Understanding the Types of Lymphoma: Hodgkin vs. Non-Hodgkin

What Is Lymphoma?

Lymphoma is a type of cancer that begins in the lymphatic system, a crucial part of the body’s immune defense network. The lymphatic system includes the lymph nodes, spleen, thymus gland, and bone marrow. When certain white blood cells called lymphocytes grow and multiply uncontrollably, they can form tumors in the lymph nodes or other organs, leading to lymphoma.

There are two major categories of lymphoma:

1. Hodgkin lymphoma (HL)

2. Non-Hodgkin lymphoma (NHL)

While both arise from lymphocytes, they differ in cell structure, behavior, and how they respond to treatment. Understanding the distinctions between these two forms is key to early diagnosis and proper management.

Key Differences

The main difference between Hodgkin and Non-Hodgkin lymphoma lies in the type of abnormal cell seen under a microscope.
In Hodgkin lymphoma, the presence of a Reed-Sternberg cell — a large, abnormal B lymphocyte — is the defining feature. Non-Hodgkin lymphoma lacks these cells and can arise from either B cells or T cells.

Beyond cellular differences, the two types also vary in:

• How they spread: Hodgkin lymphoma usually moves in an orderly fashion from one lymph node to the next, while Non-Hodgkin can spread more unpredictably.

• Age of onset: Hodgkin is more common in young adults (ages 15–35) and older adults (over 55), while Non-Hodgkin can occur at any age but is most common in those over 60.

• Response to treatment: Many Hodgkin lymphomas have high cure rates, while outcomes for Non-Hodgkin depend on the subtype and stage.

Hodgkin Lymphoma Explained

Hodgkin lymphoma (HL) is a less common form of lymphoma but often more predictable and highly treatable. It begins in B lymphocytes and typically spreads in a linear pattern through connected lymph nodes.

Common Subtypes

There are two main categories of Hodgkin lymphoma:

1. Classical Hodgkin Lymphoma (CHL):
   This makes up about 95% of all HL cases. It includes several subtypes:

   • Nodular sclerosis CHL – most common, often found in young adults, especially women.

   • Mixed cellularity CHL – more frequent in older adults or people with HIV.

   • Lymphocyte-rich CHL – has a high number of normal lymphocytes and tends to have a good prognosis.

   • Lymphocyte-depleted CHL – the rarest and most aggressive subtype.

2. Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL):
   A rarer form that behaves more like Non-Hodgkin lymphoma. It develops slowly and often affects men under 40.

Symptoms

Typical signs of Hodgkin lymphoma include:

• Painless swelling in the lymph nodes (neck, armpits, or groin)

• Persistent fatigue

• Unexplained fever

• Night sweats

• Unintended weight loss

• Itching or rash

These are often referred to as “B symptoms” and can indicate more advanced disease.

Diagnosis

Diagnosis usually involves:

• Physical examination of swollen lymph nodes

• Blood tests to evaluate immune function

• Biopsy of lymph node tissue (to detect Reed-Sternberg cells)

• Imaging tests like PET or CT scans to determine disease spread

Doctors use these results to stage the lymphoma, ranging from Stage I (localized) to Stage IV (advanced spread).

Treatment

Treatment depends on the stage and subtype but may include:

• Chemotherapy: Often the ABVD regimen (Adriamycin, Bleomycin, Vinblastine, Dacarbazine)

• Radiation therapy: To target remaining cancer cells

• Immunotherapy: Such as checkpoint inhibitors (nivolumab, pembrolizumab)

• Stem cell transplant: In relapsed or resistant cases

Modern treatment can cure over 85% of early-stage Hodgkin lymphoma cases.

Non-Hodgkin Lymphoma Explained

Non-Hodgkin lymphoma (NHL) encompasses a broad group of cancers that develop from abnormal lymphocytes — either B cells (85%) or T cells (15%). Unlike Hodgkin lymphoma, NHL has more than 60 distinct subtypes, each with different growth rates, symptoms, and outcomes.

Classification

NHL is generally divided into two categories based on how fast it grows:

1. Indolent (Slow-Growing) NHL:

   • Example: Follicular lymphoma

   • May not need immediate treatment and can be monitored (“watch and wait”).

   • Often chronic but manageable for many years.

2. Aggressive (Fast-Growing) NHL:

   • Example: Diffuse large B-cell lymphoma (DLBCL)

   • Requires prompt treatment, usually with chemotherapy and immunotherapy.

   • Can be curable if detected early.

Common Subtypes

• Diffuse Large B-Cell Lymphoma (DLBCL): The most common and often aggressive.

• Follicular Lymphoma: Slow-growing, can transform into DLBCL over time.

• Mantle Cell Lymphoma: Rare and challenging to treat.

• Burkitt Lymphoma: Very fast-growing but highly responsive to chemotherapy.

• Peripheral T-Cell Lymphoma: A group of rare but aggressive T-cell cancers.

Symptoms

Non-Hodgkin lymphoma can present similar to Hodgkin but may also include:

• Swollen lymph nodes

• Abdominal pain or swelling

• Chest pain, coughing, or shortness of breath

• Persistent fatigue

• Night sweats and fever

• Rapid or unexplained weight loss

Because symptoms are vague, many patients are diagnosed at a later stage.

Diagnosis

Diagnosis involves:

• Lymph node biopsy

• Immunophenotyping to determine if cells are B-cell or T-cell derived

• Molecular testing for genetic mutations or chromosomal abnormalities

• Imaging (CT, MRI, PET scans)

• Bone marrow biopsy, especially for advanced cases

Treatment

Treatment options for NHL vary widely due to its diversity:

• Chemotherapy: Often CHOP regimen (Cyclophosphamide, Doxorubicin, Vincristine, Prednisone).

• Immunotherapy: Rituximab (Rituxan) targets CD20-positive B cells.

• Targeted therapy: Ibrutinib, zanubrutinib, or venetoclax for specific mutations.

• CAR T-cell therapy: Uses genetically modified immune cells to destroy lymphoma cells.

• Stem cell transplantation: For relapsed or high-risk cases.

• Radiation therapy: To control localized disease.

Stages and Progression

Both Hodgkin and Non-Hodgkin lymphomas are staged using the Ann Arbor system:

• Stage I: One lymph node region affected.

• Stage II: Two or more lymph node areas on one side of the diaphragm.

• Stage III: Lymph nodes on both sides of the diaphragm.

• Stage IV: Spread beyond lymph nodes to organs like bone marrow or liver.

Hodgkin typically spreads in a step-by-step manner, while Non-Hodgkin can skip regions or appear in distant organs early.

Causes and Risk Factors

Although exact causes remain unclear, certain factors raise the risk:

Hodgkin Lymphoma:

• Epstein-Barr virus (EBV) infection

• Family history

• Weakened immune system (e.g., HIV, transplant patients)

• Male gender

Non-Hodgkin Lymphoma:

• Age over 60

• Exposure to chemicals (pesticides, solvents)

• Chronic infections (e.g., H. pylori, Hepatitis C)

• Autoimmune diseases (e.g., rheumatoid arthritis)

• Long-term immunosuppressant use

Prognosis

The outlook for lymphoma depends on:

• Type and subtype

• Stage at diagnosis

• Age and overall health

• Response to initial treatment

Hodgkin lymphoma has one of the highest cure rates among cancers, with a 5-year survival rate over 85–90%.
Non-Hodgkin lymphoma survival varies — indolent types may last decades with management, while aggressive forms require intensive treatment.

Living with Lymphoma

Living with lymphoma involves both medical and emotional management. Patients often face fatigue, anxiety, and long-term side effects from therapy.
Healthy lifestyle choices can improve recovery and quality of life:

• Eat a balanced diet rich in fruits, vegetables, and lean proteins

• Exercise regularly to boost immunity

• Stay hydrated and rest adequately

• Join support groups for emotional resilience

• Follow regular check-ups to monitor remission or relapse

Many survivors go on to lead healthy, active lives after successful treatment.

Prevention and Early Detection

While there’s no guaranteed prevention, awareness and lifestyle management can reduce risks:

• Avoid exposure to toxic chemicals

• Manage chronic infections promptly

• Maintain a strong immune system

• Avoid smoking and excessive alcohol

• Get regular medical check-ups if you have family history or immune disorders

Early detection dramatically improves outcomes, especially for Hodgkin lymphoma.

When to See a Doctor

Consult a doctor if you experience:

• Persistent swollen lymph nodes lasting over two weeks

• Unexplained weight loss

• Recurrent fever or night sweats

• Constant fatigue

• Chest discomfort or shortness of breath

These signs don’t always mean cancer but warrant professional evaluation.

Advancements in Research

Research in lymphoma treatment has made remarkable progress:

• Immunotherapies like checkpoint inhibitors and CAR T-cell therapy show great promise.

• Genetic testing helps tailor targeted treatments to individual mutations.

• New drug combinations continue to improve survival and minimize side effects.

The future of lymphoma care is increasingly personalized, focusing on precision medicine and long-term remission.

Summary: Hodgkin vs. Non-Hodgkin

Final Thoughts

Understanding the differences between Hodgkin and Non-Hodgkin lymphoma is crucial for timely diagnosis and effective treatment.
While both are serious, advances in modern medicine mean that many patients survive and thrive after therapy. Awareness, early detection, and medical follow-up are your best tools for a healthy future.