Non-Hodgkin's lymphoma is a cancer that developsin the lymphatic system, namely a collection of vessels and glands that are scattered throughout the body and function as part of the immune system.One of them is the lymph nodes.
Non-Hodgkin's lymphoma is often characterized by the appearance of lumps in the body where there are lymph nodes, such as the armpit or neck. This condition needs to be treated as soon as possible, otherwise the cancer can spread to other organs of the body and cause serious complications.
Causes of Non-Hodgkin's Lymphoma
Non-Hodgkin's lymphoma generally occurs due to changes or mutations in the DNA of one type of white blood cell called a lymphocyte. Lymphocytes are blood cells that function to fight infection in the body.
Normally, old or old lymphocytes will die, and the body will produce new lymphocytes to replace them. In the case of non-Hodgkin's lymphoma, lymphocytes continue to divide and grow abnormally (without stopping), resulting in an accumulation of lymphocytes in the lymph nodes.
This condition causes swollen lymph nodes (lymphadenopathy) and the body becomes susceptible to infection.
It is not known exactly what causes DNA changes in one of these types of white blood cells. However, there are several factors that can increase a person's risk of developing non-Hodgkin's lymphoma, namely:
- Aged 60 years and over
- Have a weak immune system, for example due to using immunosuppressant drugs
- Suffering from an autoimmune disease, such as rheumatoid arthritis, lupus, or Sjogren's syndrome
- Suffering from certain viral and bacterial infections, such as viral infections Epstein-Barr, HIV, or bacterial infection Helicobacter pylori
- Have a family history of non-Hodgkin's lymphoma
- Constant exposure to certain chemicals, such as pesticides
Types of non-Hodgkin's lymphoma
Based on the lymphocytes that undergo DNA changes, non-Hodgkin's lymphoma is divided into two types, namely:
- B Lim LymphocytesMost non-Hodgkin's lymphomas arise from these lymphocytes. 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 . LymphocytesSome T lymphocytes are in charge of destroying bacteria, viruses, or other abnormal cells in the body directly. Meanwhile, other T lymphocytes help speed up or slow down the activity of other immune system cells.
Symptoms of Non-Hodgkin's Lymphoma
Symptoms of non-Hodgkin's lymphoma depend on the type of lymphoma and where it occurs. The following are some of the symptoms of non-Hodgkin's lymphoma:
- Lumps that are generally painless in the neck, armpit, or groin
- Weight loss
- Fever
- Sweating at night
- Tired easily
- Decreased appetite
- Chest pain
- Hard to breathe
- Stomach hurts or enlarges
- Itchy skin
When to go to the doctor
Some symptoms, such as the appearance of a lump or fever, are not signs that can confirm that a person has non-Hodgkin's lymphoma. The reason, these symptoms can also occur in other conditions, such as infection.
Therefore, if you experience any of the above symptoms, consult a doctor to determine the cause, especially if you are at high risk of developing non-Hodgkin's lymphoma.
Immediately see a doctor if your symptoms have been going on for a long time or getting worse. Early examination and treatment will reduce the possibility of complications.
Diagnosis of Non-Hodgkin's Lymphoma
To diagnose non-Hodgkin's lymphoma, the doctor will ask questions about the symptoms and complaints experienced by the patient, the patient's health condition, and the patient's family history of the disease.
After that, the doctor will perform a physical examination to check for swollen lymph nodes in the neck, armpit, or groin. The doctor will then also perform additional examinations to confirm the diagnosis. These inspections can be in the form of:
- blood testBlood tests are done to determine the presence of infection or other diseases, as well as elevated levels of lactate dehydrogenase (LDH) with a complete blood count, because LDH is often elevated in lymphoma patients.
- Lymph node biopsy
A biopsy is performed by taking a sample of swollen lymph node tissue and then analyzing it in a laboratory to determine whether the patient has non-Hodgkin's lymphoma or not.
