What Is Lymphoma? Symptoms, Types, Diagnosis and Treatment

Created: 18.09.2024 · Last Updated: 12.08.2026 · · Prepared by the Academic Hospital Web and Editorial Board.

Lymphoma is the collective name for cancers that develop from lymphocytes, which are cells of the immune system. Because lymphocytes are found in lymph nodes, the spleen, bone marrow, blood and many tissues throughout the body, lymphoma is not simply a cancer of the lymph nodes.

Lymphoma includes many biologically distinct diseases. Some lymphomas grow slowly and may initially require monitoring alone, whereas others are aggressive and require treatment soon after diagnosis.

Lymphoma is not one disease. The term includes many subtypes with markedly different biology, treatment and prognosis. Establishing the correct pathological subtype is therefore fundamental to treatment planning.

What Is Lymphoma?

The lymphatic system is an important part of the immune system and includes lymph nodes, lymphatic vessels, the spleen, thymus and lymphoid tissues.

Lymphoma develops when B lymphocytes, T lymphocytes or NK cells acquire biological changes that allow abnormal growth and survival.

The clinical behaviour of the disease depends greatly on its cell of origin and its pathological and molecular characteristics.

What Are the Types of Lymphoma?

Lymphomas are traditionally divided into two broad groups:

  • Hodgkin lymphoma
  • Non-Hodgkin lymphomas

This is only the first level of classification. Modern lymphoma classification uses morphology, immunophenotype, cell of origin, genetics and molecular features to define many distinct diseases.

What Is Hodgkin Lymphoma?

Hodgkin lymphoma is less common than the broad group of non-Hodgkin lymphomas.

The most common form is classical Hodgkin lymphoma, in which characteristic Reed-Sternberg cells and the surrounding cellular environment can be identified on pathological examination.

Treatment depends on stage, age, risk factors and response to therapy and can include chemotherapy, immunotherapy-containing combinations and radiotherapy in selected patients.

What Is Non-Hodgkin Lymphoma?

Non-Hodgkin lymphoma is not one disease. It includes numerous B-cell, T-cell and NK-cell lymphoma subtypes.

They can broadly behave as:

  • Indolent or slow-growing lymphomas
  • Aggressive or rapidly growing lymphomas

For example, follicular lymphoma often follows a slower course, while diffuse large B-cell lymphoma is an aggressive lymphoma for which cure may be the treatment goal in many patients.

What Causes Lymphoma and What Are the Risk Factors?

In most people with lymphoma, no single cause can be identified.

Factors associated with an increased risk in certain lymphoma subtypes include:

  • Increasing age for some lymphoma types
  • Immunosuppression
  • Immunosuppressive treatment after organ transplantation
  • HIV infection
  • Certain autoimmune diseases
  • Certain viral or bacterial infections
  • Family history of some lymphoid malignancies
  • Previous exposure to some chemotherapy or radiotherapy treatments

Epstein-Barr virus is associated with some Hodgkin and non-Hodgkin lymphoma subtypes, while Helicobacter pylori is associated with some gastric MALT lymphomas.

Having a risk factor does not mean that a person will develop lymphoma. Many people diagnosed with lymphoma have no identifiable risk factor.

What Are the Symptoms of Lymphoma?

Symptoms vary according to the lymphoma subtype and the part of the body involved.

Possible symptoms include:

  • Painless swelling of lymph nodes in the neck, armpit or groin
  • Unexplained fever
  • Drenching night sweats
  • Unintentional weight loss
  • Persistent fatigue
  • Itching
  • Reduced appetite
  • Abdominal fullness or swelling
  • Persistent cough or shortness of breath

Enlarged lymph nodes within the chest may cause cough, chest pressure or shortness of breath. An enlarged spleen can cause abdominal fullness or early satiety.

What Are B Symptoms?

Certain systemic symptoms used in lymphoma assessment are referred to as B symptoms.

They classically include:

  • Unexplained fever above 38°C
  • Drenching night sweats
  • Unintentional loss of more than 10% of body weight within 6 months

These findings can contribute to staging and risk assessment in some Hodgkin and non-Hodgkin lymphomas.

