GPAtlas🧭 When to suspect
Lymphoma is a malignancy of lymphocytes and the most common haematological cancer in the UK.
Suspect it in any patient with:
• unexplained, persistent (more than 6 weeks) lymphadenopathy
• unexplained splenomegaly
• a progressive, painless mass.
It divides into two broad groups: non-Hodgkin lymphoma (NHL), around 90% of cases, and Hodgkin lymphoma (HL), around 10%.
Presentation is frequently non-specific and may wax and wane, so the diagnosis is easily missed.
• B symptoms – unexplained fever, drenching night sweats, and weight loss of more than 10% over 6 months – point to higher disease burden and are used in formal staging.
• The best discriminator in primary care is the character of the node: a lymph node that is persistent, enlarging, firm or rubbery, non-tender, or matted/fixed should raise concern.
• A supraclavicular node is abnormal until proven otherwise.
Recognise the high-risk node, investigate without delay, refer on the correct pathway, and never give empirical corticosteroids before a tissue diagnosis.
| Feature | Non-Hodgkin lymphoma (NHL) | Hodgkin lymphoma (HL) |
|---|---|---|
| Proportion | • ~90% of lymphomas • Over 60 subtypes |
~10% of lymphomas |
| Typical age | • Incidence rises with age • The majority occur in those ≥ 60 |
• Bimodal – a peak at 20–24 and again in the 70s • The commonest cancer in teenagers and young adults |
| Spread pattern | Greater tendency to extranodal and disseminated disease | Tends to spread contiguously between adjacent nodal groups |
| Distinctive clue | Often none – vague, systemic symptoms | • Alcohol-induced lymph node pain (rare but characteristic) • Reed–Sternberg cells on histology |
Source: NICE NG12 · NICE NG52 · Cancer Research UK
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