If you've been diagnosed with lymphoma, you might be feeling lost in a sea of terms. Is it non-Hodgkin or Hodgkin lymphoma? What are B-cells and T-cells? With some basic information, you can start to make sense of it all. Let's start from the top.

Lymphomas are cancers that form in the lymphatic system, which is part of the body's immune system.

There are two main types of lymphoma:

• Hodgkin lymphoma
• Non-Hodgkin lymphoma (NHL)

Non-Hodgkin lymphoma is the most common type, making up almost 90% of U.S. cases.

"The main difference is that Hodgkin lymphoma has special cells called Reed-Sternberg cells, which are large and look unusual under a microscope," says Dr. Siddhartha Ganguly, an oncologist who specializes in blood cancers at Houston Methodist. "Non-Hodgkin lymphoma doesn't have these cells and is a broader term for many kinds of lymphomas."

There are two major types of NHL: B-cell lymphoma and T-cell lymphoma. These types involve different cells in the lymphatic system and respond differently to cancer treatments like chemotherapy and immunotherapy.

Understanding the differences can help you make more informed treatment decisions with your health care provider.

B-cell non-Hodgkin lymphoma

B-cell lymphoma affects B-cells, which are a type of white blood cell that produces antibodies. Antibodies find and attack harmful germs such as bacteria and viruses to fight off infections.

Cancer causes B-cells to grow uncontrollably. "This keeps the body from properly fighting infections and also crowds out the healthy cells, leading to swelling of the lymph nodes," says Dr. Ganguly.

About 85% of patients with non-Hodgkin lymphoma have B-cell lymphoma. Providers diagnose it with a biopsy of an affected lymph node, which is then examined under a microscope.

There are different types of B-cell lymphomas. One common type is diffuse large B-cell lymphoma, which is more aggressive and more likely to spread to other parts of the body. Follicular lymphoma is far slower-growing and tends to stay in the lymph nodes longer before causing symptoms throughout the body.

Lymphomas can cause myriad of symptoms depending on its anatomic location such as:

• Bone, chest or abdominal pain
• Coughing or trouble breathing
• Fatigue or weakness
• Fever and infections
• Gum problems
• Headaches, seizures or vomiting
• Loss of appetite and weight
• Painless swelling of lymph nodes
• Rashes
• Swelling of the face and arms

B-cell NHLs are highly curable. The five-year survival rate for diffuse B-Cell lymphoma is about 60%-70%. "As technology progresses, this number will only go up," Dr. Ganguly says.

Treatment options

R-CHOP has remained the primary treatment for diffuse large B-cell lymphoma. This combination of chemotherapy and targeted therapy consists of five medications:

• Rituximab targets and destroys cancerous B-cells by binding to the CD20 protein on the cell surface
• Cyclophosphamide, hydroxydaunorubicin, and vincristine (Oncovin) work to kill cancer cells and prevent their growth
• Prednisone helps reduce inflammation and side effects, making the overall treatment more effective

There have been advances in the therapy for lymphomas incorporating a more targeted and personalized approach. These types of targeted immunotherapy and cellular therapy, according to Dr. Ganguly, are "like planting a big flag on each of the cancerous B cells that says, 'destroy me.'

Certain cancer centers like Houston Methodist offer advanced medications that can effectively treat certain types of B-cell NHL without the potential side effects of chemotherapy.

One, chimeric antigen receptor (CAR-T) cell immunotherapy, targets the CD19 protein. In this treatment, the medical team removes a sample of a patient's T-cells (or uses donor cells), modifies them to recognize and attack cancer cells, and returns them to the patient's body to eliminate the cancer.

Checkpoint inhibitors, another type of immunotherapy, also have been a game-changer in Hodgkin lymphoma treatment.

"Checkpoint inhibitors block the signals that prevent the immune system from attacking cancer cells," says Dr. Ganguly. "This allows the body's own defenses to better fight the cancer. You can think of it like the cancer cells have developed an armor, but these medications destroy it."

T-cell non-Hodgkin lymphoma

T-cell non-Hodgkin lymphoma accounts for less than 15% of all non-Hodgkin lymphomas. This type affects T-cells, a form of white blood cell that plays a key role in attacking cancerous cells, as well as cells infected with harmful germs. Dr. Ganguly says to think about T cells as the foot soldiers of the immune system.

In T-cell non-Hodgkin lymphoma, the T-cells themselves become cancerous. This leads to uncontrolled growth of cancerous T-cells and compromised immune function.

Symptoms are like B-cell lymphoma and can include:

• Fatigue, infection and fever
• Organ dysfunction, in extreme cases
• Skin rashes
• Swollen lymph nodes

As with B-cell lymphoma, diagnosis involves a biopsy of the affected areas, which also helps determine the severity of the disease. "The survival rate for T-cell lymphoma depends largely on the stage, type and how well the patient takes to treatment," says Dr. Ganguly.

Treatment options

Treatment for T-cell and B-cell lymphomas is similar, with a few key differences. "Rituximab doesn't work for treating T-cell lymphoma, as it targets and binds to proteins on B-cells, not T-cells," says Dr. Ganguly.

Providers also typically don't use CAR-T cell therapy for T-cell lymphomas. This is because healthy and cancerous T-cells share many of the same protein markers on their cell surfaces. This makes the cancer cells invisible to the immune system — and makes it tough to target only cancer cells.

Instead, doctors often combine chemotherapy with the medicine brentuximab, an antibody that targets CD30, which is present on most T cells. But the treatment features an added twist: a toxin is attached to the CD30 antibody. This combination, called an antibody-drug conjugate, works like a delivery system, where the antibody latches onto CD30 on cancer cells, delivers the toxin inside and kills the cancer cell. It's like a Trojan horse, sneaking the toxin into the cancer cell to destroy it from within. Some patients may benefit from stem cell transplant or radiation therapy at the disease site.

"Scientists are working on finding more specific targets on cancer cells that won't affect healthy T-cells, as well as using advanced techniques to purify T-cells before therapy," says Dr. Ganguly.

Advancements in NHL treatment

"Navigating lymphoma can be challenging, but with ongoing research and advancements in treatments, there's hope for effective management and better outcomes," says Dr. Ganguly.

After lymphoma treatment, focus on a balanced diet, regular gentle exercise and mental health support. Follow-up care is crucial to monitor recovery and prevent recurrence. Healthy habits and staying proactive can improve long-term well-being.

If you or someone you know is dealing with lymphoma, it's important to stay informed and work closely with healthcare providers to find the best approach. Talk with a doctor if you are interested in joining a clinical trial study.