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What is the difference between Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL)? What difference does it make for my treatment and prognosis?

Making Sense of Lymphoma

Lymphoma: Overview

Lymphoma, the most common hematologic malignancy, is a cancer of the lymphatic system, which includes the lymph nodes, spleen, thymus gland and bone marrow. It is a cancer that affects the lymphocytes, a type of white blood cell, that travel through the blood and lymphatic system (the part of the body that defends against bacteria and viruses). With lymphoma, a mutation occurs within the lymphocyte, causing abnormal cells to replicate at a faster pace compared with normal cells.

Signs and symptoms may include painless swelling of the lymph nodes in the neck, armpits or groin; persistent fatigue; fever; night sweats; chills; shortness of breath; unexplained weight loss; or itchy skin.

Lymphoma: Types of Disease

The main subtypes of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma. The main difference between the two subtypes is the type of lymphocyte that is affected.

Hodgkin lymphoma is marked by the presence of Reed-Sternberg cells, whereas non-Hodgkin lymphoma does not have these cells present. According to the Leukemia and Lymphoma Society, Hodgkin lymphoma is one of the most curable cancers; however, non-Hodgkin lymphoma is more common than non-Hodgkin lymphoma. Moreover, Hodgkin lymphoma occurs more often in patients over the age of 55, compared with a median age of 39 in those with Hodgkin lymphoma, according to the Moffitt Cancer Center.

The types of Hodgkin lymphoma include classic Hodgkin lymphoma, comprised of nodular sclerosis Hodgkin lymphoma, mixed cellularity Hodgkin lymphoma, lymphocyte-rich Hodgkin lymphoma or lymphocyte-depleted Hodgkin lymphoma. Non-Hodgkin lymphoma is comprised of B-cell (diffuse large B-cell lymphoma [DLBCL], follicular lymphoma, chronic lymphocytic leukemia [CLL]/small lymphocytic lymphoma [SLL], Mantle cell lymphoma [MCL], marginal zone lymphoma, Burkitt lymphoma, Waldenstrom macroglobulinemia, primary central nervous system [CNS] lymphoma and primary intraocular lymphoma) and T-cell (T-lymphoblastic lymphoma/leukemia and peripheral T-cell lymphomas) disease.

Lymphoma: Diagnosis

Lymphoma can be diagnosed through a physical exam (checking for swollen lymph nodes), biopsy of a lymph node, blood tests, removing a sample of bone marrow for testing or imaging tests. In particular, a biopsy sample evaluated by a pathologist can improve diagnosis and the type of lymphoma a patient has.

Staging is different in children, versus adults:

Stage 1: there is lymphoma in only one group of lymph nodes, one organ outside the lymphatic system, one bone or the spleen.

Stage 2: there is lymphoma in two or more lymph nodes on the same side of the diaphragm, one extranodal body organ and a nearby group of lymph nodes or the gut.

Stage 3: there is lymphoma in two or more extranodal body organs, lymph nodes above and below the diaphragm, the chest, the gut, around the spinal cord or one bone plus an extranodal body organ or distant lymph nodes.

Stage 4: there is lymphoma in the central nervous system or the bone marrow.

Stage 1: there is lymphoma in only one group of lymph nodes.

Stage 1E: the lymphoma started in a single body organ outside the lymphatic system and is only in that organ.

Stage 2: there is lymphoma in two or more groups of lymph nodes.

Stage 2E: the lymphoma started in one body organ and is also in one or more groups of lymph nodes.

Stage 3: there are lymph nodes that contain lymphoma on both sides of the diaphragm.

Stage 4: the lymphoma started in the lymph nodes and has spread to at least one body organ outside the lymphatic system.

Lymphoma: Living with Cancer

A lymphoma diagnosis comes with a new normal that many patients and their loved ones have to adjust to.

Some individuals may be on treatment long-term and its side effects, while others may be free of disease, but deal with the fear of its return.

Therefore, follow-up care is key to address relapse, recurrence or to assist with side effects from the disease or its treatments.

Lymphoma: Treatment

Treatment for lymphomas depends on the type, how quickly it is growing, size of the lumps, parts of the body affected and symptoms experienced. Moreover, age, overall health and comorbidities may also determine the type of treatment administered.

Some therapies aim to get rid of the lymphoma completely, to control the lymphoma, or some patients do not need treatment initially.

Treatment for lymphomas may include active monitoring, chemotherapy, radiation, targeted therapies, antibody therapy, steroids, stem cell transplant, chimeric antigen receptor (CAR)-T cell therapy, splenectomy, blood transfusions, growth factors, Immunoglobulin replacement therapy and maintenance therapy.

Lymphoma | Tumor

Making Sense of Lymphoma

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