Quick Answer
Non-Hodgkin’s lymphoma is a worse and more serious type of lymphoma overall compared to other forms of lymphoma. Non-Hodgkin’s lymphoma is less treatable and has a higher mortality rate than Hodgkin’s lymphoma.
Overview of Lymphoma
Lymphoma is a type of blood cancer that originates in the lymphatic system. The lymphatic system is part of the immune system and helps fight infections and filter out germs. Lymphoma occurs when white blood cells called lymphocytes grow abnormally and multiply uncontrollably.
There are two main types of lymphoma:
- Hodgkin’s lymphoma: Named after Dr. Thomas Hodgkin, who first characterized it in 1832. Accounts for about 10% of lymphoma cases.
- Non-Hodgkin’s lymphoma: Encompasses all types of lymphoma that are not Hodgkin’s. Accounts for about 90% of lymphoma cases.
Both Hodgkin’s and non-Hodgkin’s lymphoma have the potential to spread throughout the lymphatic system if they are not caught early. However, non-Hodgkin’s lymphoma tends to be more aggressive and advanced at diagnosis compared to Hodgkin’s lymphoma.
Key Differences Between Non-Hodgkin’s and Hodgkin’s Lymphoma
There are several key differences between non-Hodgkin’s and Hodgkin’s lymphoma:
| Difference | Non-Hodgkin’s Lymphoma | Hodgkin’s Lymphoma |
|---|---|---|
| Cancer cells affected | B-cells or T-cells | Reed-Sternberg cells |
| Rate of occurrence | More common (90% of cases) | Less common (10% of cases) |
| Age of diagnosis | Can occur at any age, but more common in older adults | Most common in young adults ages 16-34 |
| Subtypes | Many subtypes | 4 main subtypes |
| Symptoms | Swollen lymph nodes, weight loss, fever, fatigue | Painless swelling of lymph nodes, fever, night sweats, weight loss |
| Diagnosis | Biopsy of affected lymph node or organ | Biopsy of affected lymph node |
| Treatment | Chemotherapy, radiation, immunotherapy drugs, stem cell transplant | Chemotherapy, radiation, immunotherapy drugs, stem cell transplant |
| Prognosis and survival rate | 5-year survival rate is 69%. More aggressive and advanced at diagnosis. | 5-year survival rate is 87%. Highly treatable if caught early. |
Some key points:
– Non-Hodgkin’s lymphoma is much more common, accounting for 90% of lymphoma cases.
– Hodgkin’s lymphoma typically affects younger people while non-Hodgkin’s can occur at any age.
– Non-Hodgkin’s lymphoma has many subtypes while Hodgkin’s lymphoma has four main subtypes.
– Both share some common symptoms but Hodgkin’s lymphoma is distinguished by painless lymph node swelling.
– Non-Hodgkin’s lymphoma generally has a worse prognosis and lower 5-year survival rate compared to Hodgkin’s lymphoma.
Risk Factors
There are a number of risk factors that can increase the chances of developing non-Hodgkin’s lymphoma:
– Age: Risk increases as you get older. Most cases occur in people over age 60.
– Gender: Men are at slightly higher risk than women.
– Weakened immune system: HIV/AIDS infection, organ transplant, autoimmune disorders.
– Cancer treatments: Radiation or chemotherapy for other cancers.
– Infections: EBV, HPV, helicobacter pylori, hepatitis C.
– Family history: Having a close relative with lymphoma.
– Chemical exposures: Pesticides, solvents, herbicides.
– Obesity: Being obese or overweight.
Risk factors for Hodgkin’s lymphoma specifically include:
– Age: Most common between ages 16-34.
– Gender: Slightly more common in males.
– Epstein-Barr virus (EBV) infection.
– Family history of lymphoma.
– HIV/AIDS infection.
Signs and Symptoms
Some common signs and symptoms of both Hodgkin’s and non-Hodgkin’s lymphoma include:
– Swollen lymph nodes, often painless.
