Lymphoma is a cancer that starts in the lymphatic system. It affects white blood cells called lymphocytes. The two primary types of lymphoma are Hodgkin’s and non-Hodgkin’s.
The lymphatic system is a series of lymph nodes and vessels that move lymph fluid through the body.
Lymph fluids contain infection-fighting white blood cells. Lymph nodes act as filters, capturing and destroying bacteria and viruses to prevent infection from spreading.
While the lymphatic system typically protects your body, lymph cells called lymphocytes can become cancerous, leading to a diagnosis of lymphoma.
This article reviews the symptoms and types of lymphoma, as well as its diagnosis and treatment.
Lymphoma is a general term for cancer that starts in the lymphatic system. There are two categories of lymphoma: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.
Under these two categories, researchers have classified more than 70 types of lymphoma. Lymphomas can affect any portion of the lymphatic system, including:
- bone marrow
- thymus
- spleen
- tonsils
- lymph nodes
Lymphoma may not always cause symptoms in its early stages. Instead, a doctor may discover enlarged lymph nodes during a physical examination. These may feel like small, soft nodules under the skin. A person may feel the lymph nodes in the:
- neck
- upper chest
- armpit
- stomach
- groin
Likewise, many of the symptoms of early lymphoma are not specific. That makes them easy to overlook. These common early symptoms of lymphoma include:
- chills
- cough
- fatigue
- enlarged spleen
- fever
- night sweats
- itchy rash
- shortness of breath
- skin itching
- stomach pain
- loss of appetite
- unexplained weight loss
Because the symptoms of lymphoma are often easily overlooked, it can be difficult to detect and then diagnose it in an early stage. It’s important to know how the symptoms may begin to change as the cancer worsens.
The two major lymphoma types are Hodgkin’s lymphoma and non-Hodgkin’s lymphoma, or NHL. A pathologist in the 1800s named Dr. Thomas Hodgkin identified the cells in what is now called Hodgkin’s lymphoma.
Those with Hodgkin’s lymphoma have large cancerous cells called Reed-Sternberg (RS) cells. People with NHL don’t have these cells.
Non-Hodgkin’s lymphoma
According to the American Cancer Society (ACS),
Many lymphoma types fall under each category. Doctors refer to NHL types by the cells they affect and whether the cells are fast- or slow-growing. NHL forms in either the B cells or T cells of the immune system.
According to the ACS,
| Types of non-Hodgkin’s lymphoma | Description |
|---|---|
| B-cell lymphoma | Diffuse large B-cell lymphoma (DLBCL) is the most aggressive type of NHL. This fast-growing lymphoma comes from abnormal B cells in the blood. It can be cured if treated, but if left untreated, it can lead to death. The stage of DLBCL helps determine your outlook. |
| T-cell lymphoma | T-cell lymphoma is not as common as B-cell lymphoma. Only |
| Burkitt’s lymphoma | Burkitt’s lymphoma is a rare type of NHL that is aggressive and most common in people with compromised immune systems. This type of lymphoma is most common in children in sub-Saharan Africa, but it does occur in other parts of the world. |
| follicular lymphoma | About |
| mantle cell lymphoma | This aggressive form of lymphoma is rare — only about 6% of NHL cases are this type. Mantle cell lymphoma is also more commonly diagnosed at a later stage, and it usually occurs in or involves the gastrointestinal tract or bone marrow. |
| primary mediastinal B cell lymphoma | This subtype of B-cell lymphoma accounts for almost 10% of DLBCL cases. It predominantly affects females in their 20s and 30s. |
| small lymphocytic lymphoma (SLL) | SLL is a type of slow-growing lymphoma. The cancer cells are found mostly in the lymph nodes. SLL is identical to chronic lymphocytic leukemia (CLL), but with CLL, the majority of cancer cells are found in the blood and bone marrow. |
| lymphoplasmacytic lymphoma (LPL) | LPL is a rare type of cancer that accounts for just |
Hodgkin’s lymphoma
Hodgkin’s lymphomas typically start in RS cells. While the main cause of Hodgkin’s lymphoma isn’t known, certain risk factors can increase your risk of developing this type of cancer. Hodgkin’s lymphoma types include:
| Types of Hodgkin’s lymphoma | Description |
|---|---|
| lymphocyte-depleted Hodgkin’s disease | This rare, aggressive type of lymphoma occurs in |
