Important: This page is for general information only and is not a diagnosis. If you have swollen lymph nodes that do not go away after two weeks, or unexplained fever, drenching night sweats, or weight loss, please see a doctor. Many conditions cause these symptoms — but lymphoma is treatable, especially when found early.

What is lymphoma?

Lymphoma is cancer that begins in cells of the lymph system. The lymph system is part of the body’s immune system. It consists of a network of lymph vessels, lymph nodes (small bean-shaped glands distributed throughout the body), the spleen, thymus, bone marrow, and tonsils. This system carries lymph (a clear fluid containing white blood cells called lymphocytes) and plays a central role in fighting infection and disease.

Lymphoma occurs when lymphocytes — a type of white blood cell — grow out of control, forming tumours in the lymph nodes and other parts of the lymph system, or occasionally in organs outside the lymph system such as the brain, stomach, or bone marrow.

The two main families of lymphoma are:

  • Hodgkin lymphoma (HL) — defined by the presence of distinctive abnormal cells called Reed-Sternberg cells when lymph node tissue is examined under a microscope. Hodgkin lymphoma most commonly forms in lymph nodes above the diaphragm (in the chest, neck, and armpits). It occurs most often in adolescents aged 15 to 19 and in adults in their 30s and 40s. Hodgkin lymphoma can often be cured.

  • Non-Hodgkin lymphoma (NHL) — a large and diverse group of lymphomas that do not have Reed-Sternberg cells; the prognosis of NHL depends on the specific subtype. NHL includes many subtypes, ranging from slow-growing (indolent) forms to rapidly progressing (aggressive) forms. Primary CNS lymphoma — an NHL that arises in the brain, spinal cord, or eye — is one example of a specific NHL subtype.

Common warning signs

The most characteristic sign of lymphoma is painless swelling of one or more lymph nodes. These swollen nodes are most often felt in the neck, collarbones, armpits, or groin. Unlike the tender, sore lymph nodes you may get with an infection, lymphoma-related swollen nodes are typically painless and persist for weeks.

In addition to swollen lymph nodes, lymphoma may cause B-symptoms — a specific set of systemic symptoms that are clinically important because they affect staging and treatment decisions:

  • Fever without a known cause (not linked to an infection)
  • Drenching night sweats — soaking the clothes or sheets
  • Unexplained weight loss — usually defined as losing 10% or more of body weight over six months

Other symptoms that may be caused by lymphoma include:

  • Fatigue or persistent tiredness
  • Itchy skin without a rash
  • Coughing, shortness of breath, or difficulty breathing, especially when lying down — if lymph nodes in the chest are enlarged
  • Abdominal swelling or pain — if lymph nodes in the abdomen or the spleen are affected
  • Loss of appetite

For primary CNS lymphoma specifically (NHL in the brain), symptoms may include headaches, nausea and vomiting, seizures, confusion, arm or leg weakness, and changes in vision or hearing.

These symptoms can be caused by many conditions, including infections. The only way to know is to see a doctor. A lymph node swelling that does not shrink within two to four weeks, or any combination of B-symptoms, warrants prompt evaluation.

Risk factors

The cause of most lymphomas is not fully understood, but some factors are known to increase the risk:

For Hodgkin lymphoma:

  • Infection with Epstein-Barr virus (EBV), the virus that causes infectious mononucleosis (glandular fever / “mono”)
  • Infection with HIV
  • Conditions that weaken the immune system, including autoimmune diseases and immunosuppressive drugs taken after an organ transplant
  • A parent, sibling, or close family member with a personal history of Hodgkin lymphoma

Interestingly, exposure to common infections in early childhood may actually decrease the risk of Hodgkin lymphoma in children.

For Non-Hodgkin lymphoma and primary CNS lymphoma:

  • A weakened immune system — caused by HIV/AIDS, organ transplantation (and the drugs needed to prevent rejection), or other immune-suppressing conditions
  • Infection with EBV
  • Certain autoimmune conditions

Having one or more risk factors does not mean you will develop lymphoma, and lymphoma occurs in people with no identified risk factors. Talk with your doctor if you think you may be at elevated risk.

