Lymphomas are blood cancers that develop in lymphocytes, a type of white blood cell that helps fight infections. Lymphocytes travel through the lymphatic system, including lymph nodes and vessels, and are also found in the bloodstream, bone marrow, and organs such as the spleen.

Approximately 880,000 people in the United States were estimated to be either living with lymphoma or in remission in 2023.

There are two major types of lymphoma.

1. Hodgkin Lymphoma (HL)

Named after Dr. Thomas Hodgkin, who first described the disease in 1832, Hodgkin lymphoma, also called Hodgkin’s lymphoma or Hodgkin disease, accounts for only 10 percent of lymphoma cases.

Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells, which are large, abnormal lymphocytes. If these cells are absent, the lymphoma is identified as non-Hodgkin’s.

2. Non-Hodgkin Lymphoma (NHL)

Non-Hodgkin lymphoma is the most prevalent type of lymphoma, accounting for approximately 90 percent of all cases. Each year, more than 70,000 Americans are diagnosed with NHL, and approximately 20,000 people die from the disease. NHL is categorized into three major types:

• B-Cell Lymphomas: The most common type of NHL, these cancers start in B cells, a type of white blood cell that produces antibodies to fight infections. When B cells become abnormal and cancerous, they grow out of control and stop functioning properly, making it harder for the body to fight infections. B-cell lymphomas affect around 80 percent of NHL patients.
• T-Cell Lymphomas: These start in T cells, which are another type of white blood cell that helps regulate the immune response and directly attack infected or abnormal cells.
• Natural Killer (NK) Cell Lymphomas: A rare form of NHL, these cancers arise from natural killer (NK) cells, a specialized type of white blood cell that seeks out and destroys virus-infected and cancerous cells.

Hodgkin Lymphoma

The signs and symptoms of HL can vary depending on the cancer’s location in the body.

HL often affects young, otherwise healthy people and may not cause symptoms right away. Swollen, painless lymph nodes, especially in the neck, are a typical early sign.

Common symptoms: 

• Night sweats
• Unexplained weight loss
• Itchy skin
• Fever
• Persistent fatigue
• Loss of appetite
• Abdominal pain, swelling, or fullness due to an enlarged spleen
• Persistent cough or shortness of breath due to swollen lymph nodes in the chest

Symptoms caused by tumor growth:

• Jaundice: Yellowing of the skin and eyes due to bile duct obstruction
• Localized edema (lymphedema): Swelling in certain areas of the body caused by a blockage in the lymphatic system
• Severe dyspnea and wheezing: Caused by pressure on the windpipe from swollen lymph nodes
• Nerve compression: Enlarged lymph nodes pressing on nerves, which may cause pain, muscle weakness, numbness, hoarseness due to vocal cord nerve compression, or eyelid drooping (Horner syndrome)

Non-Hodgkin Lymphoma 

Symptoms of NHL vary by type. Slow-growing or indolent NHL develops gradually, often causing painless lymph node swelling, while patients may otherwise appear healthy. It often causes lymph nodes to swell and shrink repeatedly over many years. In contrast, fast-growing or aggressive NHL grows and spreads rapidly and typically presents with more pronounced symptoms that may become fatal within weeks if left untreated.

Common symptoms: 

• A rash or itchy skin on the chest, abdomen, or back
• Unexplained fatigue
• A persistent cough or breathlessness
• Abdominal pain or swelling, often leading to loss of appetite, constipation, nausea, and vomiting
• Headaches, trouble concentrating, personality changes, or seizures due to lymphoma affecting the brain
• Unexplained and persistent fever
• Drenching night sweats
• Unexplained weight loss of more than 10 percent of body weight over 6 months

Lymphoma occurs when immature lymphocytes multiply rapidly due to a genetic mutation or biological changes, leading to tumors in the lymph nodes, spleen, thymus, and other organs. Lymphomas can arise from either B lymphocytes (B cells), which produce antibodies, or T lymphocytes (T cells), which regulate the immune system and combat viral infections.

HL occurs when certain immune cells called B cells experience clonal transformation and multiply abnormally, creating RS cells. These cancerous cells crowd out normal white blood cells, weakening the immune system’s ability to fight infections. RS cells typically form masses in the lymph nodes but can also accumulate in other parts of the body with lymphoid tissue.

NHL starts in B cells, T cells, or NK cells because of changes in their DNA, such as chromosome rearrangements or mutations.

