Lymphoma — cancer of lymphocytes
Lymphoma is malignancy of lymphocytes in lymph nodes, spleen, bone marrow, and other organs — two main families: Hodgkin and non-Hodgkin.
~14,000 UK diagnoses/year — Hodgkin peak 20–34 — many subtypes of NHL.
Hodgkin vs non-Hodgkin
Hodgkin lymphoma (HL):
- Reed-Sternberg cells — diagnostic
- Contiguous spread — predictable staging
- ~85% cure rate — ABVD chemotherapy
Non-Hodgkin lymphoma (NHL):
- No Reed-Sternberg cells
- B-cell ~85%, T-cell ~15%
- Indolent — follicular — may not treat immediately
- Aggressive — diffuse large B-cell — urgent chemo
When to worry about a gland
Normal reactive node:
- Painful, soft, follows throat/skin infection
- Shrinks over 2 weeks
Suspicious:
- Painless, rubbery/firm, >2 cm, progressive
- Supraclavicular node — always investigate
- Generalised lymphadenopathy
See swollen glands for common benign causes — but persistent painless lump needs biopsy.
B symptoms
- Night sweats — drenching
- Weight loss — >10% in 6 months
- Fever — >38°C recurrent
Indicate more aggressive biology — affect staging and treatment intensity
Staging (Ann Arbor)
Stage I–IV — number of node regions and extranodal sites
PET-CT — standard staging — Deauville score tracks treatment response
Treatment overview
| Type | Typical first line |
|---|---|
| Early Hodgkin | ABVD ± involved-site radiotherapy |
| Advanced Hodgkin | ABVD or BEACOPP |
| DLBCL | R-CHOP |
| Follicular (symptomatic) | Chemoimmunotherapy or rituximab |
| Relapsed | Salvage chemo + autologous SCT |
After treatment
Fertility counselling — ** sperm banking**
Second primary cancers — radiotherapy field — breast screening earlier in young women treated for Hodgkin
Fatigue — common post-chemo — gradual recovery
Neutropenic fever during treatment — emergency
Persistent neck lump over 2 weeks — GP — excision biopsy answers — most are not lymphoma, but don’t assume reactive without assessment.
Common questions about lymphoma
- What is the difference between Hodgkin and non-Hodgkin lymphoma?
- Hodgkin lymphoma — Reed-Sternberg cells on histology — bimodal age peaks (young adults and older). Usually curable. Non-Hodgkin lymphoma — diverse group without Reed-Sternberg cells — indolent (slow) or aggressive subtypes — treatment and prognosis vary widely.
- What are the symptoms of lymphoma?
- Painless swollen lymph nodes — neck commonest, armpit, groin, chest (cough, breathlessness). B symptoms — night sweats soaking bedding, weight loss over 10% body weight in 6 months, fever over 38°C. Itching, fatigue, alcohol-induced node pain (Hodgkin — rare). Abdominal pain if spleen or liver involved.
- How is lymphoma diagnosed?
- Excision biopsy of whole lymph node — gold standard — not fine needle alone for initial diagnosis. CT PET scan for staging. Bone marrow biopsy if indicated. Blood tests — LDH, FBC, HIV and hepatitis screen before treatment. Lumbar puncture in selected high-grade NHL.
- How is lymphoma treated?
- Chemotherapy — ABVD for Hodgkin, R-CHOP for diffuse large B-cell NHL (rituximab plus chemo). Radiotherapy to involved sites in early Hodgkin or bulky disease. Immunotherapy — checkpoint inhibitors in relapsed Hodgkin. CAR-T cells for some relapsed aggressive NHL. Watch and wait for indolent NHL if asymptomatic.
- Can lymphoma come back after treatment?
- Yes — relapse possible — Hodgkin relapse often still curable with salvage chemo and autologous stem cell transplant. Indolent NHL may relapse multiple times over years — still treatable. Lifelong follow-up with periodic scans and bloods.
Sources
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