Hodgkin or Non-Hodgkin Lymphoma: How Can I Tell The Difference?

Lymphoma is a type of cancer that begins in the lymphatic system, a network of lymph nodes and vessels that plays a critical role in defending the body’s immunity . When someone is diagnosed with lymphoma, they will learn whether they have Hodgkin vs. Non-Hodgkin Lymphoma, which is important as the two conditions behave differently and may require different approaches to diagnosis and treatment.

At the National Cancer Centre Singapore (NCCS), patients with both Hodgkin and non-Hodgkin lymphoma are cared for by multidisciplinary teams who assess the specific type and stage of the disease. Understanding the type of lymphoma one has been diagnosed with helps patients and their families better recognise symptoms, understand how treatment works, and prepare for daily life during the treatment journey.

Although both diseases originate in white blood cells called lymphocytes, they differ in how the disease develops, spreads, and responds to treatment.

Key Takeaways

• Hodgkin lymphoma and non-Hodgkin lymphoma both begin in the lymphatic system but differ in their cellular characteristics and patterns of spread. 
• Hodgkin lymphoma, which is less common, is typically identified by the presence of Reed Sternberg cells, which are abnormal cells visible under a microscope. 
• Non-Hodgkin lymphoma represents a broader group of many lymphoma subtypes with varying growth patterns and treatment approaches. 
• Symptoms may appear similar in both conditions, including swollen lymph nodes, fatigue, fever, and night sweats. 
• Medical tests and a biopsy is essential to get an accurate diagnosis and determine the most appropriate treatment strategy.

Understanding The Lymphatic System

Before exploring Hodgkin or Non-Hodgkin Lymphoma, it helps to understand the role of the lymphatic system in the body.

The lymphatic system is part of the immune system that helps the body fight infections and maintain fluid balance. It includes:

• Lymph nodes 
• Lymph vessels 
• The spleen 
• Bone marrow 
• The thymus 
• Lymphatic tissues in organs such as the tonsils

Lymphocytes, a type of white blood cell, circulate through the lymphatic system to detect and destroy harmful pathogens.

When lymphoma develops, these lymphocytes begin to grow uncontrollably and accumulate in the lymph nodes or other tissues.

Hodgkin or Non-Hodgkin Lymphoma: Key Differences

Although both diseases involve abnormal lymphocytes, there are several medical differences between them. The table below highlights key distinctions.

This distinction between Hodgkin and Non-Hodgkin Lymphoma helps oncologists determine the most appropriate treatment strategy.

What Is Hodgkin Lymphoma?

Hodgkin lymphoma is a relatively uncommon type of lymphoma characterised by the presence of Reed Sternberg cells, which are large abnormal lymphocytes that can be identified during microscopic examination.

Although it is less common overall, Hodgkin lymphoma is often highly treatable, particularly when detected early.

Common Symptoms

People with Hodgkin lymphoma may experience symptoms such as:

• Painless swelling of lymph nodes, often in the neck or underarm 
• Persistent fatigue 
• Unexplained weight loss 
• Persistent fever 
• Night sweats 
• Itchy skin in some cases

These symptoms can overlap with many other medical conditions, which is why medical evaluation is necessary.

Who Is Commonly Affected

Hodgkin lymphoma can occur at any age, but tends to occur more commonly in:

• Young adults between the ages of 15 and 40 
• Adults aged 55 and above

How Hodgkin Lymphoma Spreads

Hodgkin lymphoma often spreads in a predictable pattern from one lymph node group to another. This pattern sometimes helps doctors determine the stage of the disease during evaluation.

What Is Non-Hodgkin Lymphoma?

Non-Hodgkin lymphoma refers to a large group of lymphomas that do not contain Reed Sternberg cells.

There are many different subtypes of non-Hodgkin lymphoma, each with distinct behaviours and treatment approaches.

Some grow slowly, while others progress more rapidly.

Major Categories

Non-Hodgkin lymphoma is often divided into two main categories based on the type of lymphocyte involved.

B-Cell Lymphomas

Most non-Hodgkin lymphomas develop from B lymphocytes, which help to produce antibodies.

Examples include:

• Diffuse large B-cell lymphoma 
• Follicular lymphoma 
• Mantle cell lymphoma

T-Cell Lymphomas

A smaller proportion of cases originate from T lymphocytes, which help regulate immune responses.

Examples include:

• Peripheral T-cell lymphoma 
• Cutaneous T-cell lymphoma

Slow-growing vs Aggressive Types

Non-Hodgkin lymphomas are sometimes grouped based on how quickly they grow.

• Slow-growing lymphomas grow and spread slowly and may not require immediate treatment in some cases. 
• Aggressive lymphomas grow and spread more quickly and often require prompt treatment.

