Hodgkin vs Non-Hodgkin Lymphoma
Hodgkin and Non-Hodgkin are two important subtypes of lymphocyte cancers. There are many differences between the two conditions while some presenting features, investigations and general treatment principles are the same for both Hodgkin and Non-Hodgkin lymphomas. This article describes the clinical features, symptoms, causes, investigation and diagnosis, treatment methods, and prognosis of Hodgkin and Non-Hodgkin lymphoma and outlines the differences between both.
Hodgkin lymphoma is a type of malignant proliferation of lymphocytes. This is twice as common in females as in males. Both young adults and elderly individuals can get Hodgkin lymphoma as there are two peak ages. There are five types of Hodgkin lymphoma. They are classical Hodgkin lymphoma, nodular sclerosing, mixed cellularity, lymphocyte rich and lymphocyte depleted Hodgkin lymphomas. Commonest presenting complaint of these lymphomas is lymph node enlargement. 25% of patients also complain of lethargy, fever, night sweats and weight loss. Alcohol may cause pain in Hodgkin patients. Fever is characteristic but rare. It is called Pel-Ebstein fever and it alters between fever and long periods of normal /low temperatures.
On examination lymph node site, size, consistency, mobility and tenderness should be assessed. Investigations include lymph node biopsy, full blood count, ESR, liver and renal function tests, CT, MRI, chest x-ray. Anemia and raised ESR suggest bad prognosis. Hodgkin lymphoma is staged with Ann Arbor method which correlates well with prognosis.
Stage 1 – Confined to a single lymph node region
Stage 2 – Involvement of two or more lymph node regions on the same side of the diaphragm
Stage 3 – Involvement of nodes on both sides of the diaphragm
Stage 4 – Spread beyond the nodes
Radiotherapy is the treatment of choice for stage 1 and 2. Chemotherapy with ABVD regimen (Adriamycin, bleomycin, vinblastine, dacarbazine) is the treatment of choice for stage 2a or above. Treatment itself can cause hypothyroidism, lung fibrosis, nausea, alopecia and subfertility in men. The % year survival rate is above 90% in 1A lymphocyte predominant disease, and less than 40% in 4A lymphocyte depleted disease.
Non-Hodgkin lymphoma is a diverse group of conditions which do not feature Reed Sternberg cells. Most are B cell lymphomas. Not all areas centered around the lymph nodes. Extra nodal lymphomas are situated at mucosa associated lymphoid tissue. EBV, HIV and other causes of immune-compromisation has increased incidence of non-Hodgkin lymphomas. Non Hodgkin lymphomas are mostly asymptomatic, but it may present with lymph node enlargement, skin, bone, gut, nervous system and lung symptoms. Staging is similar for Hodgkin’s but less important because most have widespread disease at presentation.
Investigations are the same ones done for Hodgkin’s disease. Prognosis is worse if the patient is elderly, symptomatic, with lymph nodes larger than 10cm or anemic at presentation. Low grade symptomless disease may not need treatment. Chlorambucil, purine analogues, radiotherapy are extremely effective.
What is the difference between Hodgkin and Non-Hodgkin Lymphoma?
• Hodgkin’s disease features Reed Sternberg cell while Non-Hodgkin disease does not.
• Hodgkin’s disease presents with lymph node enlargement as the primary feature while Non-Hodgkin’s disease is mostly asymptomatic.
• Hodgkin’s presents early and has better prognosis while Non-Hodgkin’s presents late with widespread disease.
• ABVD regimen in commonly used to treat Hodgkin’s disease while it is not used for Non-Hodgkin’s disease.
• Staging is necessary to prognosticate in Hodgkin’s disease while staging is almost always unnecessary because of widespread disease at presentation.