Difference between Hodgkin and Non Hodgkin Lymphoma

Hodgkin lymphoma (HL) is a specific type of cancer originating in the lymphatic system. It primarily affects the lymph nodes but can also involve other lymphoid tissues such as the spleen, bone marrow, and liver. 

One of the defining features of Hodgkin lymphoma is the presence of abnormal cells called Reed-Sternberg cells. These cells are large, atypical cells that can be identified under a microscope. 

The presence of Reed-Sternberg cells (large abnormal cells that may sometimes have multiple nuclei) and other characteristics helps differentiate Hodgkin lymphoma from other types of lymphomas.

Hodgkin lymphoma (HL) is classified into several subtypes based on the characteristics of the cancer cells, the presence or absence of specific proteins, and the overall behaviour of the disease. The two primary types of Hodgkin lymphoma are:

1. Classical Hodgkin Lymphoma (cHL): This is the most common type of Hodgkin lymphoma, accounting for approximately 95% of all cases. It is further divided into four subtypes. 
2. Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL): This type of Hodgkin lymphoma is less common, accounting for about 5% of all cases. It has distinct characteristics, including the presence of “popcorn cells” (lymphocytic and histiocytic cells) and a slow-growing behaviour compared to classical Hodgkin lymphoma.

Non-Hodgkin lymphoma (NHL) is a cancer originating in the lymphatic system, similar to Hodgkin lymphoma. 

NHL can arise from B-cells (B-cell lymphomas) and T-cells (T-cell lymphomas). B-cells and T-cells are white blood cells known as lymphocytes that fight harmful invaders and abnormal cells. 

1. Non-Hodgkin lymphoma comprises a diverse group of cancers affecting lymphocytes. 
2. These cancers can occur in various lymphoid tissues, including lymph nodes, spleen, bone marrow, and other organs involved in the immune system.
3. There are more than 30 subtypes of non-Hodgkin lymphoma, each with distinct characteristics and behaviour. 
4. These subtypes are classified based on factors such as the specific type of lymphocyte affected, the appearance of cancer cells under the microscope, and the presence of certain genetic abnormalities.

Some of the most common types of Non-Hodgkin’s lymphoma include:

1. Diffuse Large B-cell Lymphoma (DLBCL): This is the most common type of NHL, accounting for about 30% to 40% of cases. It is characterised by large B-cells that spread diffusely. DLBCL typically grows rapidly and can occur at any age.
2. Follicular Lymphoma: This slower-growing NHL arises from B-cells and often presents with enlarged lymph nodes, bone marrow involvement, and splenomegaly (enlarged spleen). Follicular lymphoma can remain stable for many years.
3. Mantle Cell Lymphoma: This subtype is characterised by the involvement of the mantle zone (outer ring of the small lymphocytes) of the lymph nodes. It is typically an aggressive lymphoma that affects older adults and has a higher propensity for spreading to other organs.
4. Marginal Zone Lymphoma: This group of slow-growing lymphomas arise from B-cells in the marginal zone (surrounds the mantle zone) of lymphoid tissues, such as the lymph nodes, spleen, and mucosa-associated lymphoid tissue (MALT). It can occur in different organs, including the stomach (gastric MALT lymphoma) and the thyroid (thyroid lymphoma).

Hodgkin and non-Hodgkin lymphoma are two distinct types of cancers affecting the lymphatic system. Both share similarities, such as the involvement of lymph nodes. However, the key difference between Hodgkin and non-Hodgkin lymphoma is based on the specific cells involved, the presence of Reed-Sternberg cells and the behaviour of the disease. 

The following table shows Hodgkin and non-Hodgkin lymphoma differences:

Parameter	Hodgkin’s Lymphoma	Non-Hodgkin’s Lymphoma
Incidence	Rare and less common than non-Hodgkin’s lymphoma	Rare but more common than Hodgkin’s lymphoma
Outlook	Generally better (88.9% 5-year relative survival rate)	Generally poorer (74.3% 5-year relative survival rate)
Cancerous Cells	B-cells (Reed-Sternberg cells)	B-cells or T-cells
Location	It can develop anywhere but is more likely to start in the lymph nodes in your upper body, including the neck, underarms, and chest.	It can develop in lymph nodes anywhere in the body or organs.

Hodgkin’s and non-Hodgkin’s lymphoma share similarities and differences in their symptoms, causes, and risk factors. Understanding these differences is critical to determine accurate diagnosis and treatment. 

Based on Symptoms

Hodgkin’s and non-Hodgkin’s lymphoma have symptoms in common. However, these symptoms depend on the particular type of lymphoma and the stage of the lymphoma.

Some patients may not have symptoms at the time of diagnosis. If the disease has spread to other critical body areas, other persons may experience life-threatening problems.

The symptoms of Hodgkin’s lymphoma vs non-Hodgkin’s lymphoma are.

1. Swollen lymph nodes
2. Loss of appetite
3. Itching
4. Fatigue
5. Swollen, painful abdomen
6. Chest pain or pressure
7. Coughing
8. Shortness of breath
9. Bleeding or bruising easily
10. Fever and night sweats
11. Weight loss

Causes and Risk Factors

The causes for Hodgkin’s and non-Hodgkin lymphoma are the same. Both conditions are caused by a change in the DNA of lymphocytes, a white blood cell. The exact reason for this change in DNA is not known. 