Symptoms Shared By Both Types Of Lymphoma

As both conditions involve the lymphatic system, symptoms of Hodgkin and Non-Hodgkin Lymphoma can be very similar.

Common warning signs include:

• Swollen lymph nodes in the neck, armpit, or groin 
• Persistent fatigue 
• Persistent fever without infection 
• Night sweats 
• Unexplained weight loss 
• Frequent infections 
• Shortness of breath if lymph nodes enlarge in the chest

Doctors sometimes refer to fever, night sweats, and weight loss collectively as “B symptoms".

How Doctors Diagnose Lymphoma

Diagnosing lymphoma involves several steps to determine the type and stage of disease.

Medical Evaluation

Doctors begin with a physical examination and review of symptoms and the patient’s medical history.

They will check for enlarged lymph nodes and assess the patient’s overall health.

Imaging Tests

Imaging scans help to identify lymph node involvement or abnormal tissue growth.

Common imaging tests include:

• CT scans 
• PET scans 
• MRI scans

These imaging tools help to determine how far the disease has spread.

Blood Tests

Blood tests are conducted to test blood cell, kidney and liver performance. Blood tests can also detect lactase dehydrogenase (LDH), a chemical associated with the aggressive form of non-Hodgkin lymphoma.

Biopsy

A biopsy is the most important step to diagnose lymphoma.

A small sample of lymph node tissue is removed and examined in the laboratory. Pathologists determine whether the cells show features of Hodgkin lymphoma or one of the many forms of non-Hodgkin lymphoma.

Additional laboratory tests may also be performed to identify specific lymphoma subtypes.

Treatment Approaches For Lymphoma

Treatment plans depend on several factors, including the lymphoma type, stage, and the patient’s overall health.

Common treatment options include:

• Chemotherapy, which uses anti-cancer drugs to destroy cancer cells 
• Radiation therapy, which targets and destroys affected lymph nodes with high-energy radiation 
• Targeted therapy, which focuses on specific cancer cell pathways 
• Immunotherapy, which trains the the body’s own immune system to attack cancer cells 
• Stem cell or bone marrow transplants, which may be used in certain cases

Many patients receive a combination of these as part of their treatment.

Medical advances have improved survival rates and long-term outcomes for many lymphoma patients.

Living With Lymphoma: What Patients Should Know

A lymphoma diagnosis can affect different aspects of daily life, including physical health, emotional wellbeing, and personal routines.

Patients may experience temporary disruptions such as:

• Fatigue during treatment 
• Changes in appetite 
• Temporary limitations in work or daily activities

Supportive care services including nutritional guidance, counselling and rehabilitation support can help to address these challenges.

Understanding the differences in Hodgkin between Non-Hodgkin Lymphoma can help patients be better informed when discussing treatment options with their healthcare team.

Understanding Hodgkin and Non-Hodgkin Lymphoma With Specialist Care

Learning about the differences between Hodgkin and Non-Hodgkin Lymphoma can help individuals recognise symptoms and better understand their diagnosis. Although these two types of lymphoma share similarities, they differ in their biological characteristics, progression patterns, and treatment strategies.

At the National Cancer Centre Singapore (NCCS), our multidisciplinary teams provide specialised care for patients with lymphoma. From accurate diagnosis to personalised treatment planning and long-term follow-up, we work closely with patients to support them throughout their cancer journey.

If you have concerns about symptoms such as persistent lymph node swelling, unexplained fever, or fatigue, seeking early medical help can ensure appropriate evaluation, guidance and prompt treatment.

Frequently Asked Questions

1. Can lymphoma develop outside the lymph nodes?
   Yes. While lymphoma often begins in lymph nodes, it can also develop in other organs that contain lymphatic tissue, such as the stomach, skin, brain, or bone marrow. 
   
   
2. Is lymphoma considered a blood cancer?
   Lymphoma is often classified as a type of blood cancer because it originates from lymphocytes, which are white blood cells that circulate within the blood and lymphatic system. 
   
   
3. Are lymphoma symptoms always obvious?
   Not always. Some people with lymphoma experience mild or vague symptoms, which may delay diagnosis. In certain cases, lymphoma may be detected during imaging tests for unrelated health concerns. 
   
   
4. Does lymphoma always require immediate treatment?
   Not necessarily. Some slow-growing types of non-Hodgkin lymphoma may be monitored through an approach called active surveillance if symptoms are minimal and the disease is stable.
    
5. Can lymphoma return after treatment?
   Although many patients achieve remission after treatment, lymphoma can sometimes recur. Regular follow up appointments help doctors monitor long term health and detect any recurrence early.