The exact cause of lymphoma is unknown, but many factors contribute to the risk.

Hodgkin Lymphoma 

• Sex: HL is slightly more common in males, with a male-to-female ratio of approximately 1.2 to 1. In children, 85 percent of cases occur in boys.
• Age: HL primarily affects people between the ages of 15 to 35 and 50 to 70.
• Race: Black and Asian people have a higher risk of HL.
• Autoimmune conditions: People with certain autoimmune diseases are at an increased risk of HL.
• Inherited immunodeficiency syndromes: People with genetic immune system disorders such as ataxia-telangiectasia, Klinefelter syndrome, Chédiak-Higashi syndrome, and Wiskott-Aldrich syndrome have a higher likelihood of developing HL.
• Genetics: Same-gender siblings who have a first-degree relative with HL are at a higher risk of developing the disease themselves.
• Environmental factors: Long-term infection with the Epstein-Barr virus (EBV), which causes mononucleosis also known as “mono” or “the kissing disease,” can increase the risk of HL. Getting EBV in early childhood or having mono as a teenager raises this risk. In around 25 percent of Americans with classic HL, traces of the virus are found in cancer cells. Additionally, people with a weakened immune system, including those infected with human immunodeficiency virus (HIV), those taking immunosuppressive medications, and those with autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, ulcerative colitis, sarcoidosis, and immune thrombocytopenic purpura have a higher risk of developing HL. The disease can still develop among people who don’t possess any of the above risk factors.

Non-Hodgkin Lymphoma

• Age: NHL is most common in people aged 65 to 74, with a median age of 67 years at diagnosis. The risk of developing NHL increases with age.
• Sex: Men have a 1 in 44 chance of developing NHL in their lifetime, while a woman’s risk is slightly lower at 1 in 54.
• Race: NHL is more common in Caucasians than in other racial groups.
• Location: NHL is more prevalent in developed countries, with the United States and Europe experiencing some of the highest rates.
• Occupational Exposure: Certain professions have been associated with an increased NHL risk due to exposure to industrial chemicals. These include farmers, hairdressers, welders, and workers in the rubber, printing, and forestry industries.
• Weight and Lifestyle Factors: Obesity is a possible risk factor for NHL, although the exact relationship is still being studied.
• Genetics and Family History: Changes in certain genes may increase the risk of developing a common type of NHL called diffuse large B-cell lymphoma. Additionally, people with a close relative who has had HL or NHL may be at a higher risk.
• Infections: Several viruses and bacteria have been linked to specific types of NHL, often by triggering chronic inflammation or altering the immune system’s function.

EBV: A common virus that causes mono and has been linked to Burkitt lymphoma, a fast-growing cancer that affects B cells Human T-cell leukemia virus Type 1: A rare virus that can infect T cells and lead to adult T-cell lymphoma, an aggressive type of NHL Hepatitis C virus: A liver infection that can cause long-term immune system changes, leading to clonal B-cell expansions—uncontrolled growth of certain B cells—associated with splenic marginal zone lymphoma and diffuse large B-cell lymphoma Human herpesvirus 8: A virus found in people with weakened immune systems that has been linked to primary effusion lymphoma, a rare and aggressive B-cell NHL that develops in body cavities like the chest or abdomen Helicobacter pylori: A type of bacteria that infects the stomach lining, causing ulcers and chronic inflammation, which can increase the risk of gastric mucosa-associated lymphoid tissue (MALT) lymphoma Campylobacter jejuni: A bacteria that infects the digestive system and has been linked to MALT lymphoma, particularly in the intestines

• Medications and Chemical Exposure: Certain drugs and chemical products, such as phenytoin, digoxin, and TNF antagonists, have been associated with an increased NHL risk. Some evidence suggests that clozapine and immunosuppressive drugs like methotrexate, azathioprine, and cyclosporine may also contribute to this risk. Exposure to organic chemicals such as benzene, pesticides like lindane, phenoxy herbicides (synthetic weedkillers), wood preservatives, dust, hair dye, and solvents has also been linked to NHL risk.
• Chronic Inflammation and Immune System Challenges: Long-term chronic inflammation and prolonged lymph node growth have been identified as potential contributing factors for NHL.
• Breast Implants: Women with breast implants, both silicone and saline, can develop a rare type of NHL called breast implant-associated anaplastic large cell lymphoma, which begins in the scar tissue around the implant.
• Immune System Deficiencies: Certain congenital immunodeficiency conditions, such as acquired immunodeficiency syndrome may result in primary central nervous system lymphoma, a type of NHL. Additionally, induced immunodeficiency from immunosuppressant medications increases the likelihood of developing NHL.
• Autoimmune Disorders: People with autoimmune diseases also face an elevated risk of developing NHL.

