Non-Hodgkin's lymphoma cancer

A type of cancer that affects lymphoid cells, Thomas Hodgkin was the first person to publish a description of lymphoma – in 1832. The particular form of lymphoma which he described came to be known originally as Hodgkin's Disease, but later and more commonly Hodgkin's Lymphoma. There are, however, many other forms of lymphoma (in excess of 70) and there several systems have been developed in attempt to classify them. One of the earliest, and for a long time most used, divided lymphoma into Hodgkin's and non-Hodgkin's lymphoma cancer.

Non-Hodgkin’s Lymphoma Cancer – Points of Difference

There is no generally accepted generic list that shows the points of difference between Hodgkin’s and non-Hodgkin’s lymphoma cancer. Indeed, earlier systems of classification which were based on such differentiation have been abandoned due to the lack of commonality between “non-Hodgkin’s” lymphomas – as is briefly discussed below. As such, non-Hodgkin’s is a term which is not widely used by practitioners – it is considered too generic – and is mainly used in medical fiction and by laymen. To put this in easier to understand terms, a parallel could be drawn to a fictional categorisation of citrus fruit into limes and non-limes, this would be of limited use as a descriptive term as there is a vast difference between, say, clementineand lemons.

Non-Hodgkin’s Lymphoma Classification

The system of classification which divides lymphoma into Hodgkin’s and non-Hodgkin’s was first published in 1982, and is generally referred to as “Working Formulation”. Apart from this broader separation, Working Formulation also divides non-Hodgkin  Lymphoma into 16 types, arranged according to grade. The result is as follows:
High Grade

  • Malignant Lymphoma (immunoblastic, large cell)
  • Malignant Lymphom (non-cleaved, small cells - commonly referred to as Burkitt's lymphoma)
  • Malignant Lymphoma (lymphoblastic)

Intermediate Grade

  • Malignant Lymphoma(predominantly large cell, follicular)
  • Malignant Lymphoma (small, cleaved cell, diffuse)
  • Malignant Lymphoma (mixed large and small cell, diffuse
  • Malignant Lymphoma (large cell, diffuse)

Low Grade

  • Malignant Lymphoma (small lymphocytic - also commonly referred to as chronic lymphocytic leukemia)
  • Malignant Lymphoma (predominantly small cleaved cell,follicular
  • Malignant Lymphoma(mixed small cleaved and large cell, follicular)

However, this system has been largely abandoned in favour of newer classifications such as the World Health Organisation’s 2008 system.  The WHO system divides lymphomas based on by cell type according to their resemblance to ‘normal’ cell types; that is, it divides them into T-cells, B-cells and Natural Killer (NK) Cells. While Hodgkin’s lymphoma is used as one of the categories within the system of classification, is generally accepted as a form of mature B-cell lymphoma, and arguably the Hodgkin’s category could thus be eliminated in favour of a widened B-cell category.

Summary

In summary, then, the term non-Hodgkin’s lymphoma cancer – while widely known and oft used by laymen – is of very limited value and has not been in common use amongst practitioners since the mid 1990’s. This is largely due to the Revised European-American Lymphoma classification, or REAL for short, which lay the foundation for the newer World Health Organisation system outlined above.

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