| lymphocyte-rich Hodgkin’s disease | This type of lymphoma is more common in men. It accounts for about 5% of Hodgkin’s lymphoma cases. Lymphocyte-rich Hodgkin’s disease is typically diagnosed at an early stage, and both lymphocytes and RS cells are present in diagnostic tests. |
| mixed cellularity Hodgkin’s lymphoma | Like with lymphocyte-rich Hodgkin’s disease, mixed cellularity Hodgkin’s lymphoma contains both lymphocytes and RS cells. It’s more common in older adult males, and it accounts for almost a quarter of Hodgkin’s lymphoma cases. |
| nodular lymphocyte-predominant Hodgkin’s disease | This type of Hodgkin’s lymphoma occurs in about 5% of people with lymphoma and is most common in males between the ages of 30 and 50 years. It involves an absence of RS cells. It rarely progresses or transforms into an aggressive type of NHL. |
| nodular sclerosis Hodgkin’s lymphoma | This common type of lymphoma occurs in 70% of Hodgkin’s cases and is more common in young adults than in any other group. This type of lymphoma occurs in lymph nodes that contain scar tissue, or sclerosis and is highly treatable. |
Lymphoma occurs when white blood cells called lymphocytes grow out of control. The average life span of a lymphocyte cell is brief, and then the cell dies.
However, in people with lymphoma, DNA changes inside the lymphocyte cells cause them to thrive and spread instead of dying.
It’s unclear what exactly causes this DNA change, and even though there are some risk factors connected with lymphoma, people without the risk factors can still develop these cancers.
Most diagnosed lymphoma cases have no known cause. However, some people are considered to be at higher risk.
Non-Hodgkin’s lymphoma risk factors
Risk factors for NHL include:
- Immunodeficiency: This could be due to a weak immune system from HIV or taking an immune system-suppressing drug after an organ transplant.
- Autoimmune disease: People with certain autoimmune diseases, such as rheumatoid arthritis and celiac disease, have an increased risk of lymphoma.
- Age: Lymphoma is most common in older individuals. However, some types are more common in children and infants.
- Sex: The overall risk of NHL is higher in males than females, but there are some types of NHL that are more likely to develop in females.
- Ethnicity: White people in the United States are more likely to develop some types of lymphoma than African Americans or Asian Americans.
- Infection: People who’ve had infections such as the human T-cell leukemia/lymphotropic virus (HTLV-1), Heliobacter pylori, hepatitis C, or the Epstein-Barr virus (EBV) are associated with an increased risk.
- Chemical and radiation exposure: Those exposed to chemicals in pesticides, fertilizers, and herbicides are also at increased risk. Nuclear radiation can also increase the risk of developing NHL.
- Body size: Individuals living with obesity may be at a higher risk of developing lymphoma, but more research is needed to understand this possible risk factor.
Hodgkin’s lymphoma risk factors
Risk factors for Hodgkin’s lymphoma include:
- Age: More cases are diagnosed in people between the ages of 20 and 30 years and in people over 55 years.
- Sex: Males are more likely than females to develop this type of lymphoma.
- Family history: If a sibling is diagnosed with this type of cancer, your risk of also developing it is higher.
- Infectious mononucleosis: An EBV infection can cause mononucleosis. This infection can increase the risk of lymphoma.
- Immunodeficiency: Individuals with HIV have a greater risk of developing lymphoma.
Typically, a doctor will do a biopsy if they suspect lymphoma. This involves removing cells from an enlarged lymph node.
A specialist known as a hematopathologist will examine the cells to determine if lymphoma cells are present and what cell type they are.
If the hematopathologist detects lymphoma cells, further testing can identify how far the cancer has spread. These tests can include:
- a chest X-ray
- blood testing to check on white and red blood cell count
- testing nearby lymph nodes or tissues
- a bone marrow aspiration, where a small amount of liquid is taken from bone marrow and tested
- a lumbar puncture (spinal tap), where a small amount of fluid from the spine is removed and tested
- an abdominal ultrasound
Imaging scans, such as CT or MRI scans may also identify additional tumors or enlarged lymph nodes.
