Lymphoma

Lymphoma is cancer of the lymph system — the network of lymph nodes, spleen and lymphatic vessels that is part of the immune system. There are two broad groups: Hodgkin lymphoma (often highly curable) and non-Hodgkin lymphoma (a family of many types, ranging from slow-growing to aggressive and potentially curable). Modern treatment has substantially improved outcomes.

Symptoms

• Painless swollen lymph node — neck, armpit, groin, or deep (chest, abdomen).
• B symptoms — fever, drenching night sweats, unexplained weight loss.
• Itching — particularly classic in Hodgkin lymphoma.
• Fatigue, reduced appetite.
• Chest pressure/cough with chest lymph nodes.
• Abdominal pain or early fullness with abdominal nodes or spleen.
• Skin lesions — in cutaneous lymphomas.

India-specific differential — rule out TB

In India, an enlarged painless neck lymph node is at least as likely to be tuberculosis (lymph-node TB) as lymphoma. A careful evaluation — history, examination, imaging, and biopsy (FNAC alone is often not enough) with TB tests AND lymphoma work-up — is essential. Treating TB empirically without ruling out lymphoma, and vice versa, can cost lives.

Diagnosis

• Excisional or core biopsy of a node — FNAC alone is often insufficient for lymphoma diagnosis.
• Immunohistochemistry, flow cytometry, molecular tests — classify the type.
• PET-CT — staging.
• Bone marrow biopsy — in select cases.
• HIV and hepatitis testing — important before and during treatment.

Treatment — excellent options now

• Hodgkin lymphoma — combination chemotherapy (ABVD-type regimens); radiation for some. Cure rates over 80-90% in many stages.
• Diffuse large B-cell lymphoma — R-CHOP is the standard; curable in a majority.
• Follicular, indolent lymphomas — watch-and-wait or gentle treatment; live with it for years.
• Burkitt and very aggressive lymphomas — intensive but often curable.
• CAR-T cell therapy — available at a few Indian centres for selected relapsed cases.
• Autologous stem-cell transplant for select relapses.
• Fertility preservation should be discussed in younger patients before treatment.

Most lymphomas are treatable; many are curable. Completing the full course of treatment is key — don't abandon in the middle. Cost and travel are real challenges; Regional Cancer Centres, NGOs, and government schemes help substantially — ask the hospital social worker.