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Serious Medicine. Extraordinary Care.

Non-Hodgkin Lymphoma FAQ

Q: What are lymphomas?

A: Lymphoma is a type of cancer. It starts in the infection-fighting lymphatic system. There are 2 main types of lymphoma. They are Hodgkin and non-Hodgkin. With either type, cells in lymphoid tissue grow out of control.

Q: What is the lymph system?

A: The lymphatic system is part of the immune system.

Illustration of the lymphatic system of the head and neck.
Lymphatic system of the head and neck.

It helps the body fight disease and sickness. The lymphatic system consists of a series of thin tubes and clusters of lymph nodes throughout the body. These tubes carry fluid, called lymph, through the lymph nodes and back into the bloodstream. This colorless, watery fluid is rich in white blood cells. Lymphocytes are the main type of cells. They help the body fight off infection. A lymph node is about the size of a pea and has large numbers of lymphocytes. Groups of lymph nodes are found in the abdomen, chest, groin, and neck. Some of the body’s internal organs are also part of the lymphatic system. These organs include the bone marrow, spleen, thymus, and tonsils. Other organs, such as parts of the digestive tract, also contain lymph tissue.

Q: What is the difference between Hodgkin lymphoma and non-Hodgkin lymphoma?

A: The cells of each of these diseases look different under a microscope. They also spread differently. Hodgkin tends to spread in a more predictable way and typically not as much as non-Hodgkin.

Q: What is a fine needle aspiration?

A: A fine needle aspiration (FNA) is a type of biopsy. A biopsy is a test to check for cancer. To do one, the doctor takes a small sample of cells from the tumor or suspicious place. For an FNA, the doctor inserts a very thin, hollow needle into the tumor to collect cells. Then the cells are looked at under a microscope for cancer cells. With lymphoma, sometimes an FNA doesn’t give the doctor enough cells to look at for a clear diagnosis. Because of this, doctors often prefer to use other types of biopsies to diagnose lymphoma.

Q: What is the difference between an excisional and incisional biopsy?

A: An excisional biopsy is when a surgeon takes out the whole lymph node. An incisional biopsy is when a surgeon takes out only a part of the lymph node. In both cases, a specialized doctor called a pathologist looks at the cells under a microscope to check for cancer cells. Both of these types of biopsies almost always give the pathologist enough tissue to confirm whether there is cancer, as well as what type it is.

Q: What are the symptoms of lymphomas?

A: One of the most common symptoms of lymphomas is swelling of the lymph nodes in the neck, groin, and/or underarms. If the lymphoma is in other organs or tissues, you may have other symptoms, such as headaches, cough, shortness of breath, swelling in the abdomen, or nausea. You may also experience generalized symptoms, such as fever, itchy skin, night sweats, and unexplained weight loss. People may have only some of these symptoms. It is important to remember that all of these symptoms can be caused by other medical problems. If you have any of these, see your doctor.

Q: How is non-Hodgkin lymphoma treated?

A: The treatment of any lymphoma depends on the type of lymphoma and on its stage, which is how far the cancer has spread. In a very early stage, radiation may be the main treatment. A combination of chemotherapy drugs is the most common treatment. There are many different regimens available. There’s also immunotherapy, which uses drugs such as monoclonal antibodies. Often, several types of treatment are used together. In rare cases, a surgeon may take out a diseased spleen. In cases when treatment stops working, a doctor may suggest high-dose chemotherapy and stem cell transplantation, which is also called bone marrow transplant.

Q: Should everyone get a second opinion for a diagnosis of non-Hodgkin lymphoma?

A: There are many reasons someone might want to ask for a second opinion. Here are some:

  • A person is not comfortable with the treatment decision.

  • The type of cancer is rare.

  • There is more than one way to treat the cancer.

  • A person is not able to see a cancer expert.

Q: How can someone get a second opinion?

A: Here are ways to find someone for a second opinion:

  • Ask the doctor for the name of a specialist.

  • Call the Cancer Information Service. The number is 800-4-CANCER (800-422-6237). Callers can learn about centers and programs supported by the National Cancer Institute.

  • Get names of doctors from the local medical society.

  • Get names of doctors from a hospital, medical school, or cancer advocacy group.

  • Ask people who have had the same kind of cancer for doctors’ names.

  • Remember, it is more important to make an informed decision about your health care team and treatment than to make a quick decision. Give yourself time to get all the information you need to make the best choice for yourself.