Different Types of Non-Hodgkin Lymphoma

NHL - 25 Different Diseases and Descriptions, All Wrapped Into One

A lymphocyte as seen in light microscopy, artistic rendition. Lymphomas arise from these lymphocyte white blood cells.

The two basic categories of lymphoma are Hodgkin lymphoma and non-Hodgkin Lymphoma, or NHL. Non-Hodgkin lymphoma is a very large group of diseases, often with very different symptoms, treatment and outcomes. The precise name of your type of NHL may include a number of descriptive terms that can be difficult to understand. Here is an explanation of some of these terms.

T-cell or B-cell

Lymphomas arise from lymphocytes, a type of white blood cell.

Lymphocytes are of 2 types – T cells and B cells. Both help in killing infectious agents but in slightly different ways. Depending on which type of lymphocyte turned into the cancer cell in your body, you may have a T-cell or a B-cell lymphoma. B-cell NHL is the more common variety. There are many different types of B cell and T cell lymphomas, each behaving in a different manner.

High, Intermediate or Low grade

Pathologists, who look at the biopsy from your tumor, often describe cancers in terms of grade. A high-grade lymphoma has cells which look quite different from normal cells. They tend to grow fast. Low-grade lymphomas have cells which look much more like normal cells and multiply slowly. Intermediate grade lymphomas fall somewhere in the middle. The behavior of these types is also described as indolent and aggressive.

Indolent or Aggressive

What the pathologist describes as a high-grade or intermediate-grade lymphoma usually grows fast in the body, so these two types are considered aggressive NHL.

Surprisingly, aggressive NHL often responds better to treatment, and many people with aggressive NHL are cured if they are diagnosed early. The most common kind of aggressive lymphoma is diffuse large B-cell lymphoma (DLBCL). Low-grade NHL, on the other hand, grows slowly, and these lymphomas are therefore called indolent NHL.

This group of NHL doesn’t give rise to too many symptoms, but they are also long-standing and are less likely to be cured. The most common kind of indolent lymphoma is follicular lymphoma. Sometimes indolent lymphomas can transform into something more aggressive.

Nodal or Extranodal

The majority of lymphomas are nodal lymphomas, meaning they originate in the lymph nodes. It’s possible, however, for lymphomas to arise almost anywhere. When the lymphoma is mainly present in your nodes, it is called nodal disease. Occasionally, most of the lymphoma may be in an organ that is not a part of the lymph system – like the stomach, the skin or the brain. In such a situation, the lymphoma is referred to as extranodal.

Diffuse or Follicular

These are two more terms used by the pathologist. In follicular lymphoma, the cancer cells arrange themselves in spherical clusters called follicles. In diffuse NHL, the cells are spread around without any clustering. Most of the time low-grade NHL looks follicular, and intermediate or high-grade NHL looks diffuse in biopsy slides.

Common or Rare

Non-Hodgkin lymphomas are also considered common or rarer, based on statistics such as the number of new cases per year.

While common forms of NHL may have more established practice standards and treatment protocols, both common and rare lymphomas may be treated using a variety of different approaches, and  treatments are the subject of ongoing investigation in clinical trials.

B-cell lymphomas are more common than T-cell lymphomas. B-cell lymphomas include both DLBCL -- the most common aggressive lymphoma -- and follicular lymphoma, the most common indolent lymphoma.

A variety of different types of NHL are considered rare lymphomas. Examples include Waldenstrom Macroglobulinemia, primary central nervous system lymphoma, and primary thyroid lymphoma, which is almost always NHL.

Updated January 2016, TI.


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