Typically, a number of medical specialists will collaborate to treat lymphoma, including:
- hematologists, who specialize in blood, bone marrow, and immune cell disorders
- oncologists, who specialize in treating cancerous tumors
- pathologists, who may work with these doctors to assist in treatment planning and identify if a particular treatment is working
Treatment plans depend on a few conditions, including:
- an individual’s age and overall health
- the type of lymphoma
- the cancer’s stage
Doctors will stage a tumor to describe how far the cancerous cells may have spread. A stage 1 tumor is limited to a few lymph nodes, while a stage 4 tumor has spread to other organs, such as the lungs or bone marrow.
Doctors also grade NHL tumors by how fast they’re growing. These terms include:
- low grade or indolent
- intermediate grade or aggressive
- high grade or highly aggressive
Treating Hodgkin’s lymphoma
Treatment for Hodgkin’s lymphoma usually includes radiation therapy to shrink and kill cancerous cells. Doctors may also prescribe chemotherapy medications to destroy cancerous cells.
Newer treatments also include immunotherapy drugs like nivolumab (Opdivo) and pembrolizumab (Keytruda), which help the body’s T cells attack the cancer.
Treating non-Hodgkin’s lymphoma
Chemotherapy and radiation are also used to treat NHL. Biological therapies that target cancerous B cells also can be effective. An example of this drug type includes nivolumab (Opdivo).
For some individuals, such as those with large B-cell lymphoma (DLBCL), CAR T cell therapy is part of the treatment. CAR T cell therapy uses the body’s own cells to treat the cancer: Immune cells are taken from the body, given with new proteins in a lab, and then infused back into the body.
In some instances of both Hodgkin’s lymphoma and NHL, a bone marrow or stem cell transplant may be used to build up healthy immune system cells. Doctors may harvest these cells or tissues before beginning chemotherapy and radiation treatments. Relatives may be able to donate bone marrow, too.
The outlook for a person with lymphoma depends on the stage and type of lymphoma they have. Many types of lymphoma are treatable and highly curable.
Some types of lymphoma also grow slowly or stop growing altogether. In these cases, doctors may choose not to recommend treatment because the outlook, even with the lymphoma, is still good in the long term.
5-year relative survival rates
According to the
For stage 1 NHL, the
What are the different stages of lymphoma?
Both NHL and Hodgkin’s lymphoma can be classified into four stages. The state of lymphoma is determined by where the cancer is and how far it has or has not spread.
- Stage 1: Cancer is in one lymph node or one organ site.
- Stage 2: Cancer is in two lymph nodes near one another and on the same side of the body, or the cancer is in one organ and nearby lymph nodes.
- Stage 3: At this point, cancer is in lymph nodes on both sides of the diaphragm.
- Stage 4: The cancer can be in an organ and spread beyond nearby lymph nodes. As NHL progresses, it may begin to spread. The most common sites for advanced NHL include the liver, bone marrow, and lungs.
While stage 4 lymphoma is advanced, it’s still treatable.
What types of lymphoma are more common in children?
Certain types of lymphoma are more common in children. For example, Hodgkin’s lymphoma is more common in children
What’s the difference between lymphoma and leukemia?
Both leukemia and lymphoma are types of blood cancer, and they share some common symptoms. However, their origins, treatments, and specific symptoms set the two types of cancer apart.
Symptoms
People with both lymphoma and leukemia experience fever and night sweats. However, leukemia is more likely to cause excessive bleeding, easy bruising, headaches, and increased infections. People with lymphoma are more likely to experience itchy skin, loss of appetite, unexplained weight loss, and swollen lymph nodes.
Origins
Leukemia typically begins in the bone marrow. It causes the marrow to produce too many white blood cells. Lymphoma begins in the lymph nodes and progresses as the abnormal white blood cells spread.
Treatment
Doctors may choose to practice watchful waiting for both lymphoma and leukemia. That’s because some types of these cancers are slow-growing and not aggressive.
If your doctor decides to treat either cancer, chemotherapy and radiation are used to treat both, but leukemia has two other common treatments. These are stem cell transplants and targeted drug therapy.
Lymphoma is a term for cancer that starts in the lymphatic system.
There are two overarching categories of lymphoma: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma, or NHL. Within these categories, there are more than 70 different types.
Depending on the cancer’s stage when doctors discover it, the age and health of the individual, and a few other factors, many types of lymphoma are treatable and curable.
Individuals diagnosed with lymphoma often have a team of doctors behind them and a treatment plan designed for their journey.