“Lymphoma” is a general term for many malignant diseases that originates in the lymphatic system. Lymphoma results when a lymphocyte (a type of white cell) undergoes a malignant change and multiplies out of control. Eventually, healthy cells are crowded out and malignant lymphocytes amass in the lymph nodes, liver, spleen and/or other sites in the body.
Living with Lymphoma
A total of 601,184 members of the US population are living with, or in remission from, lymphoma.
• There were 148,461 people living with Hodgkin lymphoma (active disease or in remission).
• There were 452,723 people living with non-Hodgkin lymphoma (active disease or in remission). Hodgkin Lymphoma. Hodgkin lymphoma has characteristics that distinguish it from other diseases classified as lymphoma, including the presence of the Reed-Sternberg cell, a large, malignant cell found in Hodgkin lymphoma tissues.
• Hodgkin lymphoma will represent about 11.4 percent of all of types of lymphoma diagnosed in 2009. Non-Hodgkin Lymphoma. Non-Hodgkin lymphoma (NHL) represents a diverse group of diseases that are distinguished by the characteristics of the cancer cells associated with each disease type. The designations “indolent” and “aggressive” are often applied to types of NHL. Each type has prognostic factors that categorize it as either more or less favorable.
• NHL is the ninth most common cause of cancer deaths in males and the sixth in females.
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.
Incidence
Gender. Incidence rates for Hodgkin lymphoma tend to be higher among males than among females. NHL is also more common in males than in females.
• 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, by gender, for NHL are as follows:
• At ages 20 to 24 years, 2.9 per 100,000 males and 1.9 per 100,000 females.
• By ages 60 to 64 years, 54.2 per 100,000 males and 39.5 per 100,000 females.
Race and Ethnicity. From 15 to 19 years, more non-Hispanic white children are diagnosed with Hodgkin lymphoma than children of other races or ethnic groups. From ages 0 to 14 years, American Indian, Alaska Native, Asian and Pacific Islander children have the lowest rates of
Hodgkin lymphoma. In children, the highest incidence rates of NHL are in black children from ages 15 to 19 years (2.06 per 100,000). In children younger than 20
• Lymphoma is most commonly diagnosed in whites (24.3 per 1 million population), followed by black children (21.9 per 1 million population) and Hispanic children (20.6 per 1 million population).
• Lymphoma is least commonly diagnosed among American Indian and Alaska Native children (12.6 per 1 million population).
Blacks, from the mid-to-late teen years to the mid-50s, have higher incidence rates of NHL than whites. However, beginning at age 55 years, whites generally have considerably higher incidence rates of NHL than blacks. NHL is the fifth most common cancer in Hispanics, comprising nearly 5 percent of all types of cancer cases. Among women, Hispanics of all races have the secondhighest incidence rates of NHL after whites.
Children. Lymphoma (Hodgkin lymphoma, 7.2 percent; NHL, 6.6 percent) is the third most common cancer in children.
• In 2009, children younger than 15 years will comprise more than 4.5 percent of all cases of Hodgkin lymphoma expected to be diagnosed and 0.7 percent of all NHL cases expected to be diagnosed. Note that the numbers of cases expected to be diagnosed in children younger than 15 years are similar: 461 for NHL and 386 for Hodgkin lymphoma.
• The incidence of Hodgkin lymphoma among young people under 20 years was 1.1 per 100,000 children in 2006. The incidence in this group decreased significantly between 1975 and 1995. It has remained fairly constant since 1999,decreasing slightly to 0.9 in 2005.
Adolescents and Young Adults. Older children and adolescents are more commonly diagnosed with Hodgkin lymphoma thanyoung children.
• About 2.4 cases of NHL per 100,000 people occur in 20- to 24-year old individuals.
• The lymphoma rates (Hodgkin lymphoma and NHL) for the years from 1997 to 2006, were higher for the 20- to 24–year old age-group (7.4 per 100,000) than for the 15- to 19-year old age-group (4.7 per 100,000).
• There was an overall decrease in the incidence of lymphoma for people between the ages of 15 years and 39 years during the span of years from 1997 to 2006.
Adults. Hodgkin lymphoma incidence rates are lower in adults in their middle years than in young adults. Incidence increases in people between 60 and 84 years.
The incidence of NHL increases with age.
• From ages 60 to 64 years the rate increases more than 19 times to 46.5 cases per 100,000.
• From ages 80 to 84 years the rate increases more than 49-fold to 118.1 cases per 100,000 person.
Signs and Symptoms
A common early sign of Hodgkin lymphoma or NHL is a painless enlargement of one or more lymph nodes. However, enlarged lymph nodes may be the result of inflammation in the body and are not necessarily a sign of cancer. Other Hodgkin lymphoma signs and symptoms may include recurrent high fever, persistent cough and shortness of breath, drenching night sweats of the whole body, itching and weight loss.
