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Lymphoma is a type of blood cancer in which white blood cells called lymphocytes develop abnormally and grow out of control. Lymphomas are cancers of the lymphatic system, which is part of the circulatory and immune systems. The lymphatic system helps remove bacteria, extra fluid, and waste from damaged or old cells. The lymphatic system includes the bone marrow, spleen, lymph nodes, thymus, and lymph channels that move lymph fluid throughout the body. Lymphoma is related to other blood cancers such as leukemia, myeloma, and myeloproliferative neoplasms.
The two main types of lymphoma are Hodgkin lymphoma (also called Hodgkin disease) and non-Hodgkin lymphoma (NHL). Both Hodgkin and non-Hodgkin lymphoma are blood cancers that originate in the lymphatic system. They share many of the same symptoms and treatments and are often diagnosed using similar methods. However, they have many distinguishing features. Below are a few differences between Hodgkin and non-Hodgkin lymphoma.
Non-Hodgkin lymphoma occurs most frequently in older adults. NHL diagnoses are most often made in people ages 65 to 74. NHL is relatively uncommon in children and young adults.
Hodgkin lymphoma is most common among teens and young adults ages 15 through 39 and adults ages 75 and above. Most cases are diagnosed between ages 20 and 34.
In the United States, non-Hodgkin lymphoma is more common than Hodgkin lymphoma. IThe American Cancer Society estimated that in 2024, 80,620 people would be diagnosed with NHL compared to 8,570 people diagnosed with Hodgkin lymphoma.
Hodgkin and non-Hodgkin lymphoma differ based on the type of lymphocyte that turns cancerous. Most NHL originates in B lymphocytes (B cells), but it can also originate in T lymphocytes (T cells). Both B cells and T cells play important roles in the immune system.
Hodgkin cells and Reed-Sternberg cells will likely be present with Hodgkin lymphoma but not NHL. Reed-Sternberg cells are large, abnormal B lymphocytes with a double nucleus. In microscope images, the cells appear to have two round eyes. Hodgkin cells are smaller than Reed-Sternberg cells but larger than normal B lymphocytes.
Hodgkin lymphoma usually spreads in sequence from cancerous lymph nodes to nearby lymph nodes. Non-Hodgkin lymphoma spreads more unpredictably to lymph nodes across the body.
Hodgkin lymphoma is considered one of the most treatable types of cancer if caught in early stages. The five-year relative survival rate for Hodgkin lymphoma is almost 89 percent, according to the National Cancer Institute. For NHL, the five-year relative survival rate is about 74 percent. These survival rates are based on data from 2014 to 2020. A person’s prognosis (outlook) depends greatly on the individual and their specific type of lymphoma.
Hodgkin lymphoma can be divided into two primary subtypes — classical Hodgkin lymphoma and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). Approximately 95 percent of people with Hodgkin lymphoma have the classical form. Hodgkin lymphoma can be treated with chemotherapy, radiation, targeted therapies, immunotherapy, and — in some cases — stem cell transplant. Your treatment plan will be influenced by your type of Hodgkin lymphoma, stage of disease, and factors such as your age and overall health.
Classical Hodgkin lymphoma is defined by the presence of Reed-Sternberg cells and Hodgkin cells. These cells are often identified as part of a lymph node biopsy. There are four subtypes of classical Hodgkin lymphoma.
Nodular sclerosis classical Hodgkin lymphoma (NSCHL) is the most common classical type, accounting for 70 percent of cases. This highly treatable form of Hodgkin lymphoma is the most common type diagnosed in young adults. About 40 percent of people with NSCHL experience fever, night sweats, and weight loss — known collectively as B symptoms. NSCHL often affects lymph nodes in the chest.
Mixed cellularity classical Hodgkin lymphoma (MCCHL) is the second most common form of classical Hodgkin lymphoma, accounting for 20 percent to 25 percent of cases. MCCHL most frequently occurs in young children, older adults, people with HIV, and males, according to the Leukemia & Lymphoma Society. People with MCCHL often experience B symptoms. MCCHL often originates in the upper body.
Lymphocyte-rich Hodgkin lymphoma affects about 5 percent of people with classical Hodgkin lymphoma. It’s usually diagnosed early and generally affects only a few lymph nodes in the upper part of the body. It behaves similarly to NHL and is often treated with similar methods.
Lymphocyte-depleted Hodgkin lymphoma is the rarest classical form and is most often seen in people with HIV. In many cases, lymphocyte-depleted Hodgkin lymphoma has already progressed by the time it’s diagnosed. It usually affects lymph nodes in the abdomen and is also frequently found in the bone marrow, liver, and spleen.
NLPHL makes up about 5 percent of Hodgkin lymphoma cases. NLPHL is an indolent (slow-progressing) and generally highly curable form of lymphoma. In about 7 percent of cases, it transforms into an aggressive NHL.
NLPHL is usually found in the neck, armpits, and groin. NLPHL cancer cells are distinguished from classical Hodgkin lymphoma cells by their appearance and by molecules called antigens that function as cell markers.
