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Health condition · Clinically reviewed

Lymphoma, from painless swelling to precise, modern treatment.

A cancer of the lymphocytes and the lymphatic system. Many subtypes, one careful workup, and a growing toolbox that now includes CAR-T and bispecific antibodies.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BSH, ESMO and peer-reviewed haematology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK haemato-oncology practice including PET-directed therapy, CAR-T, bispecifics and checkpoint inhibitors.

Key facts

Lymphoma at a glance.

The essentials, in plain English. What it is, how it splits into Hodgkin and non-Hodgkin, and how it is treated in the UK today.

  • What it is

    A group of blood cancers arising from lymphocytes and the lymphatic system, split broadly into Hodgkin and non-Hodgkin lymphoma.

  • Hodgkin lymphoma

    Defined by Reed-Sternberg cells. Classical subtypes plus nodular lymphocyte-predominant (NLPHL). Peaks in young adults and again later in life.

  • Non-Hodgkin lymphoma

    Around 85% of UK lymphomas. Highly heterogeneous B-cell, T-cell and NK-cell subtypes with very different behaviour and treatment.

  • Key symptoms

    Painless swollen lymph nodes, drenching night sweats, unexplained fever and weight loss of more than 10% over six months.

  • Diagnosis

    Excisional lymph node biopsy plus immunohistochemistry, molecular studies, staging PET-CT and, where indicated, bone marrow biopsy.

  • Outlook

    Many lymphomas are highly treatable. Hodgkin and diffuse large B-cell lymphoma are often curable; indolent lymphomas are usually managed long-term.

Why this guide matters

One diagnosis, many subtypes, a personalised plan.

Lymphoma is not one disease. The right treatment depends on subtype, stage, biology and fitness, so the workup and MDT decision are everything.

  • Subtype defines everything

    Hodgkin, DLBCL, follicular, mantle cell, Burkitt and T-cell lymphomas each demand a different regimen, so accurate pathology is essential.

  • PET-CT and Lugano staging

    Whole-body PET-CT under the Lugano classification stages disease and guides interim response-adapted decisions such as RATHL in Hodgkin lymphoma.

  • Modern therapy is transformative

    Brentuximab vedotin, checkpoint inhibitors, CAR-T and bispecific antibodies have redrawn outcomes for both first-line and relapsed disease.

How the diagnosis is made

From swollen node to a confirmed plan.

The steps a UK haemato-oncology team will normally follow, in order, so you know what to expect and why each test matters.

  1. 01

    Assessing

    Clinical assessment

    A careful history looking for painless lymphadenopathy, B symptoms, pruritus and alcohol-induced nodal pain, plus a full nodal, liver and spleen examination.

  2. 02

    Assessing

    Baseline bloods

    FBC, LFTs, LDH, beta-2 microglobulin, urate, ESR, HIV and hepatitis B and C serology to gauge burden, prognosis and treatment safety.

  3. 03

    Assessing

    Excisional lymph node biopsy

    The preferred sample for lymphoma. A whole node gives architecture and immunohistochemistry that a core biopsy often cannot.

  4. 04

    Confirming

    PET-CT staging

    Whole-body PET-CT stages disease using the Lugano system and provides the baseline for interim and end-of-treatment response.

  5. 05

    Confirming

    Bone marrow biopsy

    Routine in Hodgkin lymphoma historically and selective in non-Hodgkin lymphoma, depending on subtype and PET findings.

  6. 06

    Confirming

    CNS imaging where indicated

    MRI brain or spine and CSF assessment for primary CNS, testicular and high-risk aggressive lymphomas.

  7. 07

    Preparing

    Fertility and oncofertility

    Sperm banking, oocyte or embryo cryopreservation and ovarian tissue options discussed before chemotherapy or pelvic radiotherapy starts.

Typical timeline: from GP referral to first cycle of treatment in a matter of weeks.

Symptoms

What lymphoma can look like.

Painless swellings and the classic B symptoms of fever, drenching night sweats and unexplained weight loss, plus a handful of features that need urgent attention.

  • Painless lymphadenopathy

    Slowly enlarging, rubbery nodes, most often in the neck, above the collarbone or in the mediastinum.

  • Night sweats

    Drenching sweats that soak nightclothes and bedding, part of the classic B symptom trio.

  • Fever

    Unexplained fever above 38C without an obvious infection, sometimes with a Pel-Ebstein pattern in Hodgkin disease.

  • Unexplained weight loss

    Loss of more than 10% of body weight over six months without dieting or another cause.

  • Pruritus

    Persistent, generalised itch without a visible rash, common in Hodgkin lymphoma.

