The lymphatic system is made up of the lymph nodes, spleen, and thymus gland. It’s part of your immune system, which helps fight disease and infection. Because you have lymph tissue throughout your whole body, lymphoma can begin almost anywhere. This type of cancer can affect both adults and children. (1,2) There are two main categories of lymphoma: Hodgkin lymphoma and Non-Hodgkin lymphoma (NHL), which is much more common. Hodgkin lymphoma and non-Hodgkin lymphoma in adults can share similar symptoms. These can include:
Swelling, or feeling a lump in the lymph nodes of the neck, armpit, or groin area.Fever or chillsDrenching night sweatsUnexplained weight lossFatiguePain in the chest, abdomen, or bonesCoughing or shortness of breath
Learn More About Signs and Symptoms of Lymphoma
Different Forms of Lymphoma
Within the two main categories of NHL and Hodgkin lymphoma, there are a number of different types of lymphoma.
Non-Hodgkin Lymphoma (NHL)
NHL isn’t just one type of lymphoma. It’s the name given to describe a group of cancers that share similar characteristics. In fact, there are more than 90 types of NHL. (3) This form of lymphoma can begin in the:
B Lymphocytes (B cells) These cells make antibodies to fight infections. Most NHL is caused by B cells.T Lymphocytes (T cells) T cells have several jobs, including helping B cells make antibodies and fighting viruses.
They typically develop in the lymph nodes and lymphatic tissue. But sometimes they can affect bone marrow and blood. (3) Some NHLs are slow-growing, while others can be aggressive. Your treatment options will depend on the type of NHL you have and how advanced it is.
Types of NHL
Some of the more common types of NHL include:
Diffuse Large B-Cell Lymphoma (DLBCL) This form of NHL accounts for about 1 in every 3 lymphomas, making it the most common type. It’s often aggressive but responds well to treatment. DLBCL mostly impacts older people, though there are several subtypes, including primary mediastinal B-cell lymphoma, which primarily affects young women, notes the American Cancer Society. (4)Follicular Lymphoma Follicular lymphoma accounts for about 1 in 5 lymphomas in the United States. These NHLs are typically slow-growing, although some can be aggressive. This type of lymphoma is rare in younger people and is difficult to cure, though patients often live for many years with this, oftentimes with long periods of not needing treatment. Some follicular lymphomas can turn into fast-growing DLBCL. (4)Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) These are closely-related diseases. They’re usually slow-growing and though they’re not typically cured with standard treatments, many people with CLL and SLL live long lives. Both diseases are treated the same way, and there are many new therapies available. (4) The main difference between the two conditions is that when the cancer cells are found primarily in the lymph nodes, it is referred to as SLL. If the cancer cells are found mostly in the bloodstream and bone marrow, it is diagnosed as CLL. It is most common in older adults and is so slow growing that doctors sometimes opt to watch the disease, or monitor it with tests, for a time, before treating.Mantle Cell Lymphoma (MCL) MCLs are much more prevalent in men than in women. They’re also more likely to affect older people and are challenging to treat. This type accounts for about 5 percent of lymphomas. (4)
Some rarer types of NHL include:
Cutaneous T-Cell Lymphomas Sezary syndrome and mycosis fungoides are considered cutaneous T-cell lymphomas, which are lymphomas that start in the skin. (4)Cutaneous B-Cell Lymphomas These lymphomas also attack the skin, notes the Mayo Clinic. (5)Primary Central Nervous System Lymphoma This type of lymphoma affects the brain or spinal cord. It’s more common in older people and those who have weakened or compromised immune systems. (4)Waldenstrom Macroglobulinemia In some cases, Waldenstrom macroglobulinemia doesn’t cause signs or symptoms for years. This type of NHL is rare and slow-growing, according to the Mayo Clinic. (6)Burkitt Lymphoma This fast-growing lymphoma is more common in children, and more common in the developing world. The disease can grow quickly and requires prompt treatment. (4)
This form of lymphoma can spread from lymph node to lymph node. Hodgkin lymphoma is most common in people in their early twenties and those over age 55, but it can affect adults and children of any age.
Types of Hodgkin Lymphoma
There are two main types of Hodgkin lymphoma:
Classical Hodgkin Lymphoma Classical Hodgkin lymphoma is the more common form, accounting for about 95 percent of Hodgkin lymphomas in developed countries, notes the American Cancer Society. (8) People with this form of lymphoma have large, abnormal cells, known as Reed-Stern cells, in their lymph nodes. There are four subtypes of classical Hodgkin lymphoma, per the Mayo Clinic: nodular sclerosis Hodgkin lymphoma, mixed cellularity Hodgkin lymphoma, lymphocyte-rich Hodgkin lymphoma, and lymphocyte-depleted Hodgkin lymphoma. (9)Nodular Lymphocyte Predominant Hodgkin Lymphoma This rare type of Hodgkin lymphoma is characterized by abnormal, large cells that look like popcorn. It usually starts in the lymph nodes of the neck and underarms. (7)
According to the Rosewell Park Comprehensive Cancer Center, you might be at a greater risk for developing lymphoma if you:
Are maleHave a family history of lymphomaAre over 55Develop certain types of infection, such as Epstein-Barr virus, hepatitis C, or Helicobacter pyloriHave a compromised or weak immune systemHave received chemotherapy or radiation in the past (10)
Doctors can also take a sample of bone marrow from your hip bone to look for lymphoma cells. Your doctor also could order computerized tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans to look for signs of lymphoma elsewhere in the body. There are many types of lymphoma, and it takes an expert to identify which kind of lymphoma you have. That’s key to getting proper treatment. You need an experienced pathologist, and you might want to get a second opinion. (11,12) Learn More About Diagnosing Lymphoma
Prognosis of Lymphoma
The five-year survival rate describes the percentage of people who live at least five years after being diagnosed with a particular type of cancer. According to the American Cancer Society, the overall five-year survival rate for NHL is 72 percent. (13) It’s important to note that these figures are variable for each subtype of NHL. The five-year relative survival rate for people with localized Hodgkin lymphoma is about 92 percent. It’s about 78 percent for those with “distant”-stage disease (when the cancer has spread to areas such as the lungs, liver, or bone marrow), per the American Cancer Society. (14) The survival rates have greatly improved for this type of cancer. According to the Leukemia and Lymphoma Society, Hodgkin lymphoma is now one of the most curable forms of cancer. (15) It’s important to remember that survival rates are only estimates. Your outlook will depend on several factors, including the type of lymphoma you have and how aggressive your disease is, as well as your age, and general health.
