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Types of Lymphoma

There are two types of Lymhpoma - Hodgkin Lymphoma and Non-Hodgkin Lymphoma.

Hodgkin Lymphoma

Hodgkin lymphoma is a relatively rare type of lymphoma first identified in the 1830s by the English doctor Thomas Hodgkin. After the development of the microscope (in the late 19th and early 20th centuries) two scientist called Reed and Sternberg studied tissue samples of people with Hodgkin lymphoma and found a particular type of cell was always present. This cell - now called the Reed-Sternberg cell - is larger than other lymphocytes and is described as a "mirror cell" because it looks like a cell joining to its mirror image. It is the presence of Reed-Sternberg cells that distinguishes Hodgkin lymphoma from other types of lymphomas.

Whilst NHL refers to a wide range of illnesses that all behave in slightly different ways, Hodgkin lymphoma is more distinct and more predictable in its behaviour. Compared to NHL, Hodgkin lymphoma looks different when viewed under the microscope, responds to different treatments and is generally easier to successfully treat.

How common is Hodgkin lymphoma?

In Australia, approximately 400 people are diagnosed with Hodgkin lymphoma each year. It is a rare disease, accounting for 0.5% of all cancer types diagnosed.

Hodgkin lymphoma can occur in various age groups. In developed countries, it is most likely to occur:

  • Between the ages of 15 - 25 years old, or after the age of 65 years old
  • In young adults, it occurs in similar numbers of males and females
  • In older adults, it is more likely to occur in males

Hodgkin lymphoma is slightly more likely to occur in people who have had glandular fever and those with a relative who has had Hodgkin Lymphoma. This does not mean that another family member will definitely get the disease, but rather that other family members have a slightly higher risk of getting Hodgkin Lymphoma compared to the general population.

How does Hodgkin lymphoma develop?

Currently, it is not known how Hodgkin lymphoma develops and research continues to investigate the cause of the disease. However it is thought that the malignant (cancer) cells grow due to an abnormal immune response from a past infection e.g. the Epstein Barr virus which causes glandular fever. Other people who develop Hodgkin lymphoma may have a genetic tendency to abnormal immune responses.

What is known is that Hodgkin lymphoma is not contagious - you cannot "catch it" from someone nor can you give it to someone else. There is no evidence to suggest that anything you have done or not done (such as lifestyle choices) will cause the development of Hodgkin lymphoma.

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma is a complex disease that is relatively little known by the general public, despite its growing prevalence worldwide. Yet various treatments are available with the potential to relieve symptoms of the disease for extended periods of time or, for certain types of NHL, to offer the possibility of a cure.

How common is NHL?

In the past 20 years the number of people diagnosed with NHL has doubled. In Australia there are now nearly 4000 people diagnosed with NHL each year. NHL represents the fifth most common malignancy diagnosed in men and the sixth most common in women, with the incidence being approximately 39% higher in men.

What are the risk factors for NHL?

Despite being one of the fastest growing cancers in the western world, the cause of NHL is still unknown. People with the following risk factors may have an increased chance of developing NHL:

  • Previous infections with viruses such as Epstein-Barr virus, human immunodeficiency virus (HIV), human T-lymphotropic virus type 1 (HTLV-1) and hepatitis C
  • Chemical exposure including pesticides, fertilisers or solvents
  • Autoimmune diseases including rheumatoid arthritis, scleroderma and Sjögren’s syndrome
  • Previous organ transplant
  • Infections with certain bacteria including Helicobacter pylori
  • A family history of NHL.

It is not known with certainty that NHL can be inherited through family history. It is also important to note that having these risk factors does not mean NHL will definitely develop. Many people diagnosed with NHL have absolutely no risk factors.

How does NHL develop?

NHL can begin in any lymph node or lymph tissue found throughout the body. Tumours may involve just one lymph node or several lymph nodes at the same time. Since lymphocytes move throughout the body through either the bloodstream or more commonly the lymphatic system, any abnormal lymphocyte has a clear path to travel all through the body. This is why NHL can start in or spread to any part of the body. It is for this reason that many people have widespread disease at the time of diagnosis.

As mentioned, NHL is the name given to a group of closely related cancers, each of which has its own unique symptoms. However, the following table lists common symptoms experienced in many types of NHL:

Non Hodgkin Lymphoma

Common Symptoms Lymphoma Pathway

Painless lymph node enlargement 

 Lymph nodes larger than 2 cm are most common, often in the neck, underarm or groin

Fevers, night sweats, tiredness, weight loss > 10%

As lymphoma can trigger an immune response it can cause symptoms similar to those that develop when the body is fighting an infection. These are called "B symptoms!.

Widespread itching

Caused by immune cell histamine release similar to the itching of allergic conditions. This is sometimes triggered by alcohol

Nausea, vomiting, abdominal pain

If lymphoma is affecting the digestive tract

Shortness of breath, cough

If lymphoma is affecting the chest 

Headaches, vision changes, seizures

If lymphoma is affecting the brain

Anaemia, susceptibility to infection

If lymphoma is crowding out the bone marro

Reddened patches on the skin

May occur if lymphoma cells localise in the skin, causing inflammation 

Other signs and symptoms may be present. Their occurrence depends on the site of the tumour(s) and the extent of the disease.

Subtypes

There are more than 60 subtypes of lymphoma. Lymphoma Australia has listed the lymphoma subtypes by Hodgkin, B-cell Non - Hodgkin, T-cell Non Hodgkin, and CLL