Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) are the two main types of lymphoma, which is a type of blood cancer. HL and NHL are known as lymphoproliferative disorders. In a lymphoproliferative disorder, there is uncontrolled production of a type of white blood cell called a lymphocyte.
NHL and HL have many similarities, but the presence of specialized immune cells called Reed-Sternberg cells (which a doctor can view from a biopsy under a microscope) is primarily what differentiates HL from NHL. Besides the type of cancer cell affected, there are a few other differences, including age at diagnosis, pattern of spread, and how common and treatable each type of lymphoma is. In extremely rare cases, people can have HL and NHL at the same time.
NHL is the most common type of blood cancer in the world. According to the American Cancer Society, about 81,500 people (about 45,500 men and 36,000 women) in the United States will be diagnosed with NHL each year. The risk of developing NHL is slightly higher for men (1 in 41) than women (1 in 52). NHL is more common in white people than in Black people.
HL is much less common, accounting for about 15 percent of all lymphomas. For HL, about 8,500 new cases are estimated yearly, including about 4,500 men and 4,000 women, according to the American Cancer Society.
HL and NHL can occur at any age. However, most people diagnosed with NHL are over the age of 65. HL is usually diagnosed in teens and young adults ages 15 to 39 years.
HL and NHL used to be considered essentially incurable. However, improvements to standardized treatment have led to a better prognosis (disease outlook). More than 80 percent of people diagnosed with HL and 63 percent to 82 percent of people diagnosed with NHL are disease-free at least five years after diagnosis and treatment.
Both major types of lymphoma are similar in their risk factors, symptoms, diagnostic process, and treatment options.
There are several risk factors for lymphoma, including family history, genetics, exposure to viruses, and environmental factors.
A family history of lymphomas and heritable disorders of the immune system increases a person’s risk of developing HL and NHL. HL and NHL tumors create an environment that works to suppress the immune system. This suppression allows the abnormal cells to hide and grow instead of being destroyed by the immune system.
Viral infection may also play a role. Epstein-Barr virus infection increases the risk of developing HL or NHL. HIV infection with a large amount of viral particles increases the risk of developing NHL, but not HL. Some types of infections and exposure to radiation or certain environmental chemicals are also risk factors for developing NHL, but they have not been studied or are not considered risk factors for HL. For example, infection by human T-lymphotropic virus type 1 and human herpesvirus-8 are associated with lymphoma development. Exposures to certain chemicals (such as some pesticides) can also increase the risk of developing NHL.
Both HL and NHL have symptoms similar to other types of lymphomas. These symptoms may include:
Some people living with NHL or HL have fever, drenching night sweats, and unintentional weight loss, a combination known as “B symptoms.”
General symptoms of HL can also include loss of appetite and itchy skin.
The most common symptom of HL and NHL is enlarged lymph nodes. The location of enlarged lymph nodes may cause other symptoms to develop. For example, enlargement of certain lymph nodes in the body may cause a swollen abdomen, chest pain or chest pressure, shortness of breath, or persistent cough.
The diagnostic procedure for HL and NHL is the same. Diagnosis begins with taking a family and personal medical history and performing a thorough physical exam. Blood tests may be used to determine whether symptoms, such as swelling of lymph nodes, are caused by an infection or another problem. If HL or NHL is suspected, the affected lymph node will be biopsied and used to diagnose HL or NHL. The presence of Reed-Sternberg cells indicates HL, and their absence indicates NHL.
There are several subtypes within HL and over 60 subtypes of NHL. Oncologists may use other tests, such as imaging tests, X-rays, biopsies, lab tests, blood tests, and tests of heart and lung function, to diagnose specific types of HL or NHL.
Treatment options are also similar. Several types of immune therapies, such as immune checkpoint inhibitors, monoclonal antibodies, and chimeric antigen receptor-modified T cells, may be used to treat HL and NHL. Small molecule inhibitors and some antibody therapies have been used specifically to treat relapsed (returned) HL and NHL. Many types of chemotherapy may be followed by stem cell transplantation, which replaces damaged stem cells with healthy stem cells and generally improves outcomes of cancer treatment. For some people, trying new treatments in clinical trials can be helpful.
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