Non-Hodgkin's lymphoma

The non-Hodgkin’s lymphomas (NHL) are a group of cancers that develop in the body’s lymphatic system. There are many different types of non-Hodgkin’s lymphoma. Most types of NHL involve B cells, while a small percentage involve T cells. Common types of B-cell non-Hodgkin’s lymphomas include diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma.


Non-Hodgkin’s lymphomas are classified as indolent (slow-growing) or aggressive (fast-growing). Aggressive lymphomas, such as DLBCL, are often curable. Indolent lymphomas, such as follicular lymphoma, are more difficult to treat and tend to recur after periods of remission. With the advancement of new treatments and drugs, survival rates for patients with NHL have significantly improved.

Risk Factors

The risk of NHL increases with age, and most patients are diagnosed when they are in their 60s and 70s. NHL can develop, however, in people of any age, including children. People who have had immune system impairment through infections, disease, or exposure to certain types of chemicals appear to have increased risk. Still, people without any known risk factors can develop NHL.


The most common first sign of lymphomas is painless enlargement of one or more lymph node, usually in the neck, armpits, or groin.

More generalized symptoms can include:

  • Drenching night sweats
  • Unexplained weight loss
  • Fever
  • Severe itching

Hodgkin’s lymphoma

Hodgkin's lymphoma is a cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites.

Causes, incidence, and risk factors

The first sign of Hodgin's lymphoma is often a swollen lymph node, which appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs.

The cause is not known. Hodgkin's lymphoma is most common among people ages 15 - 35 and 50 - 70. Past infection with the Epstein-Barr virus (EBV) is thought to contribute to some cases. Patients with HIV infection are more at risk than the general population.


  • Fatigue
  • Fever and chills that come and go
  • Itching all over the body that cannot be explained
  • Loss of appetite
  • Soaking night sweats
  • Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands)
  • Weight loss that cannot be explained

Other symptoms that may occur with this disease:

  • Coughing, chest pains, or breathing problems if there are swollen lymph nodes in the chest
  • Excessive sweating
  • Pain or feeling of fullness below the ribs due to swollen spleen or liver
  • Pain in lymph nodes after drinking alcohol
  • Skin blushing or flushing
Note: Symptoms caused by Hodgkin's lymphoma may also occur also with other conditions. Talk to your doctor about the meaning of your specific symptoms.


Non-Hodgkin's lymphoma

NHL is diagnosed based on the results of physical examination, blood tests, imaging tests, and biopsy. A lymph node biopsy is the definitive test for diagnosing NHL, determining the type of NHL, and distinguishing NHL from Hodgkin’s disease.

Hodgkin's lymphoma

The disease may be diagnosed after:

  • Biopsy of suspected tissue, usually a lymph node biopsy
  • Bone marrow biopsy

If tests reveal you do have Hodgkin's lymphoma, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.

The following procedures will usually be done:

  • Blood chemistry tests including protein levels, liver function tests, kidney function tests, and uric acid level
  • CT scans of the chest, abdomen, and pelvis
  • Complete blood count (CBC) to check for anemia and white blood count
  • PET scan

In some cases, abdominal surgery to take a piece of the liver and remove the spleen may be needed. However, because the other tests are now so good at detecting the spread of Hodgkin's lymphoma, this surgery is usually unnecessary.


What now? It’s the most natural question to ask when you receive a cancer diagnosis. And it’s a question that’s hard to answer when dealing with the emotions and thoughts that inevitably overwhelm you after you’re given your test results. We understand this is a difficult time for you and your family. That’s why we offer the following treatment programs to all of our oncology patients in the CHI Health system.

Non-Hodgkin's lymphoma

Treatment depends on:

  • The type of lymphoma
  • The stage of the cancer when you are first diagnosed
  • Your age and overall health
  • Symptoms, including weight loss, fever, and night sweats

Radiation therapy may be used for disease that is confined to one body area.

Chemotherapy is the main type of treatment. Most often,multiple different drugs are used in combination together.

Another drug, called rituximab (Rituxan), is often used to treat B-cell non-Hodgkin's lymphoma.

Radioimmunotherapy may be used in some cases. This involves linking a radioactive substance to an antibody that targets the cancerous cells and injecting the substance into the body.

People with lymphoma that returns after treatment or does not respond to treatment may receive high-dose chemotherapy followed by an autologous bone marrow transplant (using stem cells from yourself).

Additional treatments depend on other symptoms. They may include:

  • Transfusion of blood products, such as platelets or red blood cells
  • Antibiotics to fight infection, especially if a fever occurs

Hodgkin's lymphoma

Treatment primarily depends on the following:

  • The type of Hodgkin's lymphoma (most people have classic Hodgkin's)
  • The stage (where the disease has spread)
  • Whether the tumor is more than 4 inches (10 cm) wide
  • The patient's age and other medical issues
  • Other factors, including weight loss, night sweats, and fever

Tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future. Staging is necessary to determine your treatment plan. Stages of Hodgkin's lymphoma range from I to IV. The higher the staging number, the more advanced the cancer.

Treatment depends on your age and stage of the cancer.

