Overview
Lymphoma is cancer of the lymphatic system, affecting lymphocytes (white blood cells). There are two main types: Hodgkin lymphoma (HL), characterised by Reed-Sternberg cells, and non-Hodgkin lymphoma (NHL), a diverse group of over 60 subtypes. Hodgkin lymphoma has a high cure rate even at advanced stages. NHL prognosis varies widely by subtype.
How common is it?
Lymphoma is the fifth most common cancer in the UK with around 14,000 new cases per year. Hodgkin lymphoma is most common in young adults (peak 20 to 30) and adults over 70. NHL is more common and increases with age.
Causes and risk factors
Lymphoma arises from genetic mutations in lymphocytes. Causative factors include viral infection, immunodeficiency, and immune-stimulating conditions.
Common risk factors
- Epstein-Barr virus (EBV) in Hodgkin lymphoma and Burkitt lymphoma
- HIV infection (increases NHL risk 60 to 100-fold)
- HTLV-1 (adult T-cell leukaemia/lymphoma)
- Helicobacter pylori (MALT gastric lymphoma)
- Coeliac disease (enteropathy-associated T-cell lymphoma)
- Autoimmune conditions: Sjogren syndrome, rheumatoid arthritis
- Previous chemotherapy or radiotherapy
- Congenital immunodeficiency syndromes
- Immunosuppressive therapy post-transplant
Symptoms
- Painless, persistent swelling of lymph nodes (neck, armpits, groin)
- B symptoms (diagnostic significance): drenching night sweats, unexplained fever above 38°C, weight loss over 10% in 6 months
- Fatigue
- Itching
- Breathlessness and cough (mediastinal involvement)
- Abdominal pain and swelling (abdominal lymphoma)
- Bone marrow infiltration: anaemia, recurrent infections, bleeding
When to see a doctor
See a doctor urgently for painless lymph node enlargement lasting more than 6 weeks, particularly with B symptoms or a swollen neck in a young person. Mediastinal lymphoma can cause SVC syndrome (facial swelling) — an emergency.
Diagnosis
Excision biopsy of lymph node (not needle biopsy) for histological diagnosis and subtyping. PET-CT for staging. Bone marrow trephine. Blood tests: FBC, LDH, ESR, uric acid, renal and liver function. Immunohistochemistry, FISH, and molecular testing for subtype.
Treatments
Chemotherapy
ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) is standard for Hodgkin lymphoma. R-CHOP (rituximab plus CHOP) for most B-cell NHL. Combination regimens produce remission in the majority.
Radiotherapy
Involved-site radiotherapy following chemotherapy for Hodgkin lymphoma. Curative alone for early-stage localised HL and some indolent NHL.
Rituximab and targeted therapy
Rituximab (anti-CD20) targets B-cell lymphomas and is combined with chemotherapy in R-CHOP. BTK inhibitors (ibrutinib), BCL-2 inhibitors (venetoclax), and PI3K inhibitors for relapsed/refractory NHL.
Autologous stem cell transplant
High-dose chemotherapy followed by rescue with the patient's own stem cells for relapsed Hodgkin lymphoma and high-risk NHL. Allogeneic transplant for relapsed disease with a suitable donor.
CAR-T cell therapy
Genetically engineered T cells targeting CD19 (axicabtagene ciloleucel, tisagenlecleucel) produce durable remissions in relapsed/refractory large B-cell lymphoma in 40 to 60% of patients.
Self-care and lifestyle
- Maintain nutrition during chemotherapy with dietitian support
- Ensure all age-appropriate vaccinations are up to date before starting treatment
- Rituximab and other biologics increase infection risk — report fevers promptly
- Fertility preservation discussion before chemotherapy in young patients
Prevention
HIV prevention and treatment reduce NHL risk. H. pylori eradication treats early gastric MALT lymphoma without chemotherapy. No reliable general prevention for most lymphomas.