Other signs and symptoms of NHL may include bone pain, cough, chest pain, abdominal pain, rash, fever, night sweats, enlarged spleen, unexplained fatigue or weight loss. Some individuals may have no symptoms and a diagnosis of NHL is made as a result of a periodic physical examination and testing.
Possible Causes
The results of certain studies about causes of Hodgkin lymphoma have not been definitive—many studies of links between Hodgkin lymphoma and environmental exposures have been conducted, with unclear results. Although Epstein- Barr Virus (EBV) has been associated with nearly half of Hodgkin lymphoma cases, EBV has not been conclusively established as a cause. Most cases of Hodgkin lymphoma occur in people who do not have identifiable risk factors; most people with identifiable risk factors do not develop Hodgkin lymphoma. The reasons for the development of NHL are not known. Immune suppression plays a role in some cases. People infected with the human immunodeficiency virus (HIV) have a higher risk of developing lymphoma. Studies suggest that specific ingredients in herbicides and pesticides may be linked to NHL. Exposure to certain viruses, such as EBV and human T-lymphotropic virus (HTLV), are also associated with NHL. The bacterium Helicobacter pylori causes ulcers in the stomach and it is associated with the development of mucosa-associated lymphoid tissue (MALT) lymphoma in the stomach wall. About a dozen uncommon, inherited syndromes can predispose individuals to later development of NHL. These risk factors explain only a small proportion of cases.
Treatment
Cure is the goal of treatment for people who have Hodgkin lymphoma. “Involved field” radiation therapy with chemotherapy (sometimes called “combined modality therapy”) is the most common treatment approach for Hodgkin lymphoma. Involved field radiation therapy targets the evident Hodgkin lymphoma cell masses, and chemotherapy is used to kill neighboring lymphoma cells. In general, the goal of treatment for NHL is to destroy as many lymphoma cells as possible and to induce a complete remission. Treatment protocols vary according to the type of disease. Chemotherapy and radiation therapy are the twoprincipal forms of treatment. Although radiation therapy is not often the sole or principal curative therapy, it is an important additional treatment in some cases. Stem cell transplantation and a watch-and-wait strategy are also used to treat some NHL subtypes. Immunotherapy is indicated to treat individuals with specific types of NHL.
Other signs and symptoms of NHL may include bone pain, cough, chest pain, abdominal pain, rash, fever, night sweats, enlarged spleen, unexplained fatigue or weight loss. Some individuals may have no symptoms and a diagnosis of NHL is made as a result of a periodicphysical examination and testing.
Survival
Hodgkin lymphoma is now considered to be one of the most curable forms of cancer.
• The five-year relative survival rate for people with Hodgkin lymphoma has more than doubled from 40 percent in whites from 1960 to 1963, to just over 86 percent for all races from 1999 to 2005.
• Five-year relative survival rates are 91.8 percent for all people who were less than 45 years old at diagnosis. The five-year relative survival rate for people with NHL has risen from 31 percent in whites from 1960 to 1963 to nearly 69 percent for all races from 1999 to 2005.
Race and Ethnicity. Hodgkin lymphoma and NHL have a five-year relative survival rates for all races, blacks and whites, spanning three decades.
Children. Five-year relative survival is 95.5 percent for Hodgkin lymphoma in people younger than 20 years. Five-year relative survival is now 95.4 percent for Hodgkin lymphoma in children aged from 0 to 14 years. In children aged from 0 to 19 years, five-year relative survival for NHL is now 84.4 percent. This represents a significant improvement in the rate of recovery. As recently as the mid-1970s, most children with NHL did not survive five years after they were diagnosed.
Subsequent Primary Cancers. 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. The information will help physicians and patients discuss the risks and anyestablished prevention and screening guidelines. Subsequent cancers among Hodgkin lymphoma survivors have been well-studied because of the high long-term survival rates and the relatively young age at diagnosis for many with thisdisease. NHL represents broad range of diseases, with varying risk factors and treatments; the relative risk for subsequent cancers depends on the NHL subtype and the treatment. The SEER data show that as a group, survivors of NHL have an increased O/E for developing subsequent cancers (O/E = 1.16), but their risk is lower than the risk of Hodgkin lymphoma survivors (O/E = 2.20).
Deaths
In 2009, an estimated 20,790 members of the US population will die from lymphoma (19,500, NHL and 1,290, Hodgkin lymphoma). Overall, death rates have been declining for people with Hodgkin lymphoma for the last 30 years.
Gender. In men, death rates for Hodgkin lymphoma have been declining by 3 percent per year since 1997 and in women death rates for Hodgkin lymphoma have been declining 3.7 percent per year since 1998. NHL is the ninth most common cause of cancer death in males and the sixth most common cause of cancer death in females in the United States.
Race and Ethnicity. 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.
This information has been provided by the Leukemia and Lymphoma Society.
