Types of Lymphoma Cancer - Differences in Hodgkin vs. Non-Hodgkin Lymphoma Symptoms and Treatment

Understanding the Different Types of Lymphoma Cancer

Lymphoma is a type of blood cancer that originates in the lymphatic system. There are two main categories of lymphoma - Hodgkin lymphoma and non-Hodgkin lymphoma. Within these two groups, there are over 60 subtypes of lymphoma cancer. It's important to understand the differences between the various types of lymphoma in terms of symptoms, diagnosis, and treatment.

What is Lymphoma?

Lymphoma starts when cells in the lymphatic system begin to multiply uncontrollably. The lymphatic system is part of the body's immune defense. It includes the lymph nodes, spleen, thymus gland, and bone marrow. Lymphoma cells can travel through the lymphatic system and invade other parts of the body.

In Hodgkin lymphoma, cancer cells originate from white blood cells called Reed-Sternberg cells. In non-Hodgkin lymphoma, cancer develops from lymphocytes, a different type of white blood cell. Knowing which subtype of lymphoma cancer is present determines the appropriate treatment.

Types of Hodgkin Lymphoma

There are two main categories of Hodgkin lymphoma - classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Classical Hodgkin lymphoma accounts for 95% of Hodgkin cases and has four subtypes:

1. Nodular Sclerosis Hodgkin Lymphoma

This is the most common form of Hodgkin lymphoma, accounting for about 60% of cases. It is most likely to affect young adults between the ages of 15 and 35. The cancer cells cluster together in chains called nodules that can be seen on imaging tests like CT scans.

The nodules often develop in lymph nodes in the chest region first, but can spread to nodes above the diaphragm and in the neck. Common symptoms include enlarged lymph nodes, fatigue, fever, and night sweats.

2. Mixed Cellularity Hodgkin Lymphoma

This subtype involves multiple types of cells including Reed-Sternberg cells, lymphocytes, and histiocytes. About 15-30% of Hodgkin lymphoma cases are mixed cellularity type. It is slightly more common in men and tends to develop in older adults.

The disease typically originates in lymph nodes in the abdomen before spreading. Symptoms often include enlarged spleen, liver, or lymph nodes, as well as fatigue, fever, and weight loss.

3. Lymphocyte-Rich Hodgkin Lymphoma

This rare form accounts for only about 5% of Hodgkin lymphoma diagnoses. As the name suggests, there are high amounts of lymphocytes along with Reed-Sternberg cells. It occurs more often in men, with a typical onset between ages 30-50.

The cancer usually originates in lymph nodes in the neck, underarm, or groin, leading to swollen glands in those areas. Painless swelling of nodes is the predominant early symptom.

4. Lymphocyte-Depleted Hodgkin Lymphoma

This is the least common subtype, representing less than 1% of Hodgkin lymphoma. It is highly aggressive and tends to affect older adults and people who are immunocompromised. The cancer cells are primarily Reed-Sternberg cells with very few lymphocytes.

The disease spreads quickly through lymph nodes in the abdomen, chest, neck, and armpits. Symptoms like fatigue, night sweats, and weight loss appear rapidly. This subtype of Hodgkin lymphoma requires urgent treatment.

Types of Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma accounts for about 90% of all lymphoma cases. It includes many subtypes of cancer that originate from lymphocytes. Non-Hodgkin lymphomas are classified as either B-cell or T-cell lymphomas, based on the type of lymphocyte that turns cancerous.

B-Cell Lymphomas

B-cell lymphomas develop from abnormal B-lymphocytes in the bone marrow and lymphatic tissues. Types of B-cell lymphoma include:

• Diffuse large B-cell lymphoma - The most common form, accounting for about 1 in 3 cases.
• Follicular lymphoma - The second most common type, tends to be slow-growing.
• Chronic lymphocytic leukemia / small lymphocytic lymphoma - Often occurs with high white blood cell counts.
• Mantle cell lymphoma - Found frequently in lymph nodes in the neck, armpits, and groin.
• Marginal zone lymphomas - A group that includes mucosa-associated lymphatic tissue (MALT) lymphoma.
• Burkitt lymphoma - A rare and fast-growing subtype more common in children.