However, various factors may increase the risk of developing these conditions. The following table compares the risk factors of Hodgkin’s lymphoma vs non-Hodgkin’s lymphoma.

Hodgkin’s Lymphoma

Non-Hodgkin’s Lymphoma

Age between 20 to 30 or above 55 Epstein-Barr Virus (EBV) Infection A weakened immune system Slightly more common in men than women Family history of Hodgkin’s lymphoma

Being older (between 65 to 74) Family history of non-Hodgkin’s lymphoma Past radiation exposure Weakened immune system Autoimmune diseases Rheumatoid arthritis Sjogren’s syndrome (an immune system disorder causing dry eyes and dry mouth) Infections  Epstein-Barr Virus (one of the most common viral infections that spread through saliva and bodily fluids),  Human T-cell lymphotropic virus (a type of virus that infects T-cells, causing lymphoma and leukaemia) Exposure to certain chemicals, like pesticides, solvents, benzene, etc.

 

The diagnostic and treatment approaches for Hodgkin and non-Hodgkin lymphoma may share similarities. However, the aim and purpose of these diagnostic and treatment approaches may differ between these two conditions. This emphasises the importance of accurate diagnosis and individualised treatment strategies.

Based on Diagnosis

The main difference between Hodgkin and non-Hodgkin lymphoma in terms of diagnosis is detecting the presence or absence of Reed-Sternberg cells, large abnormal cells found in Hodgkin’s lymphoma. While both conditions involve the same diagnostic tests, they look for different cancerous cells for diagnosis. 

The diagnostic process for Hodgkin’s and non-Hodgkin’s lymphoma begins with the doctor asking about your medical history and conducting a physical exam. The tests for diagnosing Hodgkin and non-Hodgkin lymphoma include:

1. Blood and Urine Tests: Blood tests may be conducted to assess blood cell counts, liver and kidney function and to check for certain markers associated with lymphoma. Urine tests may be conducted to rule out infection.
2. Imaging Tests: Imaging techniques like X-rays, CT scans, MRI scans, or PET scans are used to assess the extent of lymph node involvement, identify tumours in other body parts, and determine the lymphoma stage.
3. Lymph Node Biopsy: A tissue sample from an enlarged lymph node is obtained through a biopsy, usually done by removing the entire lymph node (excisional biopsy) or a small portion (incisional or needle biopsy). The sample gets sent to a lab to be examined under a microscope and determine the presence or absence of Reed-Sternberg cells and to classify the lymphoma subtype.
4. Bone Marrow Biopsy: The procedure may be performed to determine if the lymphoma has spread to the bone marrow.

For non-Hodgkin’s lymphoma, the doctor may also perform the following additional test:

1. Lumbar Puncture: The doctor may remove some fluid around the spinal cord for testing to check if the lymphoma cells have spread into the fluid around the brain and spinal cord.

Based on Treatment

Hodgkin lymphoma and non-Hodgkin lymphoma have similar treatment approaches. In general, the treatment of both lymphomas aims to achieve remission, which may vary in its definition depending on the specific type. 

Non-Hodgkin lymphoma may require longer and more intensive treatment, as it encompasses a wider spectrum of diseases with different biological behaviours and clinical courses. 

The treatment approaches for Hodgkin and non-Hodgkin lymphoma are as follows:

1. Chemotherapy: The primary treatment for Hodgkin’s and non-Hodgkin’s lymphoma involves chemotherapy. A combination of different chemotherapy drugs is typically used to kill lymphoma cells. Various chemotherapy regimens are available, and the choice depends on the subtype and stage of the disease.
   1. For classical Hodgkin’s lymphoma treatment, chemotherapy may be used as a standalone or with radiation therapy. 
   2. For nodular lymphocyte-predominant Hodgkin’s lymphoma, chemotherapy may be combined with targeted and radiation therapy. 
2. Radiation Therapy: It may be used with chemotherapy, especially in early-stage lymphoma. Radiation therapy involves targeting specific body areas with high-energy radiation to kill cancer cells.
3. Targeted Therapy: Targeted therapy drugs specifically target certain molecules or genetic mutations in cancer cells. These drugs interfere with specific pathways or signals in cancer cells’ growth and survival.
4. Immunotherapy: Immunotherapy is a treatment approach that enhances your body’s immune system to recognise and attack cancer cells. Monoclonal antibodies, such as rituximab, specifically target and bind to cancer cells, marking them for destruction by the immune system. It may be useful when the disease does not respond to other treatments. 
5. Bone Marrow Transplant: In some cases, high-dose chemotherapy, followed by a bone marrow transplant, may be considered for patients with aggressive or relapsed disease. 

           This procedure allows for the administration of more intensive chemotherapy and then the infusion of healthy stem cells to replace the damaged bone marrow.

