Hodgkin's vs. Non-Hodgkin's Lymphoma

Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) are the two main categories of lymphoma. These conditions are both lymphomas, which means that they are cancers involving lymphocytes, a type of white blood cell (WBC)—but they differ in their microscopic appearances, typical disease course, and other characteristics.

Hodgkin’s Lymphoma

There are five types of HL. The four most common types are characterized by an abnormal type of B lymphocyte called Reed-Sternberg (RS) cells. The fifth type, nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), has many similarities with NHL. In all clinical aspects, however, the features of NLPHL are similar to HL. 

Also called Hodgkin’s disease, HL was first described by Thomas Hodgkin, a doctor who lived in the early 1800s. Hodgkin examined corpses for gross pathology for years. A series of cases captured his interest—he noticed a different sort of lymph node and spleen involvement that did not look like a common infection. He wrote a paper about the condition that now bears his name, and he was later credited with discovering HL.

Non-Hodgkin’s Lymphomas Form a Diverse Group

NHL includes a variety of lymphomas that, quite literally, are not HL.

More than 60 types of lymphoma have been described that differ from HL. NHL is far more common than HL, accounting for up to 90 percent of all lymphomas today. NHL is a diverse group of malignancies with a range of diagnostic findings and varied disease courses and prognoses.

In most of the cases, the cancer cells are located in the lymph nodes or in other lymphoid tissues—in organs such as the spleen and bone marrow—but they may also invade other organs such as the small bowel and kidney.

Age Distribution Is Tricky

Among adults, NHL typically affects an older age group. But NHL is also more common than HL in children: about 60 percent of pediatric lymphomas are NHL, while about 40 percent are HL.

HL has two peak age groups—one in the 20s and one after age 55.

How Typical Cases Emerge, Manifest, and Progress

The majority of both NHL and HL are nodal lymphomas, originating within the lymph nodes.

However, NHL is much more likely to be extranodal—with some 33 percent of NHL cases considered primary extranodal lymphomas. The most frequent site of primary extranodal lymphoma is in the gastrointestinal tract—and almost all of these are NHL.

The patterns of lymph node involvement in the chest differ between NHL and HL. HL typically progresses in an orderly fashion from one group of lymph nodes to the next. The same may not be true for many common NHLs, though some can have a more Hodgkin's-like behavior.

Role of Staging

The staging system for HL is the anatomically based Cotswold system, which is a modification of the older Ann Arbor system. In HL the anatomical stage correlates strongly with prognosis and helps guide treatment.

With NHL, staging is based on the histology and grade, which are predictive of prognosis and have an influence on treatment decisions.

In HL, stages I and II are usually treated with radiation therapy, while a combination of radiation and chemotherapy or chemotherapy alone may be used in the treatment of stages III and IV.

A Word From Verywell

Both HL and NHL have numerous subtypes that can be very important clinically. In particular, NHL has subtypes that can vary substantially. These different subtypes behave differently, are treated differently, and are associated with different outcomes.

Even if you've been diagnosed with a specific subtype of HL or NHL—for example, diffuse large B cell lymphoma (DLBCL)—your prognosis can vary. Be sure to discuss any questions you may have about your treatment and prognosis with the medical team that is responsible for your care.