Does Every Swollen Lymph Node Mean Lymphoma?

No. Infections and benign immune reactions are common causes of enlarged lymph nodes.

Medical assessment is particularly appropriate when a node:

  • Does not reduce over several weeks
  • Continues to enlarge
  • Feels hard or fixed
  • Is located above the collarbone
  • Occurs with fever, night sweats or unexplained weight loss

Whether a lymph node is painful or painless does not by itself distinguish lymphoma from benign conditions.

How Is Lymphoma Diagnosed?

Evaluation generally begins with medical history and physical examination.

Depending on the clinical situation, tests can include:

  • Complete blood count
  • Kidney and liver-function tests
  • LDH and other relevant laboratory tests
  • Biopsy of a lymph node or involved tissue
  • CT
  • PET-CT
  • MRI in selected situations
  • Bone-marrow assessment in selected patients

Not every patient requires every test. Investigations are tailored to the suspected lymphoma subtype and clinical circumstances.

Why Is Biopsy Important in Lymphoma?

A tissue sample is generally required to establish a definitive lymphoma diagnosis.

A specialist pathologist can evaluate:

  • Microscopic morphology
  • Immunohistochemistry
  • Flow cytometry where appropriate
  • Relevant genetic and molecular abnormalities

When practical, an excisional biopsy or another method that provides adequate tissue can make accurate lymphoma classification easier. Image-guided core biopsy may be appropriate in some settings.

Blood tests, ultrasound or PET-CT alone do not establish the definitive histological subtype of lymphoma. Adequate pathological tissue is important before treatment is planned whenever clinically feasible.

How Is Lymphoma Staged?

Many Hodgkin and non-Hodgkin lymphomas use stages I to IV to describe the distribution of disease.

  • Stage I: Usually one lymph-node region or one limited extranodal site
  • Stage II: More than one lymph-node region on the same side of the diaphragm
  • Stage III: Lymph-node involvement on both sides of the diaphragm
  • Stage IV: Disseminated extranodal or bone-marrow involvement in appropriate lymphoma types

Not all lymphoma subtypes use the same staging system, and disease-specific prognostic scores may also be important.

Stage IV lymphoma does not automatically mean that the disease is incurable. The meaning of stage in lymphoma differs from many solid cancers. Some advanced lymphomas remain highly treatment-sensitive and some aggressive lymphomas can still be treated with curative intent.

How Is Lymphoma Treated?

There is no single treatment regimen for all lymphomas.

Treatment depends on:

  • Exact pathological subtype
  • Stage
  • Molecular and biological characteristics
  • Rate of disease progression
  • Age
  • General health
  • Previous treatment

Options can include:

  • Active monitoring
  • Chemotherapy
  • Monoclonal antibodies
  • Targeted therapy
  • Immunotherapy
  • Radiotherapy
  • Stem cell transplantation
  • CAR-T cell therapy
  • Bispecific antibody therapy

Not all of these treatments are appropriate for every lymphoma subtype.

Does Every Lymphoma Need Immediate Treatment?

No.

Some slow-growing lymphomas can be managed with active monitoring or watch and wait when there are no symptoms, threatening organ effects or other indications to begin treatment.

This does not mean that the disease is ignored. Patients are monitored with clinical review, blood tests and imaging when appropriate.

What Are Targeted Therapy, Immunotherapy and CAR-T?

Monoclonal Antibodies

These medicines recognise specific proteins on lymphoma cells. Antibodies targeting CD20, for example, play an important role in many B-cell lymphoma treatments.

Targeted Therapies

Targeted treatments interfere with molecular pathways that lymphoma cells use to grow and survive. The appropriate drug depends on the lymphoma subtype and its biological characteristics.

Checkpoint Inhibitors

PD-1-directed immunotherapies can be used in selected patients with Hodgkin lymphoma and work by enhancing immune recognition of lymphoma cells.

Bispecific Antibodies

Bispecific antibodies used in selected relapsed or refractory B-cell lymphomas are designed to bring immune T cells into close contact with lymphoma cells.

CAR-T Cell Therapy

In CAR-T therapy, a patient's T cells are collected and genetically modified in a laboratory so that they can recognise a specific target on lymphoma cells before being returned to the patient.