When to seek medical attention

Please see a doctor if you have any of the following:

  • A painless lump or swelling in your neck, armpit, or groin that lasts more than two weeks
  • Fever without an obvious cause that comes and goes over several weeks
  • Drenching night sweats for more than two weeks
  • Unexplained weight loss
  • Persistent fatigue combined with any of the above signs
  • Coughing, chest discomfort, or difficulty breathing alongside a swollen lymph node
  • A lump in the abdomen, or a feeling of fullness or pain on the left side below the ribs

For primary CNS lymphoma: see a doctor urgently if you have new headaches, confusion, seizures, or sudden weakness in an arm or leg — these symptoms require prompt neurological evaluation.

How is lymphoma diagnosed?

If your doctor suspects lymphoma based on your symptoms and physical exam, a series of tests will be needed to confirm the diagnosis and determine the extent (stage) of the disease.

Blood tests:

  • Complete blood count (CBC) — checks red blood cells, white blood cells, and platelets
  • Blood chemistry studies — measures substances released by tissues that can indicate disease
  • C-reactive protein and erythrocyte sedimentation rate (ESR) — markers of inflammation that may be elevated in Hodgkin lymphoma

Imaging:

  • CT scan — detailed cross-sectional images of the chest, abdomen, and pelvis; used to find enlarged lymph nodes and affected organs
  • PET scan (or PET-CT) — detects active cancer cells by showing where glucose is being used at a high rate; essential for staging Hodgkin lymphoma and many NHL subtypes
  • MRI — detailed imaging of soft tissues; used when lymphoma is suspected in the brain or spinal cord
  • Chest X-ray — to detect enlarged lymph nodes in the chest

Biopsy (the key diagnostic test):

  • Lymph node biopsy — removal of all or part of a lymph node; a pathologist examines it under a microscope to look for cancer cells; in Hodgkin lymphoma, Reed-Sternberg cells are the defining finding
  • Excisional biopsy (removal of the whole node), incisional biopsy (part of the node), or core biopsy (tissue sample with a needle) may be done depending on the location
  • Stereotactic biopsy — for suspected primary CNS lymphoma, a computer-guided needle biopsy of the brain is used
  • Immunophenotyping — laboratory tests using antibodies to identify the type of lymphoma cells

Additional tests that may be needed:

  • Bone marrow aspiration and biopsy — for advanced disease or when there are B-symptoms, to check if lymphoma has spread to the bone marrow
  • Lumbar puncture — for CNS lymphoma, to check cerebrospinal fluid for cancer cells

Lymphoma is staged (usually Stage I through IV) based on how many lymph node regions are involved, whether both sides of the diaphragm are involved, and whether the cancer has spread to organs outside the lymph system. The presence or absence of B-symptoms is also recorded.

Getting a second opinion from a lymphoma specialist or a major cancer centre is often helpful before starting treatment — you will need to share your pathology report, slides, and imaging with the second doctor.

Treatment basics

Treatment depends on the type of lymphoma (Hodgkin vs. non-Hodgkin and the specific subtype), the stage, whether B-symptoms are present, and the patient’s age and overall health. You and your cancer care team will work together to decide a plan that may include more than one type of treatment.

For Hodgkin lymphoma, the main treatments are:

  • Chemotherapy — combination chemotherapy is the backbone of treatment; the number of cycles and the drugs used depend on the risk group (low, intermediate, or high)
  • Radiation therapy — often given to the areas of the body where cancer was found after chemotherapy; the dose and field are limited to minimise long-term effects
  • Targeted therapy — monoclonal antibodies such as brentuximab (targets CD30 on Hodgkin lymphoma cells) or rituximab are used in certain situations, including refractory or recurrent disease
  • Immunotherapy — checkpoint inhibitors such as pembrolizumab or nivolumab are used for Hodgkin lymphoma that has come back after initial treatment
  • High-dose chemotherapy with stem cell transplant — used for relapsed or refractory Hodgkin lymphoma; stem cells from the patient or a donor are used to restore the bone marrow after high-dose treatment

Most children and adolescents with newly diagnosed Hodgkin lymphoma can be cured. Adults with early-stage Hodgkin lymphoma also have very good outcomes.

