Hodgkin Vs. Non-Hodgkin Lymphoma
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Lymphoma is a type of cancer that forms in the lymphatic system, which is a network of vessels, tissues, and organs that maintain the fluids in your body. The fluid that circulates through this network carries important substances, including lymphocytes, which are white blood cells that produce antibodies to help the body fight off infections. The two main categories of lymphomas are Hodgkin lymphoma and non-Hodgkin lymphoma, both named for Dr. Thomas Hodgkin, the researcher who chronicled symptoms of the diseases. Hodgkin lymphoma is sometimes referred to as Hodgkin’s disease or Hodgkin disease. The main difference between Hodgkin lymphoma and non-Hodgkin lymphoma is the type of cells where the cancer develops. People with Hodgkin lymphoma have a mutated lymphocyte called a Reed-Sternberg cell, which is named for two scientists who first identified them under a microscope. Reed-Sternberg cells are much larger than normal lymphocytes and are not present in non-Hodgkin lymphoma.
Hodgkin and Non-Hodgkin Lymphomas Have Similar Symptoms Common Symptoms Despite the different names, Hodgkin lymphoma and non-Hodgkin lymphoma have many symptoms in common: Chronic fatigue Severe itching Fever Night sweats Unexplained weight loss Loss of appetite Swelling of lymph nodes is typical with both types of lymphoma, but people with Hodgkin lymphoma are more likely to experience swelling in the lymph nodes of the chest, neck, or underarms. Some people with Hodgkin lymphoma may also experience pain and lymph node swelling after drinking alcohol. Not every patient will experience all of these symptoms, and these could also be symptoms of many other ailments, including less serious ones.
Hodgkin Lymphoma and Non-Hodgkin Lymphoma Differences Main Differences These are some key differences between Hodgkin lymphoma and non-Hodgkin lymphoma: Hodgkin lymphoma is rare, and non-Hodgkin lymphoma is more common . Hodgkin lymphoma is rare, making up less than 1 percent of all cancers diagnosed in 2023 and 0.1 percent of all cancer deaths, according to data from the Surveillance, Epidemiology, and End Results Program . Only 0.2 percent of people in the United States will be diagnosed with Hodgkin lymphoma in their lifetimes. Non-Hodgkin lymphoma, however, accounted for 4.1 percent of all new cancer cases in 2023 and 3.3 percent of all cancer deaths, per the National Cancer Institute . About 2.1 percent of men and women will be diagnosed with non-Hodgkin lymphoma in their lifetime. Hodgkin lymphoma is diagnosed earlier, and non-Hodgkin lymphoma diagnosed later . The median age of patients diagnosed with Hodgkin lymphoma is 39. The median age of patients diagnosed with non-Hodgkin lymphoma is 67, according to City of Hope . Hodgkin lymphoma is easier to diagnose. Hodgkin lymphoma usually develops in the neck, chest, or armpits, and tends to progress in a more predictable way than non-Hodgkin lymphoma, making it easier to diagnose and treat at an early stage. Non-Hodgkin lymphoma may develop in lymph nodes anywhere in the body, and it’s often diagnosed at an advanced stage. Hodgkin lymphoma has a higher survival rate. Both Hodgkin lymphoma and non-Hodgkin lymphoma are treatable. Hodgkin lymphoma has a five-year survival rate of about 90 percent. Non-Hodgkin lymphoma, because it is often diagnosed later, has a five-year survival rate of just under 75 percent. Remember that survival statistics are merely a guide, and every patient’s situation is different. Differences in Subtypes There are two types of Hodgkin lymphoma, classical and nodular lymphocyte-predominant. Almost all cases of Hodgkin lymphoma are classical. Of these, there are four main subtypes, and the two most common subtypes — nodular sclerosis and mixed cellularity — together account for nearly all Hodgkin lymphoma diagnoses. Non-Hodgkin lymphoma is divided into two subtypes, based on the type of cell affected: T-Cell Lymphoma This subtype tends to be more aggressive. B-Cell Lymphoma Approximately 85 percent of all lymphoma diagnoses in the United States are B-cell lymphomas. There are different B-cell lymphoma subtypes, including mantle cell lymphoma, marginal zone lymphoma, follicular lymphoma, and diffuse large B-cell lymphoma.
