Should I see a Hodgkin's lymphoma specialist?

It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much less serious that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better or respond to simple treatments. If GPs referred everyone who came to see them to a specialist immediately, the system would get jammed and people needing urgent appointments wouldn't be able to get them.

There are particular symptoms that mean your GP should refer you to a specialist straight away. The National Institute for Health and Clinical Excellence (NICE) have produced guidelines for GPs in the UK to help them decide which patients need to be seen urgently by a specialist. These NICE guidelines on referrals for Hodgkin's lymphoma were revised in 2005. While reading these guidelines, it is important to remember that

• More than 50 out of every 100 people diagnosed with Hodgkin's lymphoma are under 50
• Symptoms are very similar to those of non Hodgkin's lymphoma
• Over 90 out of every 100 people diagnosed have enlarged lymph glands somewhere in their bodies

According to the National Institute for Health and Clinical Excellence (NICE) guidelines, you should ideally get an appointment within 2 weeks for an urgent referral. You should have an urgent referral to see a specialist (usually a haematologist) if you have an enlarged spleen that is not getting better, and your doctor can't explain the cause.

You might also need further investigations or a referral if you have a swollen lymph node that

• Is larger than 2 cm wide
• Has been there for more than 6 weeks
• Is getting bigger
• Is accompanied by night sweats, weight loss and an enlarged spleen
• Is one of several swollen lymph nodes

The guidelines also say that a GP should investigate and possibly refer anyone with combinations of the following symptoms

• Fatigue
• Weight loss
• High temperature (fever)
• Night sweats
• Itching
• Being short of breath
• Bruising easily or bleeding
• Having infections that keep coming back
• Bone pain or nerve pain
• Abdominal pain
• An enlarged spleen or lymph nodes

Do bear in mind that some of these symptoms can be caused by other less serious medical conditions and do not always mean that you have Hodgkin's lymphoma.

Children should be referred immediately to a specialist if they have

• An enlarged spleen and liver, or
• A mass in their chest, seen on a chest X-ray

Children need urgent referral to see a specialist, particularly if there is no evidence of infection, if they have lymph nodes that have become swollen and are

• Firm or hard and not sore to the touch
• Larger than 2cm across
• Getting bigger
• In the armpit or just above the collar bone

Children should also be referred if they have shortness of breath with any of the above symptoms.

Remember that swollen lymph nodes are usually associated with infection and are not serious. But the guidelines advise GPs to refer a child who has the above lymph node symptoms, particularly if there are no signs of an infection.

If you are concerned that your GP is not taking your symptoms as seriously as you think they should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.