Hodgkin Lymphoma 

Currently, there are no widely recommended screening tests for Hodgkin lymphoma. The best way to detect HL early is to watch for symptoms, with swollen lymph nodes being the most common sign.

When HL is suspected, your doctor will conduct a physical exam to check for swollen lymph nodes. To confirm the diagnosis, a biopsy is needed. The most thorough method is an excisional biopsy, where part of a lymph node is removed through a small incision. For surface lymph nodes, a core needle biopsy guided by ultrasound or computed tomography (CT) may be used. Deeper lymph nodes in the abdomen or chest may require surgery to obtain a tissue sample. Doctors examine the sample for Reed-Sternberg cells and use immunophenotyping, a lab test that detects specific proteins to determine the lymphoma type.

If HL is confirmed, further testing helps determine the cancer’s stage. This includes imaging tests like chest X-rays, CT scans, positron emission tomography-computed tomography scans, and magnetic resonance imaging. Blood tests measure things like blood cell counts, metabolic factors, and inflammation levels and check for HIV and hepatitis. Bone marrow tests may be performed to see if lymphoma cells have spread there.

Non-Hodgkin Lymphoma

Like Hodgkin lymphoma, there are no widely recommended screening tests for NHL. The best approach for early detection is to watch for symptoms.

To diagnose NHL and distinguish it from other conditions causing swollen lymph nodes, doctors perform biopsies of enlarged lymph nodes. These may be excisional biopsies, core needle biopsies, or surgical procedures to obtain tissue samples. Immunophenotyping studies, using techniques like immunohistochemistry or flow cytometry with special dyes to detect cancer cell types, help identify the cell origin in NHL and determine its specific subtype. Cytogenetic analysis examines chromosomal abnormalities in cells, helping confirm the diagnosis and identify the NHL type.

In some cases, additional procedures may be needed. A lumbar puncture or spinal tap collects cerebrospinal fluid to check for NHL in the brain and spinal cord, particularly for diagnosing primary central nervous system lymphoma. Doctors may also analyze fluid from the chest using a procedure called thoracentesis or the abdomen using paracentesis to look for cancer cells.

Stages of HL:

• Stage 1: Only one lymph node or group of lymph nodes is affected in a single area of the body
• Stage 2: Multiple groups of lymph nodes are affected, but they are all on the same side of the diaphragm (either above or below)
• Stage 3: Lymph nodes on both sides of the diaphragm are involved
• Stage 4: The lymphoma has spread to other organs, such as the lungs, liver, or bone marrow

Stages of NHL:

• Stage 1: Limited to a single lymph node region or organ
• Stage 2: Affects two or more lymph node regions on the same side of the diaphragm
• Stage 3: Affects lymph node regions on both sides of the diaphragm
• Stage 4: Spreads to organs outside the lymphatic system such as the lungs or liver or both organs and lymph nodes

Hodgkin Lymphoma

Some people treated for HL may face long-term issues, even after being cured.

Potential complications include:

• Second cancers: Breast or lung cancer may develop more than 10 years after HL treatment. In rare cases, leukemia and other lymphomas can appear within a few years.
• Increased risk of other conditions: HL survivors may have a higher risk of cardiovascular and lung disease.
• Weakened immune system: Most patients also gradually develop a weakening of the immune system, specifically in the T-cells that help fight infections.

• Complications from treatment: Potential side effects include pulmonary disease, myelodysplastic syndrome, acute myeloid leukemia, infertility, peripheral neuropathy, and sexual dysfunction.

Non-Hodgkin Lymphoma 

NHL can lead to life-threatening complications that require urgent medical attention. Delayed treatment increases these risks.

