Non-Hodgkin lymphoma (NHL) is a type of blood cancer that starts in the lymphocytes, a type of white blood cell. It affects the lymph system, which includes lymph nodes, the spleen, the thymus gland, which produces and trains T-cells to fight infection, tonsils, bone marrow, and lymphatic vessels that move lymph fluid through the body to clear out waste.
Unlike Hodgkin lymphoma, NHL lacks the presence of Reed-Sternberg cells. There are several subtypes of non-Hodgkin lymphoma.
What Are the Most Common Types of Non-Hodgkin Lymphoma?
B-cell lymphomas:
The most common type of NHL, accounting for about 85% of cases. Subtypes include:
Diffuse large B-cell lymphoma (DLBCL): A fast-growing lymphoma that requires prompt treatment.
Follicular lymphoma: Typically slow-growing and may not need immediate therapy.
T-cell lymphomas:
Less common and often more aggressive, these include:
Peripheral T-cell lymphoma: A heterogeneous group with varying prognoses.
Cutaneous T-cell lymphoma: Primarily affects the skin.
Understanding the specific type of NHL is essential for determining the most effective treatment strategy.
Why Choose Shenandoah Oncology for Non-Hodgkin Lymphoma Treatment?
We serve a large region of Virginia, from the Shenandoah Valley to Leesburg, as well as the panhandle of West Virginia and regions of western Maryland. Our cancer doctors provide the latest in cancer care, including:
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Access the Most Advanced Treatments: Patients can access the latest treatment regimens, including immunotherapies and targeted therapies, without the need to travel to distant hospitals.
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Personalized Care: Our dedicated team develops individualized treatment plans tailored to each patient's needs. Our supportive care team is here to guide you through the treatment process, which includes emotional support and assistance for your family.
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Convenience: Located in Winchester, Virginia, we offer easy access and ample parking, reducing the stress associated with hospital visits.
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Cost-Effective: Community-based centers like ours often provide treatments at a lower cost compared to hospital-based outpatient cancer centers.
If you or a loved one is facing non-Hodgkin lymphoma, request an appointment at Shenandoah Oncology to explore your treatment options with our experienced team.
Learn about Non-Hodgkin Lymphoma
Symptoms of Non-Hodgkin Lymphoma (NHL)
Symptoms of NHL can vary depending on the lymphoma's location and progression. Common signs include:
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Swollen lymph nodes in the neck, armpits, or groin that are not associated with a known infection, such as the flu, COVID, or strep throat. Usually, swollen lymph nodes caused by non-Hodgkin lymphoma are painless.
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Fever without a known cause, such as a bacterial or viral infection.
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Night sweats that are not related to menopause.
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Unexplained weight loss
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Fatigue and persistent weakness.
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Abdominal pain or swelling.
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Chest pain, coughing, or shortness of breath may occur if lymph nodes in the chest are affected.
These symptoms can also be associated with other conditions, so it's important to consult a healthcare provider for an accurate diagnosis. If they suspect a blood condition as the cause, tests will be run, starting with blood tests.
How Is Non-Hodgkin Lymphoma Diagnosed?
If your doctor suspected lymphoma after learning about your symptoms and performing a physical evaluation, additional tests are needed. If lymphoma is found, the tests will finalize the diagnosis and determine its stage.
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Biopsy: Removing a sample of lymph node tissue for microscopic examination to identify cancerous cells. This biopsy is an outpatient procedure and will give your hematologist information about whether lymphoma cells are present. If they are, the specific subtype is also determined.
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Imaging tests: CT scans, PET scans, and MRIs help locate enlarged lymph nodes and assess the spread of the disease.
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Bone scan: This is done if the cancer appears to have spread. Your hematologist-oncologist will want to know if the bones are affected.
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Blood tests: Evaluating overall health and detecting markers that may indicate lymphoma.
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Bone marrow aspiration and biopsy: Determining if lymphoma has spread to the bone marrow.
The hematologists at Shenandoah Oncology use the most advanced diagnostic tools to ensure a precise diagnosis, which allows them to develop the most effective treatment plan.
What Are the Stages of NHL?
Staging describes the extent of lymphoma in the body. The higher the stage, the more treatments that are needed.
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Stage I: A single lymph node region is affected, such as the chest and lungs, collarbone (clavical) area, neck, armpit, groin, or pelvis; or a single non-lymphatic organ is affected, such as the lungs, liver, skin, intestines, stomach, brain, or spinal cord.
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Stage IE means there is one single area or organ outside the lymph system, such as the stomach or a lung, without involvement of lymph nodes elsewhere.
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Stage II: Two or more lymph node regions are affected on the same side of the diaphragm.
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Stage IIE means two or more lymph node regions are affected on the same side of the diaphragm, and localized involvement of an organ outside the lymph system.
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Stage III: Lymph node regions on both sides of the diaphragm are affected.
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Stage IIIE means lymph nodes are affected on both sides of the diaphragm, plus there is localized involvement of a nearby non-lymphatic organ.
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Stage IV: Widespread involvement of one or more non-lymphatic organs, such as the liver or bone marrow.
