Lymphoma is a type of cancer that starts in the lymphatic system. The treatment differs based on which type of lymphoma the patient has, Hodgkin’s Lymphoma (HL) or Non Hodgkin’s Lymphoma (NHL). Then, it depends on the subtypes, the stage, and so on.

Lymphoma overview

What is lymphoma?

• Lymphoma is a cancer of the lymphatic system.
• All cancers are caused by cells that behave abnormally. In Lymphoma, the cancer begins when cells called lymphocytes go out of control.

What are lymphocytes?

• Lymphocytes are a kind of white blood cells.
• There are many types of lymphocytes, but the two main types are B lymphocytes and T lymphocytes.
• Both types of lymphocytes play an active role in the body’s defense mechanism.
• In addition, T cells are also part of the control mechanism of the immune system, helping boost or suppress immune response, as needed.

What are the symptoms of lymphoma?
Both HL and NHL manifest similar symptoms, which include:

• Lumps caused by swollen lymph nodes appear in areas like your neck, groin, armpits etc.
• Fatigue
• Weight loss
• Night sweats
• Fever
• Difficulty in breathing

However, having any of these symptoms does not mean you have lymphoma; swollen glands can be caused by infections also, for instance, if the lumps persist and are painless, you should see a doctor.

What are the factors that affect treatment decisions for lymphoma?

• The process begins with diagnosing the type of lymphoma, the subtype, the stage of the disease, and so on.
• The two main types of Lymphoma are Hodgkins lymphoma and non Hodgkin’s lymphoma, and treatment depends on these types.

What is the difference between Hodgkin’s lymphoma and non Hodgkin’s lymphoma?

• Hodgkin’s Lymphoma affects the B lymphocytes.
• Non Hodgkin’s lymphoma can originate in either the B cells or T cells.
• Non Hodgkin’s lymphoma is the more common type of lymphoma.
• Around 70,000 Americans are diagnosed with non Hodgkin’s lymphoma each year, as opposed to only around 8,000 cases of Hodgkin’s lymphoma.
• There are only a few subtypes of Hodgkin’s lymphoma, but there are around 30 to 60 subtypes of non Hodgkin’s lymphoma (doctors do not agree on the number of subtypes).

How do doctors determine if a patient has HL or NHL?

• The main differentiator can be identified when cancer cells from a biopsy are examined under a microscope.
• If the examination shows the presence of Reed-Sternberg cells, it is Hodgkin’s lymphoma.
• These are malignant B cells that are huge, upto 5 times the size of normal cells.
• They are named after two scientists, Dorothy Reed and Carl Mendenhall, who first identified and described these microscopic mutations.

Which one of these is more treatable?

• Hodgkin’s lymphoma is generally more treatable.
• It progresses more gradually than NHL and is also diagnosed at earlier stages.
• While the symptoms for both HL and NHL are similar, NHL is generally diagnosed only in the advanced stages.
• There are many subtypes of non Hodgkin’s lymphoma, which makes treatment more complicated.

What are the stages?

• For both Hodgkin’s lymphoma treatment and non Hodgkin’s lymphoma treatment, the stage of the disease is important.
• Both forms of lymphoma progress through Stage I to Stage IV.
• In Stage I, the cancer is confined to one organ or one nodal region.
• After this, in each subsequent stage, the cancer progresses to other lymph nodes and even other parts of the lymphatic system from where it started.
• For non Hodgkin’s lymphoma treatment, doctors also assess whether it is indolent or aggressive.

How do doctors design the lymphoma treatment?

• This depends on the type of lymphoma, the subtypes, stage, and so on.
• While chemotherapy, radiation therapy, immunotherapy, and palliative treatments are generally part of the plan, the types of drugs used, the dosages, etc might differ based on the subtypes and the stage of the disease.
• Classical Hodgkin’s lymphoma treatment will vary depending on the subtype. For example, whether the subtype is nodular sclerosis, mixed cellularity, lymphocyte-depleted, or lymphocyte-rich.
• In NHL, some subtypes grow slowly. If the disease is in this stage of slow growth, it is called indolent lymphoma.
• In this case, doctors just monitor the patient’s condition constantly and begin treatment only if the condition changes, that is, the non Hodgkin’s lymphoma becomes aggressive.
• In aggressive lymphoma, the disease spreads and grows fast. In these cases, non Hodgkin’s lymphoma treatment is started immediately.

What is the prognosis?

• Hodgkin’s lymphoma is rare and advances in Hodgkin’s lymphoma treatments have increased the survival rate.
• The percentage of patients who live 5 years and beyond after diagnosis is now around 86%.
• While the non Hodgkin’s lymphoma survival rate is generally lower, recent treatment methods have resulted in an improvement in the prognosis for NHL.

What is B cell lymphoma?

• This is a term often used to refer to NHL subtypes that begin in the B cell rather than the T cell.
• B cell lymphomas form the major percentage of NHL in the country.
• The most common type of NHL is Diffuse Large B-cell Lymphoma (DLBCL).
• The large B cell lymphoma survival rate depends on many factors like stage of the disease, age, general health, etc. If discovered early, b cell lymphoma survival rate is high.

Lymphoma treatments and prognosis depend on the many factors mentioned above. Apart from the traditional chemotherapy and radiation treatments, newer methods like immunotherapy and targeted therapies are improving the outlook in both Hodgkin’s lymphoma and non Hodgkin’s lymphoma.