Lymphoma
Cancer of lymphocytes — broadly divided into Hodgkin and non-Hodgkin lymphomas, many of which are curable.
Overview
Lymphomas arise from B or T lymphocytes. Hodgkin lymphoma is characterised by Reed–Sternberg cells and most often affects young adults; non-Hodgkin lymphomas (NHL) form a heterogeneous group including diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma. Modern chemoimmunotherapy and CAR-T cure most Hodgkin and many aggressive NHLs.
Symptoms
- • Painless lymphadenopathy (cervical, axillary, inguinal)
- • B-symptoms: drenching night sweats, fever, ≥10% weight loss in 6 months
- • Pruritus, alcohol-induced node pain (Hodgkin)
- • Mediastinal mass: cough, breathlessness, SVC obstruction
- • Splenomegaly, hepatomegaly, fatigue
Risk factors
- • Age (NHL increases with age; Hodgkin has bimodal peak)
- • Family history
- • Autoimmune disease (Sjögren, coeliac)
- • Chronic immunosuppression
Causes
- • Epstein–Barr virus (Hodgkin, Burkitt, post-transplant NHL)
- • HIV (high-grade NHL)
- • Helicobacter pylori (gastric MALT)
- • Hepatitis C (marginal zone, lymphoplasmacytic)
- • Immunosuppression (post-transplant, congenital)
🚨 Red flags — seek urgent care
- • Rapidly enlarging nodal mass
- • SVC obstruction (facial swelling, distended veins)
- • Cord compression, tumour lysis on starting therapy
- • Neutropenic fever on chemotherapy
When to seek care
- • Lymphadenopathy >2 cm persisting >6 weeks
- • Unexplained B-symptoms
- • Any breathing difficulty with mediastinal mass — emergency
Diagnosis
- • Excision lymph node biopsy (preferred over core biopsy where possible)
- • Immunohistochemistry and molecular subtyping (cell of origin, MYC/BCL2/BCL6 rearrangements)
- • PET-CT staging (Ann Arbor / Lugano classification)
- • Bone marrow biopsy when indicated
- • Viral screen: HIV, hepatitis B/C, EBV
Treatment
- • Classical Hodgkin lymphoma: ABVD or escalated BEACOPP ± involved-site radiotherapy; pembrolizumab and brentuximab vedotin for relapse
- • DLBCL: R-CHOP × 6 (Pola-R-CHP in selected); CAR-T (axi-cel, tisa-cel, liso-cel) for relapsed/refractory
- • Follicular lymphoma: watch-and-wait if asymptomatic; R-bendamustine, R-CHOP, or rituximab monotherapy
- • Mantle cell, marginal zone, T-cell: subtype-specific regimens; BTK inhibitors, bispecific antibodies
- • Tumour lysis prophylaxis with rasburicase/allopurinol; growth-factor and antimicrobial support
Prevention
- • Treat H. pylori in gastric MALT
- • Prompt HIV and hepatitis treatment
- • Reduce occupational pesticide and solvent exposure
Complications
- • Tumour lysis syndrome, neutropenic sepsis
- • Long-term: cardiotoxicity, secondary malignancy (especially with mediastinal radiotherapy)
- • Infertility (consider gamete preservation pre-treatment)
- • Cytokine release/neurotoxicity after CAR-T
Prognosis
Hodgkin lymphoma 5-year survival >85%; DLBCL ~65% cure with R-CHOP; indolent lymphomas often controlled long-term but rarely cured without transplant.
Education & self-care
Most lymphomas are highly treatable. Specialist work-up determines the subtype, which dictates therapy — from immediate cure-intent chemotherapy to long-term observation.
Frequently asked questions
Is lymphoma contagious?
No — although some causative viruses (EBV, HIV) are transmissible.
Will I lose my fertility?
Some regimens affect fertility. Discuss egg/sperm preservation before starting treatment.
Is watch-and-wait safe in low-grade lymphoma?
Yes — for selected asymptomatic patients, early treatment offers no survival benefit.