Hodgkin vs Non-Hodgkin Lymphoma: What's the Difference?

Lymphoma is cancer that starts in the lymphatic system. This is the network of lymph nodes and vessels that is part of your immune system. It develops when white blood cells called lymphocytes grow out of control. Doctors group lymphoma into two main families. These are Hodgkin lymphoma and non-Hodgkin lymphoma.

The key difference shows up under the microscope. Hodgkin lymphoma contains a specific abnormal cell. Doctors call it the Reed-Sternberg cell. This is a large cell, sometimes with more than one nucleus. It does not appear in non-Hodgkin lymphoma. A biopsy of an affected lymph node is how pathologists make this call. That means removing a sample and examining it under a microscope. Doctors also run blood tests and imaging, such as PET-CT or MRI. They may test for hepatitis and HIV too, since these can affect treatment choices.

Both types can cause similar symptoms. The most common is a painless, swollen lymph node in the neck, underarm, or groin. Other symptoms include fever with no clear cause, drenching night sweats, and weight loss you cannot explain. Itchy skin, especially after a bath or a drink of alcohol, is another possible sign. So is ongoing fatigue. These symptoms have many other causes too. But if any of them last, tell your doctor.

Hodgkin lymphoma is the less common of the two. Doctors stage it from I to IV. Stage I means cancer in one group of lymph nodes. Stage II means two or more groups, on the same side of the diaphragm. The diaphragm is the muscle that separates the chest from the belly. Stage III means groups above and below the diaphragm, or in the spleen. Stage IV means the cancer has reached organs outside the lymph system, such as the liver, bone marrow, lungs, or the fluid around the brain and spinal cord. Doctors also weigh other factors. These include tumor size, blood counts, and symptoms like fever, night sweats, or weight loss. Together, these sort cases into early favorable, early unfavorable, or advanced groups.

Treatment is combination chemotherapy, with or without radiation aimed at the areas of the body with cancer. For lymphoma that does not respond, or comes back, more options exist. These include the targeted antibody drug brentuximab vedotin, and immunotherapy drugs such as nivolumab or pembrolizumab. Stem cell transplant is another option for harder cases. Hodgkin lymphoma can usually be cured when it is found and treated early. Even so, outcomes still depend on the individual case.

Non-Hodgkin lymphoma, or NHL, is much more common. It is really a large group of related diseases, not one illness. It has many subtypes, and they behave differently from each other. Some subtypes grow slowly. Doctors call these indolent, and may watch them closely before starting treatment. Others grow fast and need prompt treatment. Doctors call these aggressive. As a group, NHL is less predictable than Hodgkin lymphoma. It can appear in lymph nodes or in other organs.

There are many NHL subtypes, and they behave differently. So getting an accurate diagnosis is essential before choosing treatment. That means confirming the exact subtype, not just "lymphoma." Options can include chemotherapy, immunotherapy, targeted therapy, and radiation. For some slow-growing types, careful monitoring instead of immediate treatment is an option too. Two people with lymphoma in the same lymph node group can face very different plans. That is because their subtypes differ.

Ask which type and subtype of lymphoma you have. Ask whether it is Hodgkin or non-Hodgkin. Ask what stage it is, and whether it falls into a favorable or higher-risk group. Ask whether it behaves as slow-growing or fast-growing, since that changes the urgency of treatment. Ask what your specific treatment plan aims to do. Ask whether monitoring instead of immediate treatment is ever appropriate for your case.

• NCI — Adult Hodgkin Lymphoma Treatment (PDQ®) Patient Version
• NCI — Adult Hodgkin Lymphoma Treatment (PDQ®) Health Professional Version
• NCI — Lymphoma