Lymphoma
Summary
Lymphoma is malignancy of lymphoid tissue, classified as Hodgkin lymphoma (HL) or Non-Hodgkin lymphoma (NHL). Hodgkin lymphoma is characterised by Reed-Sternberg cells and has excellent prognosis with treatment (ABVD ± radiotherapy). NHL is heterogeneous — aggressive subtypes (DLBCL) require intensive treatment (R-CHOP), while indolent subtypes (follicular) may be managed with watch-and-wait. B symptoms (fever, weight loss, night sweats) indicate advanced disease and guide staging.
Key Facts
- Hodgkin Lymphoma: Bimodal age, Reed-Sternberg cells, contiguous spread, highly curable
- Non-Hodgkin Lymphoma: More common, heterogeneous, non-contiguous spread
- B Symptoms: Fever, weight loss >10% in 6 months, drenching night sweats
- Most Common NHL Subtype: Diffuse Large B-Cell Lymphoma (DLBCL)
- First-Line HL: ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine)
- First-Line DLBCL: R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone)
Clinical Pearls
"Painless Lymphadenopathy": Most common presentation — cervical nodes typically.
"Contiguous vs Non-Contiguous": HL spreads to adjacent node groups; NHL is more scattered.
"Reed-Sternberg = Hodgkin": "Owl eye" appearance is diagnostic.
"Alcohol-Induced Pain": Rare but specific symptom for HL.
Why This Matters Clinically
Lymphoma is common and often curable. Distinguishing HL from NHL and subtyping NHL guides treatment. Recognising oncological emergencies (SVC obstruction, cord compression) is essential.
Incidence
| Type | Peak Age | Notes |
|---|---|---|
| Hodgkin | 20-30, >5 | Bimodal |
| DLBCL | 60-70 | Most common NHL |
| Follicular | 50-60 | Second most common NHL |
| Burkitt | Children/young adults | Endemic (EBV), Sporadic |
Hodgkin
- Reed-Sternberg cells (malignant)
- Inflammatory background
- CD30+, CD15+
Non-Hodgkin
- Clonal B-cell or T-cell proliferation
- Variable morphology and behaviour
- CD20+ (most B-cell NHL) — target for rituximab
Symptoms
B Symptoms (Stage Modifier "B")
| Symptom | Definition |
|---|---|
| Fever | >8°C |
| Weight Loss | >0% in 6 months |
| Night Sweats | Drenching |
Red Flags
[!CAUTION] Emergencies:
- SVC obstruction
- Spinal cord compression
- Tumour lysis syndrome
| Test | Purpose |
|---|---|
| Lymph Node Biopsy | Histology, immunophenotyping |
| CT CAP | Staging |
| PET-CT | Staging, response assessment |
| Bone Marrow Biopsy | Staging (if indicated) |
| FBC, LDH, Albumin | Prognostic |
| Stage | Definition |
|---|---|
| I | Single nodal region |
| II | ≥2 regions, same side of diaphragm |
| III | Both sides of diaphragm |
| IV | Extranodal (liver, bone marrow) |
A = No B symptoms; B = B symptoms present
Hodgkin Lymphoma
| Stage | Treatment |
|---|---|
| Early (I-IIA) | ABVD x 2-4 + RT |
| Advanced (IIB-IV) | ABVD x 6 or escalated BEACOPP |
DLBCL
- R-CHOP x 6 cycles ± RT
Follicular
- Watch and wait or rituximab-based when symptomatic
| Type | Prognosis |
|---|---|
| HL Early Stage | >0% cure |
| HL Advanced | 70-80% cure |
| DLBCL | 60-70% cure |
| Follicular | Median survival 15-20 years (incurable) |
- NICE NG52: Non-Hodgkin's lymphoma (2016)
- BSH Guidelines: Hodgkin Lymphoma
What is Lymphoma?
Lymphoma is cancer of the lymphatic system — the network of glands that helps fight infection.
Types
- Hodgkin lymphoma: Usually very curable
- Non-Hodgkin lymphoma: Many types, some curable, some manageable long-term
Symptoms
- Painless lumps (usually neck, armpit, groin)
- Fever, weight loss, night sweats
- Tiredness
-
National Institute for Health and Care Excellence. Non-Hodgkin's lymphoma: diagnosis and management (NG52). 2016. nice.org.uk/guidance/ng52
-
Eichenauer DA, et al. Hodgkin lymphoma: ESMO Clinical Practice Guidelines. Ann Oncol. 2018.
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