The key to diagnosis of any cancer is to try and identify the cell of origin. That is, ‘where did my cancer come from?’ In non-Hodgkin’s lymphoma (NHL), the cell of origin is a white blood cell called the lymphocyte. Most lymphocytes are born in your bone marrow, after which they exit the bone marrow and circulate in your blood, making stops in lymph nodes around the body. These stops in lymph nodes are crucial, because it is here that they learn how to become respected members of your immune system. After their education, they circulate around the body, fighting infections wherever they may arise. The non-Hodgkin’s lymphomas represent the most complex and diverse set of cancers to fall under a single rubric. Today, there are well over 65 different kinds of NHL. These diseases represent some of the fastest, and slowest growing cancers known to medicine. The approach to any one type of NHL depends on the type of lymphoma you have (for example follicular lymphoma, diffuse large B-cell lymphoma, small lymphocytic lymphoma, peripheral T-cell lymphoma). Increasingly, lymphoma doctors are focused on tailoring conventional and new therapies not just to the histological diagnosis (that is a tissues diagnosis), but also taking into consideration some of the unique genetic features of that person’s disease.
The first step in evaluating every patient with NHL is to determine if the disease is ‘curable’, or ‘chronic’. Once that determination is made, the treatments are tailored to the patient, where more ‘curable’ diseases are typically treated more aggressively, while more chronic diseases are typically treated in a more conservative fashion.