Adult non-Hodgkin lymphoma is a disease in which malignant (cancer) cells form in the lymph system.The lymph system is part of the immune system and is made up of the following:
- Lymph: Colorless, watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the body against infections and the growth of tumors.
- Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
Because lymph tissue is found throughout the body, adult non-Hodgkin lymphoma can begin in almost any part of the body. Cancer can spread to the liver and many other organs and tissues. Non-Hodgkin lymphoma in pregnant women is the same as the disease in nonpregnant women of childbearing age. However, treatment is different for pregnant women. This summary includes information on the treatment of non-Hodgkin lymphoma during pregnancy Non-Hodgkin lymphoma can occur in both adults and children. Treatment for children, however, is different than treatment for adults. (See the PDQ summary on for more information.)
There are many different types of lymphoma.Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin lymphoma. This summary is about the treatment of adult non-Hodgkin lymphoma. For information about other types of lymphoma, see the following PDQ summaries:
- Adult Acute Lymphoblastic Leukemia Treatment
- Adult Hodgkin Lymphoma Treatment
- AIDS-Related Lymphoma Treatment
- Chronic Lymphocytic Leukemia Treatment
- Hairy Cell Leukemia Treatment
- Mycosis Fungoides and the Sézary Syndrome Treatment
- Primary CNS Lymphoma Treatment
- Childhood Non-Hodgkin Lymphoma Treatment
Waldenström macroglobulinemia is a type of non-Hodgkin lymphoma.Waldenström macroglobulinemia begins in a type of white blood cell called B lymphocytes. Certain B lymphocytes multiply out of control and make large amounts of a protein called monoclonal immunoglobulin M (IgM) antibody. High levels of IgM in the blood cause the blood to thicken and leads to many of the symptoms of Waldenström macroglobulinemia. Waldenström macroglobulinemia is also called lymphoplasmacytic lymphoma.
Age, gender, and a weakened immune system can affect the risk of adult non-Hodgkin lymphoma.Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for adult non-Hodgkin lymphoma include the following:
- Being older, male, or white.
- Having one of the following medical conditions:
- Taking immunosuppressant drugs after an organ transplant.
- Being exposed to certain pesticides.
- A diet high in meats and fat.
- Past treatment for Hodgkin lymphoma.
Possible signs of adult non-Hodgkin lymphoma include fever, sweating, fatigue, and weight loss.These and other symptoms may be caused by adult non-Hodgkin lymphoma. Other conditions may cause the same symptoms. Check with your doctor if you have any of the following problems:
- Fever for no known reason.
- Drenching night sweats.
- Feeling very tired.
- Weight loss for no known reason.
- Skin rash or itchy skin.
- Pain in the chest, abdomen, or bones for no known reason.
- Feeling very tired.
- Easy bruising or bleeding, such as nosebleeds or bleeding from the gums.
- Vision changes, such as blurred vision or blind spots.
- Pain, tingling, or numbness, especially in the hands, feet, fingers, or toes.
- Pain or a feeling of fullness below the ribs on the left side.
- Painless lumps in the neck, underarm, stomach, or groin.
- Weight loss for no known reason.
Tests that examine the body and lymph system are used to help detect (find) and diagnose adult non-Hodgkin lymphoma.The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Blood and urine immunoglobulin studies: A procedure in which a blood or urine sample is checked to measure the amounts of certain antibodies (immunoglobulins). In Waldenström macroglobulinemia, immunoglobulin M (IgM) and beta-2-microglobulin is measured. A higher- or lower-than-normal amount of these substances can be a sign of disease.
- Blood viscosity test: A procedure in which a blood sample is checked to see how “thick” the blood is. In Waldenström macroglobulinemia, when the amount of monoclonal immunoglobulin M (IgM) antibody in the blood becomes very high, the blood thickens and may cause symptoms.
- Flow cytometry: A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of cells, such as size, shape, and the presence of tumor markers on the cell surface. The cells are stained with a light-sensitive dye, placed in a fluid, and passed in a stream before a laser or other type of light. The measurements are based on how the light-sensitive dye reacts to the light. This test is used to diagnose Waldenström macroglobulinemia.
Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap. A pathologist views the cerebrospinal fluid under a microscope to look for signs of cancer.
- Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.
- Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.
- Immunophenotyping: A process used to identify cells, based on the types of antigens or markers on the surface of the cell. This process is used to diagnose specific types of leukemia and lymphoma by comparing the cancer cells to normal cells of the immune system.
Certain factors affect prognosis (chance of recovery) and treatment options.The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer.
- The type of non-Hodgkin lymphoma.
- The amount of lactate dehydrogenase (LDH) in the blood.
- The amount of beta-2-microglobulin in the blood (for Waldenström macroglobulinemia).
- Whether the lymphoma has just been diagnosed or has recurred (come back).
- The wishes of the patient
- Which trimester of pregnancy the patient is in.