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# Non-Hodgkin lymphoma

Non-Hodgkin lymphoma is a group of cancers of lymphocytes, usually B cells. Some grow slowly for years; others grow fast but can often be cured.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Neck lymph nodes](https://durgical.com/en/anatomy/lymph-nodes-of-neck/)
- [Mesenteric lymph nodes](https://durgical.com/en/anatomy/superior-mesenteric-nodes/)
- [Spleen](https://durgical.com/en/anatomy/spleen/)
- [Para-aortic lymph nodes](https://durgical.com/en/anatomy/intermediate-lumbar-nodes/)
- [Celiac and gastric lymph nodes](https://durgical.com/en/anatomy/coeliac-gastric-splenic-pancreatic-and-hepatic-nodes/)
- [Stomach](https://durgical.com/en/anatomy/stomach/)
- [Ileum](https://durgical.com/en/anatomy/ileum/)
- [Liver](https://durgical.com/en/anatomy/liver/)
- [Palatine tonsils](https://durgical.com/en/anatomy/palatine-tonsil/)

## Microorganisms that cause it

- [Epstein–Barr virus](https://durgical.com/en/microbiology/epstein-barr-virus/)

## In the clinical exam

- [Lymph node examination](https://durgical.com/en/clinical-exam/lymph-node-examination/)

## Why it happens

- [Oncogenes: RAS, MYC, HER2, BCR-ABL and the table to know](https://durgical.com/en/general-pathology/oncogenes-ras-myc-her2-bcr-abl-and-the-table-to-know/)
- [Apoptosis: the intrinsic and extrinsic pathways](https://durgical.com/en/general-pathology/apoptosis-the-intrinsic-and-extrinsic-pathways/)
- [Evading cell death and replicating without limit: BCL2 and telomerase](https://durgical.com/en/general-pathology/evading-cell-death-and-replicating-without-limit-bcl2-and-telomerase/)
- [Translocations, amplifications and epigenetic changes in cancer](https://durgical.com/en/general-pathology/translocations-amplifications-and-epigenetic-changes-in-cancer/)
- [Immunohistochemistry: the principle and the markers to know](https://durgical.com/en/general-pathology/immunohistochemistry-the-principle-and-the-markers-to-know/)
- [Naming tumours: -oma, carcinoma, sarcoma, and the misleading names](https://durgical.com/en/general-pathology/naming-tumours-oma-carcinoma-sarcoma-and-the-misleading-names/)

## Show 7 more

- [The cell cycle in cancer: cyclins, CDKs and checkpoints](https://durgical.com/en/general-pathology/the-cell-cycle-in-cancer-cyclins-cdks-and-checkpoints/)
- [Apoptosis vs necrosis: the comparison table](https://durgical.com/en/general-pathology/apoptosis-vs-necrosis-the-comparison-table/)
- [Biopsy: excisional, incisional, core needle, punch and fine-needle aspiration](https://durgical.com/en/general-pathology/biopsy-excisional-incisional-core-needle-punch-and-fine-needle-aspiration/)
- [The hallmarks of cancer](https://durgical.com/en/general-pathology/the-hallmarks-of-cancer/)
- [Molecular pathology: PCR, FISH, sequencing and liquid biopsy](https://durgical.com/en/general-pathology/molecular-pathology-pcr-fish-sequencing-and-liquid-biopsy/)
- [Oncogenic viruses and H. pylori: the table to know](https://durgical.com/en/general-pathology/oncogenic-viruses-and-h-pylori-the-table-to-know/)
- [Lymph node and spleen under the microscope](https://durgical.com/en/histology/lymph-node-and-spleen-under-the-microscope/)

## What it is

A diverse group of cancers of B, T or NK lymphocytes that form masses in lymph nodes or outside them ([stomach](https://durgical.com/en/anatomy/stomach/), gut, [skin](https://durgical.com/en/anatomy/skin/), brain). They range from indolent lymphomas that progress over years to aggressive ones that grow within weeks.

## Who gets it

More common than Hodgkin lymphoma and increasing with age; diffuse large B-cell lymphoma (DLBCL) is the most frequent type worldwide. HIV raises the risk of aggressive types. Adult T-cell leukaemia/lymphoma caused by HTLV-1 is seen in endemic areas of South America and the Caribbean, including the Colombian Pacific coast.

## Causes

- Genetic changes in lymphocytes, such as t(14;18) BCL2 in follicular lymphoma, t(8;14) MYC in Burkitt lymphoma and t(11;14) cyclin D1 in mantle cell lymphoma
- Viruses: Epstein-Barr virus (Burkitt, HIV-related and primary CNS lymphoma), HTLV-1 (adult T-cell lymphoma), hepatitis C
- Chronic antigen stimulation: Helicobacter pylori (gastric MALT lymphoma), coeliac disease (enteropathy-associated T-cell lymphoma), autoimmune disease

## Risk factors

- HIV infection and transplant immunosuppression
- Autoimmune diseases such as Sjögren syndrome, rheumatoid arthritis and lupus
- Chronic H. pylori gastritis
- Older age
- Previous chemotherapy or radiotherapy

## Pathophysiology

A lymphocyte acquires mutations that block apoptosis (BCL2) or drive proliferation (MYC) and expands as a clone. Indolent lymphomas accumulate slowly; aggressive ones divide fast, which also makes them sensitive to chemotherapy and prone to tumour lysis. Spread is often non-contiguous, with extranodal and marrow involvement more common than in Hodgkin lymphoma.

