Hodgkin vs. non-Hodgkin lymphoma

With a common origin, similar symptoms and a shared name, Hodgkin lymphoma and non-Hodgkin lymphoma are easy to confuse. Both cancers originate in the lymphatic system, the body's network of lymph nodes that dispatch white blood cells called B lymphocytes. These cells produce antibodies that help people fight off infections.

Patients with either type of cancer may experience extreme fatigue, weight loss, loss of appetite, fever, sweats and other common symptoms. And both are named for Dr. Thomas Hodgkin, the ground-breaking researcher who chronicled symptoms of the diseases. But there are important differences between the two.

Difference between Hodgkin and non-Hodgkin lymphoma

As part of the diagnostic process, the care team may perform a biopsy. During the biopsy, if the pathologist identifies a certain cell type called Reed-Sternberg cells, the patient will be diagnosed with Hodgkin lymphoma. If the pathologist does not identify Reed-Sternberg cells, the patient will be diagnosed with non-Hodgkin lymphoma (NHL).

Reed-Sternberg cells, named for the two scientists who first identified them under a microscope, are mutated B lymphocytes that are huge by cellular standards—up to five times larger than normal lymphocytes. One common variety of these cells has at least two nuclei that give them the appearance of an owl's eyes. Another variety is called a popcorn cell because of its lobular shape. The different shapes of Reed-Sternberg cells may help pathologists determine the specific type of Hodgkin lymphoma.

The main differences

Hodgkin, a British pathologist, first chronicled some of the symptoms of the disease in a landmark 1832 article detailing the postmortem examinations of several patients with enlarged lymph nodes and spleens. Thirty years later, another British physician, Dr. Samuel Wilks, learned of Hodgkin's work while conducting similar research. He named the condition Hodgkin's disease. The name of the disease has since lost the possessive and is called either Hodgkin disease or Hodgkin lymphoma. Decades after Hodgkin’s findings, researchers were better able to recognize that lymphomas could be categorized by two distinct types—Hodgkin and a similar but markedly different variety, non-Hodgkin. Each type of cancer has distinctive features.

Difference in age of diagnosis in Hodgkin vs. non-Hodgkin lymphoma

• Hodgkin lymphoma: The median age of patients diagnosed with the disease is 39.
• Non-Hodgkin lymphoma: The median age of patients diagnosed with this disease is 67.

Which is more common?

• Hodgkin lymphoma: This disease is rare, accounting for about 0.4 percent of all new cancers diagnosed. It’s estimated that about 8,540 patients will be diagnosed with Hodgkin lymphoma in 2022.
• Non-Hodgkin lymphoma: This is the seventh-most diagnosed cancer in the United States, accounting for an estimated 80,470 new cases in 2022.

Difference in survival rates in Hodgkin vs. non-Hodgkin lymphoma

Survival data regarding Hodgkin vs. non-Hodgkin lymphoma depends on each patient’s specific situation, but in general, the five-year relative survival rate for Hodgkin lymphoma is higher than that of non-Hodgkin lymphoma. One reason may be that non-Hodgkin lymphoma is often diagnosed when the cancer is more advanced.

• Hodgkin lymphoma: More than 89 percent of patients diagnosed with Hodgkin lymphoma survive five years or more.
• Non-Hodgkin lymphoma: Nearly 74 percent of patients diagnosed with non-Hodgkin lymphoma survive five years or more.

Difference in types of lymphoma

• Hodgkin lymphoma: There are four main types of Hodgkin lymphoma. The most common forms are nodular sclerosis and mixed cellularity, which together account for about 90 percent of all diagnoses.
• Non-Hodgkin lymphoma: There are more than 30 types of non-Hodgkin lymphoma, and even more subtypes. Diffuse large B-cell lymphoma (DLBCL) is the most common, accounting for about 30 percent of all cases.

Are there differences in treatment?

The care team will develop each patient’s cancer treatment plan depending on his or her specific diagnosis, lymphoma type, stage, and overall health, but there are some facts that may help patients navigate which potential treatment options to expect.

The most common Hodgkin lymphoma treatments are chemotherapy and radiation therapy, which may be used alone or together. Other treatments, such as immunotherapy or allogeneic-stem-cell-transplant, may also be recommended, depending on the patient’s unique diagnosis and needs.

Non-Hodgkin lymphoma treatment may also include chemotherapy, radiation therapy, immunotherapy and stem cell transplants. The care team may also suggest using targeted therapy medications or even surgery for non-Hodgkin lymphoma. One type of immunotherapy that has been approved within the last decade to treat non-Hodgkin lymphoma is CAR T-cell therapy. This allows doctors to remove a type of white blood cell called T-cells from the blood, then alter them genetically in a lab so they make receptors for specific cancer cells. The care team then puts those T-cells back into the patient’s body to destroy cancer cells.