The World Health Organization estimates that there are 60 subtypes of non-Hodgkin lymphoma. NHL is usually grouped by the type of lymphocyte, where the cancer originates, the way lymph node tissue looks under a microscope, and the aggressiveness of the cancer. The broad categories are B-cell lymphoma or T-cell lymphoma and aggressive or indolent lymphoma.
B-cell lymphoma accounts for 85 percent to 90 percent of non-Hodgkin lymphoma cases. B-cell lymphoma begins in B lymphocytes, white blood cells that produce proteins called antibodies, or immunoglobulins. Antibodies attach to viruses, bacteria, or other pathogens (potential causes of disease), neutralizing them or signaling other cells in the immune system to attack them.
There are several types of aggressive and indolent B-cell non-Hodgkin lymphoma. Below, we describe some of the more common aggressive types, which can progress quickly and often require timely treatment.
Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphoma in the world. It most often affects older adults, though it accounts for 15 percent to 20 percent of NHL cases in children, per the American Cancer Society. Rapidly swelling lymph nodes in the neck, armpits, and groin, combined with B symptoms, are early symptoms of DLBCL.
Diffuse large B-cell lymphoma gets its name from how its cells look under a microscope — abnormal B cells that have become cancerous are diffuse, or spread out, rather than grouped closely together. Most DLBCL cases are a nonspecific type classified as “diffuse large B-cell lymphoma not otherwise specified,” or DLBCL-NOS.
Although DLBCL is an aggressive form of NHL, it’s highly treatable. Many people achieve complete remission, meaning there’s no evidence of cancer after treatment. An individual’s prognosis will depend on the stage of their cancer and specific health factors.
Stage 1 or 2 diffuse large B-cell lymphoma is often treated with chemotherapy or chemoimmunotherapy. Chemotherapy may be followed by radiation therapy. Stage 3 or 4 DLBCL is usually treated with chemoimmunotherapy, but often with more cycles than would be used for earlier stages. Radiation may be used under specific circumstances.
Mantle cell lymphoma accounts for 3 percent to 5 percent of people with B-cell lymphoma in the U.S, with most cases occurring in older adults. Symptoms include B symptoms, nausea and vomiting, abdominal pain, and fatigue. Diagnosis usually begins with a lymph node biopsy, but additional tests will likely be necessary to identify mantle cell lymphoma. A hematopathologist (specialist in diagnosing blood disorders) will be on the lookout for a specific genetic abnormality found in about 85 percent of mantle cell lymphoma cases, as well as certain proteins.
Mantle cell lymphoma is caused by cancerous B cells in the outer part of the lymph node, called the mantle zone. Mantle cell lymphoma cells can spread throughout the body to other lymph nodes, bone marrow, the liver, and the intestines. Rarely, mantle cell lymphoma can affect the brain and lungs.
Burkitt lymphoma accounts for about 40 percent of NHL cases in children in the U.S., but it’s also more common among older people in the U.S. and presents differently for them. Burkitt lymphoma was first identified in Africa, where it accounts for almost all cases of childhood non-Hodgkin lymphoma. Among children in Africa, Burkitt lymphoma usually develops in the jaw and facial bones. In other parts of the world, this type usually develops in the abdomen.
Burkitt’s lymphoma grows very quickly and requires aggressive multidrug chemotherapy. Cancer recurrence is more likely when lymphoma cells have spread to the brain and spinal cord.
Indolent B-cell lymphoma is a slow-growing cancer that originates in the B cells. Doctors may not recommend immediate treatment for people with indolent lymphoma. Instead, people with indolent lymphoma may undergo periodic monitoring to track their disease. This approach is referred to as “watchful waiting,” “watch and wait,” and “active surveillance.” In these cases, cancer is treated more like a chronic illness than an aggressive disease.
Follicular lymphoma, the most common indolent non-Hodgkin lymphoma diagnosed in the United States, primarily affects older adults. Swollen lymph nodes in the neck, underarms, and groin can be early signs of follicular lymphoma. This slow-growing form of NHL is sometimes monitored with the watchful waiting approach. In some cases, follicular lymphoma can develop into a more aggressive form of lymphoma.
Marginal zone lymphoma begins in B cells in the marginal zone of the lymph nodes and accounts for about 9 percent of B-cell NHL cases. Marginal zone lymphoma subtypes are distinguished by where the lymphoma originates. The most common subtype is mucosa-associated lymphoid tissue (MALT) lymphoma, which most frequently begins in the stomach.
Many people diagnosed with MALT lymphoma have a history of autoimmune disease or infection in the organ where the cancer started. MALT lymphoma can be treated with antibiotics, radiation therapy, targeted therapies, chemotherapy, and surgery.
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are differentiated by where the most cancer cells are found but are otherwise essentially the same condition. The condition is considered SLL when cancer cells are primarily in the lymph nodes, as opposed to the blood and bone marrow. People with CLL/SLL may have no symptoms, and their cancer may be found as a result of routine blood tests. In other cases, people may experience B symptoms, bruising, or infection.
