Differences Between Lymphomas

Lymphoma is not just one type of cancer. There are more than 70 types. Learning the basics can help you better understand your diagnosis, treatment options, and the questions to ask your healthcare team.

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Lymphoma starts in the immune system

Lymphoma begins in lymphocytes, a type of white blood cell that helps your body fight infection. These cells are part of the lymphatic system, which includes your lymph nodes, spleen, bone marrow, and other tissues throughout your body.

Even though all lymphomas start in lymphocytes, they do not all act the same way. Some grow slowly. Others grow quickly. Some begin in B cells, while others begin in T cells or natural killer (NK) cells. These differences help doctors choose the treatment that is most likely to work.

Hodgkin lymphoma and non-Hodgkin lymphoma

The first step in diagnosing lymphoma is finding out whether it is Hodgkin lymphoma or non-Hodgkin lymphoma (NHL).

Hodgkin lymphoma makes up about 10% of lymphoma cases. Non-Hodgkin lymphoma accounts for about 90%.

Doctors tell the difference by looking at the lymphoma under a microscope. Hodgkin lymphoma has large cells called Reed-Sternberg cells. These cells are not found in non-Hodgkin lymphoma.

Hodgkin lymphoma is also one of the most treatable cancers. Many people are cured with today's treatments, especially when it is found early.

Not all non-Hodgkin lymphomas are the same

Non-Hodgkin lymphoma is not one condition. It is a large group of cancers with more than 70 subtypes. Each subtype has its own features and treatment options.

Doctors often group non-Hodgkin lymphoma by the type of immune cell where it starts.

• B-cell lymphoma begins in B lymphocytes. This is the most common type.

• T-cell or NK-cell lymphoma begins in T lymphocytes or natural killer cells. These types are less common.

Knowing whether your lymphoma is a B-cell, T-cell, or NK-cell lymphoma helps your care team choose the best treatment for you.

Some lymphomas grow slowly, while others grow quickly

Doctors also look at how fast the lymphoma is growing.

Indolent lymphoma grows slowly. Some people have few or no symptoms for many years. In some cases, treatment is not needed right away. Instead, doctors watch the lymphoma closely. This approach is called active surveillance, or watch-and-wait.

Aggressive lymphoma grows much faster. It usually needs treatment soon after diagnosis. Even so, many aggressive lymphomas respond well to treatment. Many people can be cured.

Some slow-growing lymphomas can become fast-growing over time. This is called transformation. Regular follow-up visits help doctors watch for these changes.

Common lymphoma subtypes

Some lymphoma subtypes are more common than others.

Large B-cell lymphoma (LBCL) is the most common type of non-Hodgkin lymphoma. It grows quickly and often needs treatment soon after diagnosis. Even though it is aggressive, many people respond well to treatment. 

Follicular lymphoma is the second most common subtype. It usually grows slowly. Many people live with it for years. In some cases, it can change into large B-cell lymphoma.

Mantle cell lymphoma (MCL) is less common. It can behave differently from person to person. Some people need treatment soon after diagnosis. Others may be safely monitored before treatment begins.

Other subtypes include marginal zone lymphoma (MZL), Burkitt lymphoma, peripheral T-cell lymphoma (PTCL), and many rare forms of lymphoma. Each subtype has its own treatment approach. Knowing your exact subtype helps your healthcare team recommend the best care. 

Why an accurate lymphoma diagnosis matters 

Because there are many lymphoma subtypes, an accurate diagnosis is very important.

Doctors usually diagnose lymphoma with a lymph node biopsy, which removes a small piece of tissue for testing. An excisional biopsy removes an entire lymph node. This often gives doctors the most complete information. Other laboratory tests help confirm the exact lymphoma subtype. These tests help your healthcare team learn:

• Your exact lymphoma subtype

• Whether it is a B-cell or T-cell lymphoma

• Whether it is indolent or aggressive

• Which treatments are most likely to help

New lymphoma treatments continue to expand options

Lymphoma treatment has changed a great deal over the past several years.

Depending on the lymphoma subtype, treatment may include chemotherapy, radiation therapy, stem cell transplant, targeted therapies like BTK Inhibitors, antibody-drug conjugates, monoclonal antibodies, bispecific antibodies, CAR T-cell therapy, or innovative treatments in clinical trials. Ask your lymphoma specialist which option is right for you. 

These advances continue to expand treatment options for people living with many different types of lymphoma. 

Summary

Lymphoma is a large family of cancers, not a single condition. Knowing whether your lymphoma is Hodgkin or non-Hodgkin, B-cell or T-cell, and slow-growing or fast-growing can help you better understand your diagnosis and treatment. An accurate diagnosis gives your healthcare team the information needed to recommend the care that best fits your specific type of lymphoma.