©2018 WebMD, Inc. All rights reserved. eMedicineHealth does not provide medical advice, diagnosis or treatment. See Additional Information.

Lymphoma Cancer: Hodgkin’s vs. Non-Hodgkin’s

Lymphoma Cancer Hodgkins vs Non-Hodgkin’s Related Articles

What's the Difference Between Hodgkin's and Non-Hodgkin's Lymphoma?

  • Both adult Hodgkin lymphoma and Non-Hodgkin lymphoma are types of cancer that develop in the lymphatic system, part of the body's immune system.
  • The difference between Hodgkin lymphoma and Non-Hodgkin lymphoma is that the cancer develops in different lymphocytes. If a specific type of abnormal cell called a Reed-Sternberg cell is detected, the lymphoma is classified as Hodgkin's. Non-Hodgkin lymphoma can begin in B lymphocytes (also called B cells), T lymphocytes, or natural killer cells.
  • Signs of Hodgkin lymphoma and Non-Hodgkin lymphoma are similar and include swelling in the lymph nodes in the neck, underarm, groin, or stomach; fever for no known reason, night sweats, weight loss for no known reason, itchy skin, and feeling very tired.
  • Additional symptoms of Non-Hodgkin lymphoma that are different from Hodgkin lymphoma may include skin rash or pain in the chest, abdomen, or bones for no known reason.
  • Risk factors for Hodgkin lymphoma include being in young or late adulthood, being male, being infected with the Epstein-Barr virus, and having a first-degree relative with Hodgkin lymphoma.
  • Risk factors for Non-Hodgkin lymphoma include being older, male, or white; having an inherited immune disorder, an autoimmune disease, HIV/AIDS, human T-lymphotrophic virus type I or Epstein-Barr virus infection, or Helicobacter pylori infection; and taking immunosuppressant drugs after an organ transplant.
  • Treatment for Hodgkin lymphoma includes chemotherapy, radiation therapy, and surgery.
  • Treatment for Non-Hodgkin lymphoma includes radiation therapy, chemotherapy, immunotherapy, targeted therapy, plasmapheresis, antibiotic therapy, surgery, stem cell transplant, and watchful waiting.
  • The prognosis and survival rate for Hodgkin lymphoma depends on the patient's signs and symptoms, the stage of the cancer, the type of Hodgkin lymphoma, blood test results, whether the cancer is recurrent or progressive, and the patient's age, gender, and general health.
  • The prognosis for Non-Hodgkin lymphoma depends on the stage of the cancer, the type of non-Hodgkin lymphoma, the amount of lactate dehydrogenase (LDH) in the blood, whether there are certain changes in the genes, the patient's age and general health, and whether the lymphoma has just been diagnosed or has recurred (come back).

What Is Hodgkin’s Lymphoma?

Adult Hodgkin lymphoma is a type of cancer that develops in the lymph system, part of the body's immune system. The immune system protects the body from foreign substances, infection, and diseases. The lymph system is made up of the following:

  • Lymph: Colorless, watery fluid that carries white blood cells called lymphocytes through the lymph system. Lymphocytes protect the body against infections and the growth of tumors.
  • Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
  • Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the neck, underarm, abdomen, pelvis, and groin.
  • Spleen: An organ that makes lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach.
  • Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.
  • Tonsils: Two small masses of lymph tissue at the back of the throat. The tonsils make lymphocytes.
  • Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow makes white blood cells, red blood cells, and platelets.

Lymph tissue is also found in other parts of the body such as the stomach, thyroid gland, brain, and skin. Cancer can spread to the liver and lungs.

Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin lymphoma. This summary is about the treatment of adult Hodgkin lymphoma.

Hodgkin lymphoma can occur in both adults and children. Treatment for adults is different than treatment for children. Hodgkin lymphoma may also occur in patients who have acquired immunodeficiency syndrome (AIDS); these patients require special treatment.

Hodgkin lymphoma in pregnant women is the same as the disease in nonpregnant women of childbearing age. However, treatment is different for pregnant women. This summary includes information about treating Hodgkin lymphoma during pregnancy.