– Unexplained weight loss.
– Unexplained fever.
– Drenching night sweats.
– Constant fatigue and lack of energy.
– Itchy skin.
– Coughing or chest pain.
– Difficulty breathing.
– Abdominal pain or swelling.
However, non-Hodgkin’s lymphoma symptoms can be broader due to the many subtypes. Additional symptoms may include:
– Severe or persistent infections.
– Bruising or bleeding easily.
– Petechiae (tiny red spots under the skin).
– Bone pain.
– Swollen organs or tissues.
– Digestive issues like nausea, vomiting, diarrhea.
– Headaches or dizziness.
– Numbness and tingling.
– Vision changes or blurry vision.
Sudden onset of B symptoms like fever, night sweats, and weight loss is more characteristic of Hodgkin’s lymphoma.
Diagnosis and Staging
Lymphoma is diagnosed with tissue biopsies and imaging tests:
– Biopsy: The suspected swollen lymph node or affected tissue is biopsied and examined under a microscope. This confirms a lymphoma diagnosis.
– Blood tests: Complete blood count (CBC), liver function, kidney function. Helps detect lymphoma markers.
– Bone marrow biopsy: Checks if bone marrow is involved, more common with non-Hodgkin’s.
– Imaging tests: CT scan, PET scan, MRI. Determines spread of lymphoma in body.
– Lumbar puncture: Checks if lymphoma has reached spinal fluid.
Once diagnosed, the stage of lymphoma is determined based on cancer spread:
Non-Hodgkin’s Lymphoma Stages:
– Stage I: Cancer is in 1 lymph node region.
– Stage II: Cancer is in 2 lymph node regions on the same side of the diaphragm.
– Stage III: Cancer is in lymph node regions on both sides of the diaphragm.
– Stage IV: Cancer has spread to distant organs beyond the lymphatic system.
Hodgkin’s Lymphoma Stages:
– Stage I: Cancer is in 1 lymph node region or lymphatic structure.
– Stage II: Cancer is in 2 or more lymph node regions on the same side of the diaphragm.
– Stage III: Cancer is in lymph node regions on both sides of the diaphragm.
– Stage IV: Cancer has spread outside the lymphatic system to distant organs.
Higher stages indicate more advanced and widespread cancer for both lymphoma types.
Treatment Options
Treatment options for non-Hodgkin’s and Hodgkin’s lymphoma include:
– Chemotherapy: Using anti-cancer drugs to kill lymphoma cells. Often multi-drug regimens.
– Radiation therapy: High energy beams to shrink and destroy tumors. May be used with chemo.
– Immunotherapy: Drugs that boost the immune system to fight lymphoma. Examples are rituximab and brentuximab.
– Targeted therapy: Drugs that target specific molecules on cancer cells. Ibrutinib targets B-cell lymphoma.
– Stem cell transplant: Replaces diseased bone marrow with healthy stem cells. Used for recurrent lymphoma.
– Surgery: Rarely used except for biopsies to diagnose lymphoma.
– Watchful waiting: No immediate treatment if the lymphoma is slow-growing, just active monitoring.
Factors determining lymphoma treatment include the subtype, stage, age, overall health, tolerance for therapies, and goals of care.
Chemotherapy combined with radiation is a common first line treatment for most lymphoma patients. More aggressive subtypes may require stronger chemotherapy. Higher stages often warrant combined modalities.
Relapsed or treatment-resistant lymphoma may be treated with newer targeted therapies or stem cell transplants. Supportive care is also important to control pain and side effects.
Comparing Outcomes and Survival Rates
Outcomes and prognosis for lymphoma depend heavily on the individual subtype and stage at diagnosis:
– Overall 5-year survival rate for non-Hodgkin’s lymphoma is 69%.
– For Hodgkin’s lymphoma, the 5-year survival rate is 87%.
