Lymphoma (Hodgkin's Disease and
Lymphoma (Hodgkin's Disease and Non-Hodgkin's Lymphoma) Overview
Lymphoma (also termed lymphatic cancer) is a type of cancer involving cells of the immune system, called lymphocytes. Just as cancer represents many different diseases, lymphoma represents many different cancers of lymphocytes -- about 35-60 different subtypes, in fact, depending upon which group of experts is categorizing the subtypes.
Lymphoma is a group of cancers that affect the cells that play a role in the immune system and primarily represents cells involved in the lymphatic system of the body.
- The lymphatic system is part of the immune system. It consists of a network of vessels that carry a fluid called lymph, similar to the way that the network of blood vessels carry blood throughout the body. Lymph contains white blood cells called lymphocytes that are also present in blood and tissues. Lymphocytes attack a variety of infectious agents as well as many cells in the precancerous stages of development.
- Lymph nodes are small collections of lymph tissue that occur throughout the body. The lymphatic system involves lymphatic channels that connect thousands of lymph nodes scattered throughout the body. Lymph flows through the lymph nodes, as well as through other lymphatic tissues including the spleen, the tonsils, the bone marrow, and the thymus gland.
- These lymph nodes filter the lymph, which may carry bacteria, viruses, or other microbes. At infection sites, large numbers of these microbial organisms collect in the regional lymph nodes and produce the local swelling and tenderness typical of a localized infection. These enlarged and occasionally confluent collections of lymph nodes (so-called lymphadenopathy) are often referred to as "swollen glands." In some areas of the body (such as the anterior part of the neck), they are often visible when swollen.
Lymphocytes recognize infectious organisms and abnormal cells and destroy them. There are two major subtypes of lymphocytes: B lymphocytes and T lymphocytes, also referred to as B cells and T cells.
- B lymphocytes produce antibodies (proteins that circulate through the blood and lymph and attach to infectious organisms and abnormal cells). Antibodies essentially alert other cells of the immune system to recognize and destroy these intruders (also known as pathogens); the process is known as humoral immunity.
- T cells, when activated, can kill pathogens directly. T cells also play a part in the mechanisms of immune system control to prevent the system from inappropriate overactivity or underactivity.
- After fighting off an invader, some of the B and T lymphocytes "remember" the invader and are prepared to fight it off if it returns.
Cancer occurs when normal cells undergo a transformation whereby they grow and multiply uncontrollably. Lymphoma is a malignant transformation of either B or T cells or their subtypes.
- As the abnormal cells multiply, they may collect in one or more lymph nodes or in other lymph tissues such as the spleen.
- As the cells continue to multiply, they form a mass often referred to as a tumor.
- Tumors often overwhelm surrounding tissues by invading their space, thereby depriving them of the necessary oxygen and nutrients needed to survive and function normally.
- In lymphoma, abnormal lymphocytes travel from one lymph node to the next, and sometimes to remote organs, via the lymphatic system.
- While lymphomas are often confined to lymph nodes and other lymphatic tissue, they can spread to other types of tissue almost anywhere in the body. Lymphoma development outside of lymphatic tissue is called extranodal disease.
What Are the Types of Lymphoma?
Lymphomas fall into one of two major categories: Hodgkin's lymphoma (HL, previously called Hodgkin's disease) and all other lymphomas (non-Hodgkin's lymphomas or NHLs).
- These two types occur in the same places, may be associated with the same symptoms, and often have similar appearance on physical examination (for example, swollen lymph nodes). However, they are readily distinguishable via microscopic examination of a tissue biopsy sample because of their distinct appearance under the microscope and their cell surface markers.
- Hodgkin's disease develops from a specific abnormal B lymphocyte lineage. NHL may derive from either abnormal B or T cells and are distinguished by unique genetic markers.
- There are five subtypes of Hodgkin's disease and about 30 subtypes of non-Hodgkin's lymphoma (not all experts agree on the numbers and names of these NHL subtypes).
- Because there are so many different subtypes of lymphoma, the classification of lymphomas is complicated (it includes both the microscopic appearance as well as genetic and molecular markers).
- Many of the NHL subtypes look similar, but they are functionally quite different and respond to different therapies with different probabilities of cure. For example, the subtype plasmablastic lymphoma is an aggressive cancer that arises in the oral cavity of HIV-infected patients, the follicular subtype is composed of abnormal B lymphocytes, while anaplastic subtype is comprised of abnormal T cells and cutaneous lymphomas localize abnormal T cells in the skin. As previously mentioned, there are over 30 subtypes of NHL with unusual names such as Mantle cell lymphoma, mucosa associated lymphoid tissue (MALT) lymphoma, hepatosplenic lymphoma and hereditary lymphomas. However, the World Health Organization (WHO) suggests there at least 61 types of NHL; subtyping is still a work in progress. However, no matter how many subtypes experts suggest exist, there are too many to discuss in detail in this article. HL subtypes are microscopically distinct, and typing is based upon the microscopic differences as well as extent of disease.
Lymphoma is the most common type of blood cancer in the United States. It is the seventh most common cancer in adults and the third most common in children. Non-Hodgkin's lymphoma is far more common than Hodgkin's lymphoma.
- In the United States, about 72,580 new cases of NHL and 8,500 new cases of HL were expected to be diagnosed in 2016, and the overall incidence is increasing each year.
- About 20,150 deaths due to NHL were expected in 2016as well as 1,120 deaths due to HL, with the survival rate of all but the most advanced cases of HL greater than that of other lymphomas.
- Lymphoma can occur at any age, including childhood. Hodgkin's disease is most common in two age groups: young adults 16-34 years of age and in older people 55 years of age and older. Non-Hodgkin's lymphoma is more likely to occur in older people.
Medically Reviewed by a Doctor on 5/25/2016
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