Staging Can Also Indicate Whether Symptoms are Present
Each stage of non-Hodgkin lymphoma can also have an additional classification of A or B. "A" means the patient does not have symptoms, while "B" means that systemic symptoms like fever, night sweats, and/or weight loss are present.
At Shenandoah Oncology in Winchester, Virginia, we offer a comprehensive range of treatments for non-Hodgkin lymphoma (NHL), including advanced immunotherapies and targeted therapies. These innovative approaches are designed to enhance the body's natural defenses and precisely attack cancer cells, providing effective options for patients in the Shenandoah Valley.
Treatments for Non-Hodgkin Lymphoma
The right treatment plan depends on the stage and which organs, if any, are affected by non-Hodgkin lymphoma. Your hematologist, who diagnosed you, is also an oncologist who is trained in treating cancers like non-Hodgkin lymphoma. They will review your specific test results and consult with the Shenandoah Oncology team to create a personalized plan. Patients typically receive one or more of these therapies when the time is right to start treatment:
Chemotherapy Regimen for Non-Hodgkin Lymphoma
Chemotherapy drugs kill cancer cells throughout your body. Immunotherapy drugs help the body identify and fight cancer cells.
Chemotherapy for Non-Hodgkin Lymphoma
The most common chemotherapy treatment for non-Hodgkin lymphoma (NHL), especially for fast-growing B-cell lymphomas like Diffuse Large B-Cell Lymphoma (DLBCL), is a combination regimen known as R-CHOP.
CHOP is an acronym for a combination of chemotherapy drugs commonly used to treat NHL:
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C – Cyclophosphamide
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H – Doxorubicin (Hydroxydaunorubicin)
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O – Vincristine (Oncovin)
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P – Prednisone
Immunotherapy for Non-Hodgkin Lymphoma
The R in R-CHOP stands for Rituximab, a monoclonal antibody immunotherapy drug. It specifically targets a protein called CD20, found on the surface of most B-cell lymphoma cells. It helps treat NHL by:
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Flagging cancer cells for destruction by the immune system
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Directly attacking B cells, causing them to die.
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Enhancing the effectiveness of the chemotherapy drugs in CHOP
Other types of immunotherapy used to treat non-Hodgkin lymphoma include:
CAR T-Cell Therapy
Chimeric Antigen Receptor (CAR) T-cell therapy involves collecting a patient's T cells, genetically modifying them to express receptors specific to antigens on lymphoma cells, and infusing them back into the patient. These engineered T cells can then recognize and destroy cancer cells.
Immune Checkpoint Inhibitors
Cancer cells can evade immune detection by exploiting certain pathways that suppress immune responses. Immune checkpoint inhibitors block these pathways, restoring the immune system's ability to recognize and attack cancer cells.
Targeted Therapy for Non-Hodgkin Lymphoma
Targeted therapies are designed to interfere with specific molecules involved in cancer cell growth and survival, minimizing damage to normal cells:
Proteasome Inhibitors
These agents disrupt the function of proteasomes, cellular complexes that degrade unneeded or damaged proteins. By inhibiting proteasomes, these drugs can induce apoptosis (programmed cell death) in lymphoma cells.
BTK Inhibitors
Bruton's tyrosine kinase (BTK) is an enzyme that plays a crucial role in B-cell receptor signaling and is essential for B-cell development and function. BTK inhibitors block this enzyme, slowing or stopping the growth and survival of cancerous B cells.
At Shenandoah Oncology, we integrate these advanced therapies into personalized treatment plans, ensuring that patients receive the most effective and appropriate care for their specific type of NHL.
Radiation Therapy and Non-Hodgkin Lymphoma
High-energy rays can kill lymphoma cells, typically for localized disease. While it’s rarely used as the only treatment for NHL, radiation can be used if the cancer has only affected one or two lymph nodes in a single area or a single non-lymphatic organ.
If a tumor has developed, also referred to as bulky lymphoma, radiation can be used along with systemic treatments to shrink the cancer. This is more common in aggressive (fast-growing) lymphomas such as diffuse B-cell lymphomas.
Radiation can also be used to reduce symptoms caused by a tumor growing in an area of the body. The radiation shrinks the mass, relieving pain.
Bone Marrow Transplantation
When non-Hodgkin lymphoma returns after initial treatment (relapsed) or doesn’t respond well to first-line therapy (refractory), a bone marrow transplant may offer a second chance for long-term remission or cure.
It may also be recommended for patients with an aggressive subtype of NHL, such as diffuse large B-cell lymphoma, who are at high risk of relapse. For patients with slow-growing NHL, like follicular lymphoma, transplantation is considered after multiple relapses or if the disease becomes more aggressive. Additionally, certain T-cell lymphomas, which are often more difficult to treat, may be managed with transplant if remission is achieved. Your oncologist will discuss the options and whether a transplant would be appropriate for you.
Choosing a Non-Hodgkin Lymphoma Doctor
If you or a loved one is facing non-Hodgkin lymphoma, request an appointment at Shenandoah Oncology to explore your treatment options with our experienced team.