Key Points for This Section

Non-Hodgkin's lymphoma is a disease in which malignant (cancer) cells form in the lymph system. Age and a weak immune system can affect the risk of developing non-Hodgkin's lymphoma. Possible signs of non-Hodgkin's lymphoma include fever, night sweats, fatigue, and weight loss. Tests that examine the body and lymph system are used to help detect (find) and diagnose non-Hodgkin's lymphoma during pregnancy. Certain factors affect prognosis (chance of recovery) and treatment options.

Non-Hodgkin's lymphoma is a disease in which malignant (cancer) cells form in the lymph system.

The lymph system is part of the immune system and is made up of the following:

• Lymph: Colorless, watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the body against infection and the growth of tumors.
• Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
• Lymph nodes: Small, bean-shaped structures that filter substances in lymph and help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.
• Spleen: An organ that produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach.
• Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.
• Tonsils: Two small masses of lymph tissue at the back of the throat. The tonsils produce lymphocytes.
• Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow produces white blood cells, red blood cells, and platelets.

Because lymph tissue is found throughout the body, adult non-Hodgkin’s lymphoma can begin in almost any part of the body. Cancer can spread to the liver and many other organs and tissues.

Lymphomas are divided into two general types: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. This summary refers to the treatment of non-Hodgkin’s lymphoma during pregnancy. Refer to the following PDQ summaries for more information:

• Hodgkin’s Lymphoma During Pregnancy
• AIDS-Related Lymphoma Treatment
• Adult Hodgkin's Lymphoma Treatment
• Primary CNS Lymphoma Treatment
• Adult Non-Hodgkin's Lymphoma Treatment

Age and a weak immune system can affect the risk of developing non-Hodgkin's lymphoma.

It is uncommon for non-Hodgkin's lymphoma to occur in young women during pregnancy. Risk factors include the following:

• Being white.
• Having one of the following medical conditions:
  • An inherited immune disorder (for example, hypogammaglobulinemia or Wiskott-Aldrich syndrome).
  • An autoimmune disease (for example, rheumatoid arthritis, psoriasis, or Sjögren's syndrome).
  • HIV/AIDS.
  • Human T-lymphotrophic virus type I or Epstein-Barr virus.
  • A history of Helicobacter pylori infection.
• Taking immunosuppressant drugs after an organ transplant.
• Being exposed to certain pesticides.
• A diet high in meats and fat.
• Past treatment for Hodgkin’s lymphoma.

Possible signs of non-Hodgkin's lymphoma include fever, night sweats, fatigue, and weight loss.

These and other symptoms may be caused by non-Hodgkin's lymphoma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• Painless swelling of the lymph nodes in the neck, underarm, groin, or stomach.
• Fever for no known reason.
• Drenching night sweats.
• Feeling very tired.
• Weight loss for no known reason in the past 6 months.
• Skin rash or itchy skin.
• Pain in the chest, abdomen, or bones for no known reason.

Tests that examine the body and lymph system are used to help detect (find) and diagnose non-Hodgkin's lymphoma during pregnancy.

The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the sample made up of red blood cells.
• Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
• Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. One of the following types of biopsies may be done:
  • Excisional biopsy: The removal of an entire lymph node.
  • Incisional biopsy: The removal of part of a lymph node.
  • Core biopsy: The removal of part of a lymph node using a wide needle.
  • Needle biopsy: The removal of part of a lymph node using a thin needle. This procedure is also called a fine-needle aspiration biopsy.
• Bone marrow aspiration and biopsy: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views both the bone and bone marrow samples under a microscope to look for signs of cancer.
• Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. For non-Hodgkin’s lymphoma during pregnancy, the blood is checked for an enzyme called lactate dehydrogenase (LDH). LDH levels help determine prognosis (chance of recovery).

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis depends on the following:

• The type and stage of the cancer.
• The amount of LDH in the blood.

The treatment options depend on the following:

• The type and stage of the cancer.
• The wishes of the patient.
• The patient's age and general health.
• Which trimester of pregnancy the patient is in.

Some types of non-Hodgkin’s lymphoma spread more quickly than others do. Most non-Hodgkin’s lymphomas that occur during pregnancy are aggressive. Delaying treatment of aggressive lymphoma until after the baby is born may lessen the mother's chance of survival. Immediate treatment is often recommended, even during pregnancy.