Lymphoma is a cancer of lymphocytes that usually grows in lymph nodes, the spleen or other lymphoid tissue. It is divided into Hodgkin lymphoma, often seen in young adults, and non-Hodgkin lymphoma, a larger group that ranges from slow-growing to very aggressive types.
Key symptoms
- Painless, enlarging lymph nodes in the neck, armpit or groin
- Fevers, drenching night sweats and weight loss (B symptoms)
- Fatigue and itching
- Cough, chest pressure or breathlessness from a chest mass
- Abdominal fullness or feeling full early from a large spleen
What you find on exam
- Firm, rubbery, non-tender lymph nodes; measure and map all node areas
- Enlarged spleen or liver
- Facial swelling and distended neck veins from a chest mass (superior vena cava syndrome)
- Skin, tonsils and testes as possible sites
Tests
- Excisional lymph node biopsy for diagnosis and subtype; fine needle aspiration is not enough
- Blood count, metabolic panel, LDH, uric acid
- HIV and hepatitis B and C testing
- PET-CT scan for staging; bone marrow biopsy in some cases
Treatment basics
- Treatment depends on type and stage and is planned with oncology
- Hodgkin lymphoma: combination chemotherapy such as ABVD, sometimes with radiation
- Diffuse large B cell lymphoma: R-CHOP (rituximab with chemotherapy)
- Some slow-growing lymphomas are watched until they cause symptoms
- Prevent tumor lysis with fluids and allopurinol; relapse options include stem cell transplant and CAR T cells
Red flags
- Facial swelling, stridor or breathlessness: superior vena cava or airway compression
- Back pain with leg weakness: spinal cord compression
- Fever on chemotherapy, or kidney failure with high potassium and uric acid
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.