CAR-T is an advanced cellular therapy used for selected relapsed or treatment-resistant B-cell lymphomas.

When Is Stem Cell Transplant Used in Lymphoma?

Stem cell transplantation is not required for every patient.

It can form part of treatment in selected:

  • Relapsed
  • Refractory
  • High-risk

lymphomas.

Autologous stem cell transplantation, using the patient's own previously collected stem cells after intensive treatment, is commonly used in appropriate lymphoma settings.

Allogeneic transplantation using donor cells may be considered in selected situations.

When Should You See a Doctor?

Medical assessment is appropriate for:

  • A lymph node that does not reduce over several weeks or continues to enlarge
  • Unexplained recurrent fever
  • Drenching night sweats
  • Significant unintentional weight loss
  • Persistent unexplained fatigue
  • Persistent unexplained itching
  • Unexplained abdominal fullness or early satiety
  • Persistent cough or breathlessness

Sudden or rapidly worsening shortness of breath, significant chest pressure, swelling of the face or neck, altered consciousness or severe clinical deterioration requires urgent medical assessment.

Have Persistent Lymph-Node Enlargement Assessed

Persistent lymph-node enlargement, night sweats, unexplained fever or weight loss can be assessed with clinical examination and appropriate further investigations.

Frequently Asked Questions

What is lymphoma?
Lymphoma is the collective name for cancers that develop from lymphocytes, which are cells of the immune system. It is not one disease; it includes many Hodgkin and non-Hodgkin lymphoma subtypes with different biological behaviour, treatment and prognosis.
Does every swollen lymph node mean lymphoma?
No. Lymph nodes can enlarge because of infections and other benign conditions. Nodes that do not reduce over several weeks, continue to enlarge or occur with fever, drenching night sweats or unintentional weight loss should be medically assessed.
Can lymphoma be definitively diagnosed with a blood test?
Usually not. Blood tests can support the assessment, but most patients require an adequate biopsy sample from a lymph node or involved tissue to establish a definitive diagnosis and determine the lymphoma subtype.
Can PET-CT diagnose lymphoma by itself?
PET-CT can be important for assessing disease distribution, staging and treatment response in many lymphoma types, but it does not by itself establish the definitive histological lymphoma subtype. Tissue biopsy remains important for diagnosis.
Does stage IV lymphoma mean it cannot be treated successfully?
No. Stage IV lymphoma does not have exactly the same prognostic meaning as stage IV in many solid cancers. Outcome depends on the lymphoma subtype, biology, patient factors and treatment response, and some advanced lymphomas can still be treated with curative intent.
Does every lymphoma require immediate chemotherapy?
No. Some slow-growing lymphomas can be managed with active monitoring when there are no symptoms or other indications to start treatment. Aggressive lymphomas may require treatment relatively soon after the diagnosis has been confirmed.
Is CAR-T treatment used for everyone with lymphoma?
No. CAR-T cell therapy is an advanced cellular treatment used for selected lymphoma subtypes, generally in certain relapsed or treatment-resistant patients. Eligibility depends on the lymphoma subtype, previous treatments and the patient's clinical condition.
Can lymphoma be cured?
For some lymphoma types the goal of treatment is cure. Other slow-growing lymphomas may behave more like chronic illnesses that can be controlled for many years. The expected outcome depends on the exact subtype, stage, biological features and response to treatment.
Academic Hospital note: Accurate histopathological classification is fundamental to choosing lymphoma treatment. Persistent lymph-node enlargement should not be labelled as lymphoma on imaging or blood tests alone when adequate tissue biopsy is clinically appropriate. You can book an appointment.

References

  1. Academic Hospital. Lenf Kanseri (Lenfoma) Nedir? Belirtileri ve Nedenleri
  2. World Health Organization / IARC. WHO Classification of Tumours: Haematolymphoid Tumours, 5th Edition
  3. European Society for Medical Oncology. ESMO Living Guideline: Lymphomas
  4. National Cancer Institute. Hodgkin Lymphoma Treatment
  5. National Cancer Institute. Non-Hodgkin Lymphoma Treatment