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Lymphoma — An Overview

Posted on April 02, 2021
Medically reviewed by
Todd Gersten, M.D.
Article written by
Alison Channon

Nearly 86,000 people were diagnosed with non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) in 2020, according to estimates from the National Cancer Institute. Non-Hodgkin lymphoma is the eighth most common cancer in the United States — it’s estimated to account for just over 4 percent of new cancers in 2020. Hodgkin lymphoma is less common — it’s estimated to account for 0.5 percent of new cancers in 2020. However, Hodgkin lymphoma is the most common cancer among teens 15 to 19 years old.

What Is Lymphoma?

Lymphoma is a group of blood cancers that occur when certain types of white blood cells called lymphocytes develop abnormally and crowd out healthy cells. Lymphoma is split into two main categories: Hodgkin lymphoma (also called Hodgkin disease and Hodgkin’s lymphoma) and non-Hodgkin lymphoma (also called non-Hodgkin’s lymphoma). Lymphoma is related to other blood cancers, including leukemia, myeloma, and myeloproliferative neoplasms (MPNs).

Hodgkin and non-Hodgkin lymphoma originate in the lymphatic system, a part of the circulatory and immune systems. The lymphatic system is composed of the bone marrow; organs including the spleen, lymph nodes, and thymus; and vessels that transport fluids throughout the body. When functioning properly, the lymphatic system removes bacteria, excess fluid, and waste material from old and damaged cells.

What Causes Lymphoma?

Lymphoma starts in the lymph nodes and vessels of the lymphatic system. When lymphocytes develop genetic mutations, the abnormal cells can grow faster and live longer than healthy cells. Like other cancers, lymphoma is caused by genetic mutations that allow cells to divide and grow in a disorganized way. Mutations can be inherited or acquired. Acquired mutations are caused by normal aging, as well as exposure to carcinogens, such as radiation, certain chemicals, smoking, and some viruses.

Risk Factors for Developing Lymphoma

Risk factors vary by the type of lymphoma. Some are associated with HL and NHL in general, and some are specific to certain types of HL or NHL.

Some risk factors for developing HL and NHL include:

Most risk factors, including age, genetic predisposition, and ethnicity, are beyond anyone’s control. If you are concerned you may have a high risk for developing lymphoma, focus on lowering your risk by changing the environmental factors within your control.

How Is Lymphoma Diagnosed?

Several tests are used to diagnose Hodgkin and non-Hodgkin lymphoma. Some tests are used to confirm a diagnosis, while others are used to determine the type of lymphoma and the stage of the illness. Not everyone experiences obvious symptoms of lymphoma, and their cancer is found when routine blood work or other tests return abnormal results.

Tests used to diagnose HL and NHL include:

  • Physical exam and medical history
  • Lymph node biopsy
  • Immunophenotyping
  • Chromosome tests
  • Lumbar puncture

The following tests may be used to stage your lymphoma:

  • Bone marrow aspiration
  • Bone marrow biopsy
  • Imaging tests, such as X-ray, PET scan, or CT scan
  • Blood tests, such as a complete blood count

Learn more about the path to lymphoma diagnosis.

What Are the Symptoms of Lymphoma?

Many lymphoma symptoms can be caused by illnesses like the flu or by other cancers. Some symptoms of lymphoma can also be side effects of treatment. Lymphoma symptoms vary depending on which parts of your body are affected and the type of lymphoma. Some lymphoma symptoms are local, meaning they only affect a specific area of the body, while others are systemic, affecting the entire body.

Some common symptoms of lymphoma include:

  • Swollen lymph nodes — Swollen lymph nodes often appear as lumps in the armpits, neck, or groin.
  • Unexplained weight loss — Lymphoma-related weight loss may happen quickly and without trying to lose weight.
  • Night sweats — Night sweats can leave a person soaked with sweat.
  • Fatigue — Lymphoma-related fatigue doesn’t improve with rest.
  • Fever

Night sweats, fever, and unexplained weight loss are considered B symptoms. These systemic symptoms can influence the staging of your cancer.

Symptoms of Hodgkin Lymphoma

Enlarged lymph nodes around the neck, underarms, or groin are the most common symptom of Hodgkin lymphoma. The following symptoms can also occur in HL:

Symptoms of Non-Hodgkin Lymphoma

In addition to swollen lymph nodes and B symptoms, people with NHL can also experience the following:

Read more about symptoms of lymphoma.

What Are the Different Types of Lymphoma?

There are two primary types of Hodgkin lymphoma and dozens of types of non-Hodgkin lymphoma.