A biopsy will usually be followed by an examination immunophenotype or immunohistochemistry, which is the examination of antibodies attached to the tissue. This examination is useful in determining treatment
- Peimage
Imaging can be done with X-rays, ultrasound, CT scan, MRI, or PET scan. This examination aims to determine the location and size of the cancer, as well as how far the cancer cells have spread.
- Sample Bone marrow
Blood and tissue samples are taken by aspiration to see if the lymphoma has spread to the bone marrow.
- Lumbar puncture
This examination aims to see the spread of lymphoma to the brain by taking a sample of spinal fluid.
Stage of non-Hodgkin's lymphoma
After the doctor has completed the examination and confirmed the diagnosis, the doctor will also determine the stage of the cancer the patient is suffering from. Non-Hodgkin lymphoma is divided into 4 stages, namely:
- Stage 1At this stage, the cancer only attacks one group of lymph nodes, such as lymph node groups in the groin or neck.
- Stage 2The body parts in the lymphoma stage are separated by the diaphragm. Stage 2 indicates that the cancer has invaded two or more groups of lymph nodes above or below the diaphragm.
- Stage 3At this stage, the cancer is already in the group of lymph nodes at the top and bottom of the diaphragm.
- Stage 4Stage 4 non-Hodgkin lymphoma indicates that the cancer has spread beyond the lymphatic system and into the bone marrow or other organs, such as the liver or lungs.
Non-Hodgkin's Lymphoma Treatment
Treatment for non-Hodgkin's lymphoma aims to remove the cancer and prevent it from spreading to other organs. The treatment given will be adjusted to the stage of cancer, age, and the patient's health condition.
Patients with slowly progressing non-Hodgkin's lymphomaindolent lymphoma) will generally undergo close monitoring without any treatment. The doctor will schedule regular check-ups for several months to monitor and make sure that the cancer is not getting worse.
If the patient's non-Hodgkin's lymphoma is aggressive or the symptoms and complaints are getting worse, the doctor will recommend the following treatment methods:
1. Chemotherapy
Chemotherapy is the most commonly used treatment for non-Hodgkin's lymphoma. This treatment aims to kill cancer cells with drugs.
Chemotherapy is sometimes combined with corticosteroid drugs to increase their effectiveness. However, the use of corticosteroids is only allowed for the short term.
2. Radiotherapy
Radiotherapy is commonly used to treat early-stage non-Hodgkin's lymphoma. Radiotherapy uses high doses of radiation, such as X-rays or protons, to kill cancer cells. The beam is directed to the part of the lymph node that has cancer cells.
3. Monoclonal antibody therapy
This treatment uses monoclonal antibody drugs, such as rituximab, to increase the immune system's ability to destroy cancer cells. Generally, monoclonal antibody therapy will be combined with chemotherapy.
However, this step is only effective for certain types of non-Hodgkin's lymphoma and needs to be adjusted according to the results of the examination immunophenotype.
4. Bone marrow transplant
Bone marrow transplant is performed after chemotherapy and radiotherapy. In this procedure, the doctor will transplant healthy bone marrow stem cells into the patient's body, so that the patient's body can rebuild healthy white blood cells.
Complications of Non-Hodgkin's Lymphoma
Patients with non-Hodgkin's lymphoma who have gone through the treatment process or have even been declared cured still have the risk of experiencing complications. Some of the complications that can occur are:
- Weakened immune system
- Infertility or infertility
- Another cancer appears
- Other health problems, such as heart disease, thyroid disease, or kidney disease
Prevention of Non-Hodgkin's Lymphoma
The cause of non-Hodgkin's lymphoma is not clearly known. Therefore, prevention is also difficult to do. The best step that can be taken is to avoid factors that can increase the risk of developing this disease, namely by:
- Do not abuse drugs or have sexual relations that are at risk of causing HIV/AIDS
- Use work protective equipment, such as masks and gloves, if working in an environment where there is exposure to chemicals, such as pesticides
- Consult your doctor regularly if you are taking immunosuppressant drugs to avoid possible side effects
- Carry out regular health checks if you have an autoimmune disease to determine the progress of the disease
- Eat a balanced diet