Non-Hodgkin lymphoma

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma is cancer that originates from the lymph glands and ducts, which are organs that function as part of the body's immune system. This cancer most often develops in the lymph nodes.

In people with non-Hodgkin's lymphoma, the number of white blood cells continues to divide but cannot grow normally. As a result, a type of white blood cell called lymphocytes will accumulate in the lymph nodes and ducts, causing various health problems in various organs of the body.

Non-Hodgkin lymphoma is generally characterized by a lump in a part of the body where there are lymph nodes , such as the armpit or neck. These symptoms are similar to those of Hodgkin's lymphoma .

Non-Hodgkin lymphoma needs to be treated immediately. Otherwise, the cancer can spread to other organs and cause serious complications.

Causes of Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma generally occurs due to gene mutations (changes) in lymphocytes, which are a type of white blood cell that functions to fight infection in the body.

Normally, old or old lymphocytes will die. The body will then produce new lymphocytes to replace these lymphocytes. Whereas in non-Hodgkin lymphoma, lymphocytes will continue to divide and develop abnormally.

The above conditions cause lymphocytes to accumulate in the lymph nodes resulting in swollen lymph nodes ( lymphadenopathy ). In addition, the accumulation of lymphocytes in the lymphatic channels can form tumors in various areas of the body.

It is not known exactly what causes gene mutations in lymphocytes. However, there are several factors that can increase a person's risk of developing non-Hodgkin's lymphoma, namely:

  • Over 60 years old
  • Having a weak immune system, for example as a result of using immunosuppressant drugs
  • Have an autoimmune disease, such as rheumatoid arthritis , lupus, or Sjögren's syndrome
  • Suffering from certain viral and bacterial infections, such as the Epstein-Barr virus, HIV, or the bacterium Helicobacter pylori
  • Have a family history of non-Hodgkin lymphoma
  • Continuous exposure to certain chemicals, such as pesticides

Types of L on-Hodgkin 's lymphoma

Based on lymphocytes that experience gene changes, non-Hodgkin lymphoma is divided into two types, namely:

  • B lymphocytes
    Most non-Hodgkin's lymphoma arises from B lymphocyte cells. B lymphocytes fight infection by producing antibodies that can neutralize bacteria or viruses that are harmful to the body. This type of lymphoma is also known as  diffuse large B-cell lymphoma (DLBCL).
  • T Lymphocytes
    Some T lymphocytes are responsible for directly destroying bacteria, viruses, or other abnormal cells in the body. While other T lymphocytes help speed up or slow down the activity of other cells of the immune system.
  • Burkitt
    lymphoma Burkitt lymphoma or  Burkitt lymphoma  is an aggressive type of non-Hodgkin lymphoma. This type of lymphoma is often associated with immune system disorders due to HIV/AIDS or Epstein-Barr virus infection, as well as long-term use of immunosuppressant drugs.


Symptoms of Non-Hodgkin Lymphoma

Symptoms of non-Hodgkin lymphoma depend on the type of lymphoma and the sites affected. The following are some of the symptoms of non-Hodgkin lymphoma:

  • Lumps that are generally painless in the neck, armpits, or groin
  • Weight loss
  • Fever
  • Night sweats
  • Easily tired
  • Loss of appetite
  • Chest pain
  • Hard to breathe
  • Abdominal pain or enlarged
  • Itchy skin
  • Susceptible to infection
  • Frequent bleeding

When to see a doctor

Some symptoms, such as a lump or fever, are not symptoms that can tell for sure that a person has non-Hodgkin lymphoma. The reason is, these symptoms can also occur in other conditions, such as infection of the lymph nodes ( lymphadenitis ) or other infections.

Therefore, if you experience the symptoms above, do an examination with a doctor to determine the cause, especially if you are at high risk of suffering from non-Hodgkin's lymphoma.

See a doctor immediately if your symptoms last a long time or get worse. Early examination and treatment can prevent complications.

Diagnosis of Non-Hodgkin's Lymphoma                      

To diagnose non-Hodgkin's lymphoma, the doctor will ask questions and answers about the patient's symptoms and medical history, as well as a family history of the disease. After that, the doctor will perform a physical examination to check for swollen lymph nodes in the neck , armpits, or groin.

