Clinical update

Non-Hodgkin’s lymphoma

Your essential guide to signs, symptoms, treatment and the latest guidelines on Non-Hodgkin's lymphoma

Essential facts

Non-Hodgkin’s lymphoma (NHL) is a cancer of the lymphatic system. According to Cancer Research UK, it is the sixth most common cancer in the UK, with 13,413 new cases diagnosed in 2013. There were 4,801 deaths from NHL in 2014. Although there are many different subtypes of the disease, there are two broad categories: high grade or aggressive and low grade or indolent.

Picture: SPL
What’s new

In July 2016, the National Institute for Health and Care Excellence (NICE) published new guidance on NHL, which addressed a number of areas where there is uncertainty or variation in clinical practice. It includes recommendations on diagnosis and the most effective treatments and management for six of the more common subtypes: follicular lymphoma, MALT lymphoma, mantle cell lymphoma, diffuse large B-cell lymphoma, Burkitt lymphoma and peripheral T-cell lymphoma. Improved understanding of the disease’s biology is leading to rapid development of new therapies, according to NICE.

Causes/risk factors

The risk of developing NHL depends on many factors, with around 6% of cases linked to lifestyle. Age is significant, with around half of NHL cases diagnosed in those aged 70 or more. Statistically, men are more at risk than women, with a lifetime likelihood of one in 48, compared to one in 58. Since the late 1970s, NHL rates have more than doubled - a 160% increase in Great Britain. But the survival rate is improving, tripling in the last 40 years. Now almost two-thirds of people diagnosed in England and Wales survive their disease for ten years or more, says CRUK.

Signs/symptoms

The most common early symptom of NHL is a painless swelling in the lymph nodes in one area of the body, such as the neck, armpit or groin. Other symptoms may include: a cough, difficulty swallowing or breathlessness, if the lymphoma is in the chest area; indigestion, stomach pain or weight loss, if the lymphoma is in the stomach or bowel. General symptoms may include: heavy night sweats; high temperatures that come and go with no obvious cause; unexplained weight loss; tiredness; and persistent skin itching.

How you can help your patient

Nurses play a key role in providing patient education, including advice on current treatment options. The complex nature of NHL, different treatment pathways and the rapid development of new therapies mean that nurses, especially those working in this area, need to make sure that their knowledge is in-depth and up to date. They can also discuss exercise and lifestyle with patients from diagnosis onwards.

Expert comment

Gilly Howard-Jones, lymphoma clinical nurse specialist at University Hospital Southampton NHS Foundation Trust, National Institute for Health Research clinical doctoral research fellow and a member of the NICE guideline development group

‘Although lymphoma is a common cancer, so many different subtypes make it very complicated. This guidance gives a clear direction for effective treatment of the six most common subtypes that I think everyone will find very useful. It is also medically led, so will improve understanding.

‘From the nursing perspective, I really pushed for survivorship to be included on the agenda, as this is such a big issue for nurses. Increasing numbers of people are being diagnosed, with more going on to live much longer after their treatment. But patients also have to live with the consequences of their illness and its treatments, including any ongoing side effects or late effects, which can appear months or even years after treatment has finished. This is not necessarily a medical issue, but it’s a key issue for nursing.’

RCNi article

An overview of non-Hodgkin’s lymphoma, King, H and Myatt, R, Cancer Nursing Practice (February 2014)

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