Spread of non-Hodgkin lymphoma

Understanding how a type of cancer usually grows and spreads helps your healthcare team plan your treatment and future care. NHL can spread through the lymphatic system, or sometimes through the bloodstream, to almost any tissue or organ in the body.

NHL usually starts in an area of lymph nodes. When it spreads to an organ or tissue outside of the lymph nodes, it is called extranodal spread.

If NHL spreads, it can spread to the following:

  • other lymph nodes close to where it started or in other parts of the body
  • bone marrow
  • spleen
  • liver
  • stomach
  • small intestine
  • large intestine
  • lungs or pleura
  • testicles
  • brain or spinal cord (called the central nervous system, or CNS)
  • skin
  • eyes
  • sinuses

Indolent (low-grade) types of NHL have often spread to different parts of the body by the time they are diagnosed. Lymphoma cells can be found in many lymph nodes, the bone marrow or the spleen.

Aggressive (high-grade) types of NHL usually haven’t spread outside of the lymph node area or organ they started in by the time they are diagnosed.

Transformed NHL

Some indolent types of NHL can change into a more aggressive type of NHL. Usually, the indolent type of NHL will change into diffuse large B-cell lymphoma (DLBCL). The indolent types of NHL that might change include:

  • follicular lymphoma
  • chronic lymphocytic leukemia/small lymphocytic lymphoma
  • marginal zone lymphomas

Expert review and references

  • BC Cancer Agency (BCCA). Non-Hodgkin Lymphoma. 2014: http://www.bccancer.bc.ca/PPI/TypesofCancer/NonHodgkinsLymphoma/default.htm.
  • Faber EA, Vose JM, Armitage JO, Bierman PJ . Diagnosis and treatment of non-Hodgkin's lymphoma of adults. Wiernik PH, Goldman JM, Dutcher JP, Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 47: 1027-1047.
  • Freedman AS, Jacobson CA, Mauch P, Aster JC . Non-Hodgkin lymphoma. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 103:1552-1583.