Furthermore, the doctor will carry out a number of follow-up examinations below to make a diagnosis:

  • Complete blood test , to measure levels of blood cells, check kidney function, and elevated lactate dehydrogenese (LDH) levels in lymphoma sufferers
  • Lymph node biopsy, to check whether the swelling is caused by lymphoma or the spread of cancer from other organs, such as the breast and thyroid
  • Scan with X-rays, ultrasound, CT scan, MRI , or PET scan, to detect possible symptoms caused by other conditions and determine the stage of cancer
  • Biopsy of the bone marrow , to check whether the lymphoma has spread to the bone marrow
  • Lumbar puncture test , to detect the spread of lymphoma to the brain by examining a sample of spinal fluid

Stage L of on-Hodgkin 's lymphoma

After conducting an examination and confirming the diagnosis, the doctor will determine the stage or severity of the patient's cancer. The following are the stages of non-Hodgkin lymphoma:

  • Stage 1
    At this stage, the cancer only attacks one group of lymph nodes, for example the lymph nodes in the groin or neck.
  • Stage 2
    Stage 2 indicates that the cancer attacks two or more groups of lymph nodes that are on one side of the diaphragm , both the upper and lower diaphragms.
  • Stage 3
    At this stage, the cancer has attacked the lymph node groups on both sides of the diaphragm.
  • Stage 4
    Stage 4 indicates that the cancer has spread beyond the ducts and lymph nodes, and into the bone marrow or other organs, such as the liver or lungs.

Treatment of Non-Hodgkin's Lymphoma

Treatment of non-Hodgkin lymphoma aims to destroy cancer cells and prevent them from spreading to other organs. The treatment method given will be adjusted to the stage of cancer, age, and health condition of the patient.

In patients with slow-developing non-Hodgkin's lymphoma ( indolent lymphomas ), doctors usually monitor their condition periodically without giving certain drugs. The doctor will schedule regular checkups for several months to make sure that the cancer is not getting worse.

If the patient's non-Hodgkin lymphoma is aggressive or the complaints are getting worse, the doctor will recommend the following treatment methods:

1. Chemotherapy

Chemotherapy is the administration of drugs that aim to kill cancer cells. Chemotherapy can be combined with corticosteroid drugs to increase their effectiveness. However, the use of corticosteroid drugs is only recommended for the short term.

2. Radiotherapy

Radiotherapy is generally used to treat non-Hodgkin's lymphoma that develops slowly and is located in one or two lymph nodes. Radiotherapy can also be done after chemotherapy to kill any remaining lymphoma cells.

Radiotherapy aims to kill cancer cells by directing high doses of radiation, such as X-rays or protons, to the affected lymph nodes.

3. Monoclonal antibody therapy

Monoclonal antibody therapy uses monoclonal antibody drugs, such as rituximab , to increase the body's resistance to destroying cancer cells. Generally, this therapy is combined with chemotherapy.

Please note, this therapy is only effective for some types of non-Hodgkin's lymphoma and needs to be adjusted according to the results of the immunophenotype examination .

4. Bone marrow transplant

Bone marrow transplant can be done after the patient has undergone chemotherapy and radiotherapy. Through this procedure, the doctor will transplant healthy bone marrow stem cells into the patient's body. That way, the bone marrow can re-produce healthy white blood cells.

Complications of Non-Hodgkin's Lymphoma

Non-Hodgkin lymphoma that is not treated properly can cause serious complications, namely:

  • Bleeding
  • Recurrent infection
  • Health problems due to a decrease in the number of blood cells (cytopenia), such as anemia , a decrease in the number of neutrophil white blood cells (neutropenia), or a decrease in the number of platelets (thrombocytopenia)
  • Fluid buildup in the lining of the heart ( pericardial effusion ) or lungs ( pleural effusion )
  • Blockage in the digestive tract, if cancer occurs in the digestive tract
  • Spread of cancer cells to other organs ( metastasis )

Prevention of Non-Hodgkin's Lymphoma

The cause of non-Hodgkin's lymphoma is not known with certainty, so it is difficult to prevent this disease. However, there are several measures that can be taken to reduce the risk of developing non-Hodgkin's lymphoma, such as:

  • Eat a balanced nutritional diet
  • Practice safe sex to prevent HIV/AIDS
  • Do not use  NAPZA
  • Use proper PPE , such as masks, goggles and gloves, if working in an environment where there is a risk of chemical exposure
  • Consult a doctor regularly when taking immunosuppressant drugs, to prevent side effects that can occur
  • Have regular check-ups if you have an autoimmune disease, such as rheumatoid arthritis , to prevent it from developing into non-Hodgkin's lymphoma
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