Lymphoma* is a general term for a group of cancers that originates in the lymphatic system. Lymphoma results when a lymphocyte (a type of white blood cell) undergoes a malignant change and begins to multiply, eventually crowding out healthy cells and creating tumors which enlarge the lymph nodes or other sites in the body.
Non-Hodgkin lymphoma (NHL) represents a diverse group of cancers, distinguished by the characteristics of the cancer cells associated with each disease type. The designations "indolent" (slow-growing) or "aggressive" (fast-growing) are often applied to types of NHL. Each group is diagnosed and treated differently, and each has prognostic factors that categorize it as more or less favorable.
Hodgkin lymphoma is a specialized form of lymphoma and will represent about 11.4 percent of all lymphomas diagnosed in 2009. Hodgkin lymphoma has characteristics that distinguish it from all other cancers of the lymphatic system including the presence of an abnormal cell called the Reed-Sternberg cell (a large, malignant cell found in Hodgkin lymphoma tissues), higher incidence rates in adolescents and young adults and five-year relative survival rates of more than 86 percent.
*Lymphoma facts and statistics are from the LLS booklet Leukemia, Lymphoma, Myeloma Facts 2009-2010, June 2009.
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New Cases
About 74,490 people living in the United States will be diagnosed with lymphoma in 2009 (8,510 cases of Hodgkin lymphoma and 65,980 cases of NHL). The incidence of Hodgkin lymphoma is consistently lower than that of NHL.
NHL is the seventh most common cancer in males and females in the United States. The age-adjusted incidence of NHL rose by more than 76 percent from 1975 to 2006, an average annual percentage increase of about 2.5 percent.
Age-specific incidence rates of NHL, by gender, are:
- At ages 20-24 years, 2.9 per 100,000 for males and 1.9 per 100,000 for females.
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Incidence by Gender
Among the 74,490 expected new cases of lymphoma in 2009, the diseases will affect 40,630 males and 33,860 females.
Hodgkin lymphoma will account for 8,510 cases (4,640 males and 3,870 females), and 65,980 cases will be NHL (35,990 males and 29,990 females).
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Incidence by Race and Ethnicity
African Americans, from the mid-to-late teens to mid-50s, have higher incidence rates of NHL than whites. However, beginning at age 55, whites generally have considerably higher incidence rates than African Americans.
Among women, Hispanics of all races have the second highest incidence rates after whites. NHL is the fifth most common cancer in Hispanics, comprising nearly 5 percent of all cancers diagnosed in this population.
In children, the highest incidence rates of NHL are in African American children from ages 15 to 19 years (2.06 per 100,000).
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Incidence in Children
Lymphoma (Hodgkin lymphoma, 7.2 percent, and NHL, 6.6 percent) is the third most common cancer in children, following leukemia (27.1 percent) and neoplasms of the brain and other nervous tissue (16.6 percent).
In children younger than 20, lymphoma is most commonly diagnosed in whites (24.3 per million), followed by African-American children (21.9 per million) and Hispanic children (20.6 per million). It is rarest among American Indian and Alaskan native children (12.6 per million).
In children, the highest incidence rates of NHL are in African American children from ages 15 to 19 years (2.06 per 100,000). In 2009, children younger than 15 years will comprise 0.7 percent of all NHL cases expected to be diagnosed.
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Incidence in Adults
The incidence of NHL increases with age. About 2.4 cases per 100,000 persons occur in 20- to 24-year old individuals. By age 60 to 64, the rates increase more than 19 times to nearly 46.5 cases per 100,000 persons. From ages 80 to 84 the rate increases more than 49-fold to 118.1 cases per 100,000 persons.
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Signs and Symptoms
A common early symptom of NHL is painless swelling of one or more lymph nodes, usually in the neck, armpit, groin or in the abdomen. However, enlarged lymph nodes may be the result of inflammation in the body and are not necessarily a sign of cancer.
Other signs and symptoms may include fever, cough, night sweats, abdominal pain, rash, an enlarged spleen, bone pain and unexplained fatigue or weight loss. Some individuals may have no symptoms and a diagnosis of NHL is made as a result of a routine physical examination and testing.
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Possible Causes
The reasons for the development of NHL are not known. Immune suppression may play a role in some cases.
People who have the human immunodeficiency virus (HIV) have a higher risk of developing lymphoma. The bacterium Helicobacter pylori is associated with the development of mucosa-associated lymphoid tissue (MALT) lymphoma in the stomach wall. Exposure to certain viruses, such as the Epstein Barr virus and the human T-lymphotropic virus (HTLV), are also associated with NHL.
Some studies suggest that exposure to certain ingredients in herbicides and pesticides may be linked to NHL, but these specific relationships are still under study. About a dozen uncommon, inherited syndromes can predispose individuals to later development of NHL. These risk factors explain only a small proportion of cases.
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Treatment
Treatment for NHL is generally aimed at destroying as many lymphoma cells as possible and inducing a complete remission. Specific therapies depend on a variety of factors including NHL subtype, stage and extent of disease, and a person's age and overall health. Chemotherapy and radiation therapy are the two principal forms of treatment. Although radiation therapy is not often the sole or principal curative therapy, it is an important additional treatment in some cases.
Treatment options for some NHL subtypes include stem cell transplantation and a watch-and-wait strategy. Immunotherapy is indicated to treat persons with specific types of NHL.
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Survival
The five-year relative survival rate for NHL patients has risen from 31 percent in whites from 1960 to 1963 to nearly 69 percent for persons of all races from 1999 to 2005.**
In 2009 there are approximately 601,184 people in the U.S. living with lymphoma (with active disease or in remission): 148,461 with Hodgkin lymphoma and 452,723 with NHL.
The growing US survivor population has special needs for medical follow-up. Efforts are underway to provide information about survivors' risks for developing multiple primary cancers. This information will help physicians and patients discuss the risks and any established prevention and screening guidelines. NHL represents a broad range of diseases, with varying risk factors and treatments; the relative risk for subsequent cancers depends on the NHL subtype and the treatment.
** Treatment outcomes vary, even among patients with the same diagnosis. Individuals are encouraged to talk to their physicians for more information. In addition, these statistics may underestimate survival to a degree because they may be based on data that does not include outcomes of treatment with the most current options available. Newer agents and drug combinations, progress in stem cell transplantation, better supportive care and studies of new drugs in clinical trials are all contributing to improved outcomes and quality of life for people diagnosed with blood cancers.
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Survival for Children
In children 0 to 19 years of age, the five-year relative survival for NHL is now 84.4 percent. This represents a significant improvement in the rate of recovery. As recently as 30 years ago, the majority of children with NHL did not live five years after diagnosis.
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Deaths An estimated 20,790 persons will die of lymphoma in the United States in 2009 (19,500 from NHL; 1,290 from Hodgkin lymphoma).
NHL is the ninth most common cause of cancer death in males and the sixth in females in the United States. NHL is the eighth most common cause of cancer death in Hispanic females and the seventh most common cause of cancer death in Hispanic males.
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Get More Information
For more information on specific types of NHL, treatment and supportive care, please view, print or order the following free LLS booklets:
The Lymphoma Guide: Information for Patients and Caregivers
Non-Hodgkin Lymphoma
Mantle Cell Lymphoma
Cutaneous T Cell Lymphoma
Waldenström Macroglobulinemia
Blood and Marrow Stem Cell Transplantation
Understanding Drug Therapy and Managing Side Effects
Immunotherapy Facts
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Contact Us
The Leukemia & Lymphoma Society - Home Office
1311 Mamaroneck Ave.
White Plains, NY 10605
Call the Information Resource Center at (800) 955-4572.
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