Serious complications include:

• Febrile neutropenia: A dangerous condition where a patient has a fever along with a significant drop in white blood cells
• Hyperuricemia and tumor lysis syndrome: May cause fatigue, nausea, vomiting, and joint pain
• Spinal cord or brain compression: Can lead to neurological issues and paralysis if untreated
• Focal compression: Depending on the NHL type and location, it can cause airway, intestinal, or ureteral obstructions
• Vena cava obstruction: Blockage of the superior vena cava, restricting blood flow to the heart
• Hyperleukocytosis: Extremely high white blood cell count, which can impair circulation
• Adult T-cell leukemia-lymphoma: May cause elevated calcium levels in the blood (hypercalcemia)
• Pericardial tamponade: Fluid buildup around the heart, affecting its ability to pump blood
• Liver dysfunction: May result from NHL progression or treatment-related toxicity
• Venous thromboembolism: Blood clots form in veins, which can be life-threatening
• Autoimmune hemolytic anemia: The immune system attacks and destroys red blood cells
• Thrombocytopenia: Low platelet count, increasing the risk of bleeding

Hodgkin Lymphoma 

HL is highly curable. Treatment options include:

• Chemotherapy: Often involves using multiple drugs together, known as combination chemotherapy
• Targeted therapy: First-line treatment includes brentuximab vedotin combined with AVD (doxorubicin, vinblastine, and dacarbazine)
• Radiation therapy: Can be used alone or combined with chemotherapy to treat HL, which typically spreads in a predictable pattern from one lymph node to another. If lymphoma is localized, involved-field radiation targets a small area. For more widespread diseases, extended-field radiation covers larger areas.
• Steroid medication: May be used intravenously along with chemotherapy for advanced HL or if initial treatments are ineffective.
• Stem cell transplantation: Used if HL recurs or doesn’t respond to initial treatment, followed by an autologous stem cell transplant. In this procedure, the patient’s own stem cells are collected, frozen, and later reinfused into their bloodstream after the intensive chemotherapy. Allogeneic stem cell transplants (using donor cells) are not commonly used for HL treatment

• Clinical trials: Offer access to new experimental cancer treatments or studies comparing new and existing therapies, with many focusing on reducing the side effects of current therapies

• Surgery: In some cases, surgery is performed to remove affected lymph nodes
• Immunotherapy: Enhances the immune system’s ability to identify and destroy cancer cells. Treatments include antibody-drug conjugates (like brentuximab vedotin), checkpoint inhibitors (like nivolumab and pembrolizumab), and biological therapies that create antibodies to target cancer cells

The 5-year overall survival rate for stage 1 or 2A HL is around 90 percent, while for stage 4 HL, it’s around 60 percent.

Non-Hodgkin Lymphoma 

The treatment for NHL can differ widely based on the stage and type of the cancer, its aggressiveness, and patient-specific factors such as symptoms, age, and overall health.

Indolent lymphomas have a long survival period, respond quickly to treatments, and experience varying remission periods, but current therapies do not offer a cure.

Aggressive lymphomas progress rapidly without treatment and have high cure rates with standard chemotherapy, but result in short survival periods if not treated.

Treatment options include:

• Active monitoring: Some people with indolent NHL do not require immediate treatment. Delaying treatment doesn’t affect survival outcomes but helps avoid early side effects

• Chemotherapy: A common treatment for NHL given through an IV drip if doctors believe the cancer can be cured. If a cure is unlikely, oral chemotherapy tablets may be used to manage symptoms. For cancers that might spread to the brain, chemotherapy may be injected into the cerebrospinal fluid
• Radiotherapy: Used to treat early-stage NHL when the cancer is confined to a single area of the body
• Proton therapy: Precisely targets high doses of radiation to the tumor, minimizing damage to surrounding healthy tissue. For some patients, this approach can lead to more effective cancer control and fewer side effects
• Immunotherapy: Certain types of NHL respond to monoclonal antibodies, which bind to cancer cells and help the immune system target and destroy them. One common monoclonal antibody used for treating NHL is rituximab
• Steroid medications: Often used alongside chemotherapy to treat NHL, as they enhance the effectiveness of the chemotherapy. In rare cases, long-term use of steroids may be necessary
• CAR-T cell therapy: A new treatment for certain types of NHL that uses the patient’s own T-cells. These cells are extracted from the blood, genetically modified to include a chimeric antigen receptor that targets cancerous B-cells, then multiplied and reintroduced into the patient to attack and destroy the cancerous cells
• Targeted therapies: These include Bruton tyrosine kinase inhibitors, phosphoinositide 3-kinase (PI3K) inhibitors, cereblon inhibitors, and exportin 1 (XPO1) inhibitors
• Surgery: In some cases, part of the tumor may be surgically removed

The overall chance of surviving five years with NHL is around 74 percent. However, this survival rate can differ a lot depending on the specific type and stage of the lymphoma.