For Non-Hodgkin lymphoma and primary CNS lymphoma, treatment depends heavily on the specific subtype. Options include:

  • Chemotherapy — including intrathecal (into the spinal fluid) chemotherapy for CNS lymphoma
  • Radiation therapy — including whole-brain radiation for primary CNS lymphoma, although this carries risks of cognitive side effects
  • Targeted therapy — rituximab, ibrutinib, and other agents are used for various NHL subtypes
  • Immunotherapy — including CAR T-cell therapy for relapsed or refractory NHL
  • Stem cell transplant — for certain high-risk or relapsed NHL subtypes

Long-term side effects (late effects) are an important consideration, especially for children treated with both chemotherapy and radiation. These can include effects on fertility, heart and lung function, thyroid function, and an increased risk of second cancers later in life. Discuss this with your treatment team.

In India, Ayushman Bharat (PM-JAY) may cover hospitalisation for chemotherapy, biopsies, and related procedures at empanelled hospitals, up to Rs. 5 lakh per family per year for eligible families. Ask the hospital’s Ayushman desk before paying out of pocket. For Bihar, Mahavir Cancer Sansthan (Phulwarisharif, Patna) has medical oncology and radiation oncology services and treats paediatric patients free of charge. AIIMS Patna also has oncology services including paediatric oncology clinics. For complex lymphoma cases, Tata Memorial Hospital (Mumbai) and major AIIMS centres are the main national referral centres in India.

Questions to ask your doctor

When you visit a specialist about a lymphoma diagnosis, you may want to ask:

  1. What type of lymphoma is it — Hodgkin or non-Hodgkin? What is the specific subtype?
  2. What stage is the lymphoma, and do I have B-symptoms? How does this affect my treatment plan?
  3. What are my treatment options — chemotherapy, radiation, targeted therapy, immunotherapy, or stem cell transplant?
  4. What side effects can I expect during treatment, and how will they be managed?
  5. What are the long-term or late effects of this treatment, especially for children (effects on growth, fertility, heart, or second cancer risk)?
  6. How will we know if the treatment is working? When will you repeat scans or blood tests?
  7. Should I get a second opinion?
  8. Is there a clinical trial that might apply to my situation?
  9. Is treatment covered under PM-JAY or any other scheme?
  10. After treatment ends, what follow-up schedule will I need, and what signs of relapse should I watch for?

Bring a family member or trusted person to every appointment. Ask the doctor to explain terms you don’t understand.

When urgent care is needed

Please seek urgent medical help — go to the nearest emergency department or call an ambulance — if you have any of the following:

  • Sudden difficulty breathing or swallowing, or a feeling that your throat or chest is being squeezed — enlarged lymph nodes in the mediastinum can compress the airway
  • A fever of 38°C / 100.4°F or higher during chemotherapy — febrile neutropenia is a medical emergency
  • Heavy bleeding that does not stop with pressure
  • Sudden severe headache, confusion, a seizure, or weakness in one arm or leg — may indicate lymphoma in or near the brain
  • Severe abdominal pain, inability to eat, or signs of bowel obstruction
  • A severe allergic reaction (difficulty breathing, throat swelling, widespread rash) within 24 hours of a treatment infusion

In India, call 108 or 112 for ambulance services. The Indian Cancer Society helpline is 1800-22-1951 for non-emergency questions and support.

If you are in Bihar and need urgent oncology help, Mahavir Cancer Sansthan and AIIMS Patna both have emergency departments and oncology specialists.