Subtypes of Hodgkin Lymphoma

Hodgkin lymphoma can be divided into two primary subtypes: classical HL and nodular lymphocyte-predominant HL. Classical HL accounts for approximately 95 percent of people with Hodgkin lymphoma. Classical HL can be further broken down into the categories below, listed from most to least common:

  • Nodular sclerosis classical Hodgkin lymphoma
  • Mixed cellularity classical Hodgkin lymphoma
  • Lymphocyte-rich Hodgkin lymphoma
  • Lymphocyte-depleted Hodgkin lymphoma

Hodgkin lymphoma can be treated with chemotherapy, radiation, targeted therapies, immunotherapy, and occasionally stem cell transplant. Your treatment plan will be influenced by your type of HL, stage of disease, and other factors like age and health.

Subtypes of Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma is an umbrella term for approximately 85 different subtypes of NHL. NHL is usually grouped by the type of white blood cell (lymphocyte) where the cancer originates and the aggressiveness of the cancer. The broad categories are B-cell lymphoma and T-cell lymphoma and aggressive and indolent (slow-growing) lymphomas.

B-Cell Non-Hodgkin Lymphoma

B-cell lymphomas account for between 85 percent and 90 percent of non-Hodgkin lymphoma cases. B-cell lymphomas begin in B lymphocytes or B-cells. B lymphocytes are white blood cells that create proteins called antibodies.

The following are examples of aggressive B-cell lymphomas:

  • Diffuse large B-cell lymphoma, the most common form of NHL globally
  • Mantle cell lymphoma
  • Burkitt’s lymphoma

The following are examples of indolent B-cell lymphomas:

  • Follicular lymphoma
  • Marginal zone lymphoma
  • Chronic lymphocytic leukemia/small-cell lymphocytic lymphoma (CLL/SLL)
  • Waldenström’s macroglobulinemia/lymphoplasmacytic lymphoma

T-Cell Non-Hodgkin Lymphoma

T-cell lymphomas are caused by changes to T lymphocytes, or T cells. The various types of T cells play a key role in the body’s immune response. Some T cells directly attack infected cells while others help to regulate the immune system.

The following are examples of aggressive T-cell lymphomas:

  • Peripheral T-cell lymphoma
  • Lymphoblastic lymphoma

The following are examples of indolent T-cell lymphomas that affect the skin:

  • Mycosis fungoides
  • Sézary syndrome

Staging Lymphoma

Each type of Hodgkin and non-Hodgkin lymphoma can be assigned a stage from 1 to 4, depending on how advanced it is. Stage 1 indicates the cancer is localized while stage 4 is the most widespread. Additional letters can be added to the staging number to describe symptoms. Staging is important for determining treatment.

Hodgkin Lymphoma vs. Non-Hodgkin Lymphoma

Hodgkin lymphoma and non-Hodgkin lymphoma share many of the same symptoms and treatment methods, and are often diagnosed using similar methods. However, they have many distinguishing features.

  • Non-Hodgkin lymphoma occurs most frequently in older adults, whereas most HL cases are diagnosed between ages 15 and 34.
  • In the United States, non-Hodgkin lymphoma is more common than Hodgkin lymphoma. In 2017, the year for which the most recent data is available, 70,487 people were diagnosed with NHL compared to 8,567 people diagnosed with HL.
  • Hodgkin lymphoma usually spreads from cancerous lymph nodes to nearby lymph nodes. Non-Hodgkin lymphoma spreads more unpredictably to lymph nodes across the body.
  • The five-year relative survival rate for HL is 87 percent, according to the National Cancer Institute. For NHL, the five-year relative survival rate is 73 percent.

How Is Lymphoma Treated?

An array of therapies are used to treat the many types of lymphoma, including chemotherapy, immunotherapy, targeted therapies, radiation therapy, and stem cell transplantation. Clinical trials may also be an option. The best treatment for you will be determined by your specific type of cancer as well as several additional factors, including your prognosis, age, and personal preferences. You may be treated with a combination of therapy types.

Aggressive lymphomas will likely require treatment right away, while indolent lymphomas may be treated with a watch and wait approach. During watch and wait, also called watchful waiting or active surveillance, you will be closely monitored by your doctor with regular appointments and blood tests. You may continue with this approach until there are signs or symptoms that indicate cancer is beginning to grow more quickly.

There are different treatment goals for different forms of Hodgkin lymphoma and non-Hodgkin lymphoma. In some cases, the goal of treatment is complete remission, meaning lymphoma is undetectable after treatment. In other cases, the goal may be to slow the growth of the lymphoma.

Learn more about treatments for lymphoma.

Treatment Side Effects

Chemotherapy, radiation, drug therapies, and stem cell transplants can all cause difficult side effects. Common side effects of lymphoma treatment include:

  • Hair loss
  • Nausea and vomiting
  • Fatigue
  • Cognitive challenges (sometimes called “chemo brain”)
  • Peripheral neuropathy (often experienced as pins-and-needles sensations or numbness)
  • Anemia

How Do Other Health Conditions Affect Lymphoma?