  • Alcohol-induced nodal pain

    A rare but characteristic Hodgkin symptom in which alcohol triggers pain in involved lymph nodes.

  • Fatigue and breathlessness

    From anaemia, bulky mediastinal disease pressing on the airway, or a large pleural or pericardial effusion.

  • Red flag - superior vena cava obstruction

    Facial swelling, distended neck veins and breathlessness from a bulky mediastinal mass is a medical emergency.

Treatment

How lymphoma is treated in the UK.

From ABVD, R-CHOP and involved-site radiotherapy to CAR-T cells, bispecific antibodies and stem cell transplantation, tailored by subtype, stage and fitness.

  • ABVD chemotherapy

    Doxorubicin, bleomycin, vinblastine and dacarbazine. The traditional backbone for Hodgkin lymphoma, often two to six cycles with PET-directed adjustments per RATHL.

  • Involved-site radiotherapy

    Targeted radiotherapy to previously involved nodal areas in early-stage Hodgkin disease, minimising exposure to heart, lung and breast tissue.

  • Brentuximab vedotin plus AVD

    BV+AVD (ECHELON-1) is a bleomycin-sparing option for advanced Hodgkin lymphoma with improved progression-free survival.

  • Nivolumab plus AVD

    Practice-changing 2023 data (SWOG S1826 and ADVANCE) support nivolumab-AVD as a first-line option for advanced Hodgkin lymphoma.

  • R-CHOP for DLBCL

    Rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone for six cycles, the standard first-line regimen for diffuse large B-cell lymphoma.

  • Polatuzumab-based therapy

    POLA-R-CHP (POLARIX) offers a benefit over R-CHOP in higher-risk DLBCL and is emerging into UK first-line practice.

  • CAR-T cell therapy

    Axi-cel, liso-cel and tisa-cel for relapsed or refractory large B-cell lymphoma, now moving into earlier lines of therapy.

  • Bispecific antibodies

    Epcoritamab and glofitamab (CD20xCD3 T-cell engagers) for relapsed or refractory B-cell lymphomas after multiple prior lines.

  • Rituximab-bendamustine

    A common first-line option for follicular and other indolent B-cell lymphomas, often followed by rituximab maintenance.

  • PI3K inhibitors and tazemetostat

    Targeted oral options for relapsed follicular lymphoma, including EZH2 inhibition where mutations are present.

  • DA-EPOCH-R or CODOX-M / IVAC

    Intensive regimens for Burkitt lymphoma, always with CNS prophylaxis given the risk of central nervous system involvement.

  • Autologous or allogeneic SCT

    High-dose chemotherapy with autologous stem cell rescue for relapsed Hodgkin and aggressive B-cell disease; allogeneic transplant in selected T-cell lymphomas.

Supportive and survivorship care

Modern lymphoma protocols include G-CSF support, PJP and antiviral prophylaxis, antifungals, transfusion support and tumour-lysis prevention with allopurinol or rasburicase. Long-term follow-up screens for cardiotoxicity from anthracyclines, lung effects of bleomycin and thoracic radiotherapy, second malignancies (including earlier mammographic screening for breast cancer under NICE after thoracic radiotherapy), infertility, hypothyroidism and cardiovascular risk. Charities such as Lymphoma Action UK, Blood Cancer UK and Anthony Nolan provide practical, emotional and stem cell donor support.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and peer-reviewed haematology literature, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your haematologist and specialist MDT know your subtype, stage and personal circumstances and can tell you which parts apply to you.

  • NICE. Non-Hodgkin lymphoma: diagnosis and management (NG52).

  • NICE. Haematological cancers: improving outcomes (NG47) and technology appraisals for CAR-T and bispecifics.

  • British Society for Haematology (BSH) guidelines for Hodgkin and non-Hodgkin lymphoma.

  • ESMO Clinical Practice Guidelines for Hodgkin and non-Hodgkin lymphomas.

  • Lugano classification for staging and response assessment in lymphoma.

  • Lymphoma Action UK and Blood Cancer UK patient information.

Red flags

When lymphoma needs urgent attention.

Situations that need same-day medical review, whether at diagnosis, during chemotherapy or later in survivorship.

  • Superior vena cava obstruction

    Facial and neck swelling, distended veins and breathlessness from a bulky mediastinal mass. Attend A&E for urgent imaging and oncology input.

  • Tumour lysis syndrome

    A metabolic emergency at the start of treatment for high-burden lymphoma. Prevented with hydration, allopurinol or rasburicase and close blood monitoring.