  • Stages I and II (limited disease) can be treated with radiation therapy, chemotherapy, or both.
  • Stages III is treated with chemotherapy alone or a combination of radiation therapy and chemotherapy.
  • Stage IV (extensive disease) is most often treated with chemotherapy alone.

People with Hodgkin’s lymphoma that returns after treatment or does not respond to treatment may receive high-dose chemotherapy followed by an autologous bone marrow transplant (using stem cells from yourself).

Additional treatments depend on other symptoms. They may include:

  • Transfusion of blood products, such as platelets or red blood cells, to fight low platelet counts and anemia
  • Antibiotics to fight infection, especially if a fever occurs

Stem Cell Transplant Program

CHI Health offers a Peripheral Blood Stem Cell Transplant Program for eligible patients. Peripheral stem cell transplant is a procedure where diseased bone marrow is destroyed and healthy new stem cells are re-infused back into the body through a vein. The healthy stem cells find their way to the destroyed bone marrow, engraft, and begin producing normal blood cells. Stem cells are found in bone marrow and peripheral blood.

Diseases Treated by Autologous Stem Cell Transplant
  • Leukemia
  • Multiple Myeloma
  • Lymphoma, Hodgkin Lymphoma, Diffuse Large B-Cell Lymphoma
Description/Definition of Stem Cell Transplant
  • Allogeneic – Removal, storage and re-infusion of donor stem cells based on tissue typing, may not be a relative
  • Syngeneic – Removal, storage, and re-infusion of stem cells from an identical twin
  • Autologous – Removal, storage, and re-infusion of one’s own healthy stem cells

Cancer Medical Team

Your medical team consists of a multi-disciplinary team of highly skilled professionals who care for every patient of the CHI Health Cancer Center. Using state-of-the-art technology and treatment regimens, our doctors, nurses and other healthcare professionals treat more cancer patients than any other health care provider in the Nebraska.

Nurse Navigator Program

A Nurse Navigator is an oncology-certified nurse who is available to guide you and your family through the entire process of diagnosis and treatment at CHI Health. The Nurse Navigator is a single point of contact who will be there with you every step of the way.

Support Staff

The CHI Health Cancer Support Team is comprised of a group of healthcare professionals who work together in a variety of ways to help the patient and family cope with cancer. Individual team members include Cancer Support Services Specialists, Medical Social Workers, Cancer Rehabilitation Specialist, Pastoral Services, Dietitians, Oncology Nurse Navigators, Hospice & Home Care Services, Inpatient Nursing Services, Radiation Oncology, and Volunteer Services.

Technologies & Therapies

  • TomoTherapy
    CHI Health is the first in the Omaha area to offer the TomoTherapy® Hi·Art® (Highly Integrated Adaptive Radiotherapy) System. This all-in-one solution allows doctors to check the location of tumors before each treatment, then deliver painless, precise radiation therapy resulting in unmatched accuracy for cancer patients, especially those with breast, lung and prostate tumors.

  • Varian Trilogy
    The Varian Trilogy with RapidArc® radiotherapy technology is a revolutionary breakthrough in cancer treatment that delivers powerful tumor-destroying radiation with remarkable precision. 

  • Brachytherapy
    Although brachytherapy is a very popular and proven treatment for cancer, using brachytherapy instead of external beam radiation for breast cancer is a recent idea. Brachytherapy has the advantages of being a shorter treatment, and irradiating less of the body. CHI Health has strict eligibility guidelines for patients who are candidates for partial breast irradiation.

Cancer Clinical Trials

We believe our patients should have access to the most advanced medicines or treatments available. Studies are available for cancer control, cancer prevention and cancer treatment. No patient is obligated to participate in cancer clinical trials and may withdraw at any time. However, those who do participate gain access to new medicines and other benefits, such as low or no-cost drugs and treatments.

Image Recovery Center

While cancer treatment outcomes are improving, hair loss, weight changes and skin changes leave you feeling like a shadow of your former self. At CHI Health, we won’t let you face those challenges alone. The Image Recovery Center is an appearance-enhancement program designed to help you copy with some of the physical side effects of cancer treatment. 

Complementary Therapy

The purpose of integrative movement therapy is to "complement" conventional medicine by stimulating the body’s natural healing power. Healing the body, mind and spirit, CHI Health offers massage therapy, Yoga, T’ai Chi meditation and other therapeutic exercises during cancer treatment.

Second Opinion Program

After you receive a cancer diagnosis, you will likely have many questions. It’s helpful to obtain as much information as possible to make informed decisions about your cancer management and treatment in order to feel confident about your care. Getting a second opinion from the CHI Health Cancer Center can help with these concerns.

Cancer Inpatient Services

For more acute, palliative or end of life phases of cancer care, CHI Health offers five locations throughout Omaha for inpatient cancer care services.

Cancer Rehabilitation

  • Physical Therapy
  • Occupational Therapy
  • Speech Therapy
  • Massage
  • Aquatic Therapy
  • Stress Management
  • Lymphedema Prevention and Treatment


Support Groups

  • Leukemia and Lymphoma Society
  • Cancer Related Fatigue Support Group
  • Cancer Survivorship Program
  • Just for Kids - Cancer Support Group
  • Look Good, Feel Better
  • Lunch & Learn Cancer Support Group
  • Surviving Bereavement
Learn more about our support groups.