 808 0000, 7 days a week, 8am to 8pm.

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

After the MDT meeting, you will usually meet with your cancer doctor and specialist nurse. They will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions.

Your treatment options will depend on:

• the stage of the lymphoma
• your general health
• your preferences.

If you have no symptoms, you may not need any treatment. Instead, you may have regular tests and appointments to monitor the lymphoma and check for signs that you need to start treatment. This is called watch and wait. It may also be called active surveillance or active monitoring. It is a way of safely delaying treatment until you need it.

If you need to start treatment, it may include one of the following. You may have some treatments as part of a clinical trial. 

Treatment for NMZL is often very effective. It may make all signs of lymphoma disappear for a time. Some people will not need further treatment for many years. But NMZL often comes back. This is called recurrence or relapse.

If you have a relapse with no symptoms, you may have ongoing monitoring with tests and scans. If you need to start treatment, it may involve the following:

• radiotherapy to treat an area of lymphoma that is causing symptoms
• rituximab
• rituximab with chemotherapy
• intensive treatment with a stem cell transplant
• targeted therapy drugs, such as zanubrutinib.

Your cancer team will talk to you about the best options for your situation.

Sometimes NMZL can change from low grade into high grade lymphoma. This is called transformation or transformed NMZL. It is not common. But your cancer team will do tests to check for this when you are diagnosed or have a relapse of NMZL.

High grade lymphoma grows more quickly. It is treated differently. Transformed NMZL is treated in the same way as another type of lymphoma called DLBCL.

People often have many different feelings during and after NMZL treatment. If you have finished treatment, you may feel relieved it has ended, but worried about what might happen in the future.

It is important to know where to get support or information if you need it. People often need support even some time after NMZL treatment. But sometimes it is difficult to know who to ask for help.

You can:

• ask your GP or someone from your cancer team for advice about support in your area
• find cancer support services near you
• call the Macmillan Support Line for free on 0808 808 00 00.
• chat to our cancer information specialists online.
• visit our non-Hodgkin lymphoma forum to talk to people who have been affected by lymphoma, share your experience, and ask your questions.

You may also find the HOPE programme helpful. The programme is a free 6 week self-management course designed to help you develop techniques and strategies when living with or after cancer. Topics include goal setting, fatigue management, and wellbeing.

You can sign up for the online HOPE programme. Or to find out more about face to face programmes in your area, email ServiceOpsSupport@macmillan.org.uk

• Blood Cancer UK offers support and information to people affected by blood cancers, including lymphoma.

• Lymphoma Action provides high quality information and support for people affected by lymphoma. It provides helpline services and a range of peer support including online support meetings, educational events and webinars. Its website includes TrialsLink, a database of lymphoma clinical trials.

We know cancer can affect you physically, emotionally and financially. We have information and advice about different ways cancer might impact you, such as help with:

• eating problems and your appetite
• fertility
• how you're feeling
• improving your sexual well-being
• managing pain and discomfort
• money and work
• tiredness (fatigue)
• trouble sleeping
• uncertainty
• walking and mobility problems.