Incidence

• Lymphoma starts in the lymph glands or other organs of the lymphatic system. There are two main types: non-Hodgkin and Hodgkin lymphoma
• Lymphomas are the most common group of cancers in teenagers and young adults
• Non-Hodgkin lymphoma is the sixth most common cancer in the UK, accounting for 4% of all new cancer cases, with more than a third being diagnosed in people aged 75 and over
• Hodgkin lymphoma is a cancer of lymphocytes. It accounts for less than 1% of all new cancer cases
• Hodgkin lymphoma can occur at any age; however, it is most common in people aged 15 to 40
• There are several viral and bacterial infections and auto-immune conditions that can increase the risk of lymphoma

Symptoms

Lymphadenopathy is the most common sign of lymphoma, with approximately half of patients presenting with swollen lymph nodes; however, around a third of patients will initially present to their GP with vague symptoms before referral. These include weight loss, night sweats, fever, pruritus, and fatigue. Fatigue is a common symptom of lymphoma.

When considering referral, clinicians should take a history that includes potentially associated symptoms.

Lymphadenopathy – Key points for diagnosis

• It is important to take a patient history that includes when the lump appeared and whether it was associated with an infection, as well as investigate other symptoms
• The neck should be examined for a lump, along with an axillary examination and an examination of the groin, abdomen, and chest
• A lump that is bigger than a centimetre and persists for at least three weeks should be referred for further investigations
• Local referral pathways differ – in many areas, neck lumps should be referred to a head and neck service, axillary lumps to a breast service and groin lumps to general surgery, however in some areas these patients are now assessed via a non-site-specific pathway
• Patients who may have reactive nodes due to infection should have a safety net appointment at 4-6 weeks to check these have gotten smaller

Investigations

• Blood tests should include a mononucleosis screen, HIV screen and a Full Blood Count
• Results – anaemia, low platelets (thrombocytopenia), or an abnormality with the white counts should be of concern in conjunction with associated symptoms
• Additional supporting investigations – a biochemical profile, checking renal and liver function and a LDH (lactate dehydrogenase) test
• Normal results, however, do not exclude the possibility of cancer

Lymphoma – Course summary PDF

Click here to download a copy of the course summary.