## Classification

- Aggressive B-cell: diffuse large B-cell lymphoma (most common)
- Highly aggressive: Burkitt lymphoma (endemic jaw form linked to EBV and malaria; sporadic ileocaecal form; HIV-associated)
- Indolent B-cell: follicular lymphoma, marginal zone/MALT lymphoma, small lymphocytic lymphoma
- Mantle cell lymphoma (older men, often advanced)
- T-cell lymphomas, including adult T-cell leukaemia/lymphoma (HTLV-1) and mycosis fungoides of the skin

## Symptoms and signs

- Painless enlarged lymph nodes in the neck, armpit or groin, often in several regions
- B symptoms: fever, night sweats, weight loss
- Abdominal mass, pain or bowel obstruction (Burkitt, intestinal lymphoma)
- Dyspepsia or gastric bleeding (gastric MALT or DLBCL)
- Enlarged spleen or liver
- Hypercalcaemia, skin lesions and lytic bone lesions in adult T-cell lymphoma

## Red flags

- Rapidly growing mass with high LDH and kidney failure (tumour lysis risk, especially Burkitt)
- [Superior vena cava](https://durgical.com/en/anatomy/superior-vena-cava/) syndrome or airway compression
- Back pain with weakness or urinary retention ([spinal cord](https://durgical.com/en/anatomy/spinal-cord/) compression)
- New neurological deficit in an HIV-positive patient (primary CNS lymphoma)
- Fever during chemotherapy (febrile neutropenia)

## Diagnosis

**Clinical**
Examination of all node regions, Waldeyer ring (tonsils), [liver](https://durgical.com/en/anatomy/liver/) and [spleen](https://durgical.com/en/anatomy/spleen/); history of B symptoms, HIV and autoimmune disease.

**Tests**
Excisional or core biopsy with immunohistochemistry (e.g. CD20 for B cells), flow cytometry and genetic studies; gastric biopsies with H. pylori testing for MALT lymphoma. Complete blood count, LDH, uric acid, [kidney](https://durgical.com/en/anatomy/kidney/) and liver function, calcium, HIV and hepatitis B and C (hepatitis B can reactivate with anti-CD20 therapy), HTLV-1 serology in endemic areas. Bone marrow biopsy and lumbar puncture in selected cases.

**Imaging**
PET-CT (or CT) for staging and response; endoscopy for gastrointestinal lymphoma; brain MRI when CNS involvement is suspected.

## Differential diagnosis

- Hodgkin lymphoma
- Tuberculosis and other infectious lymphadenitis
- Reactive lymphadenopathy (viral infection, autoimmune disease)
- Chronic lymphocytic leukaemia
- Metastatic carcinoma
- Sarcoidosis

## Goal of treatment

For aggressive lymphomas, cure with combination chemoimmunotherapy; for indolent lymphomas, control disease and symptoms over many years, treating only when needed.

## Treatment

**Medical**
DLBCL: chemoimmunotherapy combining the anti-CD20 antibody rituximab with CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone) or similar regimens.

**Follow-up**
Indolent lymphoma without symptoms or bulky disease: active surveillance ('watch and wait').

**Medical**
Gastric MALT lymphoma: eradication of H. pylori can produce remission in early-stage disease.

**Acute**
Burkitt and other high-burden lymphomas: intensive chemotherapy with CNS prophylaxis and aggressive prevention of tumour lysis (hydration, uric acid-lowering drugs, electrolyte monitoring).

**Procedure**
Radiotherapy for localised disease; autologous stem cell transplantation and CAR-T cell therapy for relapsed aggressive lymphoma.

## Complications

- Tumour lysis syndrome
- Febrile neutropenia and opportunistic infections
- Hepatitis B reactivation with anti-CD20 therapy
- Superior vena cava syndrome and spinal cord compression
- Bowel perforation or obstruction in intestinal lymphoma
- Transformation of an indolent lymphoma into an aggressive one

## Prognosis

Depends on type and risk factors (e.g. the International Prognostic Index: age, LDH, stage, performance status, extranodal sites). Many patients with DLBCL and Burkitt lymphoma are cured; indolent lymphomas are usually not curable but can be controlled for many years.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common type of non-Hodgkin lymphoma?

Diffuse large B-cell lymphoma, an aggressive but often curable lymphoma.

## Which translocation characterises follicular lymphoma?

t(14;18), which overexpresses the anti-apoptotic gene BCL2.

## Which lymphoma shows a 'starry sky' pattern and t(8;14)?

Burkitt lymphoma, driven by MYC; it grows very fast and carries a high risk of tumour lysis syndrome.

## Which infection is linked to gastric MALT lymphoma, and why does it matter?

Helicobacter pylori; eradicating it can lead to remission of early gastric MALT lymphoma.

## Which virus causes adult T-cell leukaemia/lymphoma, and what metabolic finding is typical?

HTLV-1, endemic in parts of Latin America including the Colombian Pacific coast; hypercalcaemia is typical.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/non-hodgkin-lymphoma/)

## Related conditions

- [Hodgkin lymphoma](https://durgical.com/en/conditions/hodgkin-lymphoma/)
- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)
- [Helicobacter pylori gastritis](https://durgical.com/en/conditions/helicobacter-pylori-gastritis/)
- [Coeliac disease](https://durgical.com/en/conditions/coeliac-disease/)
- [Gastric cancer](https://durgical.com/en/conditions/gastric-cancer/)
- [Tumour lysis syndrome](https://durgical.com/en/conditions/tumour-lysis-syndrome/)
- [Febrile neutropenia](https://durgical.com/en/conditions/febrile-neutropenia/)
- [Acute leukaemia (AML and ALL)](https://durgical.com/en/conditions/acute-leukaemia/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Non-Hodgkin lymphoma](https://medlineplus.gov/ency/article/000581.htm) (MedlinePlus (U.S. National Library of Medicine), 2025).

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Source: https://durgical.com/en/conditions/non-hodgkin-lymphoma/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/non-hodgkin-lymphoma/