- Hodgkin lymphoma is a malignancy of lymphocytes marked by the presence of Reed-Sternberg cells, mature B cells that have become malignant.
- Non-Hodgkin lymphoma is also a malignancy of lymphocytes and can be derived from B cells or T cells.
- The diseases are different in numerous ways and often follow different courses of progression.
Hodgkin and non-Hodgkin lymphoma are the two main types of lymphoma, a cancer that affects the lymphatic system. The lymphatic system produces and transports white blood cells to fight infection.
While they have many characteristics in common, there are some significant differences between Hodgkin and non-Hodgkin lymphoma, including the age groups they affect, how they spread, the type of white blood cell they affect, and the likelihood of early detection.
| Hodgkin lymphoma | Non-Hodgkin lymphoma | |
| Age group | Most common in adolescents and young adults and those over 60 | Most common in those over the age of 60 |
| Type of cell affected | Arises from B cells (a type of white blood cell that makes protein antibodies to attack infections, viruses, and other invaders). | Non-Hodgkin lymphoma can arise from either B cells or T cells (another type of white blood cell that sends chemical instructions to kill infected and tumorous cells). |
| Symptoms | Most common Painless lump under skin (often in the neck or armpits), or respiratory symptoms (eg, cough, trouble breathing) if the disease is mostly in the chest. Occasionally the enlarged lymph nodes may hurt after drinking alcohol. It’s important to note that in most cases, swollen lymph nodes are not cancerous. Swelling is often caused by inflammation instead of cancer. Secondary Fever Drenching night sweats Unexplained weight loss Itching | Same as those for Hodgkin lymphoma except there may be other symptoms depending on where the disease originates: Abdomen Swelling or abdominal pain Loss of appetite Feeling full after eating a small amount Enlarged lymph nodes in the groin Chest Cough and trouble breathing Chest pain Swelling in the head, arms, or upper chest Brain Headaches Trouble thinking Personality changes Seizures Double vision Trouble speaking |
| Where it originates | Typically begins in lymph nodes of the upper body, including the head, neck, chest, and armpits. | Can originate in lymph nodes throughout the body and sometimes outside of lymph nodes. |
| How it spreads | Progresses predictably from one set of lymph nodes to the next and rarely reaches other organs until the later stages of the disease. Often diagnosed in early stages. | Spreads more randomly. Most patients are diagnosed at a more advanced stage. |
| Subtypes of the disease | There are only two main forms of Hodgkin lymphoma: classic (more than 90 percent of all cases) and nodular lymphocyte predominant Hodgkin lymphoma. | Non-Hodgkin lymphoma includes more than 60 types of cancer which are divided into two main groups: B-cell and T-cell cancers. |
What is the lymphatic system?
The lymphatic system produces and transports white blood cells (lymphocytes) to fight infection and disease. It also helps control the amount of fluid in the body. The lymphatic system includes:
- Lymph nodes: Hundreds of bean-size sacs that are spread throughout the body
- Spleen: Filters the blood and helps make white blood cells
- Thymus: Makes T-cell lymphocytes
- Tonsils: Help make lymphocytes
- Bone marrow: Makes white blood cells, red blood cells, and platelets.
The lymphatic system is connected by a series of tubes, much like the cardiac circulatory system. Instead of blood, a colorless watery liquid (lymphatic fluid) flows through these tubes to transport white blood cells to fight disease and infection.
How is lymphoma diagnosed?
There are no reliable screening tests specifically for Hodgkin or non-Hodgkin lymphoma. The chain of diagnosis typically proceeds as follows:
- A physical exam, during which your health care provider checks for swollen lymph nodes in your neck, underarms, and groin. They will also check for a swollen spleen or liver.
- A biopsy is the most reliable test used to diagnose lymphoma. The preferred method is to remove the lymph node through a small incision in the skin, which can usually be done with local anesthetic. Alternatively, a core needle biopsy may be done, which takes a small sample through a hollow needle, with CT scan or ultrasound used to guide the needle.
- Bone marrow biopsy involves the removal of bone marrow, blood, and a small piece of bone marrow by inserting a hollow needle into the hipbone. This procedure is not needed for all patients.
- Blood tests are often performed to understand your general health and look for signs of cancer.
- Imaging tests such as X-rays, CT scans, MRIs, or PET scans can be used to look for an enlarged spleen, enlarged lymph nodes, etc, which can indicate the presence of lymphoma.
- Molecular testing, if needed, creates a precise “tumor profile” that provides information that may reveal genetic or chromosomal abnormalities. The specific mutation “profile” of a person’s cancer can be predictive of very different outcomes. Knowing the particular combination of mutations driving a patient’s disease can help physicians select a treatment option.
How is lymphoma treated?
Treatments vary depending on the type of disease, its aggressiveness, and location, along with the age and general health of the patient. The treatment options at Dana Farber’s Hematologic Oncology Treatment Center can generally include:
- Radiation
- Chemotherapy:
- Immunotherapy: a form of treatment that stimulates a person’s immune system to attack cancer cells
- Stem cell transplants: also known as bone marrow transplants, this procedure is most commonly used when there has been a recurrence of the disease. The procedure is most often performed using the patient’s stem cells but can occasionally be done using a donor’s stem cells. The Dana-Farber Brigham Cancer Center stem cell transplant program is one of the largest and most sophisticated in the country.
- CAR T-cell therapy is used to retrain the body’s cancer-fighting T-cells to attack the disease more effectively.
- Clinical trials of new chemotherapy combinations and other potential treatments can also be an option for patients in all stages of lymphoma.
What are the risk factors for lymphoma?
Risk factors for lymphoma can include:
- A family history of lymphoma
- HIV infection and other forms of immunosuppression
If you have any of these risk factors, it is important to let your primary care team know so they can be especially vigilant in watching for possible signs of lymphoma.
About the Medical Reviewer
Dr. Armand received his MD and PhD from the University of California, San Francisco in 2000. He completed his postgraduate training at Brigham and Women's Hospital and at Dana-Farber Cancer Institute in Boston. In 2007, he joined DFCI and is a member of the Hematologic Malignancies staff.
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