The Different Types of Non-Hodgkin's Lymphoma

25 Different Diseases and Descriptions

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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 that look quite different from normal cells. They tend to grow fast. Low-grade lymphomas have cells that 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. Nodal and extra nodal refer to the primary site of the disease. A lymphoma can develop in a lymph node and then come to involve other structures later, however. In such a case, it is still considered a nodal lymphoma but is said to have extranodal involvement.

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.

A Word From Verywell

There are many more ways to classify lymphoma, and not all lymphomas fall neatly into the existing categories. Sometimes the lymphoma will be described as a "mature" lymphoma, such as a mature B cell lymphoma or a mature T-cell lymphoma. The word mature in these cases refers to the fact that the cancerous cells are further along in the developmental sequence of the lymphocyte; in other words, the cancer developed from a cell that was more "grown up" or closer to the final stage of what the adult cell would normally be.

There also may be references to where the lymphoma develops. For instance, a T-cell lymphoma can be cutaneous (in the skin). Peripheral T-cell lymphoma consists of a group of rare and usually aggressive NHLs that develop from mature T-cells.

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