What can be expected with Non-Hodgkin’s lymphoma?

Non-Hodgkin's lymphoma (NHL) is not a single disease. It’s a complex group of cancers that start in the body’s immune system. The diseases have similarities at the cell level, but they have different effects on the body and show different responses to treatment. A person’s experience with NHL will depend on the type of disease, its location and the treatments given.

NHL may progress slowly (low-grade lymphoma) or quickly (high-grade lymphoma). Low-grade lymphomas typically develop over several years. High-grade lymphomas develop more quickly, but they also tend to respond better to treatment. When a high-grade lymphoma doesn’t respond to treatment, disease progression tends to be quite rapid.

NHL is usually found in parts of the body's lymphatic system, such as the lymph nodes. It also can be found in the blood and bone marrow, and at times in the brain, chest, abdomen or other areas. The primary tumor may spread to other places in the body. The location of the primary tumor and of any metastases determines many of the possible symptoms. In general, the body organs or systems that have a tumor eventually fail to function properly. For example, someone with a tumor in a lymph node in the neck may eventually have a very visible lump on the neck that can interfere with breathing or swallowing. Someone with NHL in the brain eventually shows changes in mental processes. Someone with NHL in the chest may have trouble with breathing or circulation.

The type of treatment given to someone with NHL may also affect what someone experiences. Chemotherapy, radiation therapy, bone marrow or stem cell transplants are among the most common treatment options, depending on the disease. Each of these treatments may produce ongoing symptoms.

While these and other variables play a role in what happens with NHL, people generally experience these symptoms as the disease advances:

  • Pain
    The tumor or the metastases can create pressure or an obstruction in an area, which produces pain. Pain medications are used to control the pain and keep the person comfortable.
  • Infections
    Infections may be common if the immune system is not working well.
  • Bleeding or anemia and related fatigue
    These symptoms may occur if the disease is in the bone marrow. They are treated with blood and platelet transfusions. In late stages of the illness, a patient may become exhausted by the effort to have the necessary blood tests and transfusions. As well, eventually the transfusions will not have the desired effect. At that point the patient and the health care team need to decide whether they will decrease or stop the transfusions.

Someone with NHL may experience symptoms that are common to most cancers generally, which affect energy, strength, appetite, breathing and responsiveness.

The changes can be gradual, but crises can develop. People with NHL most often die from infections, bleeding or organ failure resulting from metastases. A serious infection or sudden bleeding can quickly lead to death, even if someone doesn’t appear very ill. For this reason, the end stages of life for people with NHL are harder to predict than for people with other cancers.

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