T-Cell Lymphomas

T-cell lymphomas originate from T-lymphocytes and account for less than 15% of non-Hodgkin lymphoma cases. Types of T-cell lymphoma include:

• Peripheral T-cell lymphoma – A diverse group of aggressive lymphomas.
• Cutaneous T-cell lymphomas - Cancers that primarily affect the skin, like mycosis fungoides.
• Anaplastic large cell lymphoma - An aggressive type more common in children and young adults.
• Angioimmunoblastic T-cell lymphoma - Leads to enlarged lymph nodes and constitutional B symptoms.
• Adult T-cell leukemia/lymphoma - Caused by the human T-cell leukemia virus (HTLV-1).

Symptoms of Lymphoma

Some common lymphoma symptoms include:

• Swollen, painless lymph nodes in the neck, armpit, or groin
• Fatigue
• Unexplained weight loss
• Fever
• Drenching night sweats
• Coughing or trouble breathing
• Itchy skin
• Feeling full after small amounts of food
• Enlarged liver or spleen

However, symptoms can vary significantly depending on the type of lymphoma. Some forms may not cause any noticeable symptoms until they reach advanced stages.

When to See a Doctor

Make an appointment with your doctor if you experience persistent symptoms like swollen lymph nodes, fatigue, fever, or night sweats. Bring up any symptoms that seem unusual or worrisome. Hodgkin lymphoma and aggressive types of non-Hodgkin lymphoma require prompt treatment for the best prognosis.

Diagnosing Lymphoma

If lymphoma is suspected, your doctor will likely order imaging tests and a biopsy. Imaging through CT, PET, or MRI scans determines if any lymph nodes or organs are enlarged. A surgical biopsy of an affected lymph node is then done to establish a diagnosis.

The biopsy sample is analyzed to identify the specific subtype of lymphoma cancer cells. Immunophenotyping and genetic tests help classify the cells as Hodgkin lymphoma, B-cell non-Hodgkin, or T-cell non-Hodgkin. Staging tests determine how advanced the cancer is and if it has spread to other tissues.

Treating Different Forms of Lymphoma

Lymphoma treatment typically involves chemotherapy, radiation, immunotherapy drugs, stem cell transplants, or a combination of these. The treatment regimen is based on the type and stage of lymphoma:

• Early stage Hodgkin lymphoma - Often treated with a few cycles of chemo plus radiation therapy.
• Advanced stage Hodgkin lymphoma - Requires a more intense chemo regimen sometimes followed by stem cell transplant.
• Indolent non-Hodgkin lymphomas - May only need monitoring or modest chemo at first.
• Aggressive non-Hodgkin lymphomas - Treated urgently with full chemo plus Rituximab immunotherapy.

Understanding the exact lymphoma diagnosis is crucial for determining the appropriate treatment and prognosis. Make sure to get a full evaluation and work closely with your oncology team.

Reducing Lymphoma Risk

Researchers don't know exactly what causes lymphoma, but some factors are believed to increase risk including:

• Weakened immune system
• Certain infections like HIV, EBV, helicobacter pylori
• Autoimmune diseases like rheumatoid arthritis
• Previous chemo or radiation treatment
• Family history of lymphoma
• Obesity
• Smoking
• Exposure to certain pesticides or chemicals

You can potentially lower your lymphoma risk by maintaining a healthy weight, quitting smoking, limiting alcohol, managing stress, and avoiding unnecessary antibiotics. But most cases don't have an identifiable cause.

Lymphoma isn't always preventable, but seeking prompt treatment optimizes outcomes. Be aware of the key symptoms of lymphoma and consult your doctor about any lingering signs or unexplained health changes.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.