Common presenting features include palpable or internal lymphadenopathy, hepatomegaly and/or splenomegaly. Some patients present with fever, weight loss, drenching night sweats or fatigue, but note that these symptoms are not specific for lymphoma. 95% of people with Hodgkin’s Lymphoma present with lymph node involvement.
Consider full blood count, renal function, liver function, calcium, lactate dehydrogenase (LDH), and HIV serology, for an adult patient with any of the following unexplained features:
- Lymphadenopathy (lymph node 2cm or more in size, persisting for six weeks or more, or increasing in size, or generalised lymphadenopathy)
- Fatigue
- Drenching night sweats
- Fever
- Splenomegaly and/or hepatomegaly
- Breathlessness
- Pruritus
- Weight Loss.
In addition:
- Check serum protein electrophoresis in those with a higher level of suspicion eg splenomegaly / lymphadenopathy / sweats
- Consider TFTs / CRP depending on symptom presentation.
C.M & N.S – 18-03-26
Who to refer
If lymphadenopathy is found, refer as per RefHelp lymphadenopathy guidance. RefHelp also gives further advice on night sweats, splenomegaly and lymphocytosis:
- Generalised lymphadenopathy particularly with systemic upset (e.g. drenching night sweats or unintentional weight loss) and/or hepatomegaly and/or splenomegaly.
- Unexplained isolated lymphadenopathy (2 cm or more in size, persisting for six weeks or more, or increasing in size, or with size-significant lymphadenopathy AND drenching night sweats, weight loss, fever, alcohol-induced pain) – please refer as a USC. Again, please see lymphadenopathy guidance for more advice about who to refer.
