There are five identified subtypes of Hodgkin’s
lymphoma:
- lymphocyte-predominant (also called nodular
lymphocyte predominance) - nodular sclerosis
- lymphocyte-rich (also called classical)
- mixed cellularity
- lymphocyte-depleted
Treatment regimens and prognoses differ for
each subtype. Nodular sclerosis Hodgkin’s lym-
phoma is the most common subtype, accounting
for about two thirds of diagnoses, and tends to be
moderately progressive. Lymphocyte-predominant
Hodgkin’s lymphoma tends to progress slowly;
lymphocyte-depleted Hodgkin’s lymphoma tends
to be quite aggressive with rapid progression and
frequent metastasis to organs outside the lymphatic
system. In general, the higher the number of Reed-
Sternberg cells, the more aggressive the cancer.
Non-Hodgkin’s Lymphoma
The non-Hodgkin’s lymphomas account for about
85 percent of diagnosed lymphoma and most
commonly affect people over age 60, though can
develop at any age. There are several dozen sub-
types of non-Hodgkin’s lymphoma, currently clas-
sified according to the type of tumor (also called a
neoplasm) and its characteristics. Doctors further
classify non-Hodgkin’s lymphomas as to whether
they are aggressive (rapidly growing)—high or
intermediate grade—or indolent (slow growing)—
low grade.
NON-HODGKIN’S LYMPHOMA SUBTYPESAIDS-related anaplastic large cell
angioimmunoblastic blastic natural killer (NK)
BONE Burkitt’s
CENTRAL NERVOUS SYSTEM(CNS) cutaneous T-cell
diffuse large cell diffuse small noncleaved cell
eyelid follicular
immunoblastic lymphoblastic
lymphoplasmacytic mantle cell
marginal zone MUCOSA-ASSOCIATED LYMPHOID
mycosis fungoides TISSUE(MALT)
nodal marginal zone nasal NK/T
small lymphocytic ocular (EYE)
splenic marginal zone
Symptoms and Diagnostic Path
Many people do not have symptoms of lymphoma
at the time of diagnosis. Rather, the doctor detects
characteristic abnormalities in diagnostic blood
tests conducted for other reasons, often as part of
a ROUTINE MEDICAL EXAMINATION. When symptoms
are present they can be vague and generalized,
typical of common viral infections though they
tend to persist or recur rather than resolving. Such
symptoms may include- painless swellings in the lymph nodes, most
noticeable in the axillae (underarms), neck, or
groin (LYMPHADENOPATHY) - unexplained, frequent fevers
- unintended or unexplained weight loss
- profuse sweating at night
- tiredness, fatigue, or lethargy
- unexplained, generalized itching (PRURITUS)
The diagnostic path begins with the doctor’s
physical examination, which may reveal
SPLENOMEGALY(enlarged spleen) or detect enlarged
lymph nodes beneath the collarbone or in the
abdomen. Diagnostic blood tests and bone marrow
biopsy demonstrate the proliferation of lympho-
cytes. Other diagnostic procedures the oncologist
may conduct include tissue biopsy of swellings,
COMPUTED TOMOGRAPHY(CT) SCANor MAGNETIC RESO-
NANCE IMAGING (MRI) to detect the presence of
tumors deep within the body, POSITRON EMISSION
TOMOGRAPHY(PET) SCANto examine the lymphatic
network, and specialized immunocytology tests to
determine the subtype of lymphoma. Based on
the diagnostic findings the oncologist assesses the
status of the lymphoma, assigning it a stage classi-
fication. Oncologists further designate a grade for
non-Hodgkin’s lymphoma that characterizes the
level of aggressiveness. These assessments deter-
mine the appropriate treatment regimens and help
valuate the prognosis (likelihood of REMISSIONand
survival).
Treatment Options and Outlook
Treatment regimens depend on the subtype, stage,
and for non-Hodgkin’s lymphomas the grade of
the cancer as well as the person’s age and overall
health status. The typical treatment approaches,
often administered in combinations, includelymphoma 153