While mindset doesn’t directly impact lymphoma itself, it can influence several important aspects of the condition:

• Treatment adherence: A proactive mindset can help patients adhere to their treatment regimens and follow medical advice, which can improve outcomes.
• Coping strategies: A constructive mindset encourages seeking support, maintaining social connections, and engaging in activities that promote well-being.
• Emotional well-being: Lymphoma patients often experience emotional distress. A positive mindset can help them manage stress more effectively and build a strong supportive network, improving overall emotional health.

As the following natural approaches require further clinical trials and research to confirm their effectiveness and safety, and due to the limited size and lack of robust studies supporting their use, please consult your doctor before trying any of them.

1. Medicinal Herbs and Herbal Medicines:

• Sijunzi decoction and Prunella vulgaris: A 2023 case study published in Integrative Cancer Therapies involved a 73-year-old Caucasian man with aggressive lymphoma who could not tolerate chemotherapy. After two months of using a Chinese herbal treatment including Sijunzi Decoction and selfheal (Prunella vulgaris), also known as heal-all, his groin lymph node swelling disappeared. Sijunzi Decoction is made from ginseng root, poria mushroom, white atractylodes rhizome, and licorice root. Medical scans confirmed the improvement, and his blood tests remained normal.

• Korean medicine therapy: A 2017 case study reported that an 87-year-old Asian man with stage 3 T-cell lymphoma whose doctors had ruled out chemotherapy due to his age and health, was successfully treated with Korean herbal medicine. This included a blend of ginseng, Panax notoginseng, Cordyceps miliaris, and Cremastra appendiculata known as Hyunamdan. His lymph nodes shrank in size.

• Reishi mushroom (Ganoderma lucidum): A 2006 study showed that reishi mushroom extract had anti-cancer effects against leukemia, lymphoma, and multiple myeloma cell lines, including diffuse histiocytic lymphoma. Additionally, a 2019 meta-analysis of more than 4,000 cancer patients found that reishi mushroom and turkey tail mushroom-related natural products might improve overall survival and quality of life in cancer patients.

2. Diet

A 2010 study of 568 female NHL patients, diagnosed between 1996 and 2000, found that a high intake of vegetables before diagnosis was associated with improved overall survival, with a 26 percent reduction in the risk of death. Specifically, high consumption of green leafy vegetables and citrus fruits was linked to a 29 and 27 percent reduced risk of death, respectively. The study suggests that increasing vegetable and citrus fruit intake could enhance survival in NHL patients.

In addition to vegetables and fruits, the British organization Lymphoma Action recommends incorporating the following foods into a healthy diet to help patients better prepare for treatment and support recovery:

• Starchy foods (high in carbohydrates)
• Protein-rich foods (meat and dairy products)
• High-fiber foods (fruits, vegetables, grains)
• Foods with unsaturated fats and essential fatty acids (oily fish, nuts, and seeds)
• Fluids

3. Dietary Supplements

• Quercetin: A 2017 study found that quercetin, a bioflavonoid found in various vegetables, could block key pathways that help primary effusion lymphoma cells survive, leading to the reduction of certain proteins that support cell growth. It also lowers cytokine levels involved in cell survival, causing cancerous cells to die. Additionally, quercetin enhances the effects of the cancer drug bortezomib by promoting a type of cell process that makes the drug more effective at killing PEL cells.

• Carotenoids: A 2020 study of 512 NHL patients and 512 healthy participants found that a higher intake of carotenoids was linked to a lower risk of developing NHL, especially in smokers.

• Indole-3-carbinol (I3C): Found in vegetables such as cabbage, broccoli, and Brussels sprouts, I3C may help prevent cancer by reducing mutations, inhibiting tumor growth, and blocking estrogen’s cancer-promoting effects.

Since most risk factors for lymphoma cannot be altered, preventing the majority of cases is not currently possible. However, you can reduce your risk by:

• Preventing HIV, EBV, hepatitis C, and human herpesvirus infections
• Avoiding or quitting smoking
• Maintaining overall health, including a strong immune system, and a healthy weight
• Limiting exposure to harmful chemicals that can increase lymphoma risk
• Minimizing the use of breast implants