When someone has more than one health condition at the same time, the conditions are known as comorbidities. Comorbid conditions can influence your treatment options and possibly your prognosis.

A Dutch study of 904 people with NHL found the following conditions were prevalent in people with NHL:

  • Hypertension (high blood pressure)
  • Chronic obstructive pulmonary disease (COPD)
  • Diabetes
  • Cardiovascular disease

A British study including more than 7,000 people with HL found the following conditions were prevalent in people with Hodgkin lymphoma:

  • COPD
  • Hypertension
  • Other cancers
  • Diabetes

HIV-Related Lymphomas

In addition to the comorbidities listed above, HIV infection can greatly increase the likelihood of developing lymphoma. Nearly all HIV-related lymphomas are types of non-Hodgkin lymphoma. The two most common lymphomas in people with HIV are Burkitt’s lymphoma and diffuse large B-cell lymphoma. Lymphoma treatments are generally as effective in HIV-positive people as in HIV-negative people.

Treatment-Related Health Conditions

Other health conditions may be more likely to develop after lymphoma treatment. These include heart damage, lung damage, osteoporosis, and depression. Your doctor can help you better understand your individual risk factors for developing related conditions and recommend steps to lower your risk.

Read more about other health conditions related to lymphoma.

What Is the Prognosis for Lymphoma? Can It Be Cured?

Many people diagnosed with aggressive lymphoma achieve complete remission and are even cured. Some indolent lymphomas, like CLL/SLL, are not curable but can be managed like a chronic illness. More effective treatments for lymphoma and other blood cancers have increased survival rates and rates of remission over the last decade.

Lymphoma Condition Guide

References
  1. Cancer Stat Facts: Non-Hodgkin Lymphoma — National Cancer Institute
  2. Cancer Stat Facts: Hodgkin Lymphoma — National Cancer Institute
  3. United States Cancer Statistics: Data Visualizations — Centers for Disease Control and Prevention
  4. Key Statistics for Hodgkin Lymphoma — American Cancer Society
  5. What Is Lymphoma? — Lymphoma Action
  6. The Lymphatic System — Lymphoma Action
  7. What Is Lymphoma? — Lymphoma Research Foundation
  8. Germline and Somatic Mutations: What Is the Difference? — ONS Voice
  9. Hodgkin Lymphoma — Leukemia & Lymphoma Society
  10. Non-Hodgkin Lymphoma — Leukemia & Lymphoma Society
  11. Lymphoma — Centers for Disease Control and Prevention
  12. Non-Hodgkin Lymphoma Risk Factors — American Cancer Society
  13. How To Prevent Cancer: 10 Recommendations — American Institute for Cancer Research
  14. Understanding Non-Hodgkin Lymphoma: A Guide for Patients, Survivors, and Loved Ones — Lymphoma Research Foundation
  15. Hodgkin Lymphoma Diagnosis — Leukemia & Lymphoma Society
  16. Non-Hodgkin Lymphoma Diagnosis — Leukemia & Lymphoma Society
  17. Symptoms of Lymphoma — Lymphoma Action
  18. Signs and Symptoms of Non-Hodgkin Lymphoma — American Cancer Society
  19. Staging of Lymphoma — Lymphoma Action
  20. Signs and Symptoms of Hodgkin Lymphoma — American Cancer Society
  21. Understanding Hodgkin Lymphoma — Lymphoma Research Foundation
  22. Hodgkin Lymphoma Signs and Symptoms — Leukemia & Lymphoma Society
  23. Non-Hodgkin Lymphoma Symptoms — Cancer Research UK
  24. Hodgkin Lymphoma Subtypes — Leukemia & Lymphoma Society
  25. Understanding Non-Hodgkin Lymphoma (Lymphoid Neoplasms) — Lymphoma Research Foundation
  26. What Is Non-Hodgkin Lymphoma? — American Cancer Society
  27. Diffuse Large B-Cell Lymphoma — Lymphoma Research Foundation
  28. T Cell — Encyclopaedia Britannica
  29. Watch and Wait — Leukemia & Lymphoma Society
  30. Side Effects of Lymphoma Treatment — Lymphoma Action
  31. Comorbidity Prevalence Among Cancer Patients: A Population-based Cohort Study of Four Cancers — BMC Cancer
  32. Prevalence of Co-morbidity and Its Relationship to Treatment Among Unselected Patients With Hodgkin's Disease and Non-Hodgkin's Lymphoma, 1993-1996 — Annals of Hematology
  33. Lymphoma and HIV — Lymphoma Action
  34. Long-term and Late Effects for Cancer Survivors — Leukemia & Lymphoma Society
  35. Chemotherapy and Other Drug Therapies — Leukemia & Lymphoma Society

A MyLymphomaTeam Member said:

Not always.

posted 4 months ago

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Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Alison Channon has nearly a decade of experience writing about chronic health conditions, mental health, and women's health. Learn more about her here.

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