Treatment of Hodgkin Lymphoma vs. Non-Hodgkin Lymphoma Treatment Both Hodgkin lymphoma and non-Hodgkin lymphoma are typically treated with chemotherapy and radiation, either together or separately. Additional treatments, including immunotherapy and stem cell transplants, may be recommended for either type. Other treatment options specific to non-Hodgkin lymphoma may include targeted drug therapy and CAR T-cell therapy. Although surgery is used to treat other types of cancers, it is rarely used for lymphomas. Chemotherapy Chemotherapy uses drugs (sometimes several combined) to kill cancer. Chemo drugs are either injected into a vein or given as a pill to kill cancer cells, and the treatment can be performed on an outpatient basis. However, more aggressive types of non-Hodgkin lymphoma may require a chemotherapy combination called R-EPOCH, which requires a hospital stay. Chemo is given in cycles, allowing the body time to recover. Chemo is the main treatment for most people with Hodgkin lymphoma, and is sometimes followed by radiation. It does have side effects, including hair loss, fatigue, mouth sores, digestive complaints, and increased chance of infection. Radiation A typical treatment for both types of lymphoma is called external beam radiation, where a focused beam of radiation is delivered from a machine outside the body. The procedure is painless, and not unlike getting a series of X-rays, although the radiation is stronger. Radiation can also be given as a drug in some cases. Radiation is often performed in conjunction with chemotherapy for more advanced lymphomas. Lower doses of radiation are sometimes used to ease symptoms of lymphoma that has spread to other organs. Stem Cell Transplant Sometimes people with lymphoma don’t respond to radiation and chemo, or their cancer returns. A stem cell transplant, also called a bone marrow transplant, may be recommended, where cancerous bone marrow cells are replaced with new, healthy cells. A stem cell transplant may also be performed in combination with chemotherapy. It typically takes at least six months for a patient to recover from a stem cell transplant, and they are at increased risk of infection during this period. Targeted Drug Therapy This type of therapy is used to slow the spread of non-Hodgkin lymphoma. It works by attacking proteins that help lymphoma cells function and grow. Proteasome inhibitors stop enzyme complexes (proteasomes) in cells from attacking proteins that control cell division. HDAC inhibitors affect which genes in a cell are active. BTK inhibitors target a protein that helps some lymphoma cells grow and survive. PI3K inhibitors seek out and stop proteins that help cancer cells grow. EZH2 inhibitors target a protein that helps some cancer cells grow. Nuclear export inhibitors prevent cancer cells from moving proteins from inside the nucleus to other parts of the cell, which is important for cell life. Immunotherapy The immune system is trained to recognize, target, and destroy lymphoma cells. This therapy includes medications approved for patients with classic Hodgkin lymphoma as well as non-Hodgkin lymphoma, and may be used with chemo drugs. Monoclonal antibodies attack specific targets on the surface of lymphocytes. Brentuximab vedotin (Adcetris) and rituximab (Rituxan) are two types of monoclonal antibodies used to direct chemo drugs to the surface of cancer cells in Hodgkin lymphoma. Checkpoint inhibitors “turn on” proteins that can start an immune response to attack cancer cells (cancer cells sometimes turn these proteins off to prevent being attacked). Checkpoint inhibitors are used for both Hodgkin lymphoma and non-Hodgkin lymphoma. Pembrolizumb (Keytruda) and nivolumab (Opdivo) are two types of checkpoint inhibitors used for lymphoma. CAR T-c ell therapy for non-Hodgkin lymphoma involves taking a patient’s T cells (a type of white blood cell) and altering their surface receptors so they attach to lymphoma cells. The cells are then put back into the patient’s blood to seek out and destroy lymphoma cells. Watch and Wait Sometimes, treatment will not be recommended right away, especially in the early stages of lymphoma or if the lymphoma is slow-growing with no symptoms. With the watch-and-wait approach, your medical team will monitor the lymphoma’s progression with regular physical exams and lab tests, but without drugs or treatments until symptoms appear or change. This allows you to avoid many potential side effects of treatment, and studies have shown that early treatment isn’t always beneficial for slow-growing disease with no symptoms.
Risk Factors and Causes of Hodgkin vs. Non-Hodgkin Lymphoma Risk Factors There is no single factor that significantly increases the chances of getting Hodgkin lymphoma, but certain conditions may slightly increase the risk. These include Epstein-Barr virus infection, which causes mononucleosis (mono), and HIV infection. A family history of Hodgkin lymphoma (brothers or sisters) also raises your risk, as does taking drugs that suppress the immune system. There are several factors that can increase the risk of getting non-Hodgkin lymphoma. Age Most cases of non-Hodgkin lymphoma are diagnosed in people over 60 years old. Gender Risk is higher in men than in women, although some types of non-Hodgkin lymphoma that are more common in women. Race In the United States, white people are more likely than other races to develop non-Hodgkin lymphoma. Worldwide, non-Hodgkin lymphoma is more common in developed countries, with the United States and Europe having some of the highest rates. Family History As with many types of cancers and other diseases, the risk of developing non-Hodgkin lymphoma increases if there is a “one-degree” family member (parent, child, sibling) with non-Hodgkin lymphoma. Chemical Exposure Some studies have suggested that exposure to chemicals such as benzene and certain pesticides may increase the risk of non-Hodgkin lymphoma. Benzene exposure has also been linked to leukemia and other cancers of the blood cells. Radiation Exposure Radiation exposure is linked to an increased risk of non-Hodgkin lymphoma, as well as other types of cancer, such as leukemia and thyroid cancer. Being Immunocompromised People with a weakened immune system, including people who have received drugs that suppress the immune system (typically given for organ transplants) and people with untreated HIV, have an increased risk of non-Hodgkin lymphoma. Autoimmune Diseases Autoimmune diseases like rheumatoid arthritis, lupus, and celiac disease may increase the risk of getting non-Hodgkin lymphoma because an overactive immune system may cause lymphocytes to grow faster than normal, increasing their chances of turning into lymphoma cells. Certain Long-Term Infections An overactive immune system caused by some chronic infections may lead to mutations in key genes, which could lead to lymphoma. These include hepatitis C, Helicobacter pylori , Chlamydophila psittaci , and Campylobacter jejuni . Some lymphomas linked with these infections improve when the infection is treated. Of course, it’s important to treat these infections, especially hepatitis C, for their primary health complications, regardless of the potential risk of lymphoma. Viral Infections Certain viruses can help transform lymphocytes into cancer cells. These include HTLV-1, or the human T-cell lymphotropic virus. Epstein-Barr virus (EBV) in people who also have HIV (in developed countries) is a risk factor, as is herpes virus 8 (HHV-8) with HIV. Weight While not definitive, some studies suggest that having excess weight or obesity can increase the risk of developing non-Hodgkin lymphoma. Breast Implants In rare cases, women with breast implants have developed non-Hodgkin lymphoma in the scar tissue surrounding the implants.
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