Do We Know What Causes Non-Hodgkin Lymphoma?
Researchers have found that non-Hodgkin lymphoma is linked with a number of risk factors, but the causes of most lymphomas are unknown. This is complicated by the fact that lymphomas are actually a diverse group of cancers.
Still, scientists have made a lot of progress in understanding how certain changes in DNA can cause normal lymphocytes to become lymphoma cells. Normal human cells grow and function mainly based on the information contained in each cell’s chromosomes. Human DNA is packaged in 23 pairs of chromosomes, which are long molecules of DNA in each cell. DNA is the chemical that makes up our genes – the instructions for how our cells function. We look like our parents because they are the source of our DNA. But DNA affects more than how we look.
Some genes control when cells grow and divide. Genes that speed up cell division or help cells live longer are called oncogenes. Others that slow down cell division or make cells die at the right time are called tumor suppressor genes.
Each time a cell prepares to divide into 2 new cells, it must make a new copy of the DNA in its chromosomes. This process is not perfect, and errors can occur that may affect genes within the DNA. Cancers can be caused by DNA mutations (changes) that turn on oncogenes or turn off tumor suppressor genes.
Some people inherit DNA mutations from a parent that increase their risk for some types of cancer. But non-Hodgkin lymphoma is not one of the cancer types often caused by these inherited mutations. In other words, there’s no increased risk of lymphoma in the children of patients with lymphoma.
DNA changes related to non-Hodgkin lymphoma are usually acquired after birth, rather than being inherited. Acquired changes may result from exposure to radiation, cancer-causing chemicals, or infections, but often these changes occur for no apparent reason. They seem to happen more often as we age, and lymphomas for the most part are a cancer of older people.
Translocations are a type of DNA change that can cause non-Hodgkin lymphoma to develop. A translocation means that DNA from one chromosome breaks off and becomes attached to a different chromosome. When this happens, oncogenes can be turned on or tumor suppressor genes can be turned off. Some lymphomas tend to have specific chromosome defects. For example, most cases of follicular lymphoma have a translocation between chromosomes 14 and 18, which turns on the bcl-2 oncogene. This stops the cell from dying at the right time, which can lead to lymphoma.
Scientists are learning much about the exact gene changes involved in lymphoma. This information is being used to develop more accurate tests to detect and classify certain types of lymphoma. Hopefully, these discoveries can be used to develop new treatments as well.
Researchers are beginning to understand how these gene changes develop in people with certain risk factors, but they still do not know why most lymphomas develop in people with no apparent risk factors.
Lymphocytes (the cells from which lymphomas start) are immune system cells, so it’s not surprising that changes in the immune system seem to play an important role in many cases of lymphoma.
- People with immune deficiencies (due to inherited conditions, drug treatment, organ transplants, or HIV infection) have a much higher chance of developing lymphoma than people without an immune deficiency.
- People with certain autoimmune diseases (where the immune system constantly attacks a certain part of the body) have an increased risk of getting lymphoma.
- People with certain chronic infections are also at increased risk, probably because the immune system is constantly making new lymphocytes to fight the infection, which increases the chances for mistakes in their DNA.
Freedman AS, Jacobson CA, Mauch P, Aster JC. Chapter 103: Non-Hodgkin’s lymphoma. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
Roschewski MJ, Wilson WH. Chapter 106: Non-Hodgkin Lymphoma. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.
Last Medical Review: August 26, 2014 Last Revised: February 29, 2016