Lymphomas — Overview

This is a comparison hub — see Hodgkin Lymphoma and Non-Hodgkin Lymphoma for full detail on each.

Tumours arising from the lymphatic and reticuloendothelial system, split into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). The distinction between lymphoma and leukaemia is often vague — the notion that lymphoma is confined to the lymphatic system while leukaemia is confined to the bone marrow isn’t always true; malignant lymphoma cells can populate the bone marrow and blood as well as the lymph nodes.

Presentation and workup

Most patients present with painless lymphadenopathy. B symptoms — unexplained fever, drenching night sweats, or weight loss >10% of body weight over 6 months — carry a worse prognosis and should prompt urgent assessment regardless of subtype.

• Diagnosis — excisional biopsy is the gold standard (preserves whole lymph node architecture); fine-needle aspiration, core, and incisional biopsy are alternatives when excisional biopsy isn’t feasible.
• Staging — both HL and NHL use the Ann Arbor system (I–IV, ± B-symptom modifier). Whole-body PET/CT is preferred over CT alone; bone marrow biopsy is often needed for staging.
• Baseline bloods — FBC with differential, LDH, comprehensive metabolic panel, uric acid.
• Referral timeframe — where lymphoma is proven or strongly suspected, referral to a specialist centre should occur within days, not weeks; asymptomatic lymphadenopathy without red-flag features can have initial investigations arranged first.

Comparison table

Feature	Hodgkin lymphoma	Non-Hodgkin lymphoma
Nodal involvement	Typically localised to a specific node group	Usually disseminated across >1 nodal group
Spread	Orderly, contiguous	Non-contiguous
Waldeyer ring / mesenteric nodes	Usually unaffected	Commonly affects mesenteric nodes; may affect Waldeyer ring
Extranodal involvement	Infrequent	Frequent
Stage at diagnosis	Usually early	Usually advanced
Histologic classification in children	Usually favourable prognosis	Usually aggressive