Non-Hodgkin lymphoma (NHL) is the cancer of mature B, T and natural killer (NK) cells. It is separated from Hodgkin lymphoma (HL) by the biopsy: Reed-Sternberg cells are present in HL, and their absence is what defines this group.
Behind that dividing line sit several different diseases. They differ in three ways: whether they are indolent (built of slowly dividing cells) or aggressive (built of rapidly dividing cells), their cell of origin (the normal cell type the tumour arises from), and their cytogenetic abnormalities (the chromosomal changes the tumour cells carry). Those differences are why two tumours that share a name can behave very differently.
Where to start
Because so many subtypes share one name, the first questions are who gets the disease and what defines each subtype. Those two ideas underlie everything else:
- Non-Hodgkin Lymphoma: Epidemiology and Risk Factors explains how common NHL is compared with Hodgkin lymphoma, who it affects, and the infections and immune-suppressive states that raise the risk of particular subtypes.
- Non-Hodgkin Lymphoma: Molecular Pathogenesis and Markers explains the translocations and mutations that define the subtypes and the markers used to identify them.
The general clinical notes
The clinical course that runs across the whole family, rather than belonging to one subtype, follows the order a patient meets it: how the disease presents, how it is diagnosed, and how it is treated.
- Non-Hodgkin Lymphoma: Clinical Presentation explains how the disease announces itself: lymphadenopathy and the structures an enlarged node compresses, organomegaly, B symptoms and cytopenias.
- Non-Hodgkin Lymphoma: Diagnosis explains why the diagnosis needs intact tissue, and the biopsy, marrow, cerebrospinal fluid and imaging studies that complete it.
- Non-Hodgkin Lymphoma: Treatment and Prognosis explains the prognostic factors that set treatment intensity and the general lines of therapy.
The B-cell lymphomas
The named subtypes in this family all belong to the B-cell group, which is sorted into indolent and aggressive lymphomas. The classification explains that divide, and the three subtype entries show how individual diseases behave within it.
- B-cell Non-Hodgkin Lymphomas: Classification explains the indolent and aggressive groups, why they behave so differently, and which entities belong to each.
- Burkitt Lymphoma explains the most aggressive form, its three clinical presentations, its starry-sky histology and its urgent treatment.
- Diffuse Large B-cell Lymphoma explains the most common form, its subtypes and variants, and its treatment from first line to salvage therapy.
- Follicular Lymphoma explains the second most common form, its follicular pattern, its immunophenotype and the WHO grading that links large-cell count to survival.