Hodgkin Disease Versus Non-Hodgkin Lymphoma

Non-Hodgkin's lymphoma is the one with the most types and subtypes.

Lymphoma is a cancer involving lymphocytes, a type of white blood cell. Hodgkin’s lymphoma, or HL, and non-Hodgkin’s lymphoma, or NHL, are the two main categories of lymphoma. The difference between the two was originally historical, but today HL and NHL are also known to differ in their microscopic appearances, typical course and other characteristics.

Hodgkin’s Lymphoma is Historical

Also called Hodgkin’s disease, Hodgkin’s lymphoma refers specifically to the kind of lymphoma first described by Thomas Hodgkin, a doctor who lived in the early 1800s.

 

He was largely responsible for bringing the stethoscope from Paris, where he had been studying, back to Great Britain where it was introduced and began to be used. Hodgkin examined corpses for gross pathology for years. A series of cases captured his interest—he noticed a different sort of lymph node and spleen involvement that did not look like a common infection. He wrote a paper about the condition that now bears his name, and he was later credited with discovering Hodgkin's lymphoma.

Non-Hodgkin’s Lymphomas form a Diverse Group

Non-Hodgkin’s lymphoma essentially refers to a long list of lymphomas that, quite literally, are not Hodgkin’s lymphoma.

More than 60 types of lymphoma have been described that differ from Hodgkin’s lymphoma. NHL is far more common overall, accounting for up to 90 percent of all lymphomas today. NHL is a diverse group of malignancies that vary in the findings that show up on scans, as well as in their typical courses and prognoses.

In most of the cases, the cancer cells are located in the lymph nodes or in other lymphoid tissues – in organs such as the spleen and bone marrow -- but they may also invade other organs such as the small bowel and kidney.

HL vs. NHL: Age Distribution is Tricky

If you were looking down from space, at all human beings on the planet, NHL would be the most common lymphoma, by far.

Among adults, NHL typically affects an older age group. But NHL is also more common than HL in children: about 60 percent of pediatric lymphomas are NHL, while about 40 percent are HL. Hodgkin lymphoma has two peak age groups—one in the 20s and one in the 80s. So, a young adult athlete with lymphoma from the headlines may often have Hodgkin’s lymphoma, even though NHL is more common, overall.

HL vs. NHL: How Typical Cases Emerge, Manifest and Progress

The majority of both NHL and HL are nodal lymphomas, originating within the lymph nodes. However, NHL is the type that is much more likely to be extranodal—with some 33 percent of NHL cases considered primary extranodal lymphomas. The most frequent site of primary extranodal lymphoma is in the gastrointestinal tract—and almost all of these are NHL.

Also, typical patterns of lymph node involvement in the chest differ. HL typically progresses in an orderly fashion from one group of lymph nodes to the next. The same may not be true for many common NHLs, though some can have a more Hodgkin's-like behavior.

HL vs. NHL: Role of Staging

The staging system for HL is known as the Cotswold system, which is a modification of the older Ann Arbor system.

Though modified, it is still anatomically based. The precise staging based on the anatomy of involved sites is considered important in HL because anatomical stage correlates strongly with prognosis and helps determine treatment. With NHL, it is not that anatomical staging is unimportant, but rather that the histology and grade are more strongly predictive of prognosis and more influential in the treatment decision. In HL, stages I and II have typically been treated with radiation therapy, while a combination of radiation and chemotherapy or chemotherapy alone may be offered to patients in stages III and IV.

A Word from Verywell

Once you know the basic differences between HL and NHL, you are well on your way to understanding more about lymphoma. If you or a loved one has been diagnosed with lymphoma, it is important to know, however, that today's diagnostics and treatments go well beyond distinguishing between these two major categories. 

Both HL and NHL have numerous subtypes that can be very important clinically. In particular, NHL has subtypes that can vary remarkably from one to the next. These different subtypes behave differently, are treated differently, and are associated with different outcomes.

Even if you have an exact name for your lymphoma—for example, diffuse large B cell lymphoma (DLBCL)—it can be hard to make sure information you find on the internet is current and applicable to you, as an individual. Statistics are often from 10 years ago and may have already been "filtered" to assume you are a certain age, or that your disease was diagnosed at a certain stage, or that you received a certain treatment. So, be sure to discuss any questions you may have about your treatment and prognosis with the medical team that is responsible for your care.

Sources

American Cancer Society. Cancer facts and figures. Accessed September 2015.

Mehrian P, Ebrahimzadeh SA. Differentiation between sarcoidosis and Hodgkin’s lymphoma based on mediastinal lymph node involvement pattern: Evaluation using spiral CT scan. Pol J Radiol. 2013;78(3):15-20.

Hare SS, Souza CA, Bain G, et al. The radiological spectrum of pulmonary lymphoproliferative disease. Br J Radiol. 2012;85(1015):848-864.

Cheson BD, Fisher RI, Barrington SF et al. Recommendations for initial evaluation, staging and response assessment of Hodgkin and non-Hodgkin lymphoma: the lugano classification. J Clin Oncol. 2014;32(27)3059-3068.

Continue Reading