For non-Hodgkin’s lymphoma, doctors may recommend one additional treatment:

1. CAR-T Cell Therapy: Chimeric Antigen Receptor T-cell (CAR-T) therapy is a specialised form of immunotherapy where a patient’s T-cells are genetically modified to express a receptor that targets cancer cells.

This approach is used for specific types of NHL, such as diffuse large B-cell lymphoma.

Based on Complications

Hodgkin’s and non-Hodgkin’s lymphoma can present certain complications during and after treatment. These complications may vary depending on the stage and subtype of the lymphoma and the specific treatments administered. Some common complications include:

1. Infections: Both types of lymphoma can weaken the immune system, making patients more prone to infections. This risk may increase further during treatment, especially with chemotherapy and immunosuppressive therapies.
2. Long-Term Side Effects of Treatment: Chemotherapy and radiation therapy in treating lymphoma can lead to long-term side effects. These may include organ damage, infertility, secondary cancers, cardiac problems, lung problems, and hormonal imbalances.
3. Fatigue: Fatigue is a common symptom and complication experienced by individuals with lymphoma during and after treatment. It can significantly impact daily activities and quality of life.
4. Neuropathy: Neuropathy refers to nerve damage that causes numbness, weakness, or tingling in the feet or hands. These can be the side effects of some chemotherapy drugs.
5. Emotional and Psychological Effects: Coping with the diagnosis, treatment, and potential long-term effects of lymphoma can affect an individual’s emotional well-being. Anxiety, depression, and emotional distress are not uncommon.

Survival rate is the proportion of the people who survive a certain period of time after being diagnosed with a particular illness. 

The survival rates for Hodgkin’s and non-Hodgkin’s lymphoma can vary depending on various factors like the stage of the disease, subtype, age, overall health, and response to treatment. 

Generally speaking, the overall survival rates for HL are higher than those for NHL. The following is the difference between Hodgkin's and non-Hodgkin lymphoma based on their survival rates. 

Hodgkin’s Lymphoma

The overall 5-year relative survival rate for Hodgkin’s lymphoma is 88.9%. The survival rate of the disease based on each stage is as follows:

Stage	5-Year Relative Survival Rate
Stage 1	91.8%
Stage 2	95%
Stage 3	86.7%
Stage 4	80.5%

Non-Hodgkin’s Lymphoma

The overall 5-year relative survival rate for Hodgkin’s lymphoma is 74.3%. The survival rate of the disease based on each stage is as follows:

Stage	5-Year Relative Survival Rate
Stage 1	86.2%
Stage 2	78.9%
Stage 3	73.3%
Stage 4	64.2%

Completely preventing Hodgkin’s lymphoma and non-Hodgkin’s lymphoma is impossible as the exact causes are poorly understood. However, some general recommendations may help reduce the risk or promote overall health:

1. Stay at a Healthy Weight: Obesity can increase the risk of some types of non-Hodgkin’s lymphoma. Maintaining a healthy weight through balanced eating habits (a diet high in fruits, vegetables, and whole grains) and regular physical activity is advisable. 
2. Quit Smoking and the Use of Smokeless Tobacco: Smoking or the use of smokeless tobacco has been linked to an increased risk of various cancers, including some types of lymphoma. Quitting smoking can be beneficial for overall health.
3. Avoid Infections with Viruses: Infections with HIV can increase the risk of non-Hodgkin lymphoma. So you must limit your risk by avoiding intravenous drug use and unprotected sex with several partners. 
4. Avoid Unnecessary Radiation Exposure: Some lymphomas can occur due to treating other cancers by radiation. Healthcare professionals are trying to find better ways to treat cancer.

Consult a doctor if you experience any persistent or concerning symptoms associated with Hodgkin’s lymphoma or non-Hodgkin’s lymphoma. Some common symptoms include:

1. Painful swelling of lymph nodes in the neck, armpits, or groin
2. Unexplained and persistent fatigue
3. Unexplained fever, especially if accompanied by night sweats
4. Unintentional weight loss
5. Persistent itching
6. Persistent cough or shortness of breath
7. Abdominal pain or swelling
8. Changes in bowel habits or urinary function 

If you notice these symptoms or have other concerns, schedule an appointment with your doctor. They can evaluate your symptoms, perform necessary tests, and provide appropriate guidance or referrals to specialists. 

Early detection and diagnosis of lymphoma can greatly improve treatment outcomes, so it is best not to delay seeking medical attention.

Hodgkin’s and non-Hodgkin’s lymphoma are two distinct types of cancers affecting the lymphatic system. They differ in terms of cell types, presence of Reed-Sternberg cells, patterns of lymph node involvement, and treatment approaches. Understanding these differences is crucial for accurately diagnosing and effectively managing these diseases.

HexaHealth is a comprehensive healthcare platform that can greatly assist patients with Hodgkin’s or non-Hodgkin’s lymphoma. We provide access to personalised care, second opinions, and treatment options. Our team strives to empower patients and their families, facilitating a holistic approach to managing these lymphomas and improving the overall quality of life for those affected. Contact us TODAY to know the difference between Hodgkin's and non-Hodgkin lymphoma and get prompt diagnosis and treatment!

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