Do You Know Your Lymphomas?
Lymphoma comes in different types and the most recognizable forms tend to include the name Hodgkin. Whether it's non-Hodgkin lymphoma or Hodgkin lymphoma, the cancer involves the white blood cells of the body.
Dr. Michael Jain, hematology specialist
Which white blood cells are involved make all the difference.
"Honestly the naming of Hodgkin and non-Hodgkin is historical," explained Dr. Michael Jain, a hematology specialist at Moffitt Cancer Center.
Jain explained that the terms used to describe lymphoma are a way to wrangle a class of cancers and those terms are updated every five to 10 years.
"But tumors don't read textbooks and can sometimes overlap," Jain added. "For example, a slow-growing cancer, with enough time, can transform into an aggressive type, or a lymphoma can be in a gray zone between two different types at the same time."
So what's the difference? Hodgkin lymphoma is marked by the presence of Reed-Sternberg cells, which are mature B cells that have become malignant and are unusually large. Non-Hodgkin lymphoma is a set of more than 60 subtypes of lymphoma that can come from different types of lymphocytes including B cells, T cells or NK cells.
While the two types of lymphoma differ, Jain said it's not uncommon for patients to be diagnosed with more than one type.
| Non-Hodgkin | Hodgkin |
|---|---|
| More common | Less common |
| Most patients are diagnosed at 55 or older | Median age of diagnosis is 39 |
| Can affect lymph nodes anywhere | Usually affects upper body lymph nodes (chest, neck, armpits) |
| Absence of Reed-Sternberg Cells | Presence of Reed-Sternberg Cells |
| Many different types with very different treatments | Subtypes are treated similarly |
The first sign of the Hodgkin disease is often the appearance of enlarged lymph nodes in the upper body. Non-Hodgkin lymphoma, by contrast, can be derived from B cells or T cells and can arise in the lymph nodes as well as other organs. Both B cells and T cells are part of the body's immune response to diseases.
The name Hodgkin comes from history. Thomas Hodgkin was the British pathologist who first described the disease in the early 1800s. Hodgkin studied preserved specimens of human organs, and in 1832, he published a paper that described a pattern of disease in the lymph nodes and spleen that he believed was a specific disease rather than an infection.
That paper was rediscovered three decades later in 1865 by British physician Samuel Wilks, who was investigating the same symptoms. He credited Hodgkin by naming the disease after him.
Both Hodgkin lymphoma and non-Hodgkin lymphoma are cancers of lymphocytes, certain white blood cells that are part of our immune system. Hodgkin lymphoma is a cancer of a specific type of lymphocyte. By contrast, there are many different types of non-Hodgkin lymphomas that have very different behaviors.
"Treatment can be very different for each type of lymphoma," Jain stressed. "A lot of detail goes into assessing each patient. Biologically, each patient and their tumor are unique. A lymphoma specialist can help navigate and recommend the best treatment for each patient."
Moffitt hematologist Dr. Hayder Saeed says stem cell transplants continue to constitute an essential part of therapy in some of the subtypes of non-Hodgkin lymphomas. There has also been great progress in managing non-Hodgkin lymphoma, the more common of the two diseases.
"Many of the therapies are now provided as pill form that the patient can take at home," Saeed said. "All those options spare the patient many of the side effects that traditionally used to be associated with cancer treatment. I encourage them to continue with their normal activity as much as possible. Most of the patients are surprised at how little treatment affects their daily activity."
"The treatments we offer can put the patient in long term remission and science is accelerating," Saeed said. "We are seeing some encouraging approvals and success stories for newer therapies.
Even for some of the noncurable lymphomas, we might be talking about cure in the foreseeable future, and that gives hope to patients to continue their fight."
Regardless of the name of the cancer, Jain said, treatment for lymphomas varies based on a variety of factors. It is important for patients to be as specific as possible about the name used to describe their diagnosis, and not to think of all lymphomas as being the same.