Non-Hodgkin Lymphoma Treatment Options
Non-Hodgkin lymphoma is an umbrella term for a variety of cancers. Some of the most common are B-cell lymphomas, which include follicular lymphoma and small lymphocytic lymphoma (SLL). Once a proper classification of the lymphoma has been made, you and your doctor must consider a broad array of possible treatments, each with its own benefits and risks. The good news is you have a wide array of treatment options.
Medication Options
Chemotherapy is the main treatment for most people with non-Hodgkin lymphoma. Chemotherapy agents available for treatment include steroids, platinum drugs, such as Platinol (cisplatin), and other chemotherapy drugs, such as Oncovin or Vincasar (vincristine), Adriamycin (doxorubicin), and methotrexate, per the American Cancer Society. (17) Immunotherapy (in which medication helps the immune system recognize and eliminate cancer cells), radiation, targeted therapy, and stem cell transplants are other treatment options. (12) Kymriah (tisagenlecleucel) and Yescarta (axicabtagene ciloleucil)are two types of CAR T-cell therapy (a form of immunotherapy) that are approved for the treatment of some B cell lymphomas. Additional medication may be used to treat the effects of chemotherapy. Antiviral drugs or antibiotics may be used prevent infection. Learn More About Treating Non-Hodgkin Lymphoma
Hodgkin Lymphoma Treatment
Most Hodgkin disease is usually what’s called “the classical type,” meaning it is characterized by large, abnormal lymphocytes (a type of white blood cell) in the lymph nodes. The treatment of Hodgkin lymphoma depends upon the stage of the cancer (how advanced it is), notes the American Cancer Society. (18) There are a variety of treatments for Hodgkin disease, but chemotherapy is the first-line treatment. Radiation is an additional option. And increasingly, immunotherapy can be used to treat Hodgkin lymphoma, according to the American Cancer Society. (19) Learn More About Treating Hodgkin Lymphoma Because HIV and hepatitis C weaken the immune system, and are known to increase lymphoma risk, it’s important to avoid behavior that increases your risk for these infections — such as intravenous drug use and unprotected sex with multiple partners, notes the American Cancer Society. (20) Avoiding unnecessary exposure to radiation is another precaution you can take to lower your risk. As is maintaining a healthy weight and diet. In rare instances, women have developed lymphoma in the scar tissue around breast implants, per the Cleveland Clinic. (21) Learn More About the Complications of Surviving Lymphoma: How It Affects Your Body in the Short and Long Term An estimated 791,550 people are living with, or in remission from, lymphoma in the United States (146,789 from Hodgkin lymphoma and 644,761 from non-Hodgkin lymphoma). (15) NHL is one of the most prevalent cancers in the United States, accounting for about 4 percent of all cancers. (8) The chance that a man will develop NHL in his lifetime is around 1 in 41, which is higher than the 1 in 52 risk for a woman. (8) In the United States, NHL is more likely to develop in white Americans than in Black Americans or Asian Americans, according to the American Cancer Society. (22)
Black Americans and Lymphoma
A review of research published in November 2017 in the journal Annals of Lymphoma noted that studies suggest that while the incidence of lymphoma is lower among Black Americans than white Americans, Black patients are generally younger and the lymphoma is at more advanced, aggressive stages when diagnosed. (23) Additionally, Black patients have a decreased rate of event-free survival and overall survival. A study published in November 2015 in the journal Pediatric Blood & Cancer examined the association between race and survival in pediatric Hodgkin lymphoma. (24) Study authors concluded that Black Americans had a worse survival rate than white or Hispanic Americans. Another study, published in November 2019 in the Journal of Clinical Oncology, examined data for over 1600 patients with pediatric and adolescent Hodgkin lymphoma. (25) The researchers found that five-year post-relapse survival probabilities were 66 percent for non-Hispanic Black Americans compared with 90 percent for white Americans. Authors of both studies suggest that the reasons for these disparities are complex and warrant more investigation.
Hispanic Americans and Lymphoma
The same study published in the Journal of Clinical Oncology also found that Hispanic children and adolescents diagnosed with Hodgkin lymphoma had an 80 percent survival probability, compared with the 90 percent probably for white children and teens. (25) But while an association with lymphoma has been shown, the reasons aren’t clear. It’s possible that immunosuppressive medication taken for these conditions is also a factor, and in the case of psoriasis, misdiagnosis of cutaneous T-cell lymphoma as psoriasis may contribute to the connection, according to a study published in March 2017 in the Journal of the American Academy of Dermatology. (27) Learn More About Additional Resources and Support for Lymphoma
