Introduction to Lymphoma

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• Hodgkin Lymphoma
• Non-Hodgkin Lymphoma
• Indolent and Aggressive Lymphomas
• General Signs and Symptoms

Lymphoma, or lymphatic cancer, is a broad term encompassing a variety of cancers of the lymphatic system. The two main groups of lymphomas are Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL).

Lymphomas can originate in two different ways

1. Nodal: Originate in the lymph nodes, or other nodal structures like Waldeyer’s ring, tonsils, thymus and spleen.
   1. Also known as lymphatic
2. Extranodal: Originate outside of the lymphatic system, such as the GI tract, lung, skin, etc.
   1. Also known as extralymphatic

In more advanced lymphomas, presentation will include a combination of both nodal structures and extranodal organs.

Hodgkin Lymphoma

Hodgkin lymphoma, named after Thomas Hodgkin, a British physician who identified it in 1832, is a rare cancer. In Hodgkin lymphoma, cells in the lymphatic system become abnormal. This is marked by the presence of the Reed-Sternberg cell. Hodgkin lymphoma is marked by the presence of mature B-cells that have become malignant, are unusually large and carry more than one nucleus. They divide too rapidly and grow without any order or control.

Because lymphatic tissue is present in many parts of the body, Hodgkin lymphoma can start in almost any lymphatic region. Hodgkin lymphoma may occur in a single lymph node, a group of lymph nodes, or in other parts of the lymphatic system such as bone marrow and spleen. This type of cancer tends to spread in a fairly orderly way from one group of lymph nodes to the next group (contiguous spread). For example, Hodgkin lymphoma that arises in the neck lymph nodes spreads first to the nodes above the collarbones, and then to the lymph nodes under the arms and within the chest. Eventually, it can spread to almost any other part of the body.

Hodgkin lymphoma originating in extranodal (extralymphatic) structures is very rare.

There are two major groupings of Hodgkin lymphomas

1. Classic Hodgkin lymphoma
   1. Subtypes of Classic Hodgkin lymphoma include lymphocyte-depleted, lymphocyte-rich, mixed cellularity, and nodular sclerosis
2. Nodular lymphocyte-predominant Hodgkin lymphoma

Non-Hodgkin Lymphoma

In non-Hodgkin lymphoma, cells in the lymphatic system become abnormal. They divide and grow without any order or control, or old cells do not die as cells normally do. Because lymphatic tissue is present in many parts of the body, non-Hodgkin lymphoma can start almost anywhere in the body. Non-Hodgkin lymphoma may occur in a single lymph node, a group of lymph nodes, or in another organ. Without an orderly fashion, this type of cancer can spread to almost any part of the body, including the liver, bone marrow, and spleen (non-contiguous spread).

Non-Hodgkin lymphoma originating in extranodal (extralymphatic) structures is common, although non-Hodgkin lymphomas primarily originate in lymph nodes.

There are three major groupings of non-Hodgkin lymphomas

1. B-cell lymphomas
   1. Diffuse large B-cell
   2. Follicular
   3. Marginal zone
   4. Lymphoplasmacytic lymphoma
   5. Intravascular large B-cell lymphoma
2. T-cell lymphomas
   1. Mycosis Fungoides
   2. Angioimmunoblastic T-cell lymphoma
   3. Peripheral T-cell lymphoma
   4. Subcutaneous panniculitis-like T-cell lymphoma
   5. Hepatosplenic T-cell lymphoma
3. NK-cell lymphomas
   1. Extranodal NK-/T-cell lymphoma

Indolent and Aggressive Lymphomas

Adult non-Hodgkin lymphomas are divided into two prognostic groups based on how fast they grow and where the affected lymph nodes are in the body.

See the Hematopoietic Database or the Hematopoietic Manual (Appendix B) for more information on the types of Lymphomas.

General Signs and Symptoms

Hodgkin Lymphoma

Often there are no symptoms, but about 40% of people will have some vague signs of the disease. If symptoms do occur, they may include:

• Alcohol-induced pain
• Cough, shortness of breath, chest discomfort
• Enlarged spleen
• Persistent, painless swelling of lymph nodes, especially in the neck, underarm, or groin
• Unexplained fevers, tiredness, night sweats, weight loss, and itching

Non-Hodgkin Lymphoma

Often the first sign of NHL is swelling of the lymph nodes, usually in the neck, underarm, or groin. Symptoms can be easily ignored because they are often painless. Only about 20% of those with NHL have systemic symptoms. When they do occur, symptoms include:

• Constant tiredness
• Fever that doesn't go away
• Itching
• Night sweats
• Unexplained weight loss
• Swelling of lymph nodes

Since there are so many forms of NHL involving different organs, signs and symptoms often vary depending on the areas of the body or systems affected.

Advanced Lymphoma

• Enlarged liver
• Enlarged spleen, resulting in abdominal distension

Lymphoma Involving Gastrointestinal Tract

• Abdominal pain
• Gastrointestinal bleeding
• Intestinal obstruction
• Nausea
• Palpable abdominal mass
• Vomiting

Lymphoma Involving Bone Marrow

• Increased bruising
• Petechiae (flat, pinpoint spots under the skin caused by bleeding)
• Recurrent infections
• Symptoms of anemia, such as pallor, difficulty breathing, fatigue, and rapid heartbeat

Lymphoma Involving Urinary Tract

• Anemia
• Fatigue
• Loss of appetite
• Renal failure

Cutaneous T-Cell Lymphoma (CTCL)

• Flat, raised patches on the skin (plaques)
• Itching
• Redness
• Skin tumors of various types (for example, isolated dark patches, raised thick nodules, or oozing ulcerated lesions), depending on the exact type of CTCL and the stage of growth.

Updated: December 2, 2025