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Supporting people with non-Hodgkin's lymphoma
What is non-Hodgkin's lymphoma?

Keypoints

  • Indolent non-Hodgkin's lymphoma is slow growing, and may have few symptoms
  • Treatment can sometimes be delayed for months, or even years, on a 'watch and wait' strategy
  • Aggressive non-Hodgkin's lymphoma is fast growing, and is more likely to cause symptoms at an earlier stage
  • Although aggressive NHL needs immediate treatment, the chances of a cure are relatively high

Indolent versus aggressive non-Hodgkin's lymphoma

The classification of non-Hodgkin's lymphoma is based on a number of criteria. A simplified, but valid, way of looking at this is to have two main classifications, or gradings, of non-Hodgkin's lymphoma, which help doctors to decide what treatment to give patients:

  • Indolent (also called low-grade or slow-growing)
  • Aggressive (also called high-grade or fast-growing)

Indolent non-Hodgkin's lymphomas grow slowly. They often cause no symptoms at first, and so often go undetected for some time. Even after diagnosis, many do not need immediate treatment, sometimes for months or years. Treatment, when needed, is usually effective at making them shrink and even disappear, giving a disease-free period, or 'remission', to the patient. However, they often relapse, or 'recur', and more treatment will then be needed.

The table shows the main differences between indolent and aggressive non-Hodgkin's lymphoma

 
Indolent non-Hodgkin's lymphoma
Aggressive non-Hodgkin's lymphoma
Proportion
40% - 50% 50% - 60%
Growth
Slow Fast
Description
Often no symptoms at diagnosis; diagnosis can be accidental in many cases Symptoms are likely before diagnosis
Treatment
Sometimes not needed immediately Usually needed straight away
Outcome
Responds well to treatment, however eventual relapse is likely Responds very well to treatment, more likely to be cured

Aggressive non-Hodgkin's lymphomas grow more quickly. They are more likely to cause symptoms than indolent non-Hodgkin's lymphomas, and they usually need treatment straight away. Although the name 'aggressive' sounds very frightening, these lymphomas often respond very well to treatment. They are, in fact, more likely to be completely cured than indolent non-Hodgkin's lymphomas.

Indolent and aggressive non-Hodgkin's lymphomas can be distinguished by their appearance under a microscope. For this purpose, a sample of the lymphoma tissue needs to be collected in all patients. Most patients will have a biopsy in which an affected lymph node, or part of it, is removed surgically. In others, the diagnosis may have been established 'by accident' during a routine procedure such as a gastroscopy.

It is important to determine the classification of a non-Hodgkin's lymphoma, as the treatments for the two classes can be very different.


 

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