Lymphoma: symptoms, types, diagnosis and treatment

The NHS lists the symptoms of non-Hodgkin lymphoma and Hodgkin lymphoma separately, but they overlap. The most common symptom of both is a painless lump or swelling, usually in the neck, armpit or the groin (the area at the top of the inner thigh).

Lymphoma Action says the symptoms depend on where the lymphoma starts, which parts of the body it affects and the type of lymphoma. The abnormal lymphocytes can build up in almost any part of the body, but often are felt in the armpits, neck or groin.

The NHS stresses that some of these symptoms are common and can be caused by many different conditions, and having them does not definitely mean you have lymphoma.

• A painless lump or swelling in the neck, armpit or groin (the most common symptom).

• A high temperature, or feeling hot, cold or shivery.

• Night sweats.

• Shortness of breath.

• Itchy skin.

• Sudden unexplained weight loss.

• Pain in the glands in the neck, armpit or groin when you drink alcohol (listed for Hodgkin lymphoma).

Lymphoma Action describes lymphoma as a type of blood cancer that develops when a type of white blood cell called lymphocytes grow out of control. Lymphocytes are part of the immune system and travel around the body in the lymphatic system, which contains a fluid called lymph. The lymph passes through glands (lymph nodes) spread throughout the body, so lymphoma is sometimes called a cancer of the immune system.

Cancer Research UK explains that the abnormal white blood cells start to collect in the lymph nodes, or in other places such as the bone marrow or spleen, where they can grow into tumours and cause problems in the lymphatic system or in the organ where they are growing.

Lymphoma Action says lymphoma is the most common blood cancer in the UK and can develop at any age. Lymphoma, leukaemia and myeloma are all types of blood cancer, and although some lymphomas and leukaemias are similar, most develop differently and need different treatment.

There are two main types. Cancer Research UK says Hodgkin lymphoma has a particular appearance under the microscope and contains cells called Reed-Sternberg cells, while non-Hodgkin lymphoma looks different and does not contain them. They are two different diseases and the treatment is not the same, which is why doctors need to tell them apart.

Lymphoma Action says there are over 60 different types of lymphoma. Non-Hodgkin lymphomas are further grouped by whether they are slow-growing (low-grade or indolent) or fast-growing (high-grade or aggressive).

The NHS says the GP will ask about your symptoms and may feel for lumps in the neck, armpit and groin. You may be asked to have a blood test. If the GP thinks you may have lymphoma they will refer you to a specialist at a hospital for tests, and you may get an urgent referral if symptoms could be cancer, which does not definitely mean you have cancer.

The main test for non-Hodgkin lymphoma is a biopsy, where a sample of the affected glands (lymph nodes) is taken and checked for signs of cancer. You may have part or all of a lymph node removed (excision biopsy) or a sample of cells taken with a thin needle (needle biopsy), usually with a local or general anaesthetic. The NHS says you should get the results of a lymph node biopsy within 2 weeks.

If lymphoma is confirmed, the NHS says you may need more tests, including blood tests, PET, CT, MRI or ultrasound scans and sometimes a biopsy of the bone marrow. These show how far the cancer has spread (staging) and what type and grade it is, which helps decide treatment.

The NHS says treatment depends on the type, whether it is fast growing (high grade) or slow growing (low grade), where it is in the body, whether it has spread, your symptoms and your general health. You may be offered a combination of chemotherapy, other medicines that target cancer cells and radiotherapy.

For fast-growing non-Hodgkin lymphoma, the NHS says treatment needs to start straight away and can often get rid of it completely, although further treatment is sometimes needed. For slow-growing non-Hodgkin lymphoma, treatment does not get rid of it but can keep it under control for many years, and you can sometimes delay treatment if you have no symptoms (watch and wait).

For Hodgkin lymphoma, the NHS says that for most people treatment will get rid of the lymphoma completely, although there is a risk it might come back and need more treatment.

Cancer Research UK says cancer in children is less common than in adults, and around 85 children aged 0 to 14 are diagnosed with non-Hodgkin lymphoma in the UK every year. It is more common in boys than girls, and the reasons are unclear.

The most common symptom in children is one or more painless swellings of the lymph nodes in the neck, throat, armpit or groin. Children may also have a high temperature that comes and goes, feeling sick, loss of appetite, weight loss, swelling of the face, heavy night sweats, extreme tiredness and itchy skin, although this is less common. If the swollen glands are in the chest, a child may be breathless or have a cough that does not go away.

Cancer Research UK says symptoms can be very similar to those of other childhood illnesses, so if you notice anything that is not normal for your child, take them to the GP. For England and Wales it says the guidelines suggest a GP should refer a child for specialist assessment within 48 hours if they have swollen lymph nodes or an enlarged spleen that cannot be explained. Treatment for NHL in children is slightly different to adults.

The NHS says it is not known what causes non-Hodgkin lymphoma or Hodgkin lymphoma, but there are things that may increase your chances of getting it. Anyone can get lymphoma. The risk factors named by the NHS for non-Hodgkin lymphoma include being over 50, past infection with the Epstein-Barr virus (which causes glandular fever) or hepatitis C, a weakened immune system (from a condition such as HIV or from treatment), an autoimmune condition such as coeliac disease or psoriasis, and a close relative who has had it.

For Hodgkin lymphoma, the NHS lists being in your early 20s or late 70s, being a man, past Epstein-Barr virus infection, a weakened immune system, a close relative with Hodgkin lymphoma, smoking and being overweight.

The NHS says to see a GP if you think you might have symptoms of lymphoma. It explains that if lymphoma is the cause, finding it early means treatment is more likely to be successful.

A painless lump that does not go away, fevers or night sweats that you cannot explain, unexplained weight loss or persistent itching are all worth getting checked. The NHS says some of these symptoms are common and can be caused by many different conditions, so having them does not definitely mean you have lymphoma.

The NHS says some treatment for non-Hodgkin lymphoma can affect your ability to have children, so speak to your specialist team before treatment if you want children in future.

If you are told you have lymphoma, the NHS says a team of specialists, usually including a clinical nurse specialist as your main point of contact, will help you through diagnosis and treatment. Macmillan Cancer Support and Lymphoma Action are named as sources of information and support.

On the NHS, a GP assessment is followed by an urgent referral to hospital if lymphoma is suspected, biopsy and staging scans, and treatment by a haematology or oncology team. Lymphoma care is usually delivered through specialist NHS cancer services.

Some people choose a private haematology or oncology consultation for a second opinion or quicker access to scans and review. The key point is that diagnosis requires a biopsy and specialist interpretation, and treatment plans are agreed by a multidisciplinary team; make sure results are shared with your GP and cancer team.