  • Neutropenic sepsis

    A fever above 38C during or after chemotherapy is a medical emergency. Follow the alert card and go straight to hospital.

  • Spinal cord compression

    Back pain with leg weakness, numbness or new bladder or bowel problems needs same-day MRI and urgent oncology review.

  • CNS involvement

    New headaches, focal weakness, cranial nerve signs or seizures in aggressive lymphoma warrant urgent imaging and lumbar puncture.

  • Rapidly enlarging painful node

    A previously stable node that suddenly grows or becomes painful can indicate transformation of indolent to aggressive lymphoma.

  • Persistent B symptoms

    Ongoing drenching sweats, fevers and weight loss during or after treatment need prompt reassessment.

  • Hepatitis B reactivation

    Rituximab and other B-cell therapies can reactivate hepatitis B. Screening and antiviral prophylaxis are mandatory.

  • Late cardiac or pulmonary symptoms

    New breathlessness, chest pain or persistent cough years after anthracycline chemotherapy or mediastinal radiotherapy needs specialist review.

Living with it

A treatable disease, with a specialist team behind you.

Four things that make the biggest difference: the right MDT, layered supportive care, early fertility planning, and long-term survivorship follow-up.

A quiet reminder

Ask, question, and take someone with you.

Bring a family member or friend to your first appointments, write down the subtype and stage, and keep every letter and scan report in one folder.

  1. 01 Team

    A specialist haematology MDT

    Lymphoma care is coordinated through specialist centres such as UCLH, the Royal Marsden, King's, the Christie, Sheffield, Newcastle, Manchester, Cardiff, Southampton and Nottingham.

  2. 02 Supportive

    Preventing complications

    G-CSF support, PJP and antiviral prophylaxis, antifungals, transfusions and tumour-lysis prevention are built into modern lymphoma protocols.

  3. 03 Fertility

    Plan fertility early

    Sperm banking, oocyte or embryo cryopreservation and, in some centres, ovarian tissue preservation should be discussed before treatment starts.

  4. 04 Survivorship

    Long-term follow-up matters

    Cardiotoxicity, lung fibrosis, thyroid problems, infertility and second cancers (including breast cancer after thoracic radiotherapy) are monitored for years after treatment.

Frequently asked

Everything we get asked about lymphoma.

Quick answers on Hodgkin versus non-Hodgkin, diagnosis, treatment options and long-term care.

  • What is lymphoma?

    Lymphoma is a cancer of the lymphocytes, the white blood cells that patrol the lymphatic system. It is divided into Hodgkin lymphoma, defined by Reed-Sternberg cells, and non-Hodgkin lymphoma, a diverse group of B-cell, T-cell and NK-cell cancers. Many lymphomas are highly treatable and some are curable.

  • What is the difference between Hodgkin and non-Hodgkin lymphoma?

    Hodgkin lymphoma is defined by Reed-Sternberg cells under the microscope and often follows an orderly nodal pattern. Non-Hodgkin lymphoma accounts for roughly 85% of UK lymphomas and covers many biologically distinct subtypes, from indolent follicular lymphoma to aggressive diffuse large B-cell and Burkitt lymphoma.

  • What are the classic warning signs?

    Painless swollen lymph nodes in the neck, above the collarbone or in the armpit or groin, along with unexplained fever, drenching night sweats and weight loss of more than 10% over six months. Persistent itch and, rarely, pain in lymph nodes after drinking alcohol are also recognised.

  • How is lymphoma diagnosed?

    The gold standard is an excisional lymph node biopsy so a pathologist can assess whole-node architecture and run immunohistochemistry and molecular tests. Staging uses PET-CT under the Lugano classification, together with blood tests such as LDH and beta-2 microglobulin and, where indicated, bone marrow biopsy or CNS imaging.

  • What treatments are used?

    Treatment depends on the subtype. Hodgkin lymphoma is treated with ABVD, brentuximab-AVD or nivolumab-AVD, with or without involved-site radiotherapy. Diffuse large B-cell lymphoma is treated with R-CHOP or POLA-R-CHP. Follicular lymphoma may be observed or treated with rituximab-based therapy. CAR-T cell therapy and bispecific antibodies such as epcoritamab and glofitamab are now used for relapsed disease.

  • What about the long-term effects?

    Modern protocols reduce toxicity, but long-term survivorship still matters. Anthracyclines and mediastinal radiotherapy can affect the heart, bleomycin and thoracic radiotherapy can affect the lungs, and thoracic radiotherapy raises the risk of breast cancer so mammographic screening starts earlier under NICE guidance. Fertility, thyroid function and cardiovascular risk are all followed up long-term.

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