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Non-Hodgkin lymphoma

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If non-Hodgkin lymphoma spreads

Lymphoma cells have the potential to spread from the lymphatic system to other parts of the body where they can grow into new tumours. This process is called metastasis. The tumours are also called metastasis (singular) or metastases (plural). Metastases are also called secondary tumours.

Understanding the usual progression of cancer helps the doctor to predict its probable course, plan treatment and anticipate further care.

Unlike Hodgkin lymphoma, which usually spreads in a predictable, orderly way from one lymph node group to the next, non-Hodgkin lymphoma (NHL) doesn’t spread in a predictable way. NHL can spread to almost any tissue or organ in the body through the lymphatic system or the bloodstream. The most common sites where NHL spreads are:

  • nearby or distant lymph nodes
  • bone marrow
  • spleen
  • liver
  • gastrointestinal tract, such as the stomach and intestine
  • lung or pleura
  • brain
  • skin

Generally, slower-growing (indolent) lymphomas are often widespread when the person is first diagnosed because there are few symptoms when the disease begins. Cancer cells can be found in many lymph nodes, the bone marrow or the spleen.

Aggressive or fast-growing lymphomas are more often confined to lymph nodes or extranodal sites (organs or tissues outside of the lymph nodes).

Transformed lymphomas

Some types of indolent lymphomas can change (transform) into a different, more aggressive type of lymphoma. Usually, the indolent lymphoma progresses to a diffuse large B-cell lymphoma. People with transformed lymphomas often have poorer outcomes because the lymphoma behaves very aggressively. Some types of indolent lymphomas that may transform include:

  • follicular lymphoma
  • chronic lymphocytic leukemia and small lymphocytic lymphoma
  • marginal zone lymphoma


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