However, early stage favorable lymphomas of both types have 5-year survival rates exceeding 90%. Outcomes get progressively worse with advanced stages.
Among non-Hodgkin’s lymphoma subtypes, 5-year survival rates range from over 90% for less aggressive forms like marginal zone lymphoma down to around 50% for highly aggressive lymphomas like lymphoblastic lymphoma.
For Hodgkin’s lymphoma subtypes, the classic form has a 5-year survival rate of 85%, while more aggressive forms like lymphocyte depleted have survival rates around 65%.
In general, Hodgkin’s lymphoma is highly treatable with chemotherapy and/or radiation if diagnosed early. Non-Hodgkin’s lymphoma tends to be more aggressive and advanced at diagnosis, leading to lower survival rates overall compared to Hodgkin’s lymphoma.
However, there are low and high-grade forms of both major lymphoma categories. Working with a lymphoma specialist is crucial to determine the optimal treatment and prognosis based on individual parameters.
Key Survival Statistics
| Lymphoma Type | 5-Year Relative Survival Rate |
|---|---|
| All types non-Hodgkin’s lymphoma | 69% |
| All types Hodgkin’s lymphoma | 87% |
| Diffuse large B-cell lymphoma | 65% |
| Follicular lymphoma | 89% |
| Mantle cell lymphoma | 57% |
| Marginal zone lymphoma | 91% |
| Burkitt lymphoma | 50% to 90% depending on risk factors |
| Lymphoblastic lymphoma | 49% |
| Classical Hodgkin lymphoma | 85% |
| Lymphocyte-rich Hodgkin lymphoma | 89% |
| Lymphocyte-depleted Hodgkin lymphoma | 63% |
| Nodular sclerosis Hodgkin lymphoma | 84% |
These statistics demonstrate that non-Hodgkin’s lymphoma overall has significantly lower 5-year survival compared to Hodgkin’s lymphoma. However, outcomes for both cancer types can vary substantially depending on individual factors.
Living with Lymphoma
Living with lymphoma poses many challenges for patients and families:
– Coping with the shock and fear of a cancer diagnosis. Seeking emotional support.
– Understanding the specific subtype and stage of lymphoma and treatment options. Asking questions of your care team.
– Handling anti-cancer treatments and possible side effects like hair loss, nausea, fatigue, low blood cell counts.
– Maintaining nutrition and physical activity as able during treatment.
– Preventing infections through hand hygiene, avoiding sick contacts, getting vaccines.
– Working closely with your oncologist to monitor response to treatment and watch for recurrence.
– Getting regular follow-up scans and lab tests as recommended after treatment.
– Managing long-term and late effects of lymphoma and treatment. Examples are peripheral neuropathy, heart damage, and increased infection risk.
– Joining a lymphoma support group to connect with other patients and survivors.
– Protecting yourself from COVID exposure if you are immunocompromised from lymphoma treatment.
Coping strategies include learning lymphoma relaxation techniques, focusing on your support system, allowing yourself to feel all emotions, establishing a “new normal,” and fostering hope.
It is crucial for lymphoma patients to have open communication and a trusting relationship with their medical team. Seeking counseling services can also help process the life changes that come with lymphoma.
Conclusion
In summary, non-Hodgkin’s lymphoma is generally considered to have worse outcomes compared to Hodgkin’s lymphoma based on lower overall survival rates. However, there are many different subtypes within each major category with variable prognoses.
Non-Hodgkin’s lymphoma is more prevalent, can occur at any age, and is typically more advanced upon diagnosis. But treatment options and survival continue to improve for both Hodgkin’s and non-Hodgkin’s lymphoma.
Catching lymphoma at its earliest stages offers the best chance for long-term remission and cure. Patients should have a full understanding of their specific lymphoma diagnosis and prognosis.
With modern therapies, many lymphoma cases can be effectively managed and even cured. Patients should be hopeful about their prognosis but also realistic in working closely with their cancer care team.