Most Hodgkin lymphomas are the classical type. The classical type is broken down into the following four subtypes:

  • Nodular sclerosing Hodgkin lymphoma.
  • Mixed cellularity Hodgkin lymphoma.
  • Lymphocyte depletion Hodgkin lymphoma.
  • Lymphocyte-rich classical Hodgkin lymphoma.

What Is Non-Hodgkin’s Lymphoma?

Non-Hodgkin lymphoma is a type of cancer that forms in the lymph system, which is part of the body's immune system. The immune system protects the body from foreign substances, infection, and diseases. The lymph system is made up of the following:

Non-Hodgkin lymphoma can begin in B lymphocytes, T lymphocytes, or natural killer cells. Lymphocytes can also be found in the blood and also collect in the lymph nodes, spleen, and thymus.

  • Lymph: Colorless, watery fluid that carries white blood cells called lymphocytes through the lymph system. Lymphocytes protect the body against infection and the growth of tumors. There are three types of lymphocytes:
    • B lymphocytes that make antibodies to help fight infection. Also called B cells. Most types of non-Hodgkin lymphoma begin in B lymphocytes.
    • T lymphocytes that help B lymphocytes make the antibodies that help fight infection. Also called T cells.
    • Natural killer cells that attack cancer cells and viruses. Also called NK cells.
  • Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
  • Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the neck, underarm, abdomen, pelvis, and groin.
  • Spleen: An organ that makes lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is on the left side of the abdomen near the stomach.
  • Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.
  • Tonsils: Two small masses of lymph tissue at the back of the throat. The tonsils make lymphocytes.
  • Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow makes white blood cells, red blood cells, and platelets.

Lymph tissue is also found in other parts of the body such as the stomach, thyroid gland, brain, and skin. Cancer can spread to the liver and lungs.

Non-Hodgkin lymphoma during pregnancy is rare. Non-Hodgkin lymphoma in pregnant women is the same as the disease in nonpregnant women of childbearing age.

However, treatment is different for pregnant women. This summary includes information on the treatment of non-Hodgkin lymphoma during pregnancy.

Non-Hodgkin lymphoma can occur in both adults and children. Treatment for adults is different than treatment for children.

What Are the Symptoms of Hodgkin’s vs. Non-Hodgkin’s Lymphoma?

Hodgkin’s Lymphoma

These and other signs and symptoms may be caused by adult Hodgkin lymphoma or by other conditions. Check with your doctor if any of the following do not go away:

  • Painless, swollen lymph nodes in the neck, underarm, or groin.
  • Fever for no known reason.
  • Drenching night sweats.
  • Weight loss for no known reason.
  • Itchy skin.
  • Feeling very tired.

The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's past illnesses and treatments will also be taken.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the sample made up of red blood cells.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
  • Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube. The sedimentation rate is a measure of how much inflammation is in the body. A higher than normal sedimentation rate may be a sign of lymphoma or another condition. Also called erythrocyte sedimentation rate, sed rate, or ESR.
  • Lymph node biopsy: The removal of all or part of a lymph node. One of the following types of biopsies may be done:
    • Excisional biopsy: The removal of an entire lymph node.
    • Incisional biopsy: The removal of part of a lymph node.
    • Core biopsy: The removal of part of a lymph node using a wide needle.

A pathologist views the tissue under a microscope to look for cancer cells, especially Reed-Sternberg cells. Reed-Sternberg cells are common in classical Hodgkin lymphoma.

The following test may be done on tissue that was removed:

  • Immunophenotyping: A laboratory test used to identify cells, based on the types of antigens or markers on the surface of the cell. This test is used to diagnose the specific type of lymphoma by comparing the cancer cells to normal cells of the immune system.

Non-Hodgkin’s Lymphoma

These signs and symptoms may be caused by adult non-Hodgkin lymphoma or by other conditions. Check with your doctor if you have any of the following:

  • Swelling in the lymph nodes in the neck, underarm, groin, or stomach.
  • Fever for no known reason.
  • Recurring night sweats.
  • Feeling very tired.
  • Weight loss for no known reason.
  • Skin rash or itchy skin.
  • Pain in the chest, abdomen, or bones for no known reason.

