Lymphoma

Hodgkin lymphoma has four classified subtypes and is diagnosed by the confirmed presence of Reed-Sternberg cells (Moffitt Cancer Centre, 2018). Kuppers and Hansmann (2005) described these cells as large, multinucleated cells with strange morphology and a phenotype that does not represent any normal body tissue (Figure 1). This disease originates only from the B lymphocyte cells and its four subtypes include (DeVita et al, 2015):

• classic
• nodular
• lymphocyte depleted
• lymphocyte rich.

Non-Hodgkin lymphoma by contrast has 60 different classified subtypes, including follicular, mantle cell and Burkitt lymphoma (DeVita et al, 2015) (Figure 2). These subtypes can be categorised into two groups: aggressive (60%) and indolent (40%).

A universal principle in predicting the outcome of a cancer is that the earlier a diagnosis is made the better the prognosis. Both these disease profiles conform to this principle and it is at diagnosis that the first main similarities between the two are observed. De Vita et al's (2016) list of presenting symptoms specific to lymphomas are grouped under the umbrella term ‘B symptoms’, with or without the presence of a palpable lump, which are:

• fever
• weight loss
• night sweats.

The presence of B symptoms, as defined by Lymphoma Action (2021a), suggests the likelihood of a worse prognosis in both patient groups compared with those presenting with a palpable lump or pain caused by an internal mass in isolation. Other presenting symptoms of the lymphoma patient are less well defined, and may include indigestion, pain, repeated infection, unexpected bruising or bleeding. Although not specific to lymphoma, if a patient who

Both patient Hodgkin lymphoma and non-Hodgkin lymphoma groups are diagnosed by lymph node biopsy, followed by a further biopsy of bone marrow, to confirm a positive diagnosis. Lymph node biopsy may require a general anaesthetic, depending on the accessibility of the mass (NHS website, 2020). Radiological imaging is used to establish the extent of the disease, most commonly, initially by CT scan, followed by a PET scan.

Staging 

The disease is staged using the Ann Arbor system (Shankland et al, 2012) (Table 2). The patient will be diagnosed with disease stage I-IV (1-4), depending on the number and location of lymph nodes and other structures involved at diagnosis and then designated as A/B, depending on the absence or presence of other symptoms (Table 2).

The key aim of treatment for Hodgkin lymphoma and non-Hodgkin lymphoma is remission, which the National Cancer Institute (2017) defines as an absence of signs or symptoms in a patient with a diagnosed malignancy that cannot be surgically removed.