This type of cancer starts in white blood cells and is most common in late middle age.
“We’re getting an oncologist involved and we have to figure out what the next steps are as far as chemotherapy or radiation or more spine surgery,” Hooman M. Melamed, MD, an orthopedic spine surgeon at Cedar Sinai Marina Del Rey Hospital, who has been treating Miller, told People.
Dr. Melamed said the diagnosis is still “pending pathology and oncology reports” but “I feel … she will undergo chemotherapy or radiation.”
To learn more about the condition, Health spoke with Gwen Nichols, MD, chief medical officer of the Leukemia and Lymphoma Society. Here’s what Dr. Nichols—who is not involved in Miller’s care—wants people to know about the cancer.
What is non-Hodgkin lymphoma?
Non-Hodgkin lymphoma—sometimes also called non-Hodgkin’s lymphoma or just NHL—covers a number of different cancers that start in a specific type of white blood cells called lymphocytes. “Lymphocytes are the white blood cells that help make antibodies and are part of the normal infection-fighting machinery,” Dr. Nichols explains. While lymphocytes are typically found in lymph nodes, they circulate throughout the body as well, she says.
Lymphocytes make antibodies in response to a host of everyday infections, and as your body recovers, they stop, Dr. Nichols says. “But when this becomes a cancer, a lymphoma, these cells don’t get turned off.”
There are many different subtypes of NHL, and they often show up in the form of an enlarged lymph node—although lymphomas can also start in other lymphatic tissue in the spleen, bone marrow, tonsils, or digestive tract, among other places, according to the American Cancer Society (ACS).
The different subtypes of NHL can also spread at different speeds. So-called indolent lymphomas grow slowly and may not need immediate treatment; aggressive lymphomas usually need to be treated right away.
According to the ACS, nearly 75,000 people will be diagnosed with the disease this year, and nearly 20,000 will die from non-Hodgkin lymphoma. NHL accounts for about 4% of all cancers in the U.S.
While the average person has about a 1 in 47 chance of developing NHL, some people are at higher risk, including people with weakened immune systems due to underlying health conditions or immune-suppressing medications. Folks with chronic inflammatory diseases or autoimmune disorders also are at a higher risk, probably because their immune systems work in overdrive, Dr. Nichols says.
Exposure to certain viruses and bacteria as well as some chemicals used in farming like herbicides and pesticides has also been linked to a higher risk of developing NHL, according to the LLS. And while NHL can happen at any age, it’s most common among adults over 60.
“In the great majority of patients, we don’t find a specific cause,” Dr. Nichols says.
RELATED: What Are Lymph Nodes?
What’s the difference between non-Hodgkin and Hodgkin lymphoma?
Hodgkin lymphoma is also a type of cancer that begins in the lymphocytes, but it’s much less common, affecting just 8,000 people a year. Unlike NHL, which has many different subtypes, Hodgkin lymphoma is mostly distinguished by the presence of what’s called Reed-Sternberg cells, or abnormal types of a specific lymphocyte. “They look very different under the microscope,” Dr. Nichols says. Newer research is uncovering profound differences between Hodgkin and non-Hodgkin lymphomas at the DNA level too, she says.
Hodgkin lymphoma also strikes in a different pattern from NHL, with two peaks, Dr. Nichols explains: one in late childhood through early adulthood and another in late middle age. “NHL, on the other hand, is uncommon in childhood and increases with age,” she says.
Treatment for Hodgkin and non-Hodgkin lymphomas also differs, and survival rates do too. Hodgkin lymphoma is typically considered to be more treatable, and more than 90% of patient survive more than five years after their diagnosis. NHL survival rates are usually lower. “There are so many different subtypes and responses to therapy that make [survival rates] extremely variable,” Dr. Nichols says. Learning your NHL subtype is crucial, she says, in getting the best therapy.
What are non-Hodgkin lymphoma symptoms–and when should you see a doctor?
Some people detect a swollen lymph node—yep, the same tender glands you get when you have a sore throat. It's worrisome when that swelling doesn’t go away, Dr. Nichols says. Sometimes a swollen lymph node may be hiding in the abdomen or pelvis, and a person might not notice it until it’s quite enlarged, she says.
Miller’s emergency surgery was prompted by “excruciating neck pain” and weakness in her arm, People reported, which in theory could be related to an enlarged lymph node, Dr. Nichols says. “If the lymph node gets enlarged, it can impinge a nerve and cause pain. If you think about the structures we have in our necks, there are a lot of important nerves that go to our arms and chest.”
Other common symptoms of NHL can include fatigue, fever, unexplained weight loss, and night sweats—which of course can also be signs of countless other health concerns. If you have any of these symptoms without another explanation, it’s worth bringing them up with a doctor, Dr. Nichols says.
He or she will likely start with a physical exam, specifically checking for swollen lymph nodes. Simple blood and urine tests can help rule out other explanations and may be followed by imaging tests like X-rays, MRIs, or PET scans. A doctor might also perform a biopsy of a lymph node or a bone marrow test to analyze tissue and cells more closely. This helps determine the stage of lymphoma and the best course of treatment.
Treatment for aggressive forms of NHL can include chemotherapy, immunotherapy, radiation therapy, bone marrow transplant, and more. In some cases, slow-growing lymphomas can be carefully monitored by your doctor, sometimes for years, before any treatment is needed. “You need someone experienced in looking at these subtypes of lymphomas to know which one it is,” Dr. Nichols says. (The LLS can help you connect with specialists, social workers, and nurses via email, online chat, or hotline. Get more info here.)
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Dr. Melamed said Miller’s cancer and course of treatment has yet to be determined, but that she seemed “encouraged” while recovering in the ICU. “There’s a chance this can spread to any part of the body … this is probably coming from somewhere else,” he said. “We don’t know where the source is. Any tumor that spreads anywhere is automatically stage 4, but we have not determined the stage yet.”