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Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare form of Hodgkin lymphoma that is characterised by variants of Reed-Sternberg cells known as ‘popcorn’ cells because of their appearance. It develops slowly and is often diagnosed earlier than the classical subtypes of Hodgkin lymphoma.
The lymphatic system is a network of tissues and organs that help our bodies fight infection and disease. It is composed of lymph vessels (carries lymph fluid around the body), lymph fluid (carries nutrients around the body and removes unwanted bacteria/viruses) and lymph nodes/glands (filters lymph fluid and empties it into the bloodstream). Some of the most well-known lymph tissues include the bone marrow, the spleen, and the tonsils.
NLPHL is more common in males, and tends to be diagnosed between the ages of 30-50. However, anyone can develop this disease.
If NLPHL is detected, it will be staged and graded based on size, metastasis (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
This system can also be used in combination with a numerical value, from stage 0-IV:
Cancers can also be graded based on the rate of growth and how likely they are to spread:
Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including age, stage of disease and overall health. The types of treatments generally don’t vary between adults and children.
Treatment options for patients with NLPHL may include:
For more information on the treatment options, please refer to the Rare Cancers Australia Treatment Options page.
While the exact cause of NLPHL remains unknown, the following factors might increase the risk of a person developing this type of cancer.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
The main symptom of NLPHL is a firm, painless lump I the neck, armpits and/or groin. People may also develop what is known as ‘B symptoms’, which are:
Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.
If your doctor suspects you have Hodgkin lymphoma, they will order a range of diagnostic tests to confirm the diagnosis, and refer you to a specialist for treatment.
Your doctor will collect your overall medical history, as well as your current symptoms. Following this, they may examine your body to check for any abnormalities.
Your doctor will recommend a blood test for check for signs of Hodgkin lymphoma and determine overall health. The most common test is a full blood count, which will analyse the levels of red blood cells, white blood cells and platelets in the blood. Low counts in any of these categories could be indicative of disease.
The doctor will take images of your body using magnetic resonance imaging (MRI), a computed tomography scan (CT scan), ultrasound, and/or positron emission tomography (PET scan), to check for signs of tumours and/or metastasis.
Once the location of the cancer has been identified, the doctor will perform a biopsy to remove a section of tissue using a needle. In most cases, this may be done by either an excision biopsy (where the lymph node is completely or partially removed), or a core needle biopsy (where a needle is inserted into the lymph node to remove a sample). Both of these procedures are often performed as a day surgery. In rare cases, a bone marrow biopsy may be performed to see if it contains any cancerous cells.
This process involves inserting the needle into the hipbone (or the breastbone in some cases) to remove samples of solid and liquid bone marrow. These samples will then be analysed for cancer cells.
While it is not possible to predict the exact course of the disease, your doctor may be able to give you a general idea based on the rate and depth of tumour growth, susceptibility to treatment, age, overall fitness, and medical history. Generally, early-stage NLPHLs have a better prognosis and survival rates. However, if the cancer is advanced and has spread, the prognosis may not be as good and there may be a higher risk of cancer recurrence. It is very important to discuss your individual circumstances with your doctor to better understand your prognosis.
Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.
Page last updated: 01/03/2022