People with low-risk CLL/SLL may not begin treatment right away and instead undergo periodic monitoring as part of a watchful waiting approach. In cases where treatment is necessary, targeted therapies that attack cancer cells or chemotherapy may be used.
Also referred to as lymphoplasmacytic lymphoma, Waldenström’s macroglobulinemia (WM) is a rare type of NHL. These cancer cells are primarily found in the bone marrow. High blood levels of immune proteins are a sign of WM. Elevated levels of immunoglobulins can cause hyperviscosity (thickened blood). The resulting symptoms include nosebleeds, fatigue, headaches, dizziness, and pain. WM is usually diagnosed through blood tests and a bone marrow biopsy.
In some cases, people with Waldenström’s macroglobulinemia undergo plasmapheresis, a procedure that helps reduce the symptoms of hyperviscosity by filtering out excess immunoglobulins. Plasmapheresis doesn’t treat the cancer itself. In cases where watchful waiting is no longer appropriate, WM can be treated with targeted therapy and chemotherapy.
Lymphoma sometimes develops from lymphocytes in the skin. B-cell cutaneous lymphoma is a rare type of skin lymphoma that is most often indolent. Most skin lymphomas are T-cell lymphomas.
T-cell lymphoma is the least common type of non-Hodgkin lymphoma. T-cell lymphoma is caused by changes to T lymphocytes, or T cells. Various types of T cells play key roles in the body’s immune response. Some T cells directly attack infected cells, while others help regulate the immune system. There are multiple types of aggressive and indolent T-cell lymphoma.
Below are explanations of some of the more common types of aggressive T-cell lymphoma. These types grow fast and often require treatment soon after diagnosis.
Peripheral T-cell lymphoma (PTCL) accounts for just over half of T-cell non-Hodgkin lymphoma cases in the U.S. Peripheral T-cell lymphoma gets its name from the location of the cancer cells, which originate outside of (or peripheral to) the bone marrow. In PTCL, cancer cells develop in the lymph nodes, spleen, skin, or gastrointestinal tract.
Several subtypes fall under the PTCL umbrella, including:
Certain subtypes of PTCL are more common in certain parts of the world. For example, PTCL-NOS occurs more frequently in North America, whereas angioimmunoblastic T-cell lymphoma occurs more often in Europe.
Peripheral T-cell lymphomas may be treated with high-dose chemotherapy and sometimes with chemotherapy followed by stem cell transplant. Clinical trials may also be an option for people with PTCL.
Lymphoblastic lymphoma is also referred to as lymphoblastic leukemia/lymphoma. Although some cases are B-cell lymphomas, the vast majority are T-cell lymphomas. Lymphoblastic lymphoma often occurs in children and young adults, accounting for about 20 percent of NHL cases in children in the United States.
Lymphoblastic lymphoma often begins in the thymus, an organ located between the lungs that is only active until puberty. Breathing problems caused by tumor growth can be a symptom of lymphoblastic lymphoma. Other symptoms include B symptoms, bruising, and fever. Although this type is an aggressive cancer, it’s treatable with chemotherapy.
Indolent T-cell lymphoma is usually slow-growing but can be aggressive in certain cases.
Cutaneous T-cell lymphoma (CTCL) occurs when cancerous T cells accumulate in the skin. CTCL is rare — it accounts for about 4 percent of all NHL cases. Early symptoms, like discoloration, itchiness, and scaly patches, can mimic other skin conditions. Skin tumors may develop in advanced stages, and some instances of CTCL can be aggressive.
Cutaneous T-cell lymphoma is twice as prevalent in men than women, according to the Lymphoma Research Foundation. People are usually diagnosed over age 50. The two most common types, mycosis fungoides and Sézary syndrome, are incurable but treatable. Subcutaneous panniculitis-like T-cell lymphoma is a rare type of CTCL, occurring more often in females but accounting for less than 1 percent of NHL diagnoses, according to StatPearls. Treatment options may include topical treatments, phototherapy, targeted therapies, and chemotherapy.
Staging is important for determining a treatment plan. Each type of Hodgkin and non-Hodgkin lymphoma can be assigned a stage from 1 to 4, depending on how advanced it is. Stage 1 is the least advanced, involving just one lymph node region or lymphoid organ, such as a tonsil. Stage 4 is the most advanced. In stage 4, lymphoma cells are in the lymph nodes and have spread to organs outside the lymphatic system. The letters A and B, describing the presence or absence of lymphoma-related symptoms, can also be added after the stage number to further describe Hodgkin and non-Hodgkin lymphoma.
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What Is Mental Lymphoma??
I’m Wondering Why My Oncologist Or Hematologist Are Unable To Stage Or Sub-title My Lymphoma. They Just Say It’s B-cell NHL.
Non Gastric MALT Lymphoma
Leonora Valdez Rojas, M.D.
received her medical degree from the Autonomous University of Guadalajara before pursuing a fellowship in internal medicine and subsequently in medical oncology at the National Cancer Institute.
Learn more about her here.
Alison Channon
has nearly a decade of experience writing about chronic health conditions, mental health, and women's health.
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