Lymphoma is cancer that begins in the lymphatic system, the network of delicate structures that circulates fluids throughout the body and helps fight off infections. There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). Each of these classifications can be further broken down into a number of different subtypes—for example, there are six forms of Hodgkin lymphoma and more than 80 forms of non-Hodgkin lymphoma. Symptoms of lymphoma can vary according to its type, as can its treatment options and outlook.
Non-Hodgkin lymphoma comprises about 90% of lymphoma cases and is the seventh most common cancer affecting adults in the United States. Occurring when germ-fighting white blood cells (lymphocytes) grow abnormally and bind together to form tumors, non-Hodgkin lymphoma typically begins in the lymph nodes, spleen, bone marrow or thymus.
The World Health Organization (WHO) estimates there are at least 86 subtypes of non-Hodgkin lymphoma.The large majority of these subtypes can be classified as either B-cell lymphomas or T-cell lymphomas based on what sort of lymphocytes the cancer affects (B lymphocytes or T lymphocytes, respectively).
Accounting for more than 85% of all non-Hodgkin lymphoma diagnoses in the U.S., B-cell lymphomas begin in B lymphocytes, which are white blood cells that produce special proteins called antibodies. The most common form of B-cell lymphoma—and the most common type of non-Hodgkin lymphoma overall—is diffuse large B-cell lymphoma (DLBCL). This aggressive blood cancer is known to spread quickly and typically affects middle-aged and older adults. Follicular lymphoma, which is a slow-growing lymphoma type with a generally positive prognosis, is another commonly seen B-cell lymphoma.
Rarer types of B-cell lymphomas include:
- Burkitt lymphoma
- Lymphoplasmacytic lymphoma
- MALT lymphoma
- Mantle cell lymphoma
- Marginal zone B-cell lymphoma
- Primary central nervous system (CNS) lymphoma
- Primary mediastinal large B-cell lymphoma
- Small lymphocytic lymphoma
Less than 15% of non-Hodgkin lymphomas diagnosed in the U.S. are T-cell lymphomas. This subtype occurs in T lymphocytes, which help control immune cell activity and destroy abnormal cells and germs. The most common form of T-cell lymphoma is actually a group of aggressive diseases collectively known as peripheral T-cell lymphoma (PTCL). This cancer develops from mature white blood cells and affects lymph tissues outside of the bone marrow, such as the lymph nodes and spleen.
Another form of T-cell lymphoma is anaplastic large cell lymphoma (ALCL), which comprises about 10% to 20% of all T-cell lymphoma diagnoses and is distinguished by a special marker on the cancer cell’s surface called CD30. It may be limited to the skin (cutaneous), occur throughout the body (systemic) or develop around breast implants. Other, less common types of T-cell lymphomas include angioimmunoblastic T-cell lymphoma (AITL), lymphoblastic lymphoma and adult T-cell lymphoma (ATLL).
Indolent vs. aggressive lymphomas
While non-Hodgkin lymphoma types are primarily classified as B-cell or T-cell, they may also be labeled as either indolent or aggressive based on how quickly they spread (metastasize). Indolent lymphomas like follicular lymphoma tend to grow slowly and may not require immediate medical intervention, although they should be monitored closely by a medical professional. Conversely, aggressive lymphoma types like diffuse large B-cell lymphoma are known to spread rapidly and require prompt medical treatment.
Around 10% of lymphoma cases are classified as Hodgkin lymphoma (Hodgkin disease). Both Hodgkin lymphoma and non-Hodgkin lymphoma originate in white blood cells, including B lymphocytes and T lymphocytes. However, Hodgkin lymphoma is distinguished by the presence of Reed-Sternberg cells—abnormally large lymphocytes that sometimes contain more than one nucleus.
Classic Hodgkin lymphoma
Classic Hodgkin lymphoma (cHL) comprises about 90% of Hodgkin lymphoma cases. Its four main subtypes include:
- Nodular sclerosing Hodgkin lymphoma (NSCHL). Roughly 70% of all Hodgkin lymphomas can be classified as NSCHL, which primarily affects teens and young adults.
- Mixed cellularity Hodgkin lymphoma (MCCHL). The second most common subtype, MCCHL is known to affect people with HIV and often develops in lymph nodes of the upper body.
- Lymphocyte-rich Hodgkin lymphoma. This subtype makes up about 5% of cHL cases and is more prevalent in men than women.
- Lymphocyte-depleted Hodgkin lymphoma. A rare and aggressive cancer, lymphocyte-depleted Hodgkin lymphoma is usually seen in older adults and people with HIV.
Nodular lymphocyte-predominant Hodgkin lymphoma
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a slow-growing lymphoma type that makes up about 5% of NHL cases. It’s more common in men than women and typically begins in the lymph nodes around the underarms and neck. Unlike classic Hodgkin lymphoma, NLPHL contains large, popcorn-like cancer cells that are variants of Reed-Sternberg cells.
Symptoms of non-Hodgkin lymphoma vs. Hodgkin lymphoma
Despite their cellular differences, non-Hodgkin and Hodgkin lymphomas are generally associated with the same symptoms, including:
- Swollen lymph nodes in the neck, underarms or groin area
- Sweating at night
- Lingering fatigue
- Unexplained weight loss
- Shortness of breath
- Itchy skin
Individuals with Hodgkin lymphoma may experience pain and lymph node swelling after drinking alcohol in some cases. Hodgkin lymphomas are also more likely to affect lymph nodes in the upper body, while non-Hodgkin lymphomas can occur in lymph nodes throughout the body as well as other organs.
How to determine lymphoma type
To determine what type of lymphoma a patient has, a physician will remove a lymph node through a biopsy, then send the node to a pathologist for further testing. A pathologist will look at the node under a microscope to determine:
- What type of cells are cancerous (B cells or T cells)
- What the cells look like and in what pattern they are arranged
- What type of proteins are present
- What genetic changes (chromosome features) can be detected in the lymphoma cells
This information can not only help an oncologist distinguish between the various types of lymphoma, but also help direct the best possible course of treatment. For instance, some types are more receptive to chemotherapy than others, while patients with other lymphoma types are better candidates for immunotherapy and other targeted options.
Our approach to lymphoma
Moffitt Cancer Center is Florida's No. 1 cancer hospital and a recognized leader in cancer diagnosis and treatment for all types of lymphoma. Our pathologists work closely with our oncologists, furthering a common goal of accurately diagnosing each patient and placing him or her promptly on a path to treatment. With an onsite pathology lab and a skilled, multispecialty team of cancer experts, Moffitt is capable of efficiently diagnosing and treating even the rarest types of lymphoma.
For more information about lymphoma types and treatment options at Moffitt’s Malignant Hematology Program, call 1-888-663-3488 or complete a new patient registration form online. You may do so without a referral. We’re streamlining access to world-class cancer expertise by promptly connecting patients with cancer experts in 24 hours or less. As our patient, you can rest assured that you are a foremost priority of a cancer center that delivers nationally ranked care in new and transformative ways.