When fever, night sweats, and weight loss occur together, this group of symptoms is called B symptoms.

Other signs and symptoms of adult non-Hodgkin lymphoma may occur and depend on the following:

  • Where the cancer forms in the body.
  • The size of the tumor.
  • How fast the tumor grows.

What Causes Hodgkin’s vs. Non-Hodgkin’s Lymphoma?

Hodgkin’s Lymphoma

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for adult Hodgkin lymphoma include the following:

  • Being in young or late adulthood.
  • Being male.
  • Being infected with the Epstein-Barr virus.
  • Having a first-degree relative (parent, brother, or sister) with Hodgkin lymphoma.

Pregnancy is not a risk factor for Hodgkin lymphoma.

Non-Hodgkin’s Lymphoma

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

These and other risk factors may increase the risk of certain types of adult non-Hodgkin lymphoma:

  • Being older, male, or white.
  • Having one of the following medical conditions:
    • An inherited immune disorder (such as hypogammaglobulinemia or Wiskott-Aldrich syndrome).
    • An autoimmune disease (such as rheumatoid arthritis, psoriasis, or Sjögren syndrome).
    • HIV/AIDS.
    • Human T-lymphotrophic virus type I or Epstein-Barr virus infection.
    • Helicobacter pylori infection.
  • Taking immunosuppressant drugs after an organ transplant.

What Is the Treatment for Hodgkin’s vs. Non-Hodgkin’s Lymphoma?

Hodgkin’s Lymphoma

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Combination chemotherapy is treatment with more than one anticancer drug.

When a pregnant woman is treated with chemotherapy for Hodgkin lymphoma, it isn't possible to protect the fetus from being exposed to the chemotherapy. Some chemotherapy regimens may cause birth defects if given in the first trimester. Vinblastine is an anticancer drug that has not been linked with birth defects when given in the second half of pregnancy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

  • External radiation therapy uses a machine outside the body to send radiation toward the cancer.
  • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat adult Hodgkin lymphoma. For a pregnant woman with Hodgkin lymphoma, radiation therapy should be postponed until after delivery, if possible, to avoid any risk to the fetus. If immediate treatment is needed, the woman may decide to continue the pregnancy and receive radiation therapy. However, lead used to shield the fetus may not protect it from scattered radiation that could possibly cause cancer in the future.

Surgery

Laparotomy is a procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease. If cancer is found, the tissue or organ is removed during the laparotomy.

Non-Hodgkin’s Lymphoma

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

  • External radiation therapy uses a machine outside the body to send radiation toward the cancer.
  • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Total-body irradiation is a type of external radiation therapy that is given to the entire body. It may be given before a stem cell transplant.
The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat adult non-Hodgkin lymphoma, and may also be used as palliative therapy to relieve symptoms and improve quality of life.

For pregnant women with non-Hodgkin lymphoma, radiation therapy should be given after delivery, if possible, to avoid any risk to the baby. If treatment is needed right away, pregnant women may decide to continue the pregnancy and receive radiation therapy. However, lead used to shield the baby may not protect it from scattered radiation that could possibly cause cancer in the future.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using two or more anticancer drugs. Steroid drugs may be added, to lessen inflammation and lower the body's immune response.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Intrathecal chemotherapy may also be used in the treatment of lymphoma that first forms in the testicles or sinuses (hollow areas) around the nose, diffuse large B-cell lymphoma, Burkitt lymphoma, lymphoblastic lymphoma, and some aggressive T-cell lymphomas. It is given to lessen the chance that lymphoma cells will spread to the brain and spinal cord. This is called CNS prophylaxis.

In pregnant women, the baby is exposed to chemotherapy when the mother is treated, and some anticancer drugs cause birth defects. Because anticancer drugs are passed to the baby through the mother, both must be watched closely when chemotherapy is given.

Immunotherapy

Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.

Immunomodulators are a type of immunotherapy. Lenalidomide is an immunomodulator used to treat adult non-Hodgkin lymphoma.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy, proteasome inhibitor therapy, and kinase inhibitor therapy are types of targeted therapy used to treat adult non-Hodgkin lymphoma.

Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Rituximab is a monoclonal antibody used to treat many types of non-Hodgkin lymphoma. Monoclonal antibodies that have been joined to radioactive material are called radiolabeled monoclonal antibodies. Yttrium Y 90-ibritumomab tiuxetan is an example of a radiolabeled monoclonal antibody. Monoclonal antibodies are given by infusion.

Proteasome inhibitor therapy blocks the action of proteasomes in cancer cells and may prevent the growth of tumors.

Kinase inhibitor therapy, such as idelalisib, blocks certain proteins, which may help keep lymphoma cells from growing and may kill them. It is used to treat indolent lymphoma. Ibrutinib, a type of Bruton's tyrosine kinase inhibitor therapy, is used to treat lymphoplasmacytic lymphoma and mantle cell lymphoma.

Plasmapheresis

If the blood becomes thick with extra antibody proteins and affects circulation, plasmapheresis is done to remove extra plasma and antibody proteins from the blood. In this procedure, blood is removed from the patient and sent through a machine that separates the plasma (the liquid part of the blood) from the blood cells. The patient's plasma contains the unneeded antibodies and is not returned to the patient. The normal blood cells are returned to the bloodstream along with donated plasma or a plasma replacement. Plasmapheresis does not keep new antibodies from forming.

Watchful waiting

Watchful waiting is closely monitoring a patient's condition without giving any treatment until signs or symptoms appear or change.

Antibiotic therapy

Antibiotic therapy is a treatment that uses drugs to treat infections and cancer caused by bacteria and other microorganisms.

Surgery

Surgery may be used to remove the lymphoma in certain patients with indolent or aggressive non-Hodgkin lymphoma.

The type of surgery used depends on where the lymphoma formed in the body:

  • Local excision for certain patients with mucosa-associated lymphoid tissue (MALT) lymphoma, PTLD, and small bowel T-cell lymphoma.
  • Splenectomy for patients with marginal zone lymphoma of the spleen.

Patients who have a heart, lung, liver, kidney, or pancreas transplant usually need to take drugs to suppress their immune system for the rest of their lives. Long-term immunosuppression after an organ transplant can cause a certain type of non-Hodgkin lymphoma called post-transplant lymphoproliferative disorder (PLTD).

Small bowel surgery is often needed to diagnose celiac disease in adults who develop a type of T-cell lymphoma.

Stem cell transplant

Stem cell transplant is a method of giving high doses of chemotherapy and/or total-body irradiation and then replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient (autologous transplant) or a donor (allogeneic transplant) and are frozen and stored. After the chemotherapy and/or radiation therapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

What is the Prognosis for Hodgkin’s vs. Non-Hodgkin’s Lymphoma?

Hodgkin’s Lymphoma

The prognosis (chance of recovery) and treatment options depend on the following:

  • The patient's signs and symptoms.
  • The stage of the cancer.
  • The type of Hodgkin lymphoma.
  • Blood test results.
  • The patient's age, gender, and general health.
  • Whether the cancer is recurrent or progressive.

For Hodgkin lymphoma during pregnancy, treatment options also depend on:

  • The wishes of the patient.
  • The age of the fetus.

Adult Hodgkin lymphoma can usually be cured if found and treated early.

Non-Hodgkin’s Lymphoma

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer.
  • The type of non-Hodgkin lymphoma.
  • The amount of lactate dehydrogenase (LDH) in the blood.
  • Whether there are certain changes in the genes.
  • The patient's age and general health.
  • Whether the lymphoma has just been diagnosed or has recurred (come back).

For non-Hodgkin lymphoma during pregnancy, the treatment options also depend on:

  • The wishes of the patient.
  • Which trimester of pregnancy the patient is in.
  • Whether the baby can be delivered early.

Some types of non-Hodgkin lymphoma spread more quickly than others do. Most non-Hodgkin lymphomas that occur during pregnancy are aggressive. Delaying treatment of aggressive lymphoma until after the baby is born may lessen the mother's chance of survival. Immediate treatment is often recommended, even during pregnancy.

Health Solutions From Our Sponsors

Reviewed on 3/23/2018
Sources: References
CONTINUE SCROLLING FOR RELATED ARTICLE