Understanding the Difference Between Hodgkin's and Non-Hodgkin's Lymphoma

by Jane Ashley

Patients, family members, and friends may have a difficult time understanding the differences between Hodgkin’s Lymphoma and Non-Hodgkin’s Lymphoma. To understand the differences between the two diseases, perhaps we should first begin by learning a little about lymphoma.

Sir Thomas Hodgkin

What is Lymphoma?

Lymphoma is a type of cancer that affects the lymphatic system of our bodies — our lymph nodes, bone marrow, tonsils, adenoids, spleen and thymus gland. Lymphoma can affect any of these parts of our lymphatic system.

The lymphatic system carries lymph fluid containing white blood cells throughout our body to fight infections. Our spleen acts as a filter for our blood and helps fight infection. When our spleen detects a potentially dangerous bacteria or virus in our blood, the spleen and lymph nodes produce white blood cells called lymphocytes to fight the infection. Lymphocytes produce antibodies to kill dangerous micro-organisms and stop the spread of infection.

Lymphomas make up about half of all of the blood cancers diagnosed each year. When abnormal lymphocytes develop into cancerous cells, they damage our immune system.

What causes lymphoma to develop is unknown, but a person is more likely to develop lymphoma because of these factors.
• Being older
• Male
• Caucasian
• Having an autoimmune disease
• Having HIV/AIDS
• Having the Epstein-Bar virus, known for causing mononucleosis
• Diet high in fats and meat
• Exposure to certain pesticides

Symptoms include:
• Chest pain or difficulty breathing
• Fatigue, lack of energy
• Fever
• Itchy skin
• Rash
• Sweating
• Swollen lymph nodes
• Weight loss

There are two types of lymphoma — Hodgkin’s and non-Hodgkin’s.

What is Hodgkin’s Lymphoma?

Lymphatic System

About 12 percent of lymphomas are the Hodgkin’s type. Hodgkin’s Lymphoma was once almost universally incurable, but advanced research has turned this kind of lymphoma into a curable disease.

As might be expected, Hodgkin’s Lymphoma is named after Sir Thomas Hodgkin’s, a British physician. In 1832, Sir Thomas Hodgkin’s recounted to his colleagues about some of his patients who had swollen lymph nodes and enlarged spleens that was unlike any other known disease of that period.

In the early 1880’s, U.S. and German pathologists, independent of each other, wrote the microscopic diagnostic characteristics of the same disease that Sir Thomas Hodgkin’s had described. During that same time frame, two physicians used newly discovered X-ray beams on the enlarged lymph nodes of Hodgkin’s lymphoma patients and reported a substantial reduction in the size of their lymph nodes.

Types of Hodgkin’s Lymphoma

Classical Hodgkin’s Lymphoma (cHL). Approximately 95 percent of patients fall into the cHL category. The diagnostic criteria for cHL is the presence of a particular abnormal lymphocyte called a Reed-Sternberg cell. Then there are subsets:

Nodular sclerosis Hodgkin’s lymphoma. This is the most common sub-type of cHL, accounting for about 80 percent of those diagnosed with cHL and is most common in young adults and women. Besides the Reed-Sternberg cells, there are also band of fibroid tissue in the lymph nodes. The presence of these bands is diagnostic.
Lymphocyte-rich classical Hodgkin’s lymphoma. Only 6 percent of cHL patients fall into this subset, with more male patients. Patients have the Reed-Sternberg cells along with normal with numerous normal lymphocytes in the lymph nodes.
Uncommon subsets. Less than 15 percent of cHL patients are diagnosed with mixed cellularity Hodgkin’s lymphoma (older patients) and lymphocyte-depleted Hodgkin’s lymphoma (seen in older patients and those with HIV and AIDS).

Nodular lymphocyte-predominant Hodgkin’s lymphoma. Only 5 percent of Hodgkin’s Lymphoma patients have this type. It is more common in younger adults and is similar to one type of non-Hodgkin’s lymphoma.

Hodgkin’s Lymphoma will be diagnosed in about 8,110 people in the U.S. this year. Death rates have been steadily declining with about 1,000 deaths estimated for 2019.

Treatments may include chemotherapy, radiation and immunotherapy. Patients who don’t respond to treatment or whose cHL recurs may have a stem cell or bone marrow transplant.

What is Non-Hodgkin’s Lymphoma?

Reed Sternberg Cell

Non-Hodgkin’s Lymphoma covers the broad range of cancers that occur in our lymphatic system. The lymphatic system contains different types of lymphocytes:

B-lymphocytes. B cells make antibodies that kill bacteria and fight other infections. • T-lymphocytes. T cells fight viruses and foreign cells along with triggering B cell to make antibodies. • Natural killer cells (NK cells). These specialized cells kill certain viruses, cells infected by viruses and some cancer cells.

Non-Hodgkin’s lymphoma is diagnosed when these healthy B, T and NK cells change and grow out of control forming tumors. These tumors may cause additional symptoms depending on where the tumor is located.
An abdominal tumor may cause stretched skin over the belly or belly or back pain.
• An enlarged spleen can cause a feeling of fullness or back pain.
• A tumor in the groin can cause leg swelling.
• A tumor in your underarm area may cause swelling in your arm.
• A tumor in the center of your chest may press against your trachea, causing a cough.
• A tumor in your brain may mimic a stroke.

Almost 75,000 people in the U.S. will be diagnosed with NHL in 2019. NHL is the 9th most common cause of cancer death in the U.S.

Types of Non-Hodgkin’s Lymphoma

Treatment depends on what type of non-Hodgkin’s lymphoma a patient has. There are over 60 subtypes of non-Hodgkin’s lymphoma (NHL).
Ninety percent of patients in western countries have the B-cell type.
• Ten percent have the T-cell type — most of these are in Asian countries.
• Less than 1 percent have NK-cell type.

NHL is also divided into two categories, by rate of growth.
Indolent NHL grows slowly and may not be treated when it is first diagnosed.
• Aggressive NHL develops quickly, and treatment begins within weeks.

The two most common subtypes of B cell NHL are diffuse large B-cell lymphoma (DLBCL) and Follicular lymphoma. These two subtypes account for about half of all NHL. The remaining subtypes each account for less than 5 percent each, with most of the other subtypes considered rare.

Treatments for NHL include chemotherapy, radiation, targeted therapy and immunotherapy. Treatment choices depend on stage and type.

What are the Differences?

These two kinds of cancer surely sound similar. Although they share the lymphatic system as the site of cancer activity, they have many differences. What are the major differences?

• Hodgkin’s lymphoma’s hallmark difference is the presence of Reed-Sternberg cells (B cells that turn malignant, grow very large and may have more than one nucleus).
• The first symptom of Hodgkin’s lymphoma is enlarged lymph nodes. The swollen lymph nodes are usually in the neck, under the arms and the chest (the upper body).
• Non-Hodgkin’s lymphoma can develop from B or T cells and begin in other parts of the body, like the spleen, thymus gland tonsils or adenoids or in normal organs.
• Hodgkin’s lymphoma is seen most often in young adults, 15 to 24, and in people of 60 while non-Hodgkin’s lymphoma occurs in all age groups. The median age for NHL is 60.
• Both kinds of lymphoma can occur in children and teenagers.
• Non-Hodgkin’s lymphoma is much more common.
• Hodgkin’s lymphoma is often diagnosed at an earlier stage when it is easier to treat.

These two types of cancer are similar in that they both occur in the lymphatic system. However, they have distinct disease progressions with different treatments